Flying Under the Radar: School Reluctance in Anxious Youth

The role of student's awareness of current experiences on peer and emotional problems and school refusal

Introduction

Several studies have shown that awareness of present experiences/events can play a key role in promoting relational and emotional well-being as well as motivation to attend school. However, no study to date has analyzed whether a student's awareness of current experiences (mindfulness) may contribute to peer and emotional problems and thus promote or reduce school refusal (Anxious Anticipation, Difficult Transition, Interpersonal Discomfort and School Avoidance).

Methods

A cross-sectional study (362 Italian high school students) was conducted to evaluate the mediating role of peer problems and emotional problems in the association between students' awareness of their current experiences (mindfulness) and school refusal. In order to evaluate the association between variables, was to carry out a structural equation model (SEM) with latent variables [ χ 2 (188) = 372.163, p = 0.000, CFI = 0.94, SRMR = 0.04, RMSEA (90%CI) = 0.052 (0.044, 0.060)].

Results

Mediation analysis indicated that peer problems and emotional problems full mediate the association between mindfulness and Anxious Anticipation (peer problems: β_= -0.19, p = ≤0.001; emotional problems: β_= -10,p = ≤0.05) and Interpersonal Discomfort (peer problems: β_= -0.35, p = ≤0.001; emotional problems: β_= -0.14, p = ≤0.01). Moreover, peer problems fully mediate the association between mindfulness and School Avoidance (β_= -0.14, p = ≤0.01).

Discussion

The study extends knowledge of the factors involved in school refusal, with application implications from a preventive point of view, relating to the components of emotional, relational and current experience awareness that may be related to motivation to attend school.

School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need

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).

The inverse association between psychological resilience and emerging school refusal among bullied autistic youth

BACKGROUND

Autistic youth are often bullied at school, which may lead to school refusal (SR). Currently, there is little research on factors that may help prevent SR among autistic youth. To advance theory-driven preventative interventions, this study examined associations between psychological resilience and emerging SR (ESR) among autistic youth bullied at school.

METHODS

Fifty-eight autistic boys in elementary school (grades 1-6; n = 36) or secondary school (grades 8-11; n = 22) who were bullied at school responded to an online survey, as did their mothers. Boys reported on the experience of being bullied, psychological resilience (via the Social Emotional Assets and Resilience Scale), and ESR. Their mothers provided information regarding the boys' Autism Spectrum Disorder (ASD) diagnosis.

RESULTS

Fifty-six percent of this sample of bullied autistic youth displayed ESR. For the secondary school boys there was a significant inverse relationship between psychological resilience and ESR, principally via two characteristics of psychological resilience: 'controlling negative thoughts' and 'remaining calm when angry'. No significant relationship was found between psychological resilience and ESR among elementary school boys.

CONCLUSION

Longitudinal research is needed to determine whether psychological resilience serves as a factor protecting against the emergence of SR among autistic youth who have been bullied.

School Refusal in Immigrants and Ethnic Minority Groups: A Qualitative Study of Adolescents' and Young Adults' Experiences

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.

School refusal and isolation: The perspectives of five adolescent school refusers in London, UK

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.

Students' Trait Emotional Intelligence and Perceived Teacher Emotional Support in Preventing Burnout: The Moderating Role of Academic Anxiety

The current study sought to investigate the role of trait emotional intelligence and perceived teacher emotional support in school burnout. Furthermore, the moderating role of academic anxiety in these relationships was examined. A sample of 493 Italian high school students (81.9% female) aged 14–19 years (M = 16.27, SD = 1.48) was involved in the study. A latent moderated structural equation approach was performed to test the hypothesized model. The results showed that both trait emotional intelligence and perceived teacher emotional support were negatively associated with school burnout. Moreover, academic anxiety moderated the relation between perceived teacher emotional support and school burnout. Specifically, when the level of anxiety was high, the protective role of perceived teacher emotional support toward burnout was weakened. Findings are discussed in light of the protective role of resources on burnout and considering the detrimental impact of academic anxiety in school settings.

Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

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.

Child and Adolescent Social Adaptive Functioning Scale: Factorial Invariance, Latent Mean Differences, and Its Impact on School Refusal Behavior in Spanish Children

This study aims to examine the factorial invariance and latent mean differences across gender of the Spanish version of the Child and Adolescent Social Adaptive Functioning Scale (Study 1) and to value the function of social functioning as a protective ability of school refusal behavior (Study 2). Participants were Spanish students aged 8–12 years carefully chosen by simple random cluster, 345 for the first study (M = 9.17; SD = 1.03) and 1,032 students for the second study (M = 10.02; SD = 1.77). The measures used were the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) and the School Refusal Assessment Scale-Revised (SRAS-R). Results about the validation of the scale supported the model proposed in this study for the CASAFS, with 15 items and a four-factor structure (school performance, peer relationships, family relationships, and home duties/self-care). Findings revealed invariance across gender for this model and good internal consistency levels were exhibited in each of the four dimensions of the CASAFS (0.76, 0.72, 0.74, and 0.71). Latent mean differences did not report differences between boys and girls. Regarding the second study, the social functioning acted as a protective factor of school refusal behavior by negatively and significantly predicting high scores in school refusal behavior due to anxiety symptoms or feelings of negative affect linked to the obligation to attend school. Opposite results were found for those students who justify their refusal to attend school in pursuing tangible reinforcements outside the school setting. These findings strengthen the reliability and validity of the CASAFS and the idea of social functioning as a person’s ability which could prevent school refusal behavior is discussed.

School Nurse Perceptions of Student Anxiety

Anxiety disorders are common in youth. Because somatic complaints are a hallmark feature of anxiety, these students frequently visit their school nurse, creating an ideal opportunity for nurses to identify and assist them. In an effort to better understand current practices, we surveyed a large sample ( N = 93) of school nurses. Results indicated that the majority of nurses perceived anxiety as the most prevalent mental health issue in their students. Moreover, the majority of nurses reported that they did not use any formal screening tool or intervention protocol and stated wanting to expand their training in anxiety intervention. These data suggest that school nurses identify anxiety as a top problem but do not receive adequate training to address it. Data from this survey may be used to plan how best to fill gaps in nurse training and practices that can enhance nurses' capacity to optimize outcomes for anxious students.