Neurodevelopmental disorders, self-harm increase risk for school absence

The presence of neurodevelopmental or mental disorders or self-harm before age 24 years increased risk for missing school, according to results of a nationwide, retrospective, electronic cohort study.

“Several small-scale studies in the U.K., U.S. and Australia, with sample sizes ranging from less than 100 to 13,000, suggest that absence from school is more common in children with a mental disorder, specifically depression, anxiety and disruptive behavior disorders, through school refusal, truancy or the condition itself,” Ann John, MD, of Swansea University Medical School in the U.K., and colleagues wrote in The Lancet Psychiatry. “Studies from the U.K. and the U.S. report an association between neurodevelopmental disorders (ie, ADHD and autism spectrum disorder [ASD]) and self-harm with persistent absenteeism,” they continued. “Similarly, school exclusion appears to be strongly associated with ADHD, ASD and mental disorders, particularly depression, in U.K.-based and international studies.”

The investigators sought to examine how diagnosed neurodevelopmental and mental disorders and recorded self-harm by age 24 years correlated with school attendance and exclusion. They obtained data from the Welsh Demographic Service Dataset of 414,637 individuals aged 7 to 16 years (mean age, 10.5 years; 51.3% boys), with 16 being the school leaving age in the U.K., who were enrolled in state-funded schools in Wales between Sept. 1, 2012, and Aug. 31, 2016. They used the Adolescent Mental Health Data Platform to link attendance and exclusion data with national demographic and primary and secondary health care datasets.

Further, John and colleagues identified students diagnosed with neurodevelopmental disorders, learning difficulties, conduct disorder, depression, anxiety, eating disorder, alcohol or drugs misuse, bipolar disorder, schizophrenia, other psychotic disorder or recorded self-harm prior to age 24 years. School absence and exclusion served as outcomes.

Results showed an association between record of a neurodevelopmental disorder, mental disorder or self-harm and increased risk for being absent or excluded in any school year compared with those without a record. John and colleagues reported unadjusted ORs for absences ranging from 2.1 (95% CI, 2-2.2) among individuals with neurodevelopmental disorders to 6.6 (95% CI, 4.9-8.3) among individuals with bipolar disorder. They noted adjusted ORs for absences ranging from two (95% CI, 1.9-2.1) among individuals with neurodevelopmental disorders to 5.5 (95% CI, 4.2-7.2) among individuals with bipolar disorder. Unadjusted ORs for exclusion ranged from 1.7 (95% CI, 1.3–2.2) among individuals with eating disorders to 22.7 (95% CI, 20.8–24.7) among individuals with a record of drugs misuse. Adjusted ORs for exclusion ranged from 1.8 (95% CI, 1.5–2) among individuals with learning difficulties to 11 (95% CI, 10–12.1) among individuals with a record of drugs misuse.

“Exclusion or persistent absence is a potential indicator of current or future poor mental health that is routinely collected by schools and local education authorities and could be used to target assessment and early intervention,” John and colleagues wrote.