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(p. 1) Introduction to School Attendance Problems in Youth 

(p. 1) Introduction to School Attendance Problems in Youth
Chapter:
(p. 1) Introduction to School Attendance Problems in Youth
Author(s):

Christopher A. Kearney

DOI:
10.1093/med-psych/9780190912574.003.0001
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date: 20 January 2020

School attendance problems are among the most vexing presenting issues for mental health and school-based professionals. These cases tend to be multifaceted and multilayered in nature, with problems that span academic, behavioral, familial, social, and other functional domains. As such, they can be a bit daunting at first glance, and many professionals decline these cases. In addition, mental health professionals sometimes see attendance problems as solely within the realm of school-based professionals, and school-based professionals sometimes see attendance problems as solely within the realm of mental health professionals. The most promising approach to resolve attendance problems, however, involves active collaboration between mental health and school-based professionals. And, resolution can be attained!

The overall purpose of this book is to provide a highly practical guide to efficiently address cases of youth with school attendance problems at different levels of severity and complexity. The central feature of this book will be an emphasis on a “nuts and bolts” approach that focuses on specific and succinct recommendations and guidelines for assessment and intervention across a short time period, approximately four weeks for emerging and acute cases. Many mental health and school-based professionals cannot logistically implement detailed manualized treatment protocols or large-scale programs for clients and schools. Instead, this book is meant to be a real-world guide to address school attendance problems at a relatively fast pace and within the constraints of most practitioner and school settings, while relying on empirically supported techniques.

Throughout this book, you will sometimes see specific references to either mental health professionals or school-based professionals. The material in this book is generally designed to be useful for either set of professionals, but some material may at times be a bit more relevant to mental health professionals or to school-based professionals. From whatever perspective you have, I recommend that you absorb all of the contents of the book to fully understand the nuances of this population and to better appreciate the perspective of others who are working to resolve a child’s school attendance problems. In addition, as mentioned, school (p. 2) attendance problems are typically best resolved when collaboration exists between mental health and school-based professionals.

School-based professionals who will benefit most from this book include those who address attendance problems on a regular basis. This primarily includes guidance counselors, school-based social workers, school psychologists, school nurses, school attendance officers, truancy officers, and members of a school attendance team. However, other school-based professionals such as principals, vice principals, deans, and other at-school administrators may benefit as well. The book may apply less to teachers and other school-based professionals such as speech pathologists who may be less involved in the attendance process. Still, many teachers serve on attendance teams and are consulted in most cases of school attendance problems.

This book consists of seven chapters that will guide you through assessment, consultation, and intervention processes. These processes are often blended given the time constraints you likely experience. Opening material focuses on an overview of school attendance problems (Chapter 1) and on a rapid assessment, consultation, and initial intervention process (Chapter 2). The heart of the book is centered on recommendations to guide you through an efficient, more in-depth intervention process to resolve a child’s school attendance problems (Chapters 3 through 6). These chapters are centered around core intervention components as well as other procedures to enhance the effectiveness of these components. Later material (Chapter 7) focuses on chronic and severe school attendance problems and other challenging scenarios common to this population.

Overview of School Attendance Problems

Many youth and their families present to therapists and school officials with school attendance problems as the primary issue, though many also present a complicated set of issues that includes school attendance problems as one key facet. In either case, parents often want to focus on school attendance first because problems in this area are so disruptive to a family’s daily life. School officials also focus intently on attendance issues because attendance is the foundation for a student’s academic performance and progress. In addition, school attendance problems, even in mild forms, are a significant risk factor for social, behavioral, and academic problems in middle childhood and adolescence as well as for psychiatric, economic, and occupational difficulties in adulthood. As such, addressing school attendance problems is typically an urgent, central, and critical aspect of intervention for many youths.

School attendance problems are faced by many types of mental health professionals such as clinical professional counselors, marriage and family therapists, psychologists, psychiatrists, and social workers, among others. School attendance problems are also a key focus of many school officials, many of whom are on the “front lines” of these problems and who often serve as a family’s lone source of information and counseling on these issues. School-based professionals most pertinent to attendance issues include administrators such as principals or (p. 3) deans, attendance officers or attendance team members, guidance counselors, social workers, school psychologists, and truancy officers, in addition to regular and specialized teachers in some cases. In our work, the primary point person at school is most often the guidance counselor.

Other sets of professionals can be pertinent to school attendance problems as well, such as caseworkers, pediatricians, and probation officers. These professionals tend to be more relevant to chronic and severe cases of school attendance problems (Chapter 7). As you might guess, school attendance problems have been studied historically by professionals in many disciplines that include criminal justice, education, medicine, nursing, psychology, social work, and sociology, among others. As such, a great deal of helpful but disparate information is available about how to best address school attendance problems. This book draws on multiple perspectives to be relevant to as many of these cases as possible.

Definition of School Attendance Problems

Many therapists and even school officials tend to think of school attendance as a categorical yes/no construct; either a child is in school or is out of school. The picture for a given child with school attendance problems is often much murkier than that, however, because these problems come in many forms that can be organized along a spectrum (Figure 1.1). I strongly recommend viewing school attendance problems along a dimensional or spectrum approach because this approach accounts for various forms of absenteeism, attempted absenteeism, and problems leading (precursors) to attempted absenteeism. All of these forms of school attendance problems are problematic, disruptive, and costly for children and their parents. In addition, all of these school attendance problems tend to blend together in an individual case.

Figure 1.1. Spectrum of School Attendance Problems

Figure 1.1. Spectrum of School Attendance Problems

Adapted from Kearney, C. A. (2001). School refusal behavior in youth: A functional approach to assessment and treatment. Washington, DC: American Psychological Association.

The following sections are designed to provide some clarity about the particular school attendance problems you may see in a given case. This presentation foreshadows a common theme in this book, that school attendance problems are often fluid and change form over time, even during a particular week. As you peruse the following types of school attendance problems, think about how all of these types might pertain to your case. In addition, for mental health professionals, try to become familiar with the terminology used by the school or district you will be working with to resolve a child’s attendance problems. For school-based professionals, focus not just on a child’s total absences but his or her other forms of school attendance problems as well, including ones you may not directly see, such as morning misbehaviors in an attempt to miss school.

Complete Absence from School

The most obvious form of school attendance problem on this spectrum is complete absence from school, or total nonattendance for one day or several days or for (p. 4) (p. 5) weeks or months at a time. A complete absence from school is often classified by school districts as excused or unexcused in nature:

  • Excused absences are often considered justified and can include legitimate reasons such as illness, poor weather, or a family emergency, among other possibilities. An excused absence often requires some type of medical confirmation or parent note to be classified or reclassified as “excused.” For many districts, excused absences do not count toward some defined benchmark for problematic absenteeism or truancy (see later section).

  • Unexcused absences are often considered not justified and can result in administrative, legal, or other consequences. In essence, the child should be in school, but is not. Most school districts (or states) have a set number of allowed unexcused absences, such as 10 unexcused absences in one semester, before certain consequences are triggered. All professionals working with a child with school attendance problems should be aware of specific policies in this regard.

From an assessment/intervention standpoint, a distinction between excused and unexcused absences is not particularly useful. A child with extensive absences, whether excused or unexcused, remains at risk for grade decline, gaps in learning, social disconnection, and psychiatric and other problems. In addition, unexcused absences can often be easily reclassified as excused absences via medical notes, parent calls, administrative procedures, or other means. This can lead to a delay in, or a failure to qualify for, needed assessment and intervention services. Finally, extended absence from school in whatever form, excused or unexcused, impedes the process of reintegrating a child into a regular classroom setting on a full-time basis. The longer a student is out of school, the more difficult the return process will be, regardless of what type of absence was marked in the records.

A special case of complete absence from school involves suspension. Suspension from school means the child is not allowed to attend classes for a set period of time, often following some infraction. Ironically, this infraction could be school absenteeism itself. Suspension could be out-of-school, meaning the child is not allowed on the school campus, or in-school, meaning the child is physically in the school building but not allowed to attend class. School districts differ in whether they count suspended time in either form as an absence, so check with local policy. Suspensions often end once parents meet with school officials or some other requirement has been met. Ideally, academic work should still be completed during the suspension period.

Another special case of complete absence from school involves expulsion. Expulsion from school means the child has been permanently, administratively separated from school and cannot return. Expulsion is typically reserved for very severe infractions, though it can be applied to very long periods of school absenteeism as well. In cases of expulsion, exploring alternative pathways to graduation (Chapter 7) will be necessary. Some school districts offer these alternative (p. 6) pathways, even for expelled students, but in other cases a more flexible and innovative approach is needed.

Partial Absence from School

School attendance problems can also involve partial absences from school. Partial absences can come in the form of skipped classes, missing sections of the school day, and tardiness. Skipped classes, for middle and high school students, can involve missing one or more classes during the day. This is common among students with anxiety about a particular task, such as a public speaking or performance requirement, or a certain class such as physical education or math. Skipped classes could occur in elementary students as well if they refuse to attend a specialized class such as music or art, for example. Missing sections of the school day can involve skipping several classes at once, which is most common after lunch or toward the end of the school day. Tardiness involves arriving late to school, after the start of class time. Tardiness can be brief or can involve most of the morning, or students can be late to class.

Precursors to School Attendance Problems

School attendance problems can also involve difficulties getting to or staying in school, despite actual physical attendance at school. A common form of this involves morning misbehaviors before school, in which a child displays various behavior problems such as temper tantrums or refusal to move in an attempt to miss school or to force parents to allow the child to stay home. These behaviors can also involve difficulties separating from a parent in the morning on the school campus prior to the start of the school day. All of these behaviors are taxing for family members and can lead to eventual school absence. In addition, many children go to school but are extremely distressed while in school, sometimes to the point of crying for most of the day, being unable to concentrate, or displaying misbehaviors purposefully to be removed from the classroom and school building. Precursors to school attendance problems can come in various forms, and some of the most common subtle, early warning signs include those in Box 1.1.

Variable Patterns of School Attendance Problems

As we will mention in Chapter 2, you should identify all different forms of school attendance problems that may apply to a particular case. This is because children with school attendance problems often display variable patterns of absenteeism. For example, a child could miss all of school on Monday, be late to school on Tuesday, attend school on Wednesday, leave school after lunch on Thursday, and skip a particular class on Friday. Many youth display a particular pattern of school (p. 7) attendance difficulty that is unique to them, however, so identifying this pattern can help you target your intervention resources. For example, if you discover that a child always seems to leave the campus after Friday lunch, then intervention to short-circuit this process can be targeted toward that most salient time. In addition, different patterns of absenteeism are sometimes associated with different functions (see later section).

These variable patterns of school attendance problems can occur for different time periods as well. School attendance problems that dissipate on their own after a couple of weeks, such as at the beginning of the school year, are considered self-corrective in nature. This sometimes happens when a child takes time to acclimate to a new school building or when parents finally require school attendance after initially allowing the child to miss school. School attendance problems can still be defined as problematic during this early time period, however, if substantial interference occurs in the family’s daily routine or the child’s academic standing.

School attendance problems lasting at least two weeks (see later section also) but less than one calendar year are considered acute in nature. School attendance problems lasting at least one calendar year, or across two academic years, are considered chronic in nature. As you might guess, chronic cases will be more difficult to address, particularly if the final goal is full-time attendance in a regular classroom setting. Procedures in this book will generally apply more to acute cases but can be useful for some chronic cases as well. Chapter 7 is more specifically geared to chronic school attendance problems.

(p. 8) Terminology

School attendance problems are also commonly referred to in different terms, depending on a particular professional or school district. This book utilizes the overall term of school attendance problems to refer to any difficulties going to or remaining in school, but a cursory understanding of the terms in Box 1.2 may be useful when navigating different agencies and schools.

(p. 9) Defining Problematic School Absenteeism

School districts also differ with respect to how they define school absenteeism as problematic. Again, many districts dichotomize excused and unexcused absences, with the latter typically involving a formal school absence that is not justified in some way. Many districts or states consider 10 unexcused absences in a 15-week period (or semester) to be legally problematic, but cutoffs and enforcement vary. As mentioned, knowing your student’s district policy is recommended.

From an assessment/intervention standpoint, waiting until a child has missed 10 formal, unexcused absences is not recommended for the reasons stated earlier. A clinical definition of problematic school absenteeism usually involves missing most school time over a two-week period, or behavior that significantly interferes with academic progress or other aspects of daily functioning. Based on the research literature and many school district policies, I generally refer to problematic school absenteeism for school-aged youth who:

  • Have missed at least 25% of total school time for at least two weeks, and/or

  • Experience severe difficulty attending classes for at least two weeks with significant interference in a child’s or family’s daily routine, and/or

  • Are absent for at least 10 days of school during any 15-week period while school is in session (i.e., a minimum of 15% days absent from school for any reason, with an absence defined as missing at least 25% of the school day).

Note that this definition does not entail a distinction between excused and unexcused absences. Rather, any kind of absence is considered. In addition, this definition accounts for the spectrum of attendance problems noted earlier as well as acute and chronic forms of nonattendance. The definition is meant only as a general guideline for defining school absenteeism as problematic, however. Flexibility and good clinical judgment in this regard must apply to any individual case.

Symptoms

School attendance problems are challenging in part because many internalizing and externalizing symptoms are associated with them. Common internalizing symptoms in this population include anxiety, depression, distress, self-consciousness, worry, fear, fatigue, somatic complaints, and withdrawal. Common types of anxiety include general, separation, and social anxiety. Elementary school students often display general anxiety marked by crying, temper tantrums, lack of concentration, and behaviors designed to miss school or leave class. Elementary school students often display separation anxiety as well, displaying problems leaving home or entering school without their parents or primary caregivers. Of course, some parents also have difficulties separating from their children when school starts.

(p. 10) Social anxiety is also common to youth with school attendance problems, particularly those in middle or high school. Social anxiety can be specific to peers or adults or to certain school situations or classes, or it can be more generalized in nature. Some students are particularly anxious about speaking to authority figures such as teachers, whereas other students are particularly anxious about situations in which they must perform before others. Anxiety about academic/testing, athletic, and musical performances, for example, is not uncommon and can lead to desires to skip school. Social and evaluative anxiety is a typical part of adolescence, but more intense anxiety can lead to school attendance problems. Bullying is a special circumstance in some of these cases and is discussed throughout this book.

Depression is also commonly associated with school attendance problems. Depression symptoms can precede school attendance problems or develop as a result of school-based and other issues that are stressful and challenging. Common depressive symptoms in this population include sadness, social withdrawal, lethargy, sleep problems, and lack of concentration. Suicidal thoughts and behaviors are not uncommon in youth with severe school attendance problems as well. In many cases, anxiety and depressive symptoms blend together in a state of negative affectivity that can include amorphous symptoms such as irritability, distress, self-consciousness, and worry.

Somatic complaints are commonly seen among those with school attendance problems as well. Somatic complaints are often nebulous in nature, such as abdominal discomfort, tiredness, jitteriness, or headache. However, somatic complaints can be quite specific as well, such as vomiting, diarrhea, or fever. Somatic complaints can be manifestations of a true physical problem, so referral to a medical professional for a physical examination is always recommended in these cases. Somatic complaints can also be low-level manifestations of anxiety or an emotional issue with respect to school. In other cases, child-reported somatic complaints are not real but designed to gain attention or to force parents to keep the child home from school.

Externalizing behavior problems can be common to this population as well, and often occur in conjunction with internalizing problems. Common externalizing problems with respect to school attendance issues include refusal to move, aggression, noncompliance, defiance, running away from home or school, and tantrums. Externalizing problems may occur at home, especially in the morning before school, but can also occur as disruptive behavior problems at school to force school officials to remove the child from class, send the child home, or issue a suspension.

Functions of School Attendance Problems

In our clinical work, we rely less on symptoms and more on functions of school attendance problems (Kearney, 2007). Functions refer to what variables maintain a child’s school attendance problems over time. In essence, we want to know what (p. 11) reinforces or motivates a child to continue to refuse school or have difficulties going to school. Symptoms of school attendance problems can be myriad and overwhelming, but functions of school attendance problems tend to be more specific, cost-effective in time to identify, and amenable to assessment and intervention. In our clinical research work, we have found that children generally refuse school for one or more of the following reasons, or functions:

  • To avoid school-related objects and situations that provoke negative affectivity (i.e., dread, anxiety, depression, and somatic complaints)

  • To escape aversive social and/or evaluative situations at school

  • To receive or pursue attention from significant others outside of school

  • To obtain or pursue tangible rewards outside of school.

The first two functions refer to children who refuse school to get away from something unpleasant at school. Common examples of school-related objects that students avoid, particularly elementary school children, include buses, classroom items, fire alarms, gymnasia, hallways, and playgrounds. Common examples of school-related social situations that students avoid, particularly middle and high school youth, include interactions with peers as well as school officials such as teachers, counselors, or administrators. Common examples of school-related evaluative situations that students avoid include athletic performances, recitals, tests, speaking or writing before others, and walking into class with others present.

The latter two functions refer to children who refuse school to pursue something alluring outside of school. Elementary school children may refuse school to force parents to keep them home from school or to give in to their demands for physical and verbal attention. Middle and high school youth may refuse school because outside activities are more alluring than school. Examples can include home-based or community-based activities during school hours. Youth who refuse school to pursue something alluring outside of school may be more likely to come to the attention of clinicians and school officials than youth who refuse school to get away from something unpleasant at school. However, either type of school absenteeism should be considered problematic.

School attendance problems that are chronic in nature, lasting more than one calendar year, tend to be motivated by many different kinds of functions and are impacted by many different kinds of contextual variables (see later section). Some children are initially anxious about school, stay home, and then become attached to caregivers or fun activities at home. Other youth are absent from school for extended periods of time and then become anxious when it is finally time to return to school. In these cases, multiple motivating factors are present. These types of cases often demand more intricate attention and greater time during intervention than acute, single-function cases.

Keep in mind that functions of school attendance problems are less useful in cases involving school exclusion, parent-based school withdrawal, and actual school-based threats. School exclusion refers to suspension or expulsion or other exclusionary disciplinary practices, and school withdrawal refers to parents who (p. 12) deliberately keep their child home from school (see earlier sections). In addition, actual school-based threats must be addressed before considering other functions of absenteeism. Other issues such as broader contextual variables (see later section), chronic school attendance problems, learning or developmental disorders, or severe mental disorders can lessen the utility of examining functions as well.

Prevalence of School Attendance Problems

School attendance problems are among the most common behavior problems in children and adolescents. Up to 35% of youth display school attendance problems at some point, along the spectrum described earlier, which can be fairly minor and self-corrective but also chronic and severe. In the United States, rates of chronic absenteeism, defined as missing at least 10% of school days, are about 14–15%. About half of these cases have lasted several years. In general, school absenteeism rates tend to spike in kindergarten and first grade, decline throughout elementary school years, and then rise again in middle school and increase steadily into high school. First years in middle and high school can be especially problematic with respect to school attendance.

School attendance problems are generally similar across gender and ethnic groups, though school dropout rates tend to be elevated among Hispanic youth. School attendance problems are also similar across many geographical locations, though chronic absenteeism and dropout rates can be especially high in some urban schools and tend to be lower in private schools. In addition, school attendance problems tend to be more evident in students from poorer socioeconomic backgrounds and those in special education classes. Absenteeism rates are generally higher for youth with lower reading achievement levels, though knowing which problem came first is not always clear.

Effects of School Attendance Problems

Children and adolescents who miss school, particularly long stretches of school, are at serious risk for other short-term and long-term problems as well. In the short term, school attendance problems can lead to lower academic performance and achievement, lower reading and mathematics test scores, less developed literacy skills, grade retention, and involvement with the juvenile justice system. Other short-term problems include internalizing and externalizing behaviors (see earlier section), alienation from peers, substance use, declining educational aspirations, and family financial or legal problems stemming from the child’s absenteeism.

In the long term, school attendance problems can lead to eventual school dropout. School dropouts are more likely than graduating peers to be unemployed or underemployed, impoverished, on public assistance, imprisoned, unhealthy, and divorced. Those who drop out of school have substantially less earning power (p. 13) than those who graduate from school. Children with chronic absenteeism are also at greater risk for health problems and impairment in various aspects of developmental competence. Many studies have shown that even a moderate amount of school absenteeism can have substantial negative long-term effects (Balfanz, 2016; Kearney, 2016; Smerillo, Reynolds, Temple, & Ou, 2018).

Causes of School Attendance Problems and Contextual Factors

School attendance problems can be influenced by many different factors at various levels. Part of the challenge when addressing school attendance problems is facing the many related variables and risk factors that impinge on these problems. Children and adolescents with school attendance problems often present with their own unique set of risk factors. Common risk factors at this level, in addition to the internalizing and externalizing behaviors and functions mentioned earlier, include those listed in Box 1.3.

Several parent-based factors can contribute to school attendance problems as well. One factor mentioned earlier, school withdrawal, refers to parent-motivated absenteeism, or deliberately keeping a child home for economic purposes (e.g., babysitting, working), to conceal maltreatment, to shield a child from perceived or real school-based threats, or to assist a parent with depression or other mental health issue, among other reasons. Other possible parent-based factors include those listed in Box 1.4. (p. 14)

Broader family-based factors can also contribute to a child’s school attendance problems. Family dynamics such as isolation, detachment, enmeshment, and conflict are particularly common in this population (Chapter 7). Isolation refers to families that have little contact with outside agencies, including school officials. Detachment refers to family members who have little contact with each other, which may contribute to inattention to school attendance problems for an extended time period. Enmeshment refers to family members that are too involved with each other’s lives, which can contribute to difficulties separating at school time. Conflict is also rife in many families of youth with school attendance problems because the problems create enormous disruption in daily routines and have legal, financial, and other serious ramifications. Other family-based factors can include those listed in Box 1.5.

Peer-based factors can also contribute to school attendance problems. The most salient peer-based risk factors for this population include proximity to deviant peers and victimization. Proximity to deviant peers can mean a child is tempted by offers to miss school, skips school to be with nonattending friends, has access to peer-based social and other activities outside of school during school hours, (p. 15) and feels pressure to conform to delinquent acts. Victimization can include physical or other in-person bullying at school, cyberbullying, and being a target for theft, property damage, or other harm. In addition, social isolation at school is an important risk factor. Social isolation can come from peer or racial/ethnic alienation, lack of participation in extracurricular and other social activities, social skills deficits, anxiety and avoidance of social situations, and simply being new to a school, among other reasons.

School-based factors can contribute to attendance problems as well. Many of these factors are not necessarily fixable by one person, but understanding their potential impact on a particular case can be important. School climate, for example, refers generally to the quality of the educational experience, which can include safety, positive student–teacher relationships, clear and consistently applied rules, effective instruction, choice of courses, and good organization. School climate can also be negatively impacted by frequent teacher absences, poor responsiveness to behavior problems and absenteeism, racism and discrimination, and inadequate responsiveness to diversity issues. A poor or dangerous school climate relates to school attendance problems on a broad level.

School climate can also affect a particular individual case in several ways. Frequent teacher absences can lead to uneven instruction and academic struggles, poor responsiveness to behavior problems can lead to bullying, and inconsistently applied rules can lead to undetected absences. In addition, a lockstep curriculum with little choice can lead to boredom at school, which is a key predictor of eventual dropout among high school students. Inattention to language and cultural differences, particularly between school faculty and the surrounding community, can also hamper parent–teacher communication, a parent’s ability to decipher homework and progress notes, and trust of school officials.

Finally, broader community-based factors can influence school attendance problems as well, particularly for high school students. Communities with plentiful jobs that do not require a high school diploma, for example, can struggle with absenteeism and dropout rates. Other important community factors include violence, neighborhood disorganization, lack of support services and transportation, and underlying values regarding school and education. In addition, some school district policies and legal statutes can paradoxically aggravate school attendance problems, such as suspension or expulsion for truancy or loss of driver’s licenses for extended absenteeism (Chu & Ready, 2018; Kearney, 2016; Steinberg & Lacoe, 2017). As mentioned earlier, you will want to know the particular attendance policy for a given school or district.

A multitiered Model to Organize Interventions

A good framework to understand the types of interventions available for school attendance problems is a multitiered system of supports model. Such a model generally consists of three tiers: Tier 1, Tier 2, and Tier 3. Tier 1 interventions refer to school- or district-wide strategies to prevent school attendance problems (p. 16) and dropout and to boost school attendance rates. Tier 2 approaches refer to early intervention strategies for those with emerging and acute school attendance problems. The approaches described in this book best fit Tier 2-type cases. Tier 3 approaches refer to intensive later intervention strategies for those with chronic, severe, and complex school attendance problems. Tier 3 approaches are described generally in Chapter 7 but are infused throughout other chapters as well.

Mental health and school-based professionals are encouraged to view interventions for school attendance problems along this framework. Tier 1 strategies, though not a central aspect of this book, still have important applications to specific cases of youth with school attendance problems. Examples include daily or weekly monitoring of attendance data, examination of early warning signs of school attendance problems (see earlier section and Chapter 2), and school-based attendance teams that address absentee issues on an immediate basis. In addition, viewing school attendance problems along a multitiered framework helps demarcate different levels of needed support. Greater support is likely needed for chronic than acute absenteeism, for example.

Working Partners

As mentioned at the beginning of this chapter, resolving cases of school attendance problems ideally involves collaboration between therapists and school officials. For me as a mental health professional, the key school partner has usually been the guidance counselor, especially when accommodation plans are developed (Chapter 2). However, other key school officials in this regard can include school-based social workers, school psychologists, school nurses, and school attendance officers. In other cases, teachers, principals, vice principals, deans, or other administrators are key working partners, particularly if exclusionary disciplinary procedures pertain to a given case or if some treatment procedures are to be conducted within a school building.

Some schools have attendance teams that are specifically designed to implement Tier 1 strategies and to address emerging and long-term school attendance problems. These teams may be responsible for monitoring attendance data, intervening in some way for emerging (Tier 2) cases, linking families to appropriate services for more intense cases, and helping to prevent relapse. Other types of school attendance teams involve personnel across several schools in a given district as well as district-wide panels that are responsible for chronic and severe (Tier 3) cases of school attendance problems. Knowing the administrative structure of a particular school or district vis-à-vis school attendance problems is important for both mental health and school-based professionals.

(p. 17) Developmental Tasks

Recall that school attendance problems can have a substantial impact on a child’s and family’s daily life functioning. As such, school absenteeism can interrupt a child’s ability to successfully navigate developmental challenges such as entry into the next grade level or even graduation from high school. An important consideration for treatment for all cases of school attendance problems is how these problems have impaired a child’s ability to accomplish important developmental competencies. In addition, some child or parent skills could be underdeveloped as a result of a child’s absenteeism and thus require some remediation.

Resolving school attendance problems, and reducing the chance of future relapse, often means that key developmental tasks have to be addressed as well. These tasks involve those that a child or adolescent must accomplish in the near future to remain successful at going to school. Some of these tasks are academic, such as making an appointment with a guidance counselor, asking a teacher for help, speaking aloud in class, and navigating school buildings. Other tasks are related to school preparation, such as making one’s lunch for school, engaging in morning personal hygiene, organizing a backpack, and knowing what clothes are needed for the school day. Other short-term tasks are more general in nature but could still impact school attendance, such as making and keeping friends, initiating conversations, performing before others, and studying effectively for tests.

Other developmental tasks will include those that a child or adolescent must accomplish in the longer term to remain successful at going to school. Examples include broader social skills, emotional regulation, self-care, and even financial transactions. Long-term developmental tasks depend heavily, of course, on the child’s age. Elementary school children in the long term will need to focus on more independent social and academic task management, especially as they get ready for middle school. Middle school youth in the long term will need to focus on managing multiple demands on their time, such as academic work, extracurricular activities, and preparations for high school. High school youth in the long term will need to focus on graduation and career preparation, identity formation, problem solving, and romantic interactions, among many other tasks.

Developmental tasks will be explored in greater depth in each of the main intervention chapters (Chapters 36). These tasks can be arranged into those the child:

  • has not yet done on his or her own

  • sometimes does on his or her own

  • can do on his or her own most of the time.

A key initial focus of intervention will be those tasks the child cannot yet complete on his or her own, particularly those tasks most closely related to school attendance. As intervention progresses, and especially as school attendance improves, some of the focus of intervention can include more challenging developmental tasks that the child has only some success with, such as conversations (p. 18) with others or completing homework independently. As school attendance becomes largely resolved, intervention can focus more on longer-term developmental tasks that will be needed to prevent relapse and that allow the child to progress well to the next academic and social levels. Of course, the skills learned during the interventions described in this book, such as modifying self-talk or managing arousal, are also important developmental tasks.

The interventions described in Chapters 36 are sensitive as well to the cognitive developmental level of the child with school attendance problems. Interventions for elementary school children, for example, tend to be more basic and less cognitive in nature. In addition, these interventions often focus as much on the parents as the child. At the elementary school level, children often have difficulty attending school because of general distress or to seek attention from significant others such as parents. The interventions for this level thus tend to be more behavioral in nature, focusing on arousal management and gradual reintroduction to school.

In contrast, interventions for middle and high school youth tend to be more complex and do include cognitive components and more challenging tasks, particularly social ones. At the middle and high school level, adolescents tend to have difficulty attending school because of anxiety about social or evaluative situations or because they become disengaged from school and pursue more alluring activities outside of school. These cases also tend to have a greater number of extant contextual variables, a longer history of school attendance problems, and more severe family-based difficulties compared to elementary school cases. Middle and high school cases can be more urgent as well, particularly because specific academic credits must be accrued in a certain timeframe for graduation. Chapters 36 thus include a blending of strategies to resolve school attendance problems and to help children “catch up” developmentally and be prepared for the next academic and social stage.

Onward to Chapter 2 and Beyond

The next chapter is designed to provide guidelines for a rapid assessment, consultation, and initial intervention process. This blended process could take place in a single session given the time constraints often present in real-world clinical and school settings. Chapter 2 is thus designed to help you quickly gather important information and issue immediate generic intervention recommendations that can apply to most cases of school attendance problems. Chapter 2 is also designed to help you transition quickly to the more specific and tailored core intervention and other procedures that are covered in Chapters 36. I recommend reading each of the chapters to better understand the intervention procedures available for this population.