Lessons to learn from managing school refusal of an adolescent boy with complex clinical presentation: A case report

School refusal can lead to short and long-term impairing consequences if not treated. This case study describes the management of a 13-year-old boy who presented with school refusal comorbid with medically unexplained paralysis and depression with psychotic features. The patient underwent a psychological assessment to clarify his diagnosis, followed by developmentally appropriate cognitive behavioral therapy. With these interventions, the patient showed promising improvement in his well-being and functioning. This study illustrates a case with unique association of school refusal, depression, dissociation in conversion disorder, and psychosis. The patient’s complex comorbidity required an individualized case formulation and a systemic intervention approach for effective management. The study underscores the need for future research to focus on identifying risk factors for early detection of school refusal and exploring the role of dissociation in conversion disorder and psychosis. School refusal intervention should be tailored to each child given the heterogenous presentation.