Collaboration Between Parents and Teachers in Addressing School Refusal in Preschool Students with Rectal Atresia (A Case Study of a Home–School Collaboration-Based Educational Psychology Intervention)

Abstract

School refusal in kindergarten-aged children can develop through an interplay of anxiety, unpleasant social experiences, dependency on caregivers, and environmental responses that inadvertently reinforce school avoidance. This article analyzes the collaborative process between parents and a teacher in addressing school refusal in a kindergarten student with a history of anal atresia and difficulties with elimination control. Data were gathered through observation, interviews, cognitive testing, school refusal assessment, functional analysis, intervention implementation, and outcome evaluation. The child exhibited refusal to go to school, crying and fear at the school gate, refusal to enter the classroom without his mother, limited attendance duration, and social withdrawal from peers. Case history revealed that experiences of being teased regarding odor and diaper use/elimination management were social factors that likely reinforced feelings of shame and avoidance. A prolonged absence from school reinforced the pattern of non-attendance, while the mother's presence at school provided a sense of security but also potentially perpetuated dependency. Interventions included parental counseling and psychoeducation, teacher psychoeducation, gradual exposure to the school environment, the gradual reduction of maternal accompaniment, positive reinforcement, and structured play to enhance peer interaction. Results showed increased attendance duration, an improvement in the ability to attend without the mother (from 0% at baseline to 100% in the recorded post-intervention phase), and an increase in peer interaction (from 0% to 100% on observed indicators). A review of recent literature underscores the importance of early intervention, parental involvement, teacher support, positive teacher-child relationships, and school environment adjustments for children with medical conditions affecting continence. This case demonstrates that managing school refusal in a child with anal atresia requires integrating behavioral interventions with an approach sensitive to stigma, toileting/elimination needs, privacy, and psychosocial support.