Högskolan i Skövde

Introduction: School refusal poses significant challenges to children's education and wellbeing. Despite increased public, political and scholarly attention, there remains limited systematic knowledge about available interventions, in particular digital interventions. This scoping review therefore aims to identify and describe the range and nature of treatment interventions for school refusal, with a specific focus on digital approaches.

Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Eligible studies were empirical, peer-reviewed articles published in 1993 or later that examined interventions for school refusal among children and adolescents. Screening and data extraction were completed independently in pairs. The data was analyzed descriptively, utilizing an adapted TIDieR framework applied to intervention reporting.

Results: Thirty-one studies published between 1998 and 2025 met the inclusion criteria. Research activity increased notably from 2018 onward and was dominated by quantitative designs conducted primarily in Western, high-income contexts. Most interventions were cognitive-behavioral therapy (CBT)-based, delivered individually, in groups, or as multimodal programs, sometimes combined with pharmacological treatment. CBT interventions generally reported improved school attendance, although effect sizes and durability varied. Only six studies (19%) incorporated digital components, including remote therapeutic delivery, virtual reality exposure, serious games, and online parent coaching. These interventions were feasible and acceptable but showed limited evidence of direct effects on school attendance. Outcome measures were heterogeneous, though school attendance and anxiety symptoms were most consistently reported.

Conclusion: The evidence-base on interventions for school refusal is growing but remains fragmented, with an underrepresentation of digital approaches. Existing digital interventions predominantly target the individual or family rather than school environments or the interaction between the individual, their family and the school environment. Future research should explore how digital tools can support integrated and systemic school-refusal approaches that address individual, family and school-related factors over time.