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School refusal in adolescents is a growing issue and has been studied from several angles. Parental psychological control is a known risk factor for school refusal. Several individual factors have been linked to school refusal, including children’s emotion regulation, externalizing, and internalizing behaviours. The current study hypothesized that a child’s emotion regulation, internalizing problems, and externalizing problems mediate the relationship between parental factors and school refusal. Participants enrolled in a residential treatment programme ( n =184, 62% female;  Mage  =15.26,  SD =1.54) and their parents completed assessments as part of a pre-treatment protocol. The participants’ mean scores for school refusal types 1–4 were 2.08 ( SD =1.78), 0.97 ( SD =1.34), 2.14 ( SD =1.68), and 2.91 ( SD =1.46), respectively. Multiple-mediation analysis was performed using the PROCESS macro (Hayes, A. F. (2018).  Introduction to mediation, moderation, and conditional process analysis: A regression-based approach  (2nd ed.) New York: The Guilford Press). Parental psychological control was related to expressive suppression ( b =.24,  p =.01) and externalizing problems ( b =.36,  p =.03), though it was unrelated to cognitive reappraisal and internalizing problems ( p &gt;.05). Each model of school refusal was significant, with  r 2ranging from .18 to .43 ( p &lt;.0001 for all models). Additionally, significant indirect effects were identified for all four models. Results demonstrated a comprehensive mediated model that accounted for up to 43% of the variance in school refusal. Future studies should seek to expand on the comprehensive approach of this model.

The impact of parental and individual factors on school refusal: a multiple-mediation model