Saturday, 9 September 2017

School refusal is 'pervasive' in students with autism

The findings reported by Ellen Kathrine Munkhaugen and colleagues [1] make for worrying reading when it comes to the concept of school refusal in the context of autism spectrum disorders (ASD). Detailing how school refusal - where a child/young adult refuse to attend school because of the anxiety or distress it causes - was quite a bit more common among students with ASD compared with non-ASD students over a 20-day inspection period, the authors highlight an important issue. Indeed, an issue that has already been noted in the peer-reviewed literature [2] and has accompanying advice from the one of the larger autism organisations here in Blighty (see here).

As I've mentioned a few times on this blog, school can be a significant source of stress for many children on the autism spectrum (see here). We can for example, um-and-ah about the merits of inclusive vs. specialised education settings in the context of autism or how bullying seems to be something that quite a few children unfortunately, have to contend with (see here), but the bottom line is that stress is a likely passenger for many children with autism as they navigate the complicated world that is the childhood education system. And it is therefore perhaps unsurprising that for some children/young adults with autism, school might not be a place they necessarily want to spend a lot of time in.

One of the worries (among the many) that I have about results such as the ones from Munkhaugen et al is how, in these days of real focus on 'bottoms on seats' in school at least here in Blighty, such findings have the potential to single out families. If one reads the guidance from the UK Department of Education on the topic of school attendance (see here) for example, it's not difficult to see how tools like 'parenting contracts' and even 'parenting orders' might be something not unfamiliar in the context of school refusal. I say this bearing in mind that quite a few parents are already having to fight their child's corner when it comes to schools and local authorities providing appropriate school resources and allowances (see here) also potentially impacting on school refusal.

There are no easy or universal solutions to the issue of school refusal in the context of autism. Yes, schools can perhaps make provisions to help a child, but this needs to be set in the context that they have a school full of children who are similarly relying on them to provide the best educational experience that they can. The current cash-flow situation that many schools are faced with is also pertinent (see here). The other option is to try to manage school refusal behaviours particularly when chronic. This might first include investigations relevant to comorbid conditions that might also impact on school refusal [3] and then looking to strategies to help minimise the possible causes of school refusal [4] (tailoring them to the individual of course). Anxiety seems to be a key feature of school refusal (see here) and hence, moves to address this issue - and the core symptoms that seemed to be linked to it - should probably be part of any intervention strategy (see here). I hold back from making a big case for moving a child to a new school or into home education because this should really be a very last resort and come with their own potential issues.

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[1] Munkhaugen. EK. et al. School refusal behaviour: Are children and adolescents with autism spectrum disorder at a higher risk? Research in Autism Spectrum Disorders. 2017; 41-42: 31-38.

[2] Kurita H. School refusal in pervasive developmental disorders. J Autism Dev Disord. 1991 Mar;21(1):1-15.

[3] Egger HL. et al. School Refusal and Psychiatric Disorders: A Community Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2003; 42: 797-807.

[4] Kearney CA. & Silverman WK. A Preliminary Analysis of a Functional Model of Assessment and Treatment for School Refusal Behavior. Behavior Modification. 1990; 14: 340-366.

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