Physicians should screen and treat mothers of school-aged children for depression.Ī recent national survey found that 14% of students-or about 6.8 million children and adolescents in kindergarten through 12th grade-are chronically absent, defined as missing at least 10% of the school year (about 18 days). Physicians should connect students with school-based mental health resources when available. Physicians should recommend family involvement in therapy. Physicians should consider prescribing a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor. Physicians should recommend cognitive behavior therapy or other psychotherapy focused on a graduated return to school. To address absenteeism in children with chronic illness, physicians should set expectations for regular school attendance make a written action plan including an individualized emergency protocol, medication list, monitoring instructions, environmental triggers, and emergency contact information and offer ongoing consultation.įor children with serious illness who need to miss school for treatment, physicians should discuss the likely timeframe for returning, then communicate with school personnel about the patient’s needs once he or she has returned to school.įor children with academic and behavior problems, physicians should ensure that parents are aware of available school-based educational support services, and consider referral for mentoring and cognitive support.įor children with depression or anxiety who miss school: Physicians can use well-child visits to prepare families for kindergarten (e.g., establishing bedtime and morning routines) and to recommend preschool to families with risk factors for absenteeism. Parents should be informed about the connection between regular school attendance in early grades and academic success. Families and schools are key collaborators in interventions via parent education, parental mental health treatment, and school-based intervention programs. When assessing a child with frequent absences, physicians should inquire about bullying, even if the patient is not known to identify with a vulnerable group. Mental health conditions that interfere with school attendance can often be treated with cognitive behavior therapy and/or pharmacotherapy. If absenteeism is caused by chronic illness, management should include clear expectations about school attendance and care coordination with school personnel. Informing parents of the link between school attendance and achievement can be effective in reducing absences. Family physicians are well positioned to identify patients with frequent absences, intervene early, and tailor treatment plans to the patient’s medical and social needs. Chronic absenteeism appears to be driven by overlapping medical, individual, family, and social factors, including chronic illness, mental health conditions, bullying, perceived lack of safety, health problems or needs of other family members, inconsistent parenting, poor school climate, economic disadvantage, and unreliable transportation.
Previous research focused on distinguishing between truancy and anxiety-driven school refusal, but current policy has shifted to reducing absenteeism for any reason. Frequent school absenteeism has immediate and long-term negative effects on academic performance, social functioning, high school and college graduation rates, adult income, health, and life expectancy.
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