Absenteeism - Module 4

1. MAIN REASONS

1.1. RISK FACTORS AND FIRST WARNING SIGNS

Theoretical approaches and researches on absenteeism and school dropout have focused on different aspects to assess risk factors and to prevent school absenteeism. Therefore, the results show the following risk factors depending on the aspects analysed: social and family factors, the individual, the characteristics of the students, and their academic behaviours and the school. 

• Social risk factors: being of a minority race/ethnicity, minority language, low socio-economic status, family structure or low educational level of the parents. 
• Risk factors in the family: poverty and social precariousness, single-parent families, unstructured families, social risk behaviours in the family, lack of discipline and parental control, neglect, family events such as divorce or separation, loss or bereavement, mental and physical wellbeing of parents - presence of anxiety in a parent.
• Risk factors related to the individual: not having ties with their peer group outside of school, presenting antisocial behaviours, isolation in class, bullying situations, low intellectual capacity, prolonged or severe illness. 
• Academic risk factors: low grades, a negative school record, low academic performance, low educational expectations, early repetitions of courses or behaviour problems, pressure of curricular or cognitive demands.
• School risk factors: climate and relationships between teachers and students, not fostering relationships between equals, transition to secondary school, lack of fluently communication between parents and school

1.2. VULNERABILITY OF STUDENTS WITH ASD TO ABSENTEEISM

As we have mentioned before, there are certain risk factors for absenteeism that make students with ASD especially vulnerable. The factors associated with the individual are especially relevant. We have already mentioned in the previous modules the specific characteristics of people with autism and it is important to identify how these can make them more vulnerable to absenteeism

• Social communication: the lack of social skills to have satisfactory interpersonal relationships, often makes them isolate themselves from their group class and don not have the feeling of belonging to the class, so important as not to be an added factor for absenteeism. 
• Restrictive interests: unusual interests and in a very high intensity, makes that, sometimes, the interaction between colleagues and people with autism is not adequate because they cannot share the same interest at the same level
• Difficulty in non-verbal communication: the inadequate interpretation of jokes and ironies makes them not detect when they are being bullied. 
• Cognitive rigidity and difficulty in adapting to changes causes them to have higher levels of anxiety, which can cause them to be more irascible and perform inappropriate behaviours.
• The hyper o hypo sensitivity to certain sounds, textures, touches… also makes the anxiety levels that people with autism have to endure are higher than the resto f their peers. 

1.3. SCALES FOR ABSENTEEISM

• ‘School Refusal Assessment Scale - Revised’ (SRAS-R). Kearney and Silverman (1990)

• ‘Emotionally-Based School Refusal’ (EBSR). West Sussex County Council Educational Psychology Service (2004) 

• School Non-Attendance ChecKlist (SNACK). Heyne et al. (2019).

1.4. EFFECTS OF ABSENTEEISM

If the ASD students have a prolonged absence from school can result in: 

• Academic underachievement: students who are likely to be absent more often may face circumstances causing them to exhibit behaviours (e.g., lack of motivation) that also hurt test scores. They also missed learning and knowledge opportunities. This also sets a precedent for a reduction or loss of confidence and self-confidence, often becoming a vicious circle.
• Losing structure in their day and fewer routines: early morning starts tend to disappear, waking up very late and losing sleep habits (sleep disorders may appear). They try to occupy their free time in leisure-based activities, (e.g., watching TV, using computers or video games and/or social media). These activities often prevent a return to school as they are non-challenging and non-anxiety provoking comparing the social situations in school. This makes they feel comfortable and safe in their own environment with little change and few surprises.
• Perceived inability to cope with developmentally normal challenges. This also makes them feel different form the rest of their peers, acquiring negative self-concepts of themselves. This can lead to fear of school, fear of failure and excessive perfectionism, which generates very high levels of anxiety. Their anxiety increases since a specific intervention is rarely carried out for it, and it tends to intensify each time they are asked to do something outside of their comfort zone (e.g. going to school, socializing or going on a trip)
• Related to the above, becoming more socially alienated and have more difficulty making friends. When they have to work in a team, their socialization suffers and it is very difficult for the deal with it.
• The greater the number of days they are absent or the more number of times, a feeling of dread arises in anticipation of situations that could cause isolation, uncertainty about what will happen when they returns, the judgments that will be made about them or the behaviours and thoughts of their peers. 
• Increased aggressiveness: when they feel threatened and forced to go to school, they use aggressiveness or flight as a defence mechanism directed at parents or supporting adults 
• Engagement in premature sexual activity.

1.5. HOW TO MAINTAIN A GOOD RELATIONSHIP WITH THE FAMILY

Where a young person avoids of refuses to attend school, the scene at home may be one of unhappiness for all concerned. Parents/carers are frequently despairing and they may feel guilty or blame themselves for their young person’s anxiety and reluctance to attend school.

• Positive and constructive involvement form within the family is a key factor in overcoming absenteeism situations.
• Early contact with the family to discuss the ASD student reluctance to attend and any contributory factors as perceived by the family.
• Develop knowledge of support and resources that family members could use to help resolve issues relevant of ASD children anxiety.
• Being prepared to meet with the family on neutral territory or at home where there are family issues with school.
• A key person should be identified within school that the family can contact. It is important that this person is someone who knows the young person and is able to respond to phone calls relatively quickly. 
• Regular telephone contact with the school for monitoring purposes, to provide updates, and to exchange positive information about the young person. 
• Communicating specific needs and concerns of the young person, e.g.: placement in certain classes, seating arrangements, anxieties about specific lessons or teachers. 
• Persisting with agreed targets, despite any setbacks rather than continually seeking 'new solutions'. 
• Being prepared for difficulties or recurrence of the problem following natural breaks, e.g.: holidays and genuine illnesses. 
• Focus on positive aspects of school life and encourage all small steps towards positive progress. 
• Encourage parent/carers to ask what has gone well rather than what has gone badly in school each day. 
• Parent/carers should be encouraged to allow school to deal with issues arising in school. 
• Parent/carers and staff need to remember that some young people can have specific fears about the school environment that do not occur in other areas of their lives. 
• Encourage parent/carers to make use of other support they may have in the community - e.g.: other family members, friends, neighbours, etc. 
• Reintegration programmes should be flexible, creative and individualised to suit each particular young person. 
• Reintegration should be at an appropriate pace; it is important not to expect too much too soon. 
• Everyone working with the young person must offer a consistent and united approach

2. STRATEGIES AND TECHNIQUES

It is necessary to detect what may be the causes that may be driving the student with ASD to start or maintain absenteeism, and to provide support from the initial moments, since an early intervention is useful to avoid the consolidation of absenteeism, and get the students reinstated.

2.1. BULLYING / EXCLUSION FROM PEERS

An inability to communicate certain thoughts and feelings, while bullying is not uncommon even for kids not diagnosed with ASD, there are certain characteristics of autistic children that make them an easier target for bullying. Student diagnosed with ASD may have some or all of these characteristics:

• Show limited control over what is happening around them and situations
• Have feelings of inadequacy and poor self-esteem
• Difficulty understanding facial expressions, tone of voice and body language of others
• Socially cut off from their peers
• Labelled as “inadequate” by their peers or teachers
• Apear depressed or self-destructive

Research has obtained results that bullying can be prevented. It is created a ‘package for the prevention of youth violence and associated risk behaviours’ that intended to impact individual behaviours, as well as relationship, family, school, the community and the social factors that influence the risk and protection factors of violence.

The strategies are designed to work together and be used in combination to prevent

violence. These approaches, particularly are aimed at strengthen the skills of young people and modify the physical and social environment, have shown to reduce violence and harassment.

• Promote family environments that support healthy development: parenting skills and family relationship programs.
• Provide quality education early in life: strengthen youth’s skills
• Mentoring programs: a school-based intervention designed for at-risk middle school students that aims to develop critical social skills, encourages academic achievement and provides positive, life-enriching experiences for the participants. 
• Create protective community environments: modify the physical and social environment, reduce exposure to community-level risk. 
• Building a positive school climate: create the feeling of belonging and that it is a protected environment with details that can arise from a greeting, the way a problem is resolved, or how people work together.
• It is necessary to dedicate hours in class to learning, by teachers and students, social and emotional learning, involves teaching skills of self-awareness, self-management, social awareness, responsible decision making, and relationships management. It improves emotional well-being, self-regulation, classroom relationships, and kind and helpful behaviour among students. It reduces a range of problems like anxiety, emotional distress, and depression; reduces disruptive behaviours like conflicts, aggression, bullying, anger, and hostile attribution bias; and it improves academic achievement, creativity, and leadership.

It is important to be familiar with the symptoms that a student subject to bullying normally demonstrates in order to be able to detect this phenomenon.

• Inexplicable injuries
• Lost or destroyed clothing, books, electronics…
• Frequent headaches or stomach aches, feeling sick or faking illness
• Changes in eating habits, like suddenly skipping meals or binge eating. Kids may come home from school hungry because they did not eat breakfast.
• Difficulty sleeping or frequent nightmares
• Declining grades, loss of interest in schoolwork, or not wanting to go to school
• Sudden loss of friends or avoidance of social situations
• Feelings of helplessness or decreased self esteem
• Self-destructive behaviours such as running away from home, harming themselves, or talking about suicide

2.2. ANXIETY

When people are anxious, they usually engage in very shallow breathing which does little to oxygenate the body. People who are anxious tend to do more breath holding (they usually keep their lips closed as they breathe out; or appear tight lipped when working). Others may take short, fast breaths (this is letting carbon dioxide out but not much oxygen in). This does not help the body or mind to feel calm and relaxed. 

Guidelines for managing anxiety especially when the student is afraid of certain contexts, subjects or situations

Below we specify some guidelines to be able to deal with anxiety, it is not necessary to wait for overwhelming situations to occur in which it is difficult to handle anxiety or stress, sometimes it is useful to anticipate those situations that by observation we have appreciated that they can generate anxiety situations. That is why it is important to teach and practice relaxation skills:

• Relating a situation in a very specific way in which he feels more and more strength and power so as not to feel embarrassed because there are people around. 
• Look at details to look for distraction, such as the colour of people’s shoes.
• Observe that the rest of the people in the hall are talking without noticing you.

• Listening to music: 

• Emotive imagery:

• Modelling:

• Filmed modelling: record a person of a similar age to the student in which the “movie” is later seen in which that person performs that action or that activity that causes fear (approaches or interacts with the feared object or situations)  
• Participant modelling: this is live modelling coupled with a school mentor or peer physically guiding the student and accompanies him to carry out that activity, or to approach those feared object or situation.

• Systematic desensitisation is the most commonly used method in treating children’s fears. 

• Make a list with the student, ordering from things that cause a small worry to those causing major distress. For example, if you are afraid to go out into the yard and not find anyone you know: 

• ‘You go out into the school yard and meet your class far from where you are’

• ‘You go out into the school yard and you find your class busy talking to some boys you know’

• ‘You go out to the school yard and you find your class busy talking with some boys you don't know’

• ‘You go out to the school yard and you only see one person from your class’

• ‘You go out to the school yard and you can't find your class and you get nervous because you don't know what to do’

• Help the child to relax and then discuss their fears in order from things that cause a small worry.

• Seek supervision before attempting this approach 

• Use a drawing scale where they can indicate the level of stress or satisfaction in each situation, it might be useful (an example is the Buron and Curtis Incredible 5-point Scale).

It is common for the students with ASD to be in a constant state of worry, a kind of perpetual state of alert. From problems associated with sensory interpretation (noise, temperatures, tactile sensations, smells…) which can disturb or saturate their senses, to the correct interpretation of commonly accepted social roles (from sarcasm, corporal expression, literalities or double meanings, in short, something that for most people is something learned from childhood, for these people it is something not only difficult to understand, it generates a state of continuous stiffness levels). And this continuous tension generates emotional states that lead to anxiety attacks, depression, frustration, parasomnias and somatization, among others.

Somatoform disorders are characterized by the chronic presence of physical symptoms, which are not explained by any physical disease. All somatoform disorder subtypes share one common feature; predominance and persistence of unexplained somatic symptoms associated with significant distress and impairment.

It is important to take into account this disorder, present sometimes at the beginning of the absentee behaviours of students with ASD, with the presentation of physical symptoms, such as: stomach aches, headaches, allergies ... Knowing this disorder, action strategies can be proposed:

• Treatments or techniques to reduce anxiety and stress, such as those we have previously discussed.

• Positive suggestion: Somatic symptoms improve with “positive” suggestion about the definite diagnosis, as compared to “negative” suggestion of uncertainty of diagnosis and outcome.

• Initially provide biomedical explanations for symptoms and initiate psychosocial talk when cued by the student

• Reattribution therapy:  to elicit physical symptoms, psychosocial problems, mood state, beliefs about the problem, relevant examination and tests; to summarize physical and psychosocial findings and negotiate; and explanation relating the physical symptom to psychosocial problem based on timing or physiology

• Guided imagery: Construct an image representing a symptom in their mind and then they change it to become “how it should be” (specially for gastrointestinal disorders)

2.3. LEARNING DIFFICULTIES

People with ASD have different characteristics ones from each other, but have different learning difficulties in common, among which we can find:

• Narrow focus: refers to the accent/stress that falls on the accent-bearing syllable of one word in the sentence and highlights the part of information that has a special meaning. Studies have shown that individuals with ASD may have difficulties in the production and comprehension of prosody, and especially of affective-emotional prosody because of difficulties in understanding mental states of other people
• Take advantage of that strength to be the one who pays attention to the details
• Provide a pattern beforehand, and they could complete the information and sum up when they read a text
• When it comes to summarizing, give them clues to guide their story.
• Language development issues: struggles with language are one of the main ways autism affects learning, and problems with language development and speech delays.

• As we said, early intervention is necessary
• Model the use of verbal and nonverbal language
• Support language with images
• Poor nonverbal skills: 

• Explicitly teach the importance of non-verbal language
• Joint attention training: coordinates interactive behaviour between two people in relation to events or objects.
• Peer tutoring: imitation, visual communication, shared attention and understanding facial expressions. It is necessary instruction for an integrated setting.
• Give modelling of: eye contact, accompaniment of gestures to verbal speech, proxemia

2.4. HYPERSENSITIVITIES

Children with hypersensitivity may overreact to the rub of clothing tags or to the intensity of loud noises. Since they sometimes cannot filter out or process sensations, they can become overloaded and shut down, tantrum, feel anxiety, or get depressed. 

People with ASD can involve both hyper-sensitivities (over-responsiveness) or hypo-sensitivities (under-responsiveness) to a wide range of stimuli.

2.5. ACCESS ADAPTATIONS

Organisational Factors:

Thinking about transition children who are concerned about the change tend to worry about the following situations:

Formal and informal supports:

It is necessary to take into account the formal and informal supports available to the student with ASD and the family in order to successfully cope with absenteeism situations. Some examples of these supports could be:

• Informal supports:

• Organization of the exits and entrances of the school centre in a structured way.

• Establish an agenda or ‘traveling notebook’ system in many institutes and have online platforms where the family and teachers can exchange student information on a daily or weekly basis.

• Establish a partner to act as mentor with whom the student with ASD can ask for help (organize homework, writhe down homework, ask questions…)

• Formal supports:

• Meeting with the tutor: at least one at the beginning of the course, and one more for each term.

• Meetings with other professionals who carry out programs with their children (support teachers inside or outside the classroom, support teachers): at least one at the beginning of the course and another at the end.

• Meetings with service outside the school centre that they receive, such as psychology or pedagogy associations or cabinets).

• Online sessions: in the case of some absentee students, the option of following classes online could be considered, as it has begun to do after COVID-19. In particular, in cases in which their anxiety does not allow them to follow face-to-face classes or the comorbid symptoms make them absentee of long duration.

It is necessary to consider if it can help or if it is a solution in the short or medium term. It is also necessary to analyse whether the benefits of online training (continuing with classes, learning guidelines to manage anxiety, not losing knowledge ...) are greater than the damages (isolation, generalization to other contexts ...), depending on of each case.

• Coordination with mental health and other specialists: research has also endeavoured to link psychopathological symptoms to various levels of school absenteeism severity. It has been found that students with a mental disorder showed less schooling assistance than students without a mental disorder.

In this way, students with ASD who present comorbidities, such as: anxiety, eating disorders, depression, obsessive disorders ... would be benefit with a close coordination with mental health in their referral hospital, being able to prevent symptoms, on some occasions, or alleviate the consequences that it could come, such as absenteeism.

• Therapeutic-educational classrooms: the creation of therapeutic-educational classrooms have opened the access to many students with ASD, favouring their educational inclusion and preventing early school absenteeism.

It requires a coordinated action among all the professionals involved in the evolutionary process of students, and constitutes a combined response for students with mental health problems that, due to their severity, make it difficult to adapt to the school environment and cannot be addressed, exclusively, from a single area. The involvement of public entity is also necessary, preparing a Comprehensive Plan whose objective is to make such coordination effective in a precise, clear and adequate way to improve school integration, as well as to promote the school success of students with these special educational needs.

The aim of these classrooms is to offer students with mental health disorders, such as students with ASD, associated with serious conduct disorders, therapeutic educational tools in an environment that facilitates their school and social adaptation, and improves their academic performance and personal development.