Emerging School Refusal: A School-Based Framework for Identifying Early Signs and Risk Factors

School refusal behavior in children and adolescents: a five-year narrative review of clinical significance and psychopathological profiles

The aim of the study was to explore the clinical significance of school refusal behavior, its negative impact on psychological well-being of children and adolescents and its relationship with the most common psychopathological conditions during childhood and adolescence (e.g. neurodevelopmental disorders, psychiatric disorders). School refusal behavior refers to a distressing condition experienced by children and adolescents that compromise regular school attendance and determine negative consequences on mental health and adaptive functioning. A narrative review of the literature published between January 2019 and March 2023 was conducted. Ten studies (n = 10) were included from a literature search of the electronic databases PubMed, CINAHL, PsycInfo, MedLine, and Cochrane Library. The results indicate that school refusal is highly present in neurodevelopmental disorders such as autism and attention-deficit/hyperactivity disorder due to the presence of behavioral problems and deficits in communication skills. As for psychiatric disorders, school refusal appears to be highly common in anxiety disorders, depressive disorders, and somatic symptoms. We also found that school refusal behavior may be associated with various emotional and behavioral conditions that act as risk factors. Especially, but are not limited to, it may be associated with a diminished self-concept, exposure to cyberbullying, specific affective profiles and excessive technology usage. Our results indicate that school refusal is a condition with many clinical facets. It can be attributed to both vulnerability factors, both temperamental and relational, and to various psychopathological conditions that differ significantly from each other, such as neurodevelopmental disorders and psychiatric disorders. Recognizing these aspects can improve the implementation of patient-tailored therapeutic interventions that are consequently more likely to produce effective outcomes. The therapeutic intervention should facilitate the recognition of cognitive biases regarding school as a threatening environment, while regulating negative emotions associated with school attendance. Additionally, therapeutic intervention programs linked to social skill training and problem-solving training, conducted directly within the school setting, can enhance children's abilities to cope with academic performance and social relationships, ultimately preventing school refusal.

Which students skip school? A comparative study of sociodemographic factors and student absenteeism using PISA data

This article explores which students-with regard to gender, socio-economic background and migration background-skip school in Germany, Japan, Sweden and the United Kingdom (UK) according to PISA data. Students who skip school are observed in many countries, but there is not much systematic research that studies this across countries. Comparable data is to a large extent missing. PISA data offers an opportunity to use comparable data. In PISA, students were asked in 2018, 2015 and 2012 whether they had skipped school a whole day in the last two weeks prior to their completion of the PISA student questionnaire. Patterns of how absence relates to sociodemographic factors vary in countries and school systems. In the comparison between the four countries the UK stands out as having a higher percentage of students who have reported that they have skipped school than in the other countries. This does not seem to be related to any specific group of students. Japan also stands out with a lower percentage of students who have reported that they have skipped school. According to PISA data, skipping school is more related to socio-economic background than any other of the variables studied. The socio-economic background seems to be related to skipping school in all three PISA studies in Sweden and the UK. Gender seems not to be an important factor in the four countries. In Sweden and Germany there is a lower percentage of non-immigrant students who report that they have skipped school than first-and second-generation immigrant students. In the UK the figures are more ambiguous. When the percentages of students skipping school are compared over time and in the countries, it is difficult to find any trends, but the data only covered three measurements during a period of six years, which may be too short a time span to see trends.

Adolescent Social Anxiety, School Satisfaction, Family Emotional Support, and School Absenteeism: Findings from Young-HUNT3 and Norwegian National Education Data

Background: Adolescents grappling with social anxiety may experience poor school satisfaction, resorting to school-related avoidance behaviors, exemplified by absenteeism, as a coping mechanism. Understanding the role of family support in alleviating the adverse effects of social anxiety on school satisfaction is imperative for fostering supportive educational settings. Although there is literature regarding how school satisfaction promotes positive adolescent outcomes, empirical knowledge on the interrelation between social anxiety, school satisfaction, and family emotional support is limited. This study investigates the association between social anxiety, family emotional support, school satisfaction, and school absenteeism within the theoretical framework of the stage-environment fit theory to offer insight into how family emotional support can moderate the influence of social anxiety on school-related outcomes. Methods: Utilizing a population-based sample of 1861 upper secondary school pupils from the Trøndelag Young Health study "Young-HUNT3 study", we employed an index of moderated mediation to examine the role of family emotional support in moderating the association between social anxiety and school-related avoidance behavior related to school satisfaction. Results: Family emotional support had moderated mediation association for school absenteeism (β = 0.128, 95% CI 0.019, 0.278) and extracurricular activity (β = -0.003, 95% CI -0.008, -0.000). Conclusions: This urges further investigation into the specific mechanisms and individual differences influencing these relationships, aiming to deepen our understanding of adolescents' experiences and inform comprehensive strategies for promoting their well-being within school communities.

Trajectories of school refusal: sequence analysis using retrospective parent reports

School refusal (SR) is a form of school attendance problem (SAP) that requires specific mental health care. Despite improvements in the definition of SAPs, the course of SR is not well characterized. To explore three-year patterns of SR course in children, as reported by their parents, we deployed an anonymous web-based survey. We defined SR onset as the absence of ≥ 2 school weeks during one academic year, combined with emotional distress. We defined standard SR trajectories using sequence analysis of parents' recollection of three consecutive years of school attendance. We obtained 1970 responses, 1328 (67%) completed by a parent and meeting the definition of SR. Of these, 729 (55%) responses included three years of school attendance recollection. We identified five prototypical trajectories of SR: two profiles for children: beaded absences (n = 272), and rapid recovery (n = 132); and three for adolescents: prolonged recovery (n = 93), gradual decline (n = 89), and rapid decline (n = 143). We found five distinct trajectories of retrospective recall of SR course. Through pattern recognition, this typology could help with timely identification of SR and implementation of evidence-based interventions to optimize outcomes. Prospective replication of these findings and their field application is warranted.

School refusal: mapping the literature by bibliometric analysis

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.

How to deal with sickness absence among primary school pupils? Adaptation of the "Medical Advice for Sick-reported Students" intervention

Background

Missing school impacts both education and health. The purpose of this study was to address sickness absence in primary schools by adjusting the 'Medical Advice for Sick-reported Students' intervention for secondary schools. This was necessary because of fundamental differences in relation to the children's age and in the schools' organizational structure.

Methods

The intervention mapping approach steps 1 through 4 were used to adapt 'Medical Advice for Sick-reported Students' to primary schools (MASS-PS), including a literature search, stakeholder interviews, establishing a planning group and pre-testing.

Results

In step 1, a planning group was formed and a logic model of the problem was created. In step 2, a logic model of change was created. In step 3, a theoretical basis and practical strategies were determined. In step 4, practical support materials were designed, and two pre-tests of the materials were performed.

Conclusion

Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness absence, consultations between teacher and attendance coordinator, and addition of two experts. With MASS-PS, sickness absence can be addressed as a "red flag" for underlying problems.

Practitioner Review: Signposts for Enhancing Cognitive-Behavioral Therapy for School Refusal in Adolescence

Factors associated with adolescent development influence the occurrence and presentation of school refusal (SR). Cognitive-behavioral therapy (CBT) manuals for the treatment of SR account for these developmental issues to varying degrees. Some multimodal treatments aim to address the complexity of adolescent SR by incorporating interventions alongside CBT, such as medication, inpatient treatment, and educational support in a special setting. However, CBT manuals and multimodal treatments appear to fail to help approximately one-third to two-thirds of adolescents, with respect to achieving regular school attendance. This paper provides an overview of suggestions in the literature for improving treatment for SR, with a focus on adolescent SR. Seven signposts emerge from the literature, namely, increased number or frequency of sessions, greater attention to social anxiety disorder and social functioning, greater attention to depression, greater attention to emotion regulation, careful consideration of the role of parents, greater attention to parent-adolescent communication and problem-solving, and the use of alternative educational settings. Professionals may find these signposts helpful when planning and delivering treatment for SR in adolescents. Research is needed to determine the benefit of including one or more of these adaptations alongside an existing SR treatment.

Trajectories of fathers' childcare involvement and child behavioral outcomes

BACKGROUND

Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long-term association of paternal involvement in childcare at 1-3 years of life on subsequent behavioral outcomes at 8 years of age.

METHODS

Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group-based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child.

RESULTS

Among the 17,027 father-child dyads included in this study, two-thirds of the fathers were of the age group 30-39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32-0.66).

CONCLUSIONS

Children benefit from their fathers' involvement in early childcare activities. To improve a child's well-being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare.

Remote Teaching and School Refusal Behavior - Lessons Learned from the COVID-19 Pandemic

When the Norwegian government closed down schools and kindergartens in response to the increased spread of COVID-19, the use of homeschooling raised concerns about students with school refusal behavior and the school system's ability to address their special needs in these circumstances. Six students referred to the school absenteeism team were interviewed about their circumstances, using an author-developed interview. The results indicate that the students rated homeschooling as very satisfactory. Students with school refusal behavior participated in homeschooling and their attendance continued during the initial reopening of schools.

School Refusal in Youth: A Systematic Review of Ecological Factors

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.

[Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior]

Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior Abstract. Objective: To explore the course of patients with school absenteeism 1.5-3 years after their initial evaluation, including symptoms, school attendance, psychosocial functioning, and help-seeking behavior. Method: Of the 237 patients from specialized psychiatric units for youths displaying school absenteeism, we successfully contacted 108 of them 1.5-3 years after initial admission. We conducted a telephone interview with their parents (SDQ, school situation, help-seeking behavior). Among others, we analyzed the extent of school absenteeism, the scales of the Inventory of School Attendance Problems (ISAP; Knollmann et al., 2019), and the quality of school absenteeism (school refusal vs. truancy vs. mixed group) at admission as possible predictors. Results: The patients had received an extensive amount of youth-welfare measures and inpatient, daycare, and outpatient therapy. 46.3 % had elevated values in the SDQ total score at follow-up, mostly because of emotional problems or problems with peers. Psychosocial functioning, including school attendance, was described as poor for only about 30 %. School attendance problems were significantly predicted by having a conduct disorder and elevated scores on the ISAP-scales Aggression, Teacher Problems, and Peer Problems, though the effect sizes were weak. Conclusions: Externalizing symptoms and associated psychosocial problems seem to be predictive of a negative course of school absenteeism. Implications for prospective longitudinal studies are discussed.

Signposts for School Refusal Interventions, Based on the Views of Stakeholders

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.

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 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.

A Systematic Review of Somatic Symptoms in School Refusal

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.

Child and Parental Mental Health as Correlates of School Non-Attendance and School Refusal in Children on the Autism Spectrum

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.

Is Bullying Associated with Emerging School Refusal in Autistic Boys?

The experience of being bullied is widespread among autistic youth. Relatively little empirical work has been done on the relationship between the bullying of these youth and school refusal (SR). This study of 67 school-age autistic boys (M = 11.7 years, SD = 2.3 years) examined several factors that may contribute to SR. Data regarding boys' age, generalised anxiety disorder (GAD), major depressive disorder (MDD), key ASD diagnostic criteria, and frequency of being bullied were collected. Results indicated that, while boys displaying emerging SR also had significantly higher GAD and MDD than boys without emerging SR, only the frequency of being bullied made a significant contribution to emerging SR. Implications for prevention and treatment of SR among autistic youth are discussed.

School Refusal Behavior and Aggression in Spanish Adolescents

In order to reduce school attendance problems and aggressive behavior, it is essential to determine the relationship between both variables. The aim of this study was twofold: (1) to examine the mean differences in scores on aggression, based on school refusal behavior, and (2) to analyze the predictive capacity of high scores on aggression, based on school refusal behavior factors. The sample consisted of 1455 Spanish secondary school students, aged 13–17 (M = 14.85; SD = 1.56). The School Refusal Assessment Scale-Revised (I. Avoidance of negative affectivity, II. Escape from aversive social and/or evaluative situations, III. Pursuit of attention from significant others, and IV. Pursuit of tangible reinforcement outside of school) and the Aggression Questionnaire (I. Physical Aggression, II. Verbal Aggression, III. Anger, and IV. Hostility) were used. Results indicated that students having high levels of Physical Aggression, Verbal Aggression, Anger, and Hostility received significantly higher scores on school refusal behavior. In most cases, school refusal behavior was found to be a positive and statistically significant predictor of aggression. Students that base their school refusal on the pursuit of tangible reinforcements outside of school earned higher scores, and other functional conditions underlying school refusal behavior were found to be associated with aggression issues. The role of aggression as a risk factor for school refusal behavior is discussed.

A Scoping Review of Constructs Measured Following Intervention for School Refusal: Are We Measuring Up?

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.

The Association Between Symptoms of Depression and School Absence in a Population-Based Study of Late Adolescents

OBJECTIVE

School attendance is an important functional marker in adolescence, and knowledge of the correlates of school absence is important to inform preventive efforts. The main aim of the present study was to investigate the association between symptoms of depression and school absence in late adolescence, adjusting for sociodemographic characteristics and externalizing problems.

METHODS

Data stem from the youth@hordaland-survey, a population-based survey of adolescents between 16 and 19 years old attending upper secondary education in Hordaland County, Norway, in spring 2012. Administrative data on school absence was provided for 8222 adolescents. In addition to days and hours absent the past semester, a variable of total absence was calculated and divided into quartiles of absence. Symptoms of mental health problems and sleep duration was based on adolescent self-reports.

RESULTS

Reports of depressive symptoms were significantly associated with school absence when investigated as continuous variables. The strength of the association attenuated but remained statistically significant when controlling for sociodemographic factors and externalizing problems. When investigating the association at different levels of school absence, adolescents in the second, third and fourth quartile of school absence reported significantly higher depression scores compared to adolescents in the first quartile. The association between reports of symptoms of depression and school absence was partially mediated by sleep duration.

CONCLUSION

The association between reported symptoms of depression and school absence was evident even at low levels of school absence, indicating a role for universal prevention strategies. The findings suggest both depression and sleep problems as possible targets for intervention in late adolescence.

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.

Rapid Return for School Refusal: A School-Based Approach Applied With Japanese Adolescents

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.

Measuring School Absenteeism: Administrative Attendance Data Collected by Schools Differ From Self-Reports in Systematic Ways

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.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2)

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.

Family Environment Variables as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

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.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1)

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.

Secondary school practitioners' beliefs about risk factors for school attendance problems: a qualitative study

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.

School Refusal and Absenteeism: Perception of Teacher Behaviors, Psychological Basic Needs, and Academic Achievement

School refusal (SR) is a complex problem that may be caused by different risk factors such as individual and contextual factors (Kearney, 2007; Maynard et al., 2018; Heyne et al., 2019). These mechanisms can be described in the context of self-determination theory (SDT). For these reasons, the purpose of the present study is investigate the relationship between teacher perceived psychological control and support, psychological basic needs, SR behavior, and academic achievement, on adolescent sample. It is hypothesized that teacher perceived psychological control and autonomy support play a role on need frustration and need satisfaction; in turn, need satisfaction could reduce while need frustration could promote SR behavior and number of absences. Finally, SR behavior and number of absences could reduce academic achievement. 263 students (196 females, 67 males) with an average age of 16.14 (SD = 1.35; range 13-20 years). SEM analyses with observed variables have shown that the final model fit well the data, χ2(8) = 16.34, p = 0.04, CFI = 0.96, SRMR = 0.04, RMSEA (90% CI) = 0.06 (0.01; 0.10), showing the following significant path: need satisfaction was positively predicted by perceived teacher support and negatively predicted by teacher perceived psychological control; need frustration was positively predicted by teacher perceived psychological control; number of absences was negatively predicted by need satisfaction; SR was positively predicted by need frustration; school achievement was negatively predicted by SR and number of absences. These results have several implications for the school context and the deepening of the construct of SR and absenteeism.