School Refusal Behavior in Students with Autism Spectrum Disorder, an Exploratory Study of Prevalence and Associated Factors

Background:  

School refusal behavior refers to unauthorized absenteeism in compulsory school; it is defined as child-motivated refusal to attend school and/or difficulties remaining in class for an entire day. Failure to attend school might negatively influence the student’s academic, psychological and social development and increase the risk for dropping out of school.

Despite increased research in factors associated with quality of school experiences less attention has been directed to absenteeism and school refusal behavior in students with ASD. The research is to our knowledge sparse, however, parent reports from the Danish and the Swedish Autism Association found a prevalence of school refusal behaviour in students with ASD, 39% and 36.5%, respectively. A better knowledge of the prevalence and the individual risk factors can be important for professionals to prevent and treat school refusal behavior in students with ASD.

Objectives:  

This study aimed to explore the prevalence of school refusal behaviour in students with ASD aged 9-16 years without intellectual disability (IQ > 70), compared to typically developing (TD) students in Norwegian schools. Further, to explore if individual characteristics can predict risk for displaying school refusal behavior in the students with ASD.

Methods:  

A cross-sectional study involving 80 students with a confirmed diagnosis of ASD without intellectual disability, and a comparison group of 138 children and adolescents at the same age, sex and classes with no disabilities are included in the study. The participants were recruited from schools, child and adolescent psychiatric and pediatric outpatient clinics or via the Norwegian Autism Association website. The diagnoses were assessed and confirmed by specialists in child and adolescent psychiatric and paediatric outpatient hospital clinics.  Teachers and parents registered absences and school refusal behavior over 20 days. Parents answered a socioeconomic questionnaire. To assess data characterizing the students with ASD, parents answered the Behavior Rating Inventory of Executive Function (BRIEF), the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale (SRS) questionnaires. Information regarding demographic factors was collected via the Norwegian educational information system.

Results:  

School refusal behaviour was revealed in 42% of students with ASD compared to 7.1% of TD students based on teachers collected data. Parent registrations showed a prevalence of school refusal behaviour in 52.6% of the students with ASD and 2.3% of the TD students. Strong associations were found between school refusal behaviour and illness in other family members and in those attending junior high school. Preliminary results in total scores from the BRIEF, the SRS and the CBCL showed significant differences between students with ASD and students with ASD and school refusal behavior. 

Conclusions:  

Findings showed that school refusal behaviour in students with ASD is most prevalent and associated with illness in other family members, and attending eight to tenth grade. Further, students with ASD and school refusal behaviour tend to have more problems assessed with the BRIEF, the SRS and the CBCL.