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Whelan M, McGillivray J, Rinehart NJ. Using Life Course Theory to Explore the Association Between Autistic Traits, Child, Family, and School Factors and the Successful Transition to Secondary School. J Autism Dev Disord 2024; 54:2333-2346. [PMID: 37022578 PMCID: PMC11143022 DOI: 10.1007/s10803-022-05845-z] [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] [Accepted: 11/21/2022] [Indexed: 04/07/2023]
Abstract
Life Course Theory contends that school transitions can interrupt academic and wellbeing trajectories, depending on child, family, and school factors. Hierarchical regression analyses examined how autistic traits were associated with school transition outcomes. Autistic traits explained 12% of the variance in Quality of Life (QOL), 24% of the variance in mental health and 9% of the variance in school belonging. When autistic traits were accounted for, gender was a significant predictor of changes in QOL whereas changes in school belonging were predicted by cognitive functioning, parent education, school attendance and school refusal. Changes in mental health after transition were mostly predicted by family factors including family structure, family functioning and parent education but were also significantly predicted by sleep problems.
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Affiliation(s)
- Moira Whelan
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia.
| | - Jane McGillivray
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Nicole J Rinehart
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, VIC, Australia
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Gussin HA, Shiu CS, Danguilan C, Mihaila I, Acharya K, Berg KL. Impact of Adverse Childhood Experiences and Mental Health on School Success in Autistic Children: Findings from the 2016-2021 National Survey of Children's Health. J Autism Dev Disord 2024:10.1007/s10803-024-06338-x. [PMID: 38819702 DOI: 10.1007/s10803-024-06338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE School is an important developmental setting for children. Adverse childhood experiences (ACEs) are linked to overall lower educational attainment and are more prevalent in children with Autism Spectrum Disorder (ASD) than in their neurotypical peers. The aim of this study is to test the association between ACEs and school outcomes among autistic children and whether mental health conditions explain this association. METHODS We combined 2016-2021 data from the National Surveys of Children's Health for children, ages 6-17, identified by parents as having ASD (N = 4,997), to examine the relationship between ACEs and school outcomes (grade progression, school attendance, and engagement). We analyzed depression and anxiety variables to investigate the extent to which mental health can explain the relationships between ACEs and school outcomes. RESULTS ACEs were significantly associated with school outcomes. With increased ACEs, autistic children experienced a significant decrease in the odds of school attendance, grade progression and school engagement (p < .05). Furthermore, although depression and anxiety symptoms were significantly associated with school outcomes, they cannot explain away the enduring, strong relationship between ACEs and level of grade progression, engagement, and school success index. CONCLUSION Our findings suggest ACEs predict school success among autistic children, with mental health conditions appearing to mediate the relationship between ACEs and key factors in school success. Efforts should be made to proactively identify and address the impact of ACEs and associated mental health conditions among autistic students.
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Affiliation(s)
- Hélène A Gussin
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Cheng-Shi Shiu
- University of California Los Angeles, Los Angeles, CA, 90095, USA
- National Taiwan University, Taipei, 106, Taiwan
| | - Christianna Danguilan
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois Chicago, 1640 W. Roosevelt Road, Chicago, IL, 60608, USA
| | - Iulia Mihaila
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Kruti Acharya
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, 60612, USA
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois Chicago, 1640 W. Roosevelt Road, Chicago, IL, 60608, USA
| | - Kristin L Berg
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, 60612, USA.
- Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois Chicago, 1640 W. Roosevelt Road, Chicago, IL, 60608, USA.
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Di Vincenzo C, Pontillo M, Bellantoni D, Di Luzio M, Lala MR, Villa M, Demaria F, Vicari S. School refusal behavior in children and adolescents: a five-year narrative review of clinical significance and psychopathological profiles. Ital J Pediatr 2024; 50:107. [PMID: 38816858 PMCID: PMC11141005 DOI: 10.1186/s13052-024-01667-0] [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] [Received: 10/11/2023] [Accepted: 04/28/2024] [Indexed: 06/01/2024] Open
Abstract
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.
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Affiliation(s)
- Cristina Di Vincenzo
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy.
| | - Maria Pontillo
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Domenica Bellantoni
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Michelangelo Di Luzio
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Maria Rosaria Lala
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Marianna Villa
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Francesco Demaria
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
| | - Stefano Vicari
- Child & Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, 00165, Italy
- Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, 00168, Italy
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Ambrose K, Simpson K, Adams D. Using Q-sort method to explore autistic students' views of the impacts of their anxiety at school. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241231607. [PMID: 38390716 DOI: 10.1177/13623613241231607] [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: 02/24/2024]
Abstract
LAY ABSTRACT Many autistic students experience anxiety, but there is little research that explores how anxiety might affect autistic students in the school environment. In this study, 45 autistic students, aged 7 to 17 years, completed an online sorting activity to tell us how anxiety impacts them at school. The students were given 21 statements about possible social and academic effects of anxiety (for example, 'When I'm worried it's hard to start my schoolwork' or 'When I'm worried I talk less to my friends or other students'), and sorted them based on how much they agreed each statement was true for them. The three statements most highly rated as being impacted by anxiety were difficulties related to schoolwork. By comparing the information provided by students, six smaller groups of students were identified who sorted the statements in a similar order. These groups show that anxiety affects different autistic students in different ways, including missing school or activities, communicating less with friends and teachers and finding it harder to complete schoolwork. This online sorting activity enabled autistic students themselves to report how anxiety affects them at school. The results suggest that it is important to provide individualised support for autistic students who experience anxiety at school, to reduce the impact of their anxiety on their participation, communication and interactions, and schoolwork. Further research about the effects of anxiety on the academic outcomes of autistic students is also needed.
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Affiliation(s)
- Kathryn Ambrose
- Griffith University, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Kate Simpson
- Griffith University, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Dawn Adams
- Griffith University, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Australia
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5
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Li B, Heyne D, Scheeren A, Blijd-Hoogewys E, Rieffe C. School participation of autistic youths: The influence of youth, family and school factors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231225490. [PMID: 38311864 DOI: 10.1177/13623613231225490] [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: 02/06/2024]
Abstract
LAY ABSTRACT School-aged youths have a basic human right to participate in educational and recreational activities at school. Yet, autistic youths are at high risk of being excluded from school and from school-based activities. It is important to understand how this occurs, to ensure that all autistic youths have opportunities to participate in school activities that are equal to the opportunities of their non-autistic peers. The present study investigated multiple influences on the school participation of autistic youths, including youth factors (age and autistic traits), family factors (parent education level and parental self-efficacy for supporting their child's schoolwork) and school factors (the impact of problems autistic youths experienced with the physical and social environments of school). Using an online survey, we gathered the views and experiences of the parents of 200 autistic youths aged between 4 and 16 years, in the Netherlands. We found that among the factors, only the impact of problems that autistic youths experienced with the physical environment of school was associated with their school participation. In particular, autistic youths who experienced greater difficulties with the physical environment of school had lower levels of school participation. Our findings highlight the pressing need to modify school environments to better accommodate the needs of autistic youths so that they can participate easily and comfortably.
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Affiliation(s)
- Boya Li
- Leiden University, The Netherlands
- Delft University of Technology, The Netherlands
| | | | | | | | - Carolien Rieffe
- Leiden University, The Netherlands
- University of Twente, The Netherlands
- University College London, UK
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Cleary M, West S, Johnston-Devin C, Kornhaber R, McLean L, Hungerford C. Collateral Damage: The Impacts of School Exclusion on the Mental Health of Parents Caring for Autistic Children. Issues Ment Health Nurs 2024; 45:3-8. [PMID: 38190434 DOI: 10.1080/01612840.2023.2280718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Despite legislative and policy mechanisms that promote inclusion in education for children with disabilities, many students still experience exclusion from the education setting. For example, autistic children are more likely than their neurotypical counterparts to be expelled or suspended from school or to refuse to attend school on an ongoing basis. This situation gives rise to various challenges for their parents. This discursive paper synthesizes current knowledge on school exclusion involving autistic children, including the causes and consequences of exclusionary practices. The paper also considers the negative impacts of these exclusionary practices on the emotional and psychological well-being of parents and caregivers. Mental health nurses who understand the issues related to school exclusion can better support the educational, social, and developmental needs of autistic children and the mental health needs of parents or caregivers.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, NSW, Australia
| | | | - Rachel Kornhaber
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, NSW, Australia
- Western Clinical School, The University of Sydney, Sydney, NSW, Australia
- Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, NSW, Australia
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Nordin V, Palmgren M, Lindbladh A, Bölte S, Jonsson U. School absenteeism in autistic children and adolescents: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613231217409. [PMID: 38159071 DOI: 10.1177/13623613231217409] [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: 01/03/2024]
Abstract
LAY ABSTRACT Autistic children and teenagers are, on average, absent from school more than their peers. The aim of this review was to provide an overview of the research on absence from school in autistic learners in primary and secondary school, to help guide future research. We sifted through 4632 reports and found 42 studies with a focus on school absence and autism. We looked at how, when, and where the studies were conducted. We also summarized the results and outlined how absence was measured in the studies. Absence from school may lead to problems later in life, like incomplete education and unemployment. It is therefore important to know how common this problem is among autistic learners, what the reasons may be, and what type of support they need. The studies were from high-income countries and were mainly published in the last 10 years. Studies based on school registers from the United States and the United Kingdom clearly showed that children and teenagers with autism had higher risk of school absence than those without autism. Absence was often linked to problems with mental health or additional neurodevelopmental conditions. Several studies also showed that absence in autistic children and adolescents was related to problems in school, like bullying or lack of knowledge about autism. Support programs were only evaluated in a few studies with a small number of study participants. We conclude that more research is needed to better understand why autistic learners are absent and what they need to thrive in school.
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Affiliation(s)
- Viviann Nordin
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maud Palmgren
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Lindbladh
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Ulf Jonsson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
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8
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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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Totsika V, Kouroupa A, Timmerman A, Allard A, Gray KM, Hastings RP, Heyne D, Melvin GA, Tonge B. School Attendance Problems Among Children with Neurodevelopmental Conditions One year Following the Start of the COVID-19 Pandemic. J Autism Dev Disord 2023:10.1007/s10803-023-06025-3. [PMID: 37480438 DOI: 10.1007/s10803-023-06025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The present study investigated school absence among 1,076 5-15 year-old children with neurodevelopmental conditions (intellectual disability and/or autism) approximately one year following the start of COVID-19 in the UK. METHODS Parents completed an online survey indicating whether their child was absent from school during May 2021 and the reason for each absence. Multi-variable regression models investigated child, family and school variables associated with absenteeism and types of absenteeism. Qualitative data were collected on barriers and facilitators of school attendance. RESULTS During May 2021, 32% of children presented with persistent absence (missing ≥ 10% of school). School refusal and absence due to ill-health were the most frequent types of absence, accounting for 37% and 22% of days missed, respectively. COVID-19 related absence accounted for just 11% of days missed. Child anxiety was associated with overall absenteeism and with days missed because of school refusal. Parent pandemic anxiety and child conduct problems were not associated with school absenteeism. Hyperactivity was associated with lower levels of absenteeism and school refusal but higher levels of school exclusion. A positive parent-teacher relationship was associated with lower levels of absenteeism, school refusal and exclusion. Child unmet need in school was the most frequently reported barrier to attendance while COVID-19 was one of the least frequently reported barriers. CONCLUSION COVID-19 had a limited impact on school attendance problems during this period. Findings highlighted the role of child mental health in different types of absence and the likely protective role of a positive parent-teacher relationship.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK.
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.
- Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Athanasia Kouroupa
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK
| | - Amanda Timmerman
- Division of Psychiatry, University College London, 149 Tottenham Court Road, Maple House 6th Floor, London, W1T 7NF, UK
| | - Amanda Allard
- Council for Disabled Children, National Children's Bureau, London, UK
| | - Kylie M Gray
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Australia
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
| | - David Heyne
- Developmental and Educational Psychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Glenn A Melvin
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
| | - Bruce Tonge
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Melbourne, Australia
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10
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Melvin GA, Freeman M, Ashford LJ, Hastings RP, Heyne D, Tonge BJ, Bailey T, Totsika V, Gray KM. Types and correlates of school absenteeism among students with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:375-386. [PMID: 36744441 DOI: 10.1111/jir.13011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/24/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND It appears that students with intellectual disability (ID) are more frequently absent from school compared with students without ID. The objective of the current study was to estimate the frequency of absence among students with ID and the reasons for absence. Potential reasons included the attendance problems referred to as school refusal, where absence is related to emotional distress; truancy, where absence is concealed from parents; school exclusion, where absence is instigated by the school; and school withdrawal, where absence is initiated by parents. METHODS Study participants were 629 parents (84.6% mothers) of Australian school students (Mage = 11.18 years; 1.8% Aboriginal and/or Torres Strait Islander) with an ID. Participants completed a questionnaire battery that included the School Non-Attendance ChecKlist via which parents indicated the reason their child was absent for each day or half-day absence their child had over the past 20 school days. The absence data presented to parents had been retrieved from school records. RESULTS Across all students, absence occurred on 7.9% of the past 20 school days. In terms of school attendance problems as defined in existing literature, school withdrawal accounted for 11.1% of absences and school refusal for 5.3% of absences. Students were also absent for other reasons, most commonly illness (32.0%) and appointments (24.2%). Of students with more than one absence (n = 217; 34.5%), about half were absent for more than one reason. Students attending mainstream schools had lower attendance than those attending special schools. CONCLUSIONS Students with ID were absent for a range of reasons and often for multiple reasons. There were elevated rates of school withdrawal and school refusal. Understanding the reasons for absenteeism can inform targeted prevention and intervention supports.
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Affiliation(s)
- G A Melvin
- School of Psychology, Deakin University, Burwood, Australia
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - M Freeman
- Centre for Developmental Psychiatry & Psychology, Monash University, Clayton, Australia
| | - L J Ashford
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Australia
| | - R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry & Psychology, Monash University, Clayton, Australia
| | - D Heyne
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - B J Tonge
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry & Psychology, Monash University, Clayton, Australia
| | - T Bailey
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - V Totsika
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry & Psychology, Monash University, Clayton, Australia
- Division of Psychiatry, University College London, London, UK
| | - K M Gray
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry & Psychology, Monash University, Clayton, Australia
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11
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Kouroupa A, Allard A, Gray K, Hastings RP, Heyne D, Melvin GA, Tonge B, Totsika V. The association between home learning during COVID-19 lockdowns and subsequent school attendance among children with neurodevelopmental conditions. Child Care Health Dev 2023. [PMID: 36898964 DOI: 10.1111/cch.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Children with neurodevelopmental conditions have high levels of school absence. During the COVID-19 pandemic, schools closed for many students. The relationship between home learning during school closures and subsequent school attendance requires attention to better understand the impact of pandemic education policy decisions on this population. This study aims to investigate the association between home learning, hybrid learning and school learning during school closures (in January-March 2021) with subsequent school attendance (in May 2021) in children with neurodevelopmental conditions. METHODS An online survey was completed by 809 parents/carers of 5- to 15-year-old autistic children and/or children with intellectual disability. Regression models examined the association of learning location during school closures with subsequent school absence (i.e., total days missed, persistent absence and school refusal). RESULTS Children who were learning from home during school closures later missed 4.6 days of a possible 19. Children in hybrid and school learning missed 2.4 and 1.6 school days, respectively. The rates of school absence and persistent absence were significantly higher in the home learning group even after adjusting for confounders. Learning location was not associated with subsequent school refusal. CONCLUSIONS Policies for school closures and learning from home during public health emergencies may exacerbate school attendance problems in this group of vulnerable children.
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Affiliation(s)
| | - Amanda Allard
- Council for Disabled Children, National Children's Bureau, London, UK
| | - Kylie Gray
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - David Heyne
- Developmental and Educational Psychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Glenn A Melvin
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Bruce Tonge
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK.,Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK.,Tavistock and Portman NHS Foundation Trust, London, UK
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12
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Gray L, Hill V, Pellicano E. "He's shouting so loud but nobody's hearing him": A multi-informant study of autistic pupils' experiences of school non-attendance and exclusion. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2023; 8:23969415231207816. [PMID: 37860824 PMCID: PMC10583514 DOI: 10.1177/23969415231207816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background and aims Children and young people on the autism spectrum frequently report a range of negative educational experiences and face disproportionally high rates of school non-attendance, including school avoidance and permanent exclusion, which can have a significant impact on their well-being as well as educational and broader life outcomes. To date, few studies have examined the full range of proximal (child, parent/family, school levels) and distal (community and society levels) barriers to ensuring the school attendance and the inclusion of autistic pupils. The current study sought to do just that by examining autistic young peoples' school non-attendance and exclusion experiences from the perspectives of multiple informants. Methods We recruited 12 autistic pupils, who had previously experienced school avoidance and/or exclusion, from one local authority in England, United Kingdom. We conducted semi-structured interviews with the young people themselves, ten of their parents, eight of their current teachers and nine local authority professionals, including six educational psychologists and three specialist autism teachers. We analyzed interviewees' responses using reflexive thematic analysis. Results Interviewees gave overwhelmingly negative accounts of autistic pupils' school non-attendance and exclusion experiences. Our analysis identified a range of school-related factors they felt led to, or exacerbated, negative experiences in their former mainstream schools, and which ultimately led to their or their children's school non-attendance. It also went further to identify distal factors, including fragmented educational experiences, parents "fighting" against a complex bureaucratic system to secure appropriate education for their children, and limited professional involvement. Conclusions Our findings emphasize the importance of examining the broader context in which autistic pupils are embedded and demonstrate that such pupils are able to successfully attend-and even enjoy-school when they receive the appropriate care and support. Implications Schools and local authority professionals should seek to work in partnership with parents and autistic pupils to secure the necessary support for their inclusion in mainstream education. Government policy should support the provision of sufficient local authority professionals to adopt a more proactive approach to mitigate autistic pupils' avoidance of and exclusion from school.
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Affiliation(s)
- Laura Gray
- Educational Psychology Service, Barnet, UK;
UCL Institute of Education, University College London, London, UK
| | - Vivian Hill
- UCL Institute of Education, University College London, London, UK
| | - Elizabeth Pellicano
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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13
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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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14
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Impact of an Interoception-Based Program on Emotion Regulation in Autistic Children. Occup Ther Int 2022; 2022:9328967. [PMID: 35539883 PMCID: PMC9045986 DOI: 10.1155/2022/9328967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to determine the feasibility and effectiveness of a 25-week school-based intervention and its ability to improve interoception and emotion regulation in an autistic pediatric population. Method One-group pre- and posttest design implementing The Interoception Curriculum: A Guide to Developing Mindful Self-Regulation in a self-contained school. Participants were 14 (11 male, 3 female) students between 9 and 19 years old. The Behavior Rating Inventory of Executive Function 2 (BRIEF-2) and the Caregiver Questionnaire for Interoceptive Awareness-2nd Edition (CQIA-2) were used to determine changes in interoceptive awareness and emotion regulation. Results Statistically significant improvements were found between the preintervention and postintervention scores for both interoceptive awareness and emotion regulation. Conclusion This was the first study to examine the Interoception Curriculum in its entirety, providing evidence that the use of the Interoception Curriculum is feasible in a school setting and suggests that this intervention is effective for improvement of interoception. Findings also suggest that this improvement in interoception is related to improvement in emotional regulation for an autistic pediatric population.
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15
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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] [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
- grid.425979.40000 0001 2326 2191Child and Adolescent Psychiatry Research Center (CAP), Stockholm County Council, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- grid.4714.60000 0004 1937 0626Centre 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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16
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Deep learning-based school attendance prediction for autistic students. Sci Rep 2022; 12:1431. [PMID: 35082310 PMCID: PMC8791997 DOI: 10.1038/s41598-022-05258-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
Autism Spectrum Disorder is a neurodevelopmental disorder characterized by deficits in social communication and interaction as well as the presence of repetitive, restricted patterns of behavior, interests, or activities. Many autistic students experience difficulty with daily functioning at school and home. Given these difficulties,
regular school attendance is a primary source for autistic students to receive an appropriate range of needed educational and therapeutic interventions. Moreover, school absenteeism (SA) is associated with negative consequences such as school drop-out. Therefore, early SA prediction would help school districts to intervene properly to ameliorate this issue. Due to its heterogeneity, autistic students show within-group differences concerning their SA. A comprehensive statistical analysis performed by the authors shows that the individual and demographic characteristics of the targeted population are not predictive factors of SA. So, we used the students’ recent previous attendance to predict their future attendance. We introduce a deep learning-based framework for predicting short-and long-term SA of autistic students using the Long Short-Term Memory (LSTM) and Multilayer Perceptron (MLP) algorithms. The adopted algorithms outperform other machine learning algorithms. In detail, LSTM increased the accuracy and recall of short-term SA prediction by 20% and 13%, while the same scores of long-term SA prediction increased by 5% using MLP.
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17
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Bitsika V, Heyne DA, Sharpley CF. The inverse association between psychological resilience and emerging school refusal among bullied autistic youth. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104121. [PMID: 34768056 DOI: 10.1016/j.ridd.2021.104121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Vicki Bitsika
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia
| | - David A Heyne
- Leiden University Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia.
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18
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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 2021; 52:3353-3365. [PMID: 34331173 PMCID: PMC8323746 DOI: 10.1007/s10803-021-05211-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [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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19
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Adams D, McLucas R, Mitchelson H, Simpson K, Dargue N. Form, Function and Feedback on the School Refusal Assessment Scale-Revised in Children on the Autism Spectrum. J Autism Dev Disord 2021; 52:2156-2167. [PMID: 34081301 DOI: 10.1007/s10803-021-05107-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 01/28/2023]
Abstract
School refusal is more prevalent in children on the autism spectrum than among their peers. The function of school refusal can be explored using the school refusal assessment scale-revised (SRAS-R) but its relevance to children on the spectrum has not been investigated. Parents of 121 children (M age 11.9 years) on the autism spectrum completed the SRAS-R and provided feedback on it applicability. Confirmatory factor analysis suggests unsuitability of the original four-factor structure proposed for neurotypical students. Only 41.7% of parents considered the questionnaire an adequate method for reporting on school refusal in children on the autism spectrum with the majority (90%) identifying additional questions to evaluate factors associated with school refusal in autism.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, School of Education and Professional Studies and Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mount Gravatt, Brisbane, QLD, 4122, Australia.
| | - Raechel McLucas
- Autism Centre of Excellence, School of Education and Professional Studies and Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Hayley Mitchelson
- Autism Centre of Excellence, School of Education and Professional Studies and Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Kate Simpson
- Autism Centre of Excellence, School of Education and Professional Studies and Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Nicole Dargue
- Autism Centre of Excellence, School of Education and Professional Studies and Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mount Gravatt, Brisbane, QLD, 4122, Australia
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