Childhood anxiety tied to school absences

Kids with school attendance or truancy problems might be suffering from anxiety, a research review suggests. 

Chronic physical problems like asthma and diabetes have long been linked to an increased risk of school absences, poor grades and test scores, and lower odds of obtaining a college degree or a high-paying job. The current study offers fresh evidence that mental illness can also limit school performance and success in life, said lead study author Katie Finning of the University of Exeter Medical School in the UK. 

“We were surprised to find evidence that anxiety is associated with unexcused absences, or truancy, which is often assumed to be related to behavioural difficulties rather than emotional difficulties like anxiety or depression, as well as authorized absences,” Finning said by e-mail. 

“Poor attendance could be a sign of anxiety, no matter what type of absence,” Finning added. 

Finning’s team reviewed eight previously published studies with a total of almost 26,000 young students from Europe, North America and Asia. The youth were 15 years old on average, with ages ranging from five to 21. 

The analysis focused on four categories of absences: truancy and unexcused absences; medical and excused absences; school refusal tied to emotional distress about attendance; and absenteeism for any reason. 

Anxiety was strongly linked to school refusal, as expected. It was also associated with truancy, which was a surprise. 

Parents and teachers may mistakenly assume some children are missing school due to disobedience or behaviour problems when they are actually suffering from anxiety, Finning said. And some of kids considered truant might have undiagnosed anxiety, depression or other mental health problems. 

“There are lots of things about the school environment that might be challenging for young people with anxiety, including social interaction with peers and/or school staff, academic challenges, or separation from caregivers at home,” Finning said. 

“Anxiety can also cause physical symptoms like headaches or tummy aches, which might also impact on children’s school attendance,” Finning added. 

Most of the studies in the analysis were small, and none were designed to prove whether or how anxiety might directly cause school absences. 

The studies also measured anxiety and school attendance in a variety of ways, so the researchers could not pool data across all the studies. 

Even so, the results suggest that at least some absences attributed to misbehaviour might be due to anxiety, said Bonnie Leadbeater, a psychology researcher at the University of Victoria in Canada who was not involved in the study. 

 “Parents should consider the possibility that anxiety is behind school refusal and seek treatment once physical causes are ruled out,” Leadbeater said by e-mail. “Punishing children for school refusal due to anxiety will likely be unsuccessful,” she added. 

“Children experiencing excessive anxiety need help,” Leadbeater said. “While identifying this may be difficult, sometimes even asking your child, ‘what is it about going to school you find so difficult,’ and trying empathically to understand their point of view may get you started in helping them, and getting help for them to build the confidence to manage anxiety is important.”