Several risks of bias were found in most studies included in this review, indicating a need for better-controlled studies. Moreover, independent replications of the manualized interventions examined in this review are needed, as are longer-term evaluations of effects of interventions. Assessing long-term effects could provide additional answers and insights regarding the mixed findings of the effects of interventions on attendance and anxiety. Future studies should also consider other types of interventions for rigorous evaluation. While the functional treatment of school refusal behavior has been identified by experts in this area as a promising approach (Kearney & Silverman, 1990; 1999), this intervention lacks rigorous evaluation. Furthermore, future studies could benefit from larger sample sizes and attention to mitigating potential biases to improve statistical power and causal inference.