Abstract
BackgroundFew studies have explored school refusal in children with autism spectrum disorder (ASD), despite being considered a serious problem. One of the leading causes of school refusal is bullying, which is defined by the feelings of students who are bullied or not, and psychological suffering caused by a psychological or physical attack. This study investigated the characteristics of school refusal in children with ASD.MethodsA total of 94 outpatients with school refusal and ASD and 143 outpatients with school refusal without ASD aged 6–18 years were included. Chi squared tests and Mann–Whitney tests were used to compare the characteristics of school refusal in children with and without ASD. Univariate and multivariate logistic regression analyses were performed to analyze the reasons for school refusal in children with ASD by sex.ResultsSchool refusal significantly occurred earlier in children with ASD than in those without. In addition, “bullying” was significantly associated with school refusal in both boys and girls with ASD.ConclusionsThese findings suggest that school refusal should be monitored early in children with ASD. The importance of recognizing bullying among children with ASD should be highlighted as an opportunity for early intervention.
Highlights
Few studies have explored school refusal in children with autism spectrum disorder (ASD), despite being considered a serious problem
Children’s Global Assessment Scale (CGAS) scores were significantly lower in participants with ASD than in those without (P < 0.05)
Two children without ASD were diagnosed with obsessive compulsive disorder (OCD), two were diagnosed with eating disorders (ED), and one was diagnosed with brief psychiatric disorder
Summary
Few studies have explored school refusal in children with autism spectrum disorder (ASD), despite being considered a serious problem. School refusal is an increasingly serious issue among children. According to the National Association of School Psychologists, individuals who avoid school are more likely to have long-term emotional issues, such as depression and anxiety, poor academic achievement, dropping out of school, and suicide [3, 4]. In Japan, the educational system is under the authority of the Ministry of Education, Culture, Sports, Science, and Technology (MEXT), which defines school refusal as the students’ lack of attendance for > 30 days per year for reasons other than sickness or economic causes, including psychological, emotional, physical, or social reasons [7]. The number of students with school refusal is an increasingly serious issue in Japanese education.
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