Impact of Mental Health Disorders on School Attendance
When it comes to wellbeing, mental health is at the top of the list as the leading cause of disability for children and adolescents. In Australia 1 in 7 (13.9%) children and adolescents aged 4- 17 experienced a mental disorder in 2013- 20141.
Attention Deficient Hyperactivity Disorder (ADHD) was the most common mental health disorder overall (7.4%). Anxiety disorders were close behind (6.9%), followed by major depressive disorder (2.8%) and conduct disorder (2.1%).
A recent study by Lawrence et al, (2019)2 found a direct link between the diagnosis of a mental health disorder and the prevalence of attendance concerns. The researchers drew data from the Report on the Second Child and Adolescent Survey of Mental Health and Wellbeing 2015. The survey collected responses from a random sample of 6310 families with children aged four to 17 years from around Australia.
Interestingly, the prevalence of mental disorders did not vary greatly between Years 1–6 (15.4%), Years 7–10 (14.6%) and Years 11–12 (13.0%)
However, it was found that students with one or more mental disorders had higher rates of absence from school.
In Years 1–6, students with:
no mental disorder were absent an average of 8.2 days per year,
students with one mental disorder were absent on average 10.7 days per year (95% CI: 9.0–12.3)
students with two or more disorders were absent on average 15.0 days per year (95% CI: 11.6–18.5).
In Years 7–12, students with
no mental disorder were absent an average 11.0 days per year
students with one mental disorder were absent on average 21.6 days per year
students with two or more disorders were absent on average 28.3 days per year.
ADHD was more common in younger students than older students and more common in males than in females.
Most pressing it was found that anxiety disorder was more common in older young people (secondary school) than younger students (primary school) and more common in females than in males. Anxiety disorders also accounted for more days absent amongst older students than any other mental health issues (pp 13-14).
I found it surprising that there has been limited broad research drawing links between mental health disorders and school attendance. Given that students with mental health disorders feature widely in the literature on school absenteeism, it is expected that the prevalence of mental health issues would feature as a significant factor of attendance concerns across the broad population of students.
How can Schools Support Students experiencing Anxiety?
There is research to support that children who experience anxiety can be taught how to successfully cope with it. There is a large body of research pointing to Cognitive Behavioural Therapy (CBT) as an effective treatment for anxiety disorders3. CBT provides young people with tools to face their anxieties. It also provides then them with ‘reframing’ strategies. These strategies support young people to think about situations in a different way so they are able to better manage their anxiety. CBT is not sold as a cure but it is a way that children can learn how to manage their anxiety.
Cognitive Behaviour Therapy consists of:
Young people developing an understanding of their anxiety and how it makes them feel (psycho education). At school this means validating a young person’s anxiety “ I can see that this assessment makes you worried”. It helps to explain and reassure the student that anxiety and worry is normal, and that everyone experiences it. While anxiety is uncomfortable, and may cause them to feel physically sickness this won’t hurt them. Understanding that it is just worry that is making them feel sick enables them to identify the feeling and take practical steps to address it.
Learning mindfulness techniques to focus attention away from the anxiety and relaxation skills. Once young people are able to identify their triggers or the physical symptoms of anxiety they can move towards relaxation techniques to assist in self- calming when they are experiencing anxiety. Teachers may use these techniques with the whole class to begin with. Many classrooms have relaxation corners where soft cushions and books have been placed.
Realistic thinking - thinking through a perceived worry and discussing it (cognitive exposure). It is common that a young person with anxiety will jump to the worst possible scenario to fuel their worry. Instead of dismissing worries teachers can help students by encouraging realistic thinking. This entails having the young person walk through the situation and draw on evidence from past experience (e.g. what happened before when you went to that class? What is most likely to happen?). It must be noted that realistic thinking is only useful if the perceived worry is unrealistic. If there is a real chance that the student will be bullied or they will fail the test this may not always be appropriate in all situations.
Problem solving - develop a system of sound logic when face with perceived problems. logic is often the first casualty when a young person is anxious. Therefore, it is helpful that a young person experiencing anxiety has some strategies to think logically. For example, if assessment deadlines and homework seem overwhelming writing out a plan of due dates and when each task will be completed can help. It can also help to have a young person articulate the problem they are feeling anxious about. Naming the problem and assigning an action to it can support identifying where the anxiety is coming from.
Gradually facing the fear/anxiety (graded exposure) - gradual exposure to a cause of anxiety is one way of overcoming it. A practical way of gradual exposure is drawing up a mind map of things or places that the young person feels anxious about. These can then be ordered into things that the young person feels uncomfortable doing but can tolerate and things that the young person cannot face at this point. To gradually face a fear intermediary steps could be made (e.g. coming to a space at school where the student feels comfortable) to build up exposure. In some cases the anticipation of the exposure may be more intense than the experience itself.
With each of these techniques it is important the young person’s effort and progress is praised. Progress is made explicit so that the young person can see that applying the techniques alleviates their anxiety (it will not make it go away).
Schools can support all students by increasing awareness of mental health issues and increasing students Wellbeing literacies4. There is evidence to support that young people who are able to articulate their mental health state are better able to manage a mental health issue should it arise56.
Commonwealth Government (2015)The Mental Health of Children and Adolescents Report on the Second Australian Survey of Child and Adolescent Mental Health and Wellbeing.
Lawrence, D., Dawson, V., Houghton, S., Goodsell, B., & Sawyer, M. G. (2019). Impact of mental disorders on attendance at school. Australian Journal of Education, 63(1), 5-21.
WayAhead Mental Health Association NSW (2016) Strategies to Support Anxious Children In the Classroom
Oades, L. G., Jarden, A., Hou, H., Ozturk, C., Williams, P., R Slemp, G., & Huang, L. (2021). Wellbeing Literacy: A Capability Model for Wellbeing Science and Practice. International Journal of Environmental Research and Public Health, 18(2), 719.
Kelly, C. M., Jorm, A. F., & Wright, A. (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Medical Journal of Australia, 187(S7), S26-S30.
Simkiss, N. J., Gray, N. S., Malone, G., Kemp, A., & Snowden, R. J. (2020). Improving mental health literacy in year 9 high school children across Wales: a protocol for a randomised control treatment trial (RCT) of a mental health literacy programme across an entire country. BMC Public Health, 20, 1-8.