The Presentation and Impact of School Refusal Behaviour in Children on the Autism Spectrum.

Abstract

Almost half of all children on the autism spectrum experience school refusal (Totsika et al., 2020), yet very little is known about the presentation of school refusal, the way families support their children, and the impact of this upon families. In this study, seven mothers of children on the autism spectrum with school refusal participated in semistructured interviews exploring the behavioural presentations of school refusal and their experiences supporting their child. Directed content analysis was used to analyse the way school refusal presentations align with neurotypical school refusal presentations; inductive content analysis was used to explore the consequences and impact of school refusal for families. Results showed that children demonstrated heterogenous presentations of school refusal, between 10 and 30 unique behaviours in six of the seven categories of the continuum of school refusal behaviour in youth (Kearney, 2001). Many behaviours may not be recorded in attendance data, such as physical school attendance with psychological avoidance. Participants experienced reduced capacity to work and negative impacts on their mental wellbeing, as well as changes to parent-school connections and parenting strategies as a result of school refusal. This is the first study to qualitatively explore the presentation and impact of school refusal in children on the autism spectrum. Findings will be important for planning future research directions and supporting children on the autism spectrum with school refusal and their families.