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Chen J, Feleppa C, Sun T, Sasagawa S, Smithson M, Leach L. School Refusal Behaviors: The Roles of Adolescent and Parental Factors. Behav Modif 2024:1454455241276414. [PMID: 39187947 DOI: 10.1177/01454455241276414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
School refusal behaviors in adolescents have deleterious immediate and long-term consequences and are associated with mental ill-health such as anxiety and depression. Understanding factors that place youth at higher risk of school refusal behavior may assist in developing effective management approaches. We investigated parental and adolescent factors that may be associated with school refusal behaviors by specifically focusing on the role of parental and adolescent emotion dysregulation, their anxiety and depression, and parental rearing style. First, we hypothesized that adolescents with school refusal behaviors, as well as their parents, will report higher levels of emotion dysregulation, anxiety, and depression compared to their counterparts without school refusal behaviors. Furthermore, we hypothesized that multivariate models testing the role of parental and child factors concurrently will show that parental (emotion dysregulation, anxiety and depression, and rearing styles) and adolescent (emotion dysregulation, anxiety, and depression) factors are associated with school refusal behaviors. One hundred and six adolescents aged 12 to 18 years and their parents completed an online questionnaire measuring both parental and adolescent emotion dysregulation, anxiety, depression, parental rearing styles, and adolescents' school refusal behaviors. Adolescents with school refusal behaviors reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Multivariate analyses showed that parental emotion dysregulation and adolescent age were associated with school refusal behaviors independently. Future management for school refusal behaviors should consider age-tailored approaches by incorporating training for parental emotion regulation skills.
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Affiliation(s)
- Junwen Chen
- Australian National University, Canberra, ACT, Australia
| | | | - Tingyue Sun
- Australian National University, Canberra, ACT, Australia
| | | | | | - Liana Leach
- Australian National University, Canberra, ACT, Australia
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Leduc K, Tougas AM, Robert V, Boulanger C. School Refusal in Youth: A Systematic Review of Ecological Factors. Child Psychiatry Hum Dev 2024; 55:1044-1062. [PMID: 36422762 PMCID: PMC9686247 DOI: 10.1007/s10578-022-01469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
To guide school practitioners in the identification and intervention of youth with anxious school refusal, this systematic review used an ecological lens to examine the factors that differentiated children and adolescents with school refusal from those without. Based on the rigorous protocol from the Center for Reviews and Dissemination's (CRD) internationally recognized guidelines, 15 studies examining 67 different factors were identified. Results reveal 44 individual, social and contextual factors that differentiate youth with school refusal from peers without school refusal. Findings highlight the centrality of anxiety, or anxiety-related symptoms, and diverse learning needs as main points of contrast between youth with school refusal and those without. Implications of an ecological understanding of the factors associated with school refusal for selective and indicative prevention by school and mental health practitioners are discussed.
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Affiliation(s)
- Karissa Leduc
- Department of Educational and Counseling Psychology, McGill University, Montreal, QC, Canada.
- Groupe de recherche sur les inadaptations sociales de l'enfance (GRISE), Sherbrooke, QC, Canada.
| | - Anne-Marie Tougas
- Groupe de recherche sur les inadaptations sociales de l'enfance (GRISE), Sherbrooke, QC, Canada
- Department of Psychoeducation, Faculty of Education, Université de Sherbrooke, Sherbrooke, QC, Canada
- Institut universitaire de première ligne en santé et services sociaux (IUPLSSS), Sherbrooke, QC, Canada
| | - Virginie Robert
- Department of Learning Sciences, Faculty of Education, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Camille Boulanger
- Department of Psychoeducation, Faculty of Education, Université de Sherbrooke, Sherbrooke, QC, Canada
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McDonald B, Michelson D, Lester KJ. Intervention for school anxiety and absenteeism in children (ISAAC): Co-designing a brief parent-focused intervention for emotionally-based school avoidance. Clin Child Psychol Psychiatry 2024; 29:850-866. [PMID: 38130129 PMCID: PMC11188550 DOI: 10.1177/13591045231222648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Emotionally-based school avoidance (EBSA) is an important driver of persistent school absenteeism and may have worsened in the context of COVID-19. This paper describes the development of a brief parent-focused psychosocial intervention with the goal to address the lack of accessible early interventions for EBSA. The developmental process used a person-based approach with two phases. In Phase 1, qualitative data were collected about intervention preferences and priorities from N = 10 parents and N = 7 practitioners in a series of co-design workshops. Phase 2 refined an intervention blueprint based on iterative consultations with N = 4 parents and N = 3 practitioners. Framework analysis was used to organise findings around key intervention parameters, including relevant mechanisms, content, and delivery methods needed to provide effective, acceptable and feasible support for families affected by EBSA. The resulting blueprint incorporates three online modules to be delivered over three weeks with each module consisting of psychoeducational videos, self-completed learning tasks and a corresponding coaching session. Respective module content includes: (i) self-care strategies to increase parent wellbeing and self-efficacy; (ii) parenting strategies to change behavioural patterns that maintain child distress and avoidance of school; and (iii) strategic communication strategies to increase the quality of home-school relationships. The blueprint has been developed into a full prototype for a forthcoming feasibility study.
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Affiliation(s)
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, UK
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Shayganfard M, Kaboudi B, Arabsheibani K, Shakiba E, Cheshmekaboudi S. Effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral problems in elementary school boys: a preliminary randomized controlled trial. Arch Psychiatr Nurs 2024; 50:108-114. [PMID: 38789222 DOI: 10.1016/j.apnu.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 05/26/2024]
Abstract
This study aimed to examine the effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral issues in elementary school boys. A randomized controlled trial design (pretest-posttest with a control group) was utilized. Thirty elementary school boys with school refusal issues were randomly assigned to intervention (n = 15) and control (n = 15) groups. The intervention group received ten sessions of cognitive-behavioral group play therapy. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) questionnaire and Rutter's Children's Behavior Questionnaire were used as assessment tools. Mean scores for anxiety-based school refusal and behavioral problems in the intervention group showed a significant decrease (p < 0.001). Cognitive-behavioral group play therapy is a practical approach to reducing anxiety levels and behavior problems in children with anxiety-based school refusal in primary school grades.
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Affiliation(s)
- Mahsa Shayganfard
- Clinical Psychology Fattahi Clinic, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Bijan Kaboudi
- Cardiology Research Center of Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khadijeh Arabsheibani
- Clinical Psychology Department of Psychology, Payame Noor Tehran University, Tehran, Iran
| | - Ebrahim Shakiba
- Biochemistry Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepide Cheshmekaboudi
- Medical Sciences Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Lester KJ, Michelson D. Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context. BMJ MENTAL HEALTH 2024; 27:e300944. [PMID: 38580437 PMCID: PMC11021743 DOI: 10.1136/bmjment-2023-300944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 04/07/2024]
Abstract
School absences have risen following the COVID-19 pandemic and persistent absenteeism remains high in primary and secondary schools in England compared with pre-pandemic levels. This coincides with an upward trend in emotionally based school avoidance (EBSA). EBSA adversely affects children's educational attainment, health, social functioning and life prospects and warrants early intervention before a pattern of absenteeism becomes entrenched. In this article, we consider how the COVID-19 pandemic and its sequelae have created a 'perfect storm' of conditions, amplifying known school, family and child-based risk factors for EBSA while simultaneously reducing access to support services. We then outline priorities for developing new EBSA interventions and argue for a multi-component approach, which works across education, health and social care, and voluntary sectors to address the complex interplay between risk factors. Given the difficulties that families often face in obtaining timely support for EBSA, it is also essential that new interventions are accessible, resource-efficient and scalable. To this end, we specifically discuss the potential for contextually-sensitive, parent-focused interventions that can be delivered online with minimal synchronous support from a trained coach or facilitator.
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Affiliation(s)
- Kathryn J Lester
- School of Psychology, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, UK
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Wang Y, Gu H, Zhao X, Liu L. Chinese clients' experiences throughout family therapy for school-refusing adolescents: A multiperspectival interpretative phenomenological analysis. Acta Psychol (Amst) 2024; 243:104161. [PMID: 38280349 DOI: 10.1016/j.actpsy.2024.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE This study aimed to explore Chinese clients' experiences with family dynamic change throughout family therapy for school refusal and the interventions adolescents and their parents identified as useful during family therapy. METHODS A multiperspective interpretative phenomenology analysis (IPA) was adopted. Thirty-two participants from 11 Chinese families with school-refusing adolescents were recruited after completing family therapy at the hospitals. Semistructured interviews were conducted with the families, and the transcripts were analyzed. RESULTS Four main superordinate themes emerged: reshaping healthy family boundaries, building a harmonious family atmosphere, learning to cooperate and fight against stress, and achieving individual growth. CONCLUSION Our analysis suggested that changes in school-refusing adolescents through family therapy consisted of multilevel factors. These factors influence the reversal of adolescents' school refusal. Some targeted interventions for Chinese adolescents who refuse school are discussed and suggested.
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Affiliation(s)
- Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, PR China
| | - Hong Gu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, PR China
| | - Xudong Zhao
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, PR China
| | - Liang Liu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, PR China.
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Ulaş S, Gonzálvez C, Seçer İ. School refusal: mapping the literature by bibliometric analysis. Front Psychol 2024; 15:1265781. [PMID: 38410402 PMCID: PMC10896000 DOI: 10.3389/fpsyg.2024.1265781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
School refusal is considered a risk factor for academic, social, and personal situations, such as school dropouts. Studies have been carried out on school refusal for almost 50 years. However, general research trends have not been mapped yet. This study summarizes the bibliometric analysis of scientific collaborations and prevalence across locations by country and institution, leading researchers, journals, and trends (keywords) in school refusal research. The United States, Japan, Spain, and England are the countries that stand out in terms of school refusal. It can be said that the Journal of American Academy of Child and Adolescent Psychiatry, Cognitive and Behavioral Practice, and Frontiers in Psychology are important journals that publish on school refusal. Researchers named Christopher A. Kearney, Carolina Gonzálvez, Jose Manuel Garcia-Fernandez, David A. Heyne, and Brigit M. Van Widenfelt have been found to have more intensive studies and collaborations on school refusal. The authors keywords common use for school refusal; are truancy, school absenteeism, adolescence, school attendance, school phobia, autism spectrum disorder, and bullying. The findings show that school refusal is a current research area, and scientific collaborations continue to be established. The findings reveal all the details of the school refusal research.
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Affiliation(s)
- Sümeyye Ulaş
- Department of Psychological Counseling and Guidance, Atatürk University, Erzurum, Türkiye
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Didactics, Alicante University, Alicante, Spain
| | - İsmail Seçer
- Department of Psychological Counseling and Guidance, Atatürk University, Erzurum, Türkiye
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Vidal C, Hinson L, Bartolini E. School Absenteeism and the COVID-19 Pandemic: The Role of Pediatricians. Clin Pediatr (Phila) 2024; 63:5-9. [PMID: 37208918 PMCID: PMC10200804 DOI: 10.1177/00099228231174772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Carol Vidal
- Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Ellen Bartolini
- Children’s National Hospital, Washington, DC,
USA
- The George Washington University, Washington,
DC, USA
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Russell AE, Benham-Clarke S, Ford T, Eke H, Price A, Mitchell S, Newlove-Delgado T, Moore D, Janssens A. Educational experiences of young people with ADHD in the UK: Secondary analysis of qualitative data from the CATCh-uS mixed-methods study. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2023; 93:941-959. [PMID: 37227452 DOI: 10.1111/bjep.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and/or impulsivity. Young people with ADHD have poorer educational and social outcomes than their peers. We aimed to better understand educational experiences of young people with ADHD in the UK, and make actionable recommendations for schools. METHODS In this secondary analysis of qualitative data, we used Thematic Analysis to analyse information relating to experiences of education from 64 young people with ADHD and 28 parents who participated in the Children and adolescents with ADHD in Transition between Children's services and adult Services (CATCh-uS) study. Emerging patterns within and across codes led to organization of the data into themes and subthemes through an iterative process. RESULTS Two main themes were generated. The first described young people's early experiences of education, often within a mainstream setting; we labelled this the problematic provision loop, as this was a negative cycle that was repeated several times for some participants. The second theme described young people's more positive progression through education once they progressed out of the problematic loop. CONCLUSIONS Educational experiences for young people with ADHD are often negative and fraught with complication. Young people with ADHD often found themselves on a more positive trajectory after they were placed in an alternative form of education provision (mainstream or otherwise), or where they were able to study topics that interest them and play to their strengths. We make recommendations that commissioners, local authorities and schools could consider in order to better support those with ADHD.
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Affiliation(s)
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Helen Eke
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Anna Price
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Siobhan Mitchell
- University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | | | - Darren Moore
- University of Exeter Graduate School of Education, Exeter, UK
| | - Astrid Janssens
- Center for Innovativ Medicinsk Teknologi, University of Southern Denmark, Odense, Denmark
- Center for Research in Partnership with Patients and Relatives, Odense University Hospital, Odense, Denmark
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Dinesen TA, Blix BH, Gramstad A. Professional strategies in upper secondary school dropout management among youth in the Sami areas of Norway: a focus group study. Int J Circumpolar Health 2023; 82:2198112. [PMID: 37014958 PMCID: PMC10075505 DOI: 10.1080/22423982.2023.2198112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
The upper secondary school dropout rate is a challenge in many western countries, and measures have been taken to prevent dropout. The dropout rate in Norway is stable but is the highest among the northernmost counties. The aim of this study is to explore the strategies employed by upper secondary school teachers and their collaborators to prevent dropout from upper secondary school among Sami youth in northern Norway. This study is based on three focus group interviews with teachers, advisers, nurses, and counsellors in the Sami areas of northern Norway. The thematic analysis identified two main strategies, namely tracking the student and giving the student time. A transparent environments, cultural competence, and interdisciplinary collaboration were identified as prerequisites for successfully implementing the two strategies to prevent dropout from upper secondary school.
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Affiliation(s)
- Tone Aashild Dinesen
- Department of Social Education, Faculty of Health Sciences, UiT, The Arctic University of Norway, Harstad, Norway
| | - Bodil H Blix
- Department of health and care sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway
- Department of education, arts and sports, Western Norway University of Applied Sciences
| | - Astrid Gramstad
- Department of health and care sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway
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Li G, Niu Y, Liang X, Andari E, Liu Z, Zhang KR. Psychological characteristics and emotional difficulties underlying school refusal in adolescents using functional near-infrared spectroscopy. BMC Psychiatry 2023; 23:898. [PMID: 38041012 PMCID: PMC10691063 DOI: 10.1186/s12888-023-05291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND This study aims to explore the psychological characteristics, related emotional problems and potential NIR brain function mechanism of adolescents who refuse to attend school. METHODS The study included 38 adolescents (12-18 years old) who were not attending school and 35 healthy controls (12-18 years old) who are attending school regularly. Participants completed (1) general demographics, (2) Eysenck Personality Questionnaire (EPQ), (3) Zung Self-Rating Depression Scale (SDS), (4) Zung Self-Rating Anxiety Scale (SAS), and (5) Symptom Checklist-90 (SCL-90). In addition to the clinical tests, participants completed functional near-infrared spectroscopy (fNIRS). Mental health, personality, and emotional state were evaluated in both groups to explore the differences and to understand the underlying mechanisms of school refusal during adolescence. RESULTS Adolescents who did not attend school had higher neuroticism scores on the Eysenck Personality Questionnaire than healthy controls (p(FDR) < 0.001), introversion and concealment scores were lower than those of healthy controls (p(FDR) < 0.001), there was no significant difference in psychoticism scores between groups. SDS, SAS, SCL-90 scores and factor scores were higher than those of healthy control group (p(FDR) < 0.001), NIR functional brain imaging was different from healthy control group in the 12 and 27 channels (p(FDR) = 0.030, p(FDR) = 0.018), and no difference was found in the remaining channels (p(FDR) > 0.05). There were statistically significant differences in age and gender between the adolescents who refused school and the control group (p(FDR) < 0.001). CONCLUSION School refusal adolescents are relatively introverted and sensitive and need more attention in daily life. Although the adolescents' emotional problems did not reach the diagnostic criteria of depressive disorder and anxiety disorder, their scores were still higher than those of the control group, suggesting that we should pay more attention to their emotional problems in order to better help them return to school. Using fNIRS, it was found that abnormalities in frontal lobe regions in adolescents with school refusal behaviors, which would contribute to early diagnosis and timely intervention of school refusal behaviors.
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Affiliation(s)
- Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi Province, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Ying Niu
- College of Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiumei Liang
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi Province, China
| | - Elissar Andari
- Department of Psychiatry, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi Province, China.
| | - Ke-Rang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, 030001, Shanxi Province, China.
- First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China.
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Chockalingam M, Skinner K, Melvin G, Yap MBH. Modifiable Parent Factors Associated with Child and Adolescent School Refusal: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1459-1475. [PMID: 35397716 PMCID: PMC10435607 DOI: 10.1007/s10578-022-01358-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
School refusal is a complex problem that refers to difficulty attending/remaining at school due to emotional distress about attendance. Despite its occurrence being associated with negative outcomes, many are unresponsive to the current treatment options. While parent factors have a key role to play in school refusal, they are not adequately addressed in existing treatments. Further research is needed to consolidate understanding and implement new treatments. Employing the PRISMA method, this review aims to identify modifiable parent factors associated with child and/or adolescent school refusal. Eight studies met inclusion criteria from which nine factors were identified. Factors found to be associated with school refusal included: parent psychopathology, family functioning and maternal overprotection (communication subdomain). Other factors such as maternal overprotection (affection, assistance and travel subdomains) and parental self-efficacy had weak or inconsistent results warranting further investigation. Overall, findings call for action in this field that has sparse and dated literature.
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Affiliation(s)
- Meena Chockalingam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Kayan Skinner
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Glenn Melvin
- School of Psychology, Centre for Social and Early Emotional Development, Deakin University, Melbourne, Australia.
| | - Marie B H Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Connolly SE, Constable HL, Mullally SL. School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need. Front Psychiatry 2023; 14:1237052. [PMID: 37810599 PMCID: PMC10556686 DOI: 10.3389/fpsyt.2023.1237052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Background The Covid-19 pandemic has brought into sharp focus a school attendance crisis in many countries, although this likely pre-dates the pandemic. Children and young people (CYP) struggling to attend school often display extreme emotional distress before/during/after school. We term this School Distress. Here we sought to elucidate the characteristics of the CYP struggling to attend school in the United Kingdom. Methods Using a case-control, concurrent embedded mixed-method research design, 947 parents of CYP with experience of School Distress completed a bespoke online questionnaire (February/March 2022), alongside an age-matched control group (n = 149) and a smaller group of parents who electively home-educate (n = 25). Results In 94.3% of cases, school attendance problems were underpinned by significant emotional distress, with often harrowing accounts of this distress provided by parents. While the mean age of the CYP in this sample was 11.6 years (StDev 3.1 years), their School Distress was evident to parents from a much younger age (7.9 years). Notably, 92.1% of CYP currently experiencing School Distress were described as neurodivergent (ND) and 83.4% as autistic. The Odds Ratio of autistic CYP experiencing School Distress was 46.61 [95% CI (24.67, 88.07)]. Autistic CYP displayed School Distress at a significantly earlier age, and it was significantly more enduring. Multi-modal sensory processing difficulties and ADHD (among other neurodivergent conditions) were also commonly associated with School Distress; with School Distress CYP having an average of 3.62 NDs (StDev 2.68). In addition, clinically significant anxiety symptomology (92.5%) and elevated demand avoidance were also pervasive. Mental health difficulties in the absence of a neurodivergent profile were, however, relatively rare (6.17%). Concerningly, despite the striking levels of emotional distress and disability reported by parents, parents also reported a dearth of meaningful support for their CYP at school. Conclusion While not a story of exclusivity relating solely to autism, School Distress is a story dominated by complex neurodivergence and a seemingly systemic failure to meet the needs of these CYP. Given the disproportionate number of disabled CYP impacted, we ask whether the United Kingdom is upholding its responsibility to ensure the "right to an education" for all CYP (Human Rights Act 1998).
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Affiliation(s)
- Sophie E. Connolly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah L. Constable
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sinéad L. Mullally
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Yamada T, Sato A, So Y, Kobayashi K, Fujii Y. Review of cognitive-behavioural approaches for school absenteeism in Japan. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2023. [DOI: 10.1080/21507686.2023.2193753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Fletcher M, Bond C, Qualter P. User perspectives of robotic telepresence technology in schools: A systematic literature review. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2023. [DOI: 10.1080/02667363.2022.2155932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Matthew Fletcher
- Doctorate in Educational and Child Psychology, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Caroline Bond
- Doctorate in Educational and Child Psychology, School of Environment, Education and Development, University of Manchester, Manchester, UK
| | - Pamela Qualter
- Doctorate in Educational and Child Psychology, School of Environment, Education and Development, University of Manchester, Manchester, UK
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16
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Contemporary Hermits: A Developmental Psychopathology Account of Extreme Social Withdrawal (Hikikomori) in Young People. Clin Child Fam Psychol Rev 2023; 26:459-481. [PMID: 36653555 PMCID: PMC9848719 DOI: 10.1007/s10567-023-00425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
Although it is widely accepted that human beings have an ingrained 'need to belong,' there seem to be a substantial subset of young people who seclude themselves for most of the time at home and no longer engage in education or work, ultimately withdrawing from participation in society. In Japan, this phenomenon has been labeled as 'hikikomori,' but given its global presence it may be preferable to use the term 'extreme social withdrawal' (ESW). In this qualitative review, we provide a description and definition of ESW, provide figures on its prevalence, and discuss a number of associated concepts, including loneliness and "aloneliness," school absenteeism and dropout, the 'new' developmental stage of adultolescence, and the labor force categories of freeter ('freelance arbeiter') and NEET (a young person not in employment, education, or training). The core of the paper is focused on the origins of ESW in young people and provides a narrative overview of relevant etiological factors, such as aberrant brain processes, unfavorable temperament, psychiatric conditions, adverse family processes including detrimental parenting, negative peer experiences, societal pressures, and excessive internet and digital media use, which are all placed within a comprehensive developmental psychopathology framework. We will close with a discussion of possible interventions for young people with ESW and formulate a guideline that describes (the temporal order of) various components that need to be included in such a treatment.
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Kanzaki M, Suzuki H. School refusal as a representation of questioning normality: Understanding the richness of socio-cultural transitions. CULTURE & PSYCHOLOGY 2022. [DOI: 10.1177/1354067x221146487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effects of school refusal on one’s life depend on how the adolescent lives their life after refusing school. Previous studies have focused on meaning making for past refusal and have not adequately addressed the changes and transitions after school refusal. The current study elaborates on the richness of the transitions of adolescents who refused to go to school, based on the socio-cultural psychology of life course. By looking at school refusal from the perspective of the life course theory, we found that school refusal was a process of questioning normality. In addition, by using Yamada’s relational model of people and environments (Yamada, 1987, 2010), we found there are three patterns in the adolescents’ transitions: a) expanding their involvement in the here and now by encountering resources and then expanding reality, b) reforming relationships in the here and now by representing an other’s world and then reconstructing reality, and c) blocking their involvement in the here and now by touching resources and then escaping from reality. We discuss formation of resistance and richness of transition which would bring richness to our lives.
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18
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Nwosu KC, Wahl WP, Nwikpo MN, Hickman GP, Ezeonwunmelu VU, Akuneme CC. School refusal behaviours profiles among nigerian adolescents: differences in risk and protective psychosocial factors. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Tekin I, Aydın S. School refusal and anxiety among children and adolescents: A systematic scoping review. New Dir Child Adolesc Dev 2022; 2022:43-65. [DOI: 10.1002/cad.20484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Işıl Tekin
- Department of Psychological Counselling and Guidance Faculty of Education Sciences Istanbul Medeniyet University Istanbul Turkey
| | - Selami Aydın
- The Department of English Language Teaching Faculty of Educational Sciences Istanbul Medeniyet University Istanbul Turkey
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20
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Adams D. Child and Parental Mental Health as Correlates of School Non-Attendance and School Refusal in Children on the Autism Spectrum. J Autism Dev Disord 2022; 52:3353-3365. [PMID: 34331173 PMCID: PMC8323746 DOI: 10.1007/s10803-021-05211-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
Children on the autism spectrum miss more school than their peers, but limited work has explored why this may be. This study aimed to document the frequency at which children on the autism spectrum miss half and full days of school and the reasons for these absences. Parents of 106 school-aged children on the autism spectrum completed online questionnaires on rates of school non-attendance, family factors, child anxiety, and parental mental health. On average across a four week period, children missed 6 full days of school. The most common reason for full-day absences was school refusal and for half-day absences was medical/therapy appointments. Parental employment status, increased child age, child anxiety, and differing aspects of parental mental health were identified as correlates of specific subtypes of school non-attendance.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD, 4122, Australia.
- Griffith Institute of Educational Research, Griffith University, Brisbane, Australia.
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21
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Heyne D. Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:471-494. [PMID: 35762908 DOI: 10.1024/1422-4917/a000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is important to consider developmental issues when addressing school refusal (SR) in adolescence. Referral rates appear to be higher among adolescents relative to children, and treatment appears to be less effective among adolescents. This paper provides an in-depth review of developmental issues associated with adolescent SR and treatment via cognitive-behavioral therapy (CBT). It begins by considering the reasons for the higher referral and poorer treatment outcomes, including the higher level of absenteeism in adolescence, higher rates of concurrent social anxiety disorder and depressive disorder, and the developmental challenges inherent to adolescence. Such challenges include increased academic and social demands in the secondary-school environment, and increasing autonomy which may contribute to family conflict. These developmental issues may potentiate and exacerbate an adolescent's difficulty attending school, make it difficult for families to cope, and complicate practitioners' efforts to provide effective treatment for SR. Further, the review describes CBT manuals for SR and the extent to which they are developmentally sensitive. There are five CBT manuals, which vary in their sensitivity to developmental issues. Various multimodal treatments employ interventions in addition to CBT, such as medication or inpatient treatment, to address the complexity of SR in adolescence. Nevertheless, nonresponse to treatment for adolescent SR ranges from one-third to two-thirds of youths. Attention thus needs to be given to ways of improving treatment outcomes.
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Affiliation(s)
- David Heyne
- Institute of Psychology, Leiden University, The Netherlands
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22
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Heyne D, Brouwer-Borghuis M. Signposts for School Refusal Interventions, Based on the Views of Stakeholders. CONTINUITY IN EDUCATION 2022; 3:25-40. [PMID: 38774290 PMCID: PMC11104337 DOI: 10.5334/cie.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/26/2022] [Indexed: 05/24/2024]
Abstract
School refusal (SR) signals a young person's difficulty attending school. It jeopardizes their development, often contributes to distress for parents, and places an extra burden on school personnel. Reviews of empirical studies indicate that intervention for SR helps to increase school attendance, but not for all youths. This practice-based manuscript aims to support practitioners and organisations addressing the needs of youths and families affected by SR. Specifically, we present 14 signposts for the development and delivery of intervention for SR. The signposts represent important conditions for effective intervention based on key findings from the Knowing What Works project in the Netherlands. During that project, 76 professionals shared their views about the important elements in SR interventions they delivered, and 39 youths and 86 parents shared their views about the helpful elements in SR interventions in which they participated. These 201 stakeholders were variously associated with 21 SR interventions across 9 of the 12 Dutch provinces, most situated in mainstream or special education settings. Their responses informed the development of the 14 signposts presented here, supported by the extant literature on SR intervention. We describe the essence of each signpost and conclude with suggestions for using the signposts and evaluating their utility.
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Melin J, Jansson-Fröjmark M, Olsson NC. Clinical practitioners' experiences of psychological treatment for autistic children and adolescents with school attendance problems: a qualitative study. BMC Psychiatry 2022; 22:220. [PMID: 35346125 PMCID: PMC8958765 DOI: 10.1186/s12888-022-03861-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND School attendance problems (SAPs) are common among children and adolescents with autism spectrum disorder (ASD). Currently, there is a lack of guidelines for treatment or interventions aimed at this group. METHOD Twelve clinical practitioners were interviewed via in-depth interviews using a semi-structured question guide. Interviews were audiotaped, transcribed verbatim, and initially independently coded by two coders. The interviews were analyzed according to thematic analysis. RESULTS The majority of the clinicians reported that it was common that children and adolescents with ASD at CAP had prolonged SAPs. A total of four themes and 22 sub-themes were identified in the analysis: the treatment situation; treatment goals at CAP; treatment interventions; and desired development. Insufficient adaptations in response to core impairment of ASD and lack of support in their daily life could be factors to the development of SAPs. Prolonged social isolation in combination with severe psychiatric comorbidities was reported as a treatment barrier. Also, insufficient collaboration between mental health care services, school and social services obstructed the return to school for this group of students. Favorable factors for positive treatment outcome were: early detection, accurate assessment and coordination between mental health care and schools and environmental adaptation at school as well as at home, parent support and sometimes change of school. Concerning useful therapeutic techniques, exposure from cognitive-behavioral treatment was reported. CONCLUSION Children and adolescents with ASD with limited societal support tend to develop SAPs. Important factors that impact the outcome of treatment were the length of the absence from school and the severity of psychiatric comorbidities. Tailored and adapted interventions at school, parent support and mental health care are needed. Research about assessment and treatment for children and adolescents with ASD and SAPs is needed.
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Affiliation(s)
- Johanna Melin
- Child and Adolescent Psychiatry Research Center (CAP), Stockholm County Council, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience (CNS), Karolinska Institutet, & Stockholm Health Care Services, Liljeholmstorget 7, 117 63, Stockholm, Sweden
| | - Nora Choque Olsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience (CNS), Karolinska Institutet, & Stockholm Health Care Services, Liljeholmstorget 7, 117 63, Stockholm, Sweden.
- Department of Psychology, Stockholm University, Stockholm, Sweden.
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24
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Corcoran S, Bond C, Knox L. Emotionally based school non-attendance: two successful returns to school following lockdown. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2022. [DOI: 10.1080/02667363.2022.2033958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shannon Corcoran
- School of Environment, Education and Development (SEED), University of Manchester, Manchester, UK
| | - Caroline Bond
- School of Environment, Education and Development (SEED), University of Manchester, Manchester, UK
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25
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Brault C, Thomas I, Moro MR, Benoit L. School Refusal in Immigrants and Ethnic Minority Groups: A Qualitative Study of Adolescents' and Young Adults' Experiences. Front Psychiatry 2022; 13:803517. [PMID: 35479494 PMCID: PMC9035588 DOI: 10.3389/fpsyt.2022.803517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND School refusal is one cause of school absenteeism along with truancy, and the two can be difficult to distinguish. School absenteeism behaviors among students in transcultural situations (immigrants or children of immigrants) and from ethnic minority groups are subject to misdiagnosis and decreased access to care. To improve the care provided, this exploratory study addresses the experience of adolescents and young adults engaging in school refusal, from immigrant and ethnic minority groups. METHODS Sixteen participants between the ages of 16 and 20 years old presenting with school refusal were interviewed for this qualitative study. All participants were either immigrants, children of immigrants, or from an ethnic minority group. We conducted a qualitative analysis based on Interpretative Phenomenological Analysis. RESULTS Participants experienced school refusal as a loss of identity and as a failure to achieve what was perceived as parental expectations of success, which triggered feelings of worthlessness, shame, and guilt. The loss of a peer group, namely their classmates, as a result of school absenteeism was experienced as a marginalization from the larger society. Although participants denied having personally experienced racism, some of them recalled their parents experiencing racism at school. CONCLUSION School refusal complicates identity construction, autonomy, and integration into society. For adolescents and young adults from immigrant and ethnic minority backgrounds, it also triggers guilt, transgenerational traumatic memories, and the fear of marginalization. In addition to validated therapies for school refusal, sociological, intersectional, and cross-cultural tools would be a valuable addition to treatment.
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Affiliation(s)
- Camille Brault
- Etablissement Public de Santé Ville-Evrard, Neuilly sur Marne, Paris, France
| | - Isaiah Thomas
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Marie Rose Moro
- Maison des Adolescents-Maison de Solenn, Hôpital Cochin, AP-HP, Paris, France.,University of Paris, Faculty of Psychology, Boulogne-Billancourt, Paris, France.,Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France
| | - Laelia Benoit
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Maison des Adolescents-Maison de Solenn, Hôpital Cochin, AP-HP, Paris, France.,Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France
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Kljakovic M, Kelly A, Richardson A. School refusal and isolation: The perspectives of five adolescent school refusers in London, UK. Clin Child Psychol Psychiatry 2021; 26:1089-1101. [PMID: 34154457 PMCID: PMC8593279 DOI: 10.1177/13591045211025782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has identified a subset of young people who feel unable to engage in mainstream education. Given the hard-to-reach nature of this group, their views on what has caused their isolation from others have received little focus in previous literature. The present study aimed to explore the experiences and views of a subset of young people seen within an inner London Pupil Referral Unit who were extremely socially withdrawn and unable to attend mainstream education. They were asked what they believe led them to their current situation, the impact of isolation, how their life is going and what they value. Key themes identified were the role of anxiety in withdrawal from education and the protective capacity of social contact, even via social media, in preventing negative outcomes of withdrawal. Sleep, health, education, family and social contact were identified as risk and protective factors and were also things participants identified as values. This research provides insight into potential ways to support young people in returning to mainstream education as well as ideas for preventative measures that may protect future generations from such extreme isolation. This research was conducted before the COVID-19 pandemic, but lessons learned bear relevance in current times.
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School Refusal Behavior Profiles, Optimism/Pessimism, and Personality Traits in Spanish Children. EDUCATION SCIENCES 2021. [DOI: 10.3390/educsci11090524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The relationship between school refusal behavior (SRB) profiles and personality traits has received little attention from investigators. Identifying the profiles of students with school attendance problems may improve the understanding of the characteristics defining these students. The aim of this study was to identify different SRB profiles and analyze the relationship between these profiles, and optimism/pessimism and personality traits. The School Refusal Assessment Scale-Revised, the Youth Life Orientation Test, and the Big Five Questionnaire were administrated to 739 Spanish students aged 8–11 (Mage = 9.92; SD = 1.12). Pearson’s correlation coefficients revealed a significant association between personality dimensions and SRB. Three distinct profiles were identified: (1) SRB by negative reinforcement (high scores on avoiding school-related stimuli provoking negative affectivity), (2) SRB by positive reinforcement (high scores on pursuing positive tangible reinforcement outside of school), and (3) Low SRB. The SRB profile by positive reinforcement scored higher on Extraversion, Agreeableness, Conscientiousness, Openness, and Optimism, whereas the SRB profile by negative reinforcement scored higher on Neuroticism and Pessimism. More statically significant differences were found between the negative and positive reinforcement profiles. The role of negative personality traits and pessimism as risk factors for students who are truant or refuse to attend school are discussed.
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Li A, Guessoum SB, Ibrahim N, Lefèvre H, Moro MR, Benoit L. A Systematic Review of Somatic Symptoms in School Refusal. Psychosom Med 2021; 83:715-723. [PMID: 33951013 DOI: 10.1097/psy.0000000000000956] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE School refusers often display somatic symptoms that are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. METHODS PubMed and PsycINFO databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1025 identified studies, 148 were included. RESULTS Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue, and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training, and ignoring the somatic symptoms. CONCLUSIONS Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third-wave behavioral therapies, and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians, and psychologists/psychiatrists is needed to improve well-being in children who experience somatic symptoms as related to school avoidance.
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Affiliation(s)
- Anne Li
- From the AP-HP, Cochin Hospital, Maison des Adolescents-Maison de Solenn, Integrated Youth Health Care Service (Li, Guessoum, Ibrahim, Lefèvre, Moro, Benoit), Paris; Faculty of Medicine, Paris-Saclay University (Li), Orsay; University of Paris, PCPP (Guessoum, Ibrahim, Moro), Boulogne-Billancourt; Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy (Guessoum, Ibrahim, Lefèvre, Moro, Benoit), Villejuif, France; Yale School of Medicine, Yale University (Benoit), New Haven, Connecticut; and French Clinical Research Group in Adolescent Medicine and Health (Li, Ibrahim, Lefèvre), Paris, France
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Kearney CA. Integrating Systemic and Analytic Approaches to School Attendance Problems: Synergistic Frameworks for Research and Policy Directions. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-020-09591-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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30
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Epstein S, Roberts E, Sedgwick R, Polling C, Finning K, Ford T, Dutta R, Downs J. School absenteeism as a risk factor for self-harm and suicidal ideation in children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1175-1194. [PMID: 30989389 PMCID: PMC7116080 DOI: 10.1007/s00787-019-01327-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/30/2019] [Indexed: 11/29/2022]
Abstract
Self-harm and suicidal ideation in children and adolescents are common and are risk factors for completed suicide. Social exclusion, which can take many forms, increases the risk of self-harm and suicidal ideation. One important marker of social exclusion in young people is school absenteeism. Whether school absenteeism is associated with these adverse outcomes, and if so to what extent, remains unclear. To determine the association between school absenteeism and both self-harm (including completed suicide) and suicidal ideation in children and adolescents, we conducted a systematic review of observational studies. We conducted meta-analysis and report a narrative synthesis where this was not possible. Meta-analysis of cross-sectional studies showed that school absenteeism was associated with an increased risk of self-harm [pooled adjusted odds ratio (aOR) 1.37, 95% confidence interval 1.20-1.57, P = 0.01] and of suicidal ideation (pooled aOR 1.20, 95% CI 1.02-1.42, P = 0.03). A small number of studies showed that school absenteeism had a longitudinal association with both adverse outcomes. Heterogeneity in the exposure and outcome variables, study design and reporting was prominent and limited the extent to which it was appropriate to pool results. School absenteeism was associated with both self-harm and suicidal ideation in young people, but this evidence was derived from a small number of cross-sectional studies. Further research into the mechanisms of this association could help to inform self-harm and suicide prevention strategies at clinical, school and population levels.
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Affiliation(s)
- Sophie Epstein
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK
- National Addiction Centre, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosemary Sedgwick
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Catherine Polling
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Rina Dutta
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Johnny Downs
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Heyne D, Strömbeck J, Alanko K, Bergström M, Ulriksen R. A Scoping Review of Constructs Measured Following Intervention for School Refusal: Are We Measuring Up? Front Psychol 2020; 11:1744. [PMID: 32973595 PMCID: PMC7468385 DOI: 10.3389/fpsyg.2020.01744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Reviews of the effectiveness of interventions for school refusal (SR) rely upon well-conducted primary studies. Currently there are no guidelines for those conducting primary studies about the measurement of outcome following intervention for SR. Most people would agree that it is important to measure school attendance as an outcome but there has been little discussion about other constructs that warrant measurement. To facilitate this discussion and support the development of guidelines, we conducted a scoping review of constructs measured in studies evaluating intervention for SR. We screened the title and abstract of 3,213 publications found in peer-reviewed journals between 1980 and 2019. After full text review of 271 publications, 50 publications describing 51 studies were included. Results address the frequency with which constructs were measured, along with instruments used, informants, and time-points for measurement. Based on the results, we offer guidelines for choosing constructs to measure following intervention for SR and considerations for how to measure the constructs. Guidelines can increase consistency across primary studies, with benefits for future meta-analyses and international comparisons. They also provide support for practitioners contemplating routine evaluation of their interventions for SR. Ultimately, a core outcome set for SR can be developed.
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Affiliation(s)
- David Heyne
- Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Johan Strömbeck
- Magelungen Utveckling AB, Stockholm, Sweden.,Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Katarina Alanko
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
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32
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Heyne D, Gentle-Genitty C, Gren Landell M, Melvin G, Chu B, Gallé-Tessonneau M, Askeland KG, Gonzálvez C, Havik T, Ingul JM, Johnsen DB, Keppens G, Knollmann M, Lyon AR, Maeda N, Reissner V, Sauter F, Silverman WK, Thastum M, Tonge BJ, Kearney CA. Improving school attendance by enhancing communication among stakeholders: establishment of the International Network for School Attendance (INSA). Eur Child Adolesc Psychiatry 2020; 29:1023-1030. [PMID: 31372748 DOI: 10.1007/s00787-019-01380-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/22/2019] [Indexed: 01/05/2023]
Affiliation(s)
- David Heyne
- Leiden University Institute of Psychology, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | | | | | - Glenn Melvin
- Deakin University School of Psychology, Burwood, Australia
| | - Brian Chu
- Rutgers University, New Brunswick, USA
| | | | | | | | | | - Jo Magne Ingul
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Gil Keppens
- Vrije Universiteit Brussel, Brussels, Belgium
| | - Martin Knollmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Naoki Maeda
- Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Volker Reissner
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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33
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A Multidimensional, Multi-tiered System of Supports Model to Promote School Attendance and Address School Absenteeism. Clin Child Fam Psychol Rev 2020; 23:316-337. [DOI: 10.1007/s10567-020-00317-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Finning K, Ford T, Moore DA, Ukoumunne OC. Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey. Eur Child Adolesc Psychiatry 2020; 29:187-198. [PMID: 31054124 PMCID: PMC7024694 DOI: 10.1007/s00787-019-01342-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
Abstract
Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.
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Affiliation(s)
- Katie Finning
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Tamsin Ford
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Darren A Moore
- Graduate School of Education, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- School of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
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Fornander MJ, Kearney CA. Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis. Front Psychol 2020; 10:3079. [PMID: 32038423 PMCID: PMC6985447 DOI: 10.3389/fpsyg.2019.03079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/29/2019] [Indexed: 12/05/2022] Open
Abstract
School attendance problems are highly prevalent worldwide, leading researchers to investigate many different risk factors for this population. Of considerable controversy is how internalizing behavior problems might help to distinguish different types of youth with school attendance problems. In addition, efforts are ongoing to identify the point at which children and adolescents move from appropriate school attendance to problematic school absenteeism. The present study utilized ensemble and classification and regression tree analysis to identify potential internalizing behavior risk factors among youth at different levels of school absenteeism severity (i.e., 1+%, 3+%, 5+%, 10+%). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 160 youth aged 6-19 years (M = 13.7; SD = 2.9) and their families from an outpatient therapy clinic (39.4%) and community (60.6%) setting, the latter from a family court and truancy diversion program cohort. One particular item relating to lack of enjoyment was most predictive of absenteeism severity at different levels, though not among the highest levels. Other internalizing items were also predictive of various levels of absenteeism severity, but only in a negatively endorsed fashion. Internalizing symptoms of worry and fatigue tended to be endorsed higher across less severe and more severe absenteeism severity levels. A general expectation that predictors would tend to be more homogeneous at higher than lower levels of absenteeism severity was not generally supported. The results help confirm the difficulty of conceptualizing this population based on forms of behavior but may support the need for early warning sign screening for youth at risk for school attendance problems.
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Affiliation(s)
- Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Maeda N, Heyne D. Rapid Return for School Refusal: A School-Based Approach Applied With Japanese Adolescents. Front Psychol 2019; 10:2862. [PMID: 31920885 PMCID: PMC6934052 DOI: 10.3389/fpsyg.2019.02862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is often effective in the treatment of school refusal (SR). Its usefulness is limited, however, if youth displaying SR also refuse to attend treatment sessions. In these cases parents and school staff may consider using school-based interventions that do not rely on face-to-face assessment and treatment with the young person. The current study examined the effectiveness of a school-based intervention applied in Japan to achieve rapid return to school among adolescents displaying SR. Between 2009 and 2015, the parents of 62 adolescents displaying SR were invited to implement a school-based rapid return approach. Thirty-nine parents agreed to implement the approach and 23 decided to wait until their child spontaneously attended school. Of the 39 cases in which the approach was implemented, 28 adolescents (72%) resumed attendance at their original school, 2 (5%) transferred to another school, and 9 (23%) did not resume attendance. In contrast, all 23 non-intervention cases continued to refuse to attend school for 3 months or longer, and none of these adolescents returned to regular school attendance within 9 months. This study tentatively suggests that the rapid return approach may be an effective form of intervention for adolescents displaying SR and simultaneously refusing to attend individual therapy. Because this approach is ethically complex, involving forced school attendance in adolescence, it should only be employed under specific circumstances. These circumstances are discussed.
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Affiliation(s)
- Naoki Maeda
- School of Social Welfare, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - David Heyne
- Institute of Psychology, Leiden University, Leiden, Netherlands
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Keppens G, Spruyt B, Dockx J. Measuring School Absenteeism: Administrative Attendance Data Collected by Schools Differ From Self-Reports in Systematic Ways. Front Psychol 2019; 10:2623. [PMID: 31849752 PMCID: PMC6901495 DOI: 10.3389/fpsyg.2019.02623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/06/2019] [Indexed: 11/16/2022] Open
Abstract
In order to use attendance monitoring within an integrative strategy for preventing, assessing and addressing cases of youth with school absenteeism, we need to know whether the attendance data collected by schools cover all students with (emerging) school attendance problems (SAPs). The current article addresses this issue by comparing administrative attendance data collected by schools with self-reported attendance data from the same group of students (age 15–16) in Flanders, the Dutch-speaking part of Belgium (N = 4344). We seek to answer the following question: does an estimation of unauthorized absenteeism based on attendance data as collected by schools through electronic registration differ from self-reported unauthorized absenteeism and, if so, are the differences between administrative and self-reported unauthorized absenteeism systematic? Our results revealed a weak association between self-reported unauthorized school absenteeism and registered unauthorized school absenteeism. Boys, students in technical and vocational tracks and students who speak a foreign language at home, with a less-educated mother and who receive a school allowance, received more registered unauthorized absences than they reported themselves. In addition, pupils with school refusal and who were often authorized absent from school received more registered unauthorized absences compared to their self-reported unauthorized school absenteeism. In the discussion, we elaborate on the implications of our findings.
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Affiliation(s)
- Gil Keppens
- Research Group TOR, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bram Spruyt
- Research Group TOR, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jonas Dockx
- Centre for Educational Effectiveness and Evaluation, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Kearney CA, Gonzálvez C, Graczyk PA, Fornander MJ. Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2). Front Psychol 2019; 10:2605. [PMID: 31849743 PMCID: PMC6895679 DOI: 10.3389/fpsyg.2019.02605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/04/2019] [Indexed: 01/08/2023] Open
Abstract
As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.
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Affiliation(s)
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Teaching, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Patricia A. Graczyk
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Fornander MJ, Kearney CA. Family Environment Variables as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis. Front Psychol 2019; 10:2381. [PMID: 31681130 PMCID: PMC6813209 DOI: 10.3389/fpsyg.2019.02381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/07/2019] [Indexed: 11/13/2022] Open
Abstract
School attendance problems, including school absenteeism, are common to many students worldwide, and frameworks to better understand these heterogeneous students include multiple classes or tiers of intertwined risk factors as well as interventions. Recent studies have thus examined risk factors at varying levels of absenteeism severity to demarcate distinctions among these tiers. Prior studies in this regard have focused more on demographic and academic variables and less on family environment risk factors that are endemic to this population. The present study utilized ensemble and classification and regression tree analysis to identify potential family environment risk factors among youth (i.e., children and adolescents) at different levels of school absenteeism severity (i.e., 1 + %, 3 + %, 5 + %, 10 + %). Higher levels of absenteeism were also examined on an exploratory basis. Participants included 341 youth aged 5-17 years (M = 12.2; SD = 3.3) and their families from an outpatient therapy clinic (68.3%) and community (31.7%) setting, the latter from a family court and truancy diversion program cohort. Family environment risk factors tended to be more circumscribed and informative at higher levels of absenteeism, with greater diversity at lower levels. Higher levels of absenteeism appear more closely related to lower achievement orientation, active-recreational orientation, cohesion, and expressiveness, though several nuanced results were found as well. Absenteeism severity levels of 10-15% may be associated more with qualitative changes in family functioning. These data may support a Tier 2-Tier 3 distinction in this regard and may indicate the need for specific family-based intervention goals at higher levels of absenteeism severity.
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Kearney CA, Gonzálvez C, Graczyk PA, Fornander MJ. Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1). Front Psychol 2019; 10:2222. [PMID: 31681069 PMCID: PMC6805702 DOI: 10.3389/fpsyg.2019.02222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
School attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Many efforts have been made to conceptualize and address this population across various categories and dimensions of functioning and across multiple disciplines, resulting in both a rich literature base and a splintered view regarding this population. This article (Part 1 of 2) reviews and critiques key categorical and dimensional approaches to conceptualizing school attendance and school absenteeism, with an eye toward reconciling these approaches (Part 2 of 2) to develop a roadmap for preventative and intervention strategies, early warning systems and nimble response, global policy review, dissemination and implementation, and adaptations to future changes in education and technology. This article sets the stage for a discussion of a multidimensional, multi-tiered system of supports pyramid model as a heuristic framework for conceptualizing the manifold aspects of school attendance and school absenteeism.
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Affiliation(s)
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Teaching, University of Alicante, San Vicente del Raspeig, Spain
| | - Patricia A. Graczyk
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Finning K, Waite P, Harvey K, Moore D, Davis B, Ford T. Secondary school practitioners' beliefs about risk factors for school attendance problems: a qualitative study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019; 25:15-28. [PMID: 32536954 PMCID: PMC7254525 DOI: 10.1080/13632752.2019.1647684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
School staff have an important role to play in identifying and assisting pupils who require additional support to regularly attend school, but their beliefs about risk factors might influence their decisions regarding intervention. This qualitative study investigated educational practitioners' beliefs about risk factors for attendance problems. Sixteen practitioners from three secondary schools were interviewed via focus groups. Data were analysed using thematic analysis. Practitioners identified risk factors related to the individual, their family, peers and school. Poor mental health was identified as a risk factor, but practitioners primarily focused on anxiety rather than other mental health problems like depression or behavioural disorders. The overall perception was that school factors were less important than individual, family and peer factors. Implications include a need for increased awareness of the role of school factors in attendance problems, focus on promoting positive peer and pupil-teacher relationships, and collaborative working between young people, families and schools.
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Affiliation(s)
- Katie Finning
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Polly Waite
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Becky Davis
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Tamsin Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
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Towards a comprehensive assessment of school absenteeism: development and initial validation of the inventory of school attendance problems. Eur Child Adolesc Psychiatry 2019; 28:399-414. [PMID: 30043236 DOI: 10.1007/s00787-018-1204-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
School attendance problems (SAPs) become manifest in many ways and are associated with multiple risk factors, calling for comprehensive assessment methods. This study documents the development of the inventory of school attendance problems (ISAP), which assesses both the quality and the function of a broad spectrum of SAPs by first asking students with SAPs to rate the intensity of symptoms prior to or at school and then to rate their impact on school attendance. An empirically generated pool of 124 items was analyzed (explorative factor analysis) using a clinical sample of N = 245 students with SAPs (53.5% male; Mage: 14.4). The Youth Self Report (YSR), a German version of the School Refusal Assessment Scale (SRAS), and the extent of school absenteeism were used to determine construct validity. The resulting 48 items loaded on 13 factors. The 13 scales assess internalizing and externalizing symptoms (Depression, Social Anxiety, Performance Anxiety, Agoraphobia/Panic, Separation Anxiety, Somatic Complaints, Aggression, School Aversion/Attractive Alternatives) as well as emotional distress due to problems in the school or family context (Problems with Teachers, Dislike of the Specific School, Problems with Peers, Problems Within the Family, Problems with Parents). All scales showed good internal consistencies. Their correlations with the YSR and the SRAS indicated convergent and discriminant validity. Positive associations between most of the scales and the extent of school absenteeism were obtained. Although preliminary, these results support the usefulness of the ISAP for a comprehensive assessment of SAPs in clinical settings.
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