•Three school refusal behavior profiles were identified.•Multiple reinforcement group reported higher scores in depression, anxiety and stress.•Non-school refusers group was the most adaptative ...profile.
Negative emotional states are common among youth with problematic school absenteeism, but little is known about their presence across different school refusal behavior profiles. The aim of this study was twofold: to identify different cluster solutions across functional profiles of school refusal behavior (I. Avoidance of Negative Affectivity, II. Escape from Social and/or Evaluative Situations, III. Pursuit of Attention, and IV. Pursuit of Tangible Reinforcement) and to determine whether these profiles differ from each other based on dimensions of depression, anxiety, and stress. The sample consisted of 1582 Ecuadorian adolescents aged 12–18 years (M = 14.83; SD = 1.86) who completed the School Refusal Assessment Scale-Revised (SRAS-R) and the Depression, Anxiety and Stress Scale-21 (DASS-21). Latent class analysis revealed three school refusal profiles: non-school refusal behavior, school refusal behavior by tangible reinforcements, and school refusal behavior by multiple reinforcements. The last group displayed the most maladaptive profile and revealed highest mean scores on the three dimensions of the DASS-21 compared to other groups. To promote mental health in this group it is a necessary goal due to their link with these negative emotional states. Prevention measures to strengthen emotional self-regulation should be considered in these cases.
School absenteeism is a major societal problem, with a range of potential adverse long-term consequences. This scoping review aimed to provide a comprehensive overview of the research on school ...absenteeism in autistic children and adolescents, expose important gaps in the literature, and explore possibilities for future systematic reviews. Five relevant databases were searched systematically from inception to June 2023, yielding a total of 46 eligible reports from 42 separate studies. All studies were conducted in high-income countries, and most were published in the last decade. Three major themes emerged: occurrence, contextual factors, and interventions. The results of large-scale population-based studies clearly suggested that autistic children and adolescents were absent from school more often than their non-autistic peers, which partly was attributable to co-occurring conditions. Bullying also emerged as a potential risk factor. Only a few preliminary studies were available on targeted interventions, emphasizing the need for more robust studies. More research is also needed on the mechanisms leading to and maintaining school absenteeism in this group of learners. Overall, the diversity of research questions, methods, and definitions used in this body of research suggests that systematic reviews with narrow focus on a few key questions may still be premature.
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.
The literature on school attendance problems (SAPs) is diverse and sometimes confusing, but it is also promising. This special series presents seven articles and a discussion that attest to the ...diversity, complexity, and exciting developments associated with SAPs. While some articles focus on school refusal in particular, others have relevance for school refusal, truancy, and other types of SAPs. Collectively, the seven articles provide direction in thinking about two key questions: (1) How can SAPs best be classified and identified?; and (2) Which innovative approaches can be applied when a SAP is severe, chronic, and/or complex? In this way the series has direct relevance for Tiers 1 and 3 of the Response to Intervention model for managing school absenteeism (Kearney & Graczyk, 2014). Three innovative treatment programs presented in this series illustrate ways in which mental health interventions and educational interventions can be combined to address Tier 3 SAPs. The discussion article presents thought-provoking reflections on the topics covered in the seven articles and on the gaps in practice and research in the field of SAPs. You are invited to critically and creatively respond to the ideas offered in this series.
•Presents key issues for those working with school attendance problems.•Introduces seven articles spanning the topics of classification, identification, and intervention.•Describes and compares three programs that incorporate interventions from mental health and education.•Summarizes key points made in the discussants’ article.
This study uses a novel measure to describe school refusal (SR) behavior among 91 adolescents ages 13 to 18 years old in the month leading up to a partial hospitalization program (PHP) admission. ...Youth exhibit a range of SR behaviors. Three fourths (77%) reported missing at least two full days of school and nearly one third (29%) reported being absent from school the entire month before PHP admission. Among youth who reported attending school, 36% reported leaving school early, 55% reported leaving the classroom, and 59% reported arriving late to school at least “a little” or 2 days in the month prior to PHP admission. Youth rarely shared that they spend time with friends or doing homework while absent from school. In addition, agreement between caregivers and youth on the extent to which youth are struggling with school attendance and how youth spend their time while out of school was low to moderate (r = .14–.52). Results suggest that the School Interference Questionnaire (SIQ) can complement existing SR instruments to offer descriptive information about the frequency and type of SR behavior, perceived impact, and targets of intervention by identifying potential positive and negative reinforcers.
Le refus scolaire anxieux est un sujet d’étude international et constitue une préoccupation majeure dans les domaines de l’éducation et de la santé. Ce phénomène est une réalité clinique ancienne, ...complexe et multiforme qui reste, malgré tout, mal connue et mal-diagnostiquée. Cette confusion retarde le repérage et donc la prise en charge des personnes concernées. Cet article présente les dernières avancées et consensus scientifiques en matière de repérage du refus scolaire anxieux. Il s’intéresse particulièrement à la School REfusal EvaluatioN (SCREEN), une échelle de mesure et de repérage du refus scolaire anxieux. Deux illustrations de l’utilisation de la SCREEN sur le terrain (en milieu scolaire et en population clinique) sont présentées. Enfin, sont évoqués la place et le rôle de l’International Network for School Attendance (INSA), dans ce travail nécessaire d’amélioration du repérage et de la prise en charge du refus scolaire anxieux sur le plan international.
School refusal is an international topic of study and a major concern worldwide in the fields of education and health. This is a complex and multifaceted clinical reality that is misdiagnosed and not yet widely known phenomenon. This confusion delays the identification and, therefore, the clinical care of youth displaying school refusal. This article presents the latest scientific advances and consensus concerning the criteria, screening and assessment of school refusal. It focuses on the SChool REfusal EvaluatioN (SCREEN), a scale for assessing and diagnosing school refusal. Two examples of the use of SCREEN in the field (school and clinical settings) are presented. Finally, we discuss the place and role of the International Network for School Attendance (INSA) in this vital work towards improving the screening and management of school refusal at an international level.
There has been little attention to personality in research on school refusal (SR). This study examined personality traits among 41 adolescents receiving cognitive–behavioral therapy (CBT) during ...participation in a School Refusal Program. Traits were examined via clinical scales and 2-point code types derived from the Minnesota Multiphasic Personality Inventory—Adolescent. The influence of personality traits on treatment outcome was examined at post-treatment and 1-year follow-up. At pretreatment, eight of the 10 clinical scales were disproportionately skewed toward the “high to very high” range relative to a norm group. Social introversion and depressive symptomatology were significantly increased relative to the norm group, and nearly one-half of the adolescents were characterized by code type 2-3/3-2 (depression/hysteria) or 2-0/0-2 (depression/social introversion). Adolescents characterized by a 2-0/0-2 code type were almost twice as likely (odds ratio = 1.78) to be treatment responders at post-treatment. There was no relation between personality traits and treatment outcome at follow-up. The small sample size limits generalization of the study’s findings. If the results are replicated, personality traits may provide useful indications for personalizing treatment when employing interventions recommended in CBT manuals for SR.
Little has been studied on the relationship between affect and school problems related with attendance. This study aims to identify different affective profiles and to determine whether these ...profiles differ from each other based on the four functional conditions of school refusal behavior. Participants comprised 1,816 Spanish adolescents aged 15-18 years (
= 16.39;
= 1.05). The Positive and Negative Affect Schedule for Children-Short Form and the School Refusal Assessment Scale-Revised for Children (SRAS-R-C) were administered. Latent profile analysis revealed five affective profiles: low affective profile, self-fulfilling profile, low positive affect profile, self-destructive profile, and high affective profile. The self-destructive profile revealed the highest average scores in the first three factors of the SRAS-R-C, whereas the high affective profile reached the highest average score in the fourth factor. On the contrary, the self-fulfilling profile obtained the lowest average scores in the first two factors of the SRAS-R-C, whereas the low affective profile revealed the lowest average scores in the last two factors. Findings suggest the relevance of developing more adaptative affective profiles, such as the self-fulfilling profile, which would contribute to diminishing school attendance problems.
Cyberbullying is a common relational problem having negative repercussions on the academic performance of adolescents. Numerous questions remain to be answered with regard to the relationship between ...cyberbullying and school refusal behavior. This study examines school refusal profiles (measured by School Refusal Assessment Scale-Revised) and assesses whether these profiles vary with respect to the level of victimization, aggression, aggression-victimization, and observation of cyberbullying (measured with the Screening of Harassment among Peers). The sample consisted of 1,102 Spanish high school students, aged 12-18 (
= 14.30, SD = 1.71). Latent class analysis revealed three school refusal behavior profiles: non-school refusal behavior, school refusal behavior by negative reinforcements (oriented to the avoidance of social evaluation and negative affectivity in school situations), and school refusal behavior by positive reinforcements (oriented to obtaining the attention of others with significant or tangible reinforcements). The ANOVA found statistically significant differences for all cyberbullying behaviors. Students with school refusal by negative reinforcements had significantly higher mean scores as compared to the other profiles in victimization, aggression, aggression-victimization, and observation behaviors, while the levels of cyberbullying were similar between students without school refusal and students with school refusal behavior by positive reinforcements. These findings underscore the need to consider priority interventions to prevent cyberbullying in children who refuse school for the purpose of avoiding situations of anxiety and negative emotions.
There is a growing interest in quantifying the risk of presenting maladaptive behaviors through the use of multivariate prediction algorithms such as logistic regressions. The objective of this study ...was to analyze the predictive capacity of school refusal behavior on high levels of social anxiety. The study used a sample of 895 Chilean adolescents (54.3% girls) aged between 14 and 17 years. The School Refusal Assessment Scale-Revised (SRAS-R) and the Social Anxiety Scale for Adolescents (SAS-A) were administered. The results revealed that adolescents with school refusal presented significantly higher scores in social anxiety than their peers with low scores in school refusal. This is due to feelings of social aversion, negative affectivity, fear of evaluation, or the use of this behavior to pursue the attention of significant others. This type of school refusal was found to be a positive and statistically significant predictor of high scores for social anxiety. On the contrary, when school refusal is based on obtaining tangible reinforcement outside the school, this factor acts as a negative and statistically significant predictor of high scores for social anxiety. These findings are discussed with reference to the differences found according to the type of school refusal behavior and its impact on the appearance of high levels of social anxiety.
The term ‘school refusal,’ which first originated from Great Britain, is used to describe problems in children not going to school because of emotional difficulties. School refusal is a symptom and ...may be accompanied by several psychiatric disorders (such as anxiety disorder, disruptive behavior disorder and mood disorder). School refusal is common in the children of parents with psychological disorders. This supports the idea of genetic and environmental factors being involved in the development of school refusal. A separate therapeutic protocol must be established for each case through the detailed assessment of child-related, family-related and social environment and school-related factors. School refusal is more common in children 5, 6, 10 and 11 years of age. The aim of treatment must be to ensure a return to school as early as possible. Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, it can be associated with several psychiatric disorders. Therefore it is necessary that youths who are school refusing receive an evaluation by a mental health professional. We discuss a case of school refusal in the older of two siblings with an age difference of 1 year who started school in the same class but who were subsequently assigned to different classes. The purpose of this report is to emphasize the importance of siblings of a similar age starting school in difference classes, similarly to twins, and to raise awareness of this.
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