Review: the association between anxiety and poor attendance at school – a systematic review

Finning, Katie; Ukoumunne, Obioha C.; Ford, Tamsin; Danielson‐Waters, Emilia; Shaw, Liz; Romero De Jager, Ingrid; Stentiford, Lauren; Moore, Darren A.

doi:10.1111/camh.12322

Cited by 189Youth Substance Use and School AttendanceChild and Adolescent Psychosocial and Emotional DevelopmentSchool Health and Nursing Education

Review: the association between anxiety and poor attendance at school – a systematic review

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Finning, Katie, Ukoumunne, Obioha C., Ford, Tamsin, Danielson‐Waters, Emilia, Shaw, Liz, Romero De Jager, Ingrid, Stentiford, Lauren, Moore, Darren A.·2019·Child and Adolescent Mental Health

DOI 10.1111/camh.12322

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Abstract

BACKGROUND: Anxiety may be associated with poor attendance at school, which can lead to a range of adverse outcomes. We systematically reviewed the evidence for an association between anxiety and poor school attendance. METHODS: Seven electronic databases were searched for quantitative studies that reported an estimate of association between anxiety and school attendance. Anxiety had to be assessed via standardised diagnostic measure or validated scale. Articles were screened independently by two reviewers. Meta-analyses were performed where possible, otherwise results were synthesised narratively. RESULTS: A total of 4930 articles were screened. Eleven studies from six countries across North America, Europe and Asia, were included. School attendance was categorised into: (a) absenteeism (i.e. total absences), (b) excused/medical absences, (c) unexcused absences/truancy and (d) school refusal. Findings from eight studies suggested associations between truancy and any anxiety disorder, as well as social and generalised anxiety. Results also suggested cross-sectional associations between school refusal and separation, generalised and social anxiety disorders, as well as simple phobia. Few studies investigated associations with absenteeism or excused/medical absences. CONCLUSIONS: Findings suggest associations between anxiety and unexcused absences/truancy, and school refusal. Clinicians should consider the possibility of anxiety in children and adolescents with poor attendance. However, there is a lack of high quality evidence, little longitudinal research and limited evidence relating to overall absenteeism or excused/medical absences, despite the latter being the most common type of absence. These gaps should be a key priority for future research.

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Anxiety-related school refusal may be viewed more sympathetically by school staff than truancy.
“Indeed, anxiety-related school refusal may be viewed more sympathetically by school staff than truancy”
From Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1) (2019) · cites this paper as Finning et al., 2019
Professionals' discourse reveals underlying pedagogical knowledge of the association between mental health and school attendance, as widely established in literature.
“their discourse reveals underlying pedagogical knowledge of the association between mental health and school attendance, as widely established in literature (e.g., Finning et al., 2019;Lereya et al., 2019).”
From Their voices matter: student and professional perspectives on overcoming school attendance problems in the context of social, emotional, and behavioral difficulties (2025) · cites this paper as Finning et al., 2019
Review studies show that school attendance problems are closely linked to mental health difficulties and can be both a cause and a consequence of emotional and behavioral challenges.
“Review-studies show that SAPs are closely linked to mental health difficulties and can be both a cause and a consequence of emotional and behavioral challenges”
From “So That You Can Feel Well”: Perspectives of Students with Social, Emotional and Behavioral Difficulties on Factors that Support School Attendance (2025) · cites this paper as Finning et al., 2019
The relationships between social anxiety and school absenteeism remain fragmented.
“The relationships between social anxiety and school absenteeism (SAB) remain fragmented [16,17].”
From Adolescent Social Anxiety, School Satisfaction, Family Emotional Support, and School Absenteeism: Findings from Young-HUNT3 and Norwegian National Education Data (2024) · cites this paper as [16]
The gap persists amid inconsistencies in findings and a lack of robust theoretical perspectives.
“This gap persists amid inconsistencies in findings [16] and a lack of robust theoretical perspectives [18,19].”
From Adolescent Social Anxiety, School Satisfaction, Family Emotional Support, and School Absenteeism: Findings from Young-HUNT3 and Norwegian National Education Data (2024) · cites this paper as [16]

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“…of suffering from anxiety disorders, having a higher level of depressive symptoms, and displaying more oppositional behavior (Allen et al., 2010; Egger et al., 2003; Finning et al., 2019a; Finning et al., 2019b; Ingul et al., 2012; Kim & Barthelemy, 2011; Vaughn et al., 2013; Weeks et al., 2009).”
Background
A systematic review of dramatherapy interventions used to alleviate emotional distress and support the well‐being of children and young people aged 8–18 years old
Keiller, E., Tjasink, M., Bourne, J., Ougrin, D., Carr, C., & Lau, J. (2023) · JCPP Advances · doi:10.1002/jcv2.12145 · Cited by 21 · see citing works
Risk and Influencing Factors for School Absenteeism among Students on the Autism Spectrum—A Systematic Review
Sasso, I., & Sansour, T. (2024) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-024-00474-x · Cited by 22 · see citing works
School Absenteeism, Health-Related Quality of Life [HRQOL] and Happiness among Young Adults Aged 16–26 Years
van den Toren, S. J., van Grieken, A., Mulder, W. C., Vanneste, Y. T. M., Lugtenberg, M., de Kroon, M. L. A., Tan, S. S., & Raat, H. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16183321 · Cited by 18 · see citing works
“Previous reviews on the association between mental health issues and school absenteeism did not find an association between sickness absence and depression or anxiety, since mixed results from a small amount of evidence were found [4,37].”
Result
Adolescent school refusal and academic self‐efficacy: A latent profile and regression analysis
Pérez‐Marco, M., Gonzálvez, C., Fuster‐Rico, A., Vicent, M., Fernández‐Sogorb, A., & Flores, M. D. P. A. (2024) · Psychology in the Schools · doi:10.1002/pits.23263 · Cited by 17 · see citing works
What should a Universal School-Based Psychoeducational Programme to Support Psychological Well-Being amongst Children and Young People in South Africa Focus on and how should it be Delivered? A Multi-Stakeholder Perspective
Coetzee, B., Gericke, H., Human, S., Stallard, P. N., & Loades, M. E. (2021) · School Mental Health · doi:10.1007/s12310-021-09465-3 · Cited by 17 · see citing works
“In the short term, mental health problems in CYP have been shown to impact on daily functioning, disrupt educational attendance and attainment, affect social relationships and interfere with normative development (Belfer, 2008; Finning et al., 2019; Giel et al., 1981; Patel et al., 2007; Rescorla et al., 2007; Wickers…”
Background
Translating sophisticated data analytic strategies regarding school attendance and absenteeism into targeted educational policy
Kearney, C. A., & Childs, J. (2023) · Improving Schools · doi:10.1177/13654802231174986 · Cited by 17 · see citing works
“School attendance and lack of school attendance (absenteeism) are vital predictors of child and adolescent development across multiple domains of functioning (Allison & Attisha, 2019; Finning et al., 2019).”
Background
Adolescent mental health problems, suicidality and seeking help from general practice: A cross-sectional study (Northern Ireland Schools and Wellbeing study)
Leavey, G., Rosato, M., Harding, S., Corry, D. A. S., Divin, N., & Breslin, G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.083 · Cited by 17 · see citing works
Delivering Face-to-Face Dance Classes in Singapore during the COVID-19 Pandemic
Tariao, F. C., & Yang, J. M. J. (2021) · Journal of Dance Education · doi:10.1080/15290824.2020.1843172 · Cited by 16 · see citing works
“Mental health illness—particularly anxiety and depression—may lead to poor attendance and participation (Finning et al. 2019a, 2019b).”
Background
Using Q-sort method to explore autistic students’ views of the impacts of their anxiety at school
Ambrose, K., Simpson, K., & Adams, D. (2024) · Autism · doi:10.1177/13623613241231607 · Cited by 15 · see citing works
“Although it has been established that anxiety impacts the school attendance of non-autistic students (de Lijster et al., 2018; Finning et al., 2019), and anxiety has been associated with school non-attendance in autistic children (D. Adams, 2021; Munkhaugen et al., 2019), it has been suggested that…”
Background
Adolescent Social Anxiety, School Satisfaction, Family Emotional Support, and School Absenteeism: Findings from Young-HUNT3 and Norwegian National Education Data
Halidu, M. D., & Kotera, Y. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13092547 · Cited by 14 · see citing works
“The relationships between social anxiety and school absenteeism (SAB) remain fragmented [16,17].”
Background
Mental Health and Attendance at School
Heyne, D. A., Kearney, C. A., & Finning, K. (2022) · Cambridge University Press eBooks · doi:10.1017/9781911623151.002 · Cited by 14 · see citing works
Parent/carer views on support for children's school non‐attendance: ‘How can they support you when they are the ones who report you?’
Lissack, K., & Boyle, C. (2022) · Review of Education · doi:10.1002/rev3.3372 · Cited by 14 · see citing works
Secondary school students’ perspectives on supports for overcoming school attendance problems: a qualitative case study in Germany
Enderle, C., Kreitz-Sandberg, S., Backlund, Å., Isaksson, J., Fredriksson, U., & Ricking, H. (2024) · Frontiers in Education · doi:10.3389/feduc.2024.1405395 · Cited by 14 · see citing works
Children and Young People’s Perception of the Active Ingredients of Dramatherapy When Used as a Treatment for Symptoms of Emotional Disorders: A Meta-synthesis
Keiller, E., Murray, A., Tjasink, M., Bourne, J., Ougrin, D., Carr, C. E., & Lau, J. Y. F. (2023) · Adolescent Research Review · doi:10.1007/s40894-023-00221-z · Cited by 15 · see citing works
“Reduced school attendance (Finning et al., 2019), social withdrawal (Hards et al., 2022), lack of life satisfaction (Hoseini-Esfidarjani et al., 2022) and, perhaps most severely, suicide (Centers for Disease Control & Prevention, 2022) are just some ways in which symptoms of emotional disorders can…”
Four Steps To My Future (4STMF): acceptability, feasibility and exploratory outcomes of a universal school‐based mental health and well‐being programme, delivered to young adolescents in South Africa
Coetzee, B., Loades, M. E., Human, S., Gericke, H., Laning, G., Kidd, M., & Stallard, P. N. (2023) · Child and Adolescent Mental Health · doi:10.1111/camh.12660 · Cited by 13 · see citing works
“…problems like depression in childhood and adolescence is associated with numerous unfavourable outcomes, both short-term (Benarous et al., 2019; Finning et al., 2019; Schwartz-Mette, Shankman, Dueweke, Borowski, & Rose, 2020; Wickersham et al., 2021) and into adult-hood (Clayborne, Varin, &…”
Background
School Attendance Problems Among Children with Neurodevelopmental Conditions One year Following the Start of the COVID-19 Pandemic
Totsika, V., Kouroupa, A., Timmerman, A., Allard, A., Gray, K. M., Hastings, R. P., Heyne, D. A., Melvin, G. A., & Tonge, B. J. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06025-3 · Cited by 13 · see citing works
“…with absence due to ill-health in autistic children (Adams, 2021), though a recent review called for more research on the association between anxiety and different types of absence (Finning, et al., 2019) as it is likely that child anxiety relates differently to different types of absence.”
Background
Anxiety and school absenteeism without permission among adolescents in 69 low- and middle-income countries
Dalforno, R. W., Wengert, H. I., Kim, L. P., & Jacobsen, K. H. (2022) · Dialogues in Health · doi:10.1016/j.dialog.2022.100046 · Cited by 21 · see citing works
Mental health and risk behaviors among secondary school students: A study on ethnic minorities
Cheah, Y. K., Kee, C. C., Lim, K. H., & Omar, M. A. (2021) · Pediatrics & Neonatology · doi:10.1016/j.pedneo.2021.05.025 · Cited by 13 · see citing works
The German version of the Revised Children's Anxiety and Depression Scale—Psychometric properties and normative data for German 8‐ to 17‐year‐olds
Grothus, S., Sommer, A., Claus, B. B., Stahlschmidt, L., Chorpita, B. F., & Wager, J. (2023) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1965 · Cited by 11 · see citing works
“Thus, it would be possible in a school ‐ based study that these children were absent due to their anxiety and depressive disorder and therefore did not participate (Askeland et al., 2020; Finning et al., 2019).”
Background
Do Teachers Perceive Absent Students Differently?
Gottfried, M. A., Kim, P., & Fletcher, T. L. (2024) · AERA Open · doi:10.1177/23328584241259398 · Cited by 10 · see citing works
“Research unequivocally shows that absenteeism leads to worse outcomes for children across multiple measures (Anderson & Romm, 2020; Easton & Engelhard, 1982; Finning et al., 2019; Gershenson et al., 2017; Gottfried, 2009, 2010, 2014; Gottfried & Kirksey, 2017; Moonie et al., 2008; Roby, 2004).”
Depressive and Anxious Symptoms in Spanish Adolescents: Normative Data for the PHQ-9 and GAD-7
García, M. D. L. A. C., Díez-Gómez, A., Pérez‐Albéniz, A., Lucas‐Molina, B., & Fonseca‐Pedrero, E. (2024) · Clínica y Salud · doi:10.5093/clysa2024a13 · Cited by 10 · see citing works
“…are associated with physical and mental health problems, as well as with a range of adverse outcomes including social relationships and educational impairments (Baker, 2021; Finning et al., 2019; García-Escalera et al., 2020; Quevedo-Blasco et al., 2023; Riglin et al., 2014; Veldman et al., 2015).”
Social anxiety tendency and autism spectrum disorder in Japanese adolescence
Minami, K., & Horikawa, E. (2020) · Pediatrics International · doi:10.1111/ped.14576 · Cited by 10 · see citing works
Mental Health Service Urgency in Children’s Mental Health: Factors Impacting the Need for Expedited Services
Semovski, V., King, C. B., & Stewart, S. L. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01161-2 · Cited by 10 · see citing works
“Excessive absenteeism has been linked to social isolation, involvement with the juvenile system, and permanent dropout from school, placing students at greater risk for poorer occupational and economic outcomes [68, 69].”
Background
“So That You Can Feel Well”: Perspectives of Students with Social, Emotional and Behavioral Difficulties on Factors that Support School Attendance
Enderle, C. (2025) · School Mental Health · doi:10.1007/s12310-025-09764-z · Cited by 12 · see citing works
“Review-studies show that SAPs are closely linked to mental health difficulties and can be both a cause and a consequence of emotional and behavioral challenges (Epstein et al., 2020; Finning et al., 2019; Melvin et al., 2025b; Sobba, 2019; Tekin & Aydın, 2022).”
Longitudinal association of conduct and emotional problems with school exclusion and truancy: A fixed effect analysis of the UK Millennium Cohort Study
Villadsen, A., Cameron, C., Evans, J., Herwegen, J. V., Hill, V., Hurry, J., Roberts, A., Wyse, D., & Johansen, T. (2023) · Child and Adolescent Mental Health · doi:10.1111/camh.12681 · Cited by 9 · see citing works
The K-16 education movement: common themes across K-12 and higher education systems to inform development and evaluation
Kearney, C. A., Fensken, M., & Dupont, R. (2024) · Frontiers in Education · doi:10.3389/feduc.2024.1272297 · Cited by 8 · see citing works
An exploration of school attendance problems experienced by children receiving mental health services
Klan, A., Whitley, J., Krause, A., McBrearty, N., Rogers, M. A., & Smith, J. D. (2024) · Educational and Child Psychology · doi:10.53841/bpsecp.2024.41.1.73 · Cited by 8 · see citing works
Early detection of students’ mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization
Nishimura, T., Wakuta, M., Osuka, Y., Tsukui, N., Hirata, I., Takahashi, M., Adachi, M., Katayama, T., Aizaki, K., Sumiya, M., et al. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1430011 · Cited by 8 · see citing works
Understanding the parental experience of emotional barriers to school attendance: a systematic literature review
Onslow, J., & Cartmell, H. (2025) · Educational Psychology in Practice · doi:10.1080/02667363.2025.2475041 · Cited by 9 · see citing works
“…to conceptualise school attendance difficulties that are brought on by strong and enduring emotional responses to school, rooted in anxiety or fear, that make attending school extremely difficult, and may prevent children from attending altogether (Corcoran & Kelly, 2023; Finning et al., 2019).”
Cognitive Behavioral Interventions for School Attendance Problems: A Systematic Review and Meta-analysis
Jakobsen, S., Tølbøll, K. B., Mikael Thastum, A., & Lomholt, J. J. (2025) · Child Psychiatry & Human Development · doi:10.1007/s10578-025-01847-x · Cited by 7 · see citing works
“Too little, too late”: youth retrospectives on school attendance problems and professional support received
Hamadi, S. E., Havik, T., & Holen, S. (2025) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1595289 · Cited by 8 · see citing works
A longitudinal investigation of school absenteeism and mental health challenges among Canadian children and youth in the COVID-19 context
Krause, A., Rogers, M., Jiang, Y., Climie, E. A., Corkum, P., Mah, J. W. T., McBrearty, N., Smith, J., & Whitley, J. (2025) · Frontiers in child and adolescent psychiatry · doi:10.3389/frcha.2025.1604431 · Cited by 9 · see citing works
What school-based interventions work to improve attendance in secondary school students with persistent absence? A systematic review
Middleton, A. S., Watson, M., & Anderson, J. K. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1603680 · Cited by 12 · see citing works
Teacher attitudes towards evidence-based practices for social, emotional and mental health difficulties in school and association with teacher academic research engagement
Kallitsoglou, A., & Mahmud, A. (2023) · Emotional and Behavioural Difficulties · doi:10.1080/13632752.2023.2276024 · Cited by 7 · see citing works
“forms of school absenteeism (unexcused absences/truancy, school refusals) were reported to be more common amongst CYP with SEMHD than CYP without those difficulties (Finning et al. 2019).”
Background
Social determinants of health and youth chronic pain
Chen, Y., Liu, Z., Werneck, A. O., Huang, T., Damme, T. V., Kramer, A. F., Cunha, P. M., Zou, L., & Wang, K. (2024) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2024.101911 · Cited by 7 · see citing works
Working with Adolescents to Understand Bullying and Self–Exclusion from School
Dadswell, A., & O’Brien, N. (2020) · International Journal of Developmental Science · doi:10.3233/dev-200288 · Cited by 7 · see citing works
“In addition to an association between anxiety and self-exclusion (e.g. Finning et al., 2019), the literature also shows a relationship between being bullied and high levels of anxiety (Thambirajah et al., 2008).”
Social well-being and problematic school absence among Danish adolescents: A nationwide cross-sectional study
Lindholdt, L., Svendsen, K., Rothausen, K. W., & Bech, B. H. (2023) · Scandinavian Journal of Public Health · doi:10.1177/14034948231173176 · Cited by 6 · see citing works
“…with school absence problems were at higher risk of suffering from mental health problems such as anxiety disorders and depressive symptoms [11,12], while associations also have been found between the presence of chronic illness, subjective health complaints and sleep problems in children and…”
Associations between sleep duration, insomnia, depression, anxiety and registry‐based school grades: A longitudinal study among high‐school students
Evanger, L. N., Pallesen, S., Saxvig, I. W., Hysing, M., Sivertsen, B., Lie, S. A., Gradisar, M., & Bjorvatn, B. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14430 · Cited by 7 · see citing works
Associations Between Sleep Patterns, Circadian Preference, and Anxiety and Depression: A Two-Year Prospective Study Among Norwegian Adolescents
Evanger, L. N., Saxvig, I. W., Pallesen, S., Gradisar, M., Lie, S. A., & Bjorvatn, B. (2025) · Clocks & Sleep · doi:10.3390/clockssleep7020026 · Cited by 6 · see citing works
“Furthermore, as the invited schools were asked to prioritize one school hour to complete the survey and sleep, anxiety and depressive disorders in previous studies have been related to school absenteeism [56,57], the sample may have been underrepresented by students with these diagnoses.”
School-based support for emotion-related attendance challenges: effectiveness of @School when implemented with neurodiverse adolescents, their parents, and school staff
Karel, E., Defourny, C., Keppens, G., Graczyk, P. A., Sauter, F. M., & Heyne, D. A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1613712 · Cited by 9 · see citing works
“Anxiety and depressive disorders, in particular, are common and have significant implications for school attendance and academic performance (Finning et al., 2019; Finning et al., 2022; World Health Organization, 2021).”
Influential
Predictors of Functional School Outcome in Children With Pediatric Acquired Brain Injury
Stubberud, J., Hypher, R. E., Brandt, A. E., Finnanger, T. G., Skovlund, E., Andersson, S., Risnes, K. R., & Rø, T. B. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.872469 · Cited by 6 · see citing works
The relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders
Kang‐Yi, C. D., Arnold, K. T., Tieu, T., Olubiyi, O., Xie, M., Lawson, G. M., Locke, J. J., & Pisciella, A. E. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231190852 · Cited by 6 · see citing works
“…to their peers without psychiatric disorders, have more negative educational outcomes including lower academic achievement, lower school attendance (Finning et al., 2019), higher risk of school dropout (Goulding et al., 2010; Quiroga et al., 2013), and higher risk of failing to graduate high…”
Background
What issues bring primary school children to counselling? A service evaluation of presenting issues across 291 schools working with Place2Be
Tóth, K., Samad, L., Golden, S., Johnston, P., Hayes, R. A., & Ford, T. J. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12333 · Cited by 6 · see citing works
Determinants of school attendance in elementary school students in Japan: a structural equation model
Nakamura‐Thomas, H., Sano, N., & Maciver, D. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00391-5 · Cited by 8 · see citing works
“Systematic reviews have identified the importance of identifying anxiety or depression among children and adolescents [6, 7].”
Background
Their voices matter: student and professional perspectives on overcoming school attendance problems in the context of social, emotional, and behavioral difficulties
Enderle, C., Kotschy, L., Ricking, H., & Kreitz-Sandberg, S. (2025) · Frontiers in Education · doi:10.3389/feduc.2025.1627098 · Cited by 5 · see citing works
The Mediation Role of School Alienation Between Perceptions of the School Atmosphere and School Refusal in Italian Students
Sorrenti, L., Fumia, A., Caparello, C., Meduri, C. F., & Filippello, P. (2025) · Education Sciences · doi:10.3390/educsci15070786 · Cited by 5 · see citing works
Social-Emotional Learning (SEL) and Its Impact on Teacher Stress, Self-Efficacy, and Attitudes Towards Inclusion: Longitudinal Insights from the StaFF-BL Project
Hövel, D. C., Röösli, P., Jurkic, A., Nideröst, M., Link, P.-C., & Sticca, F. (2025) · Behavioral Sciences · doi:10.3390/bs15111511 · Cited by 6 · see citing works
“…of its pupils, but internalising problems such as anxiety and depression are especially likely to be overlooked in school settings (Bilz, 2014), even though systematic reviews have established robust associations with learning difficulties and school absenteeism (Finning et al., 2019a, 2019b).”
The collaborative development of a local authority emotionally based school non-attendance (Ebsna) early identification tool
Boaler, R., Bond, C., & Knox, L. H. (2024) · Educational Psychology in Practice · doi:10.1080/02667363.2023.2300027 · Cited by 5 · see citing works
“However, in line with the current study findings, professionals reported the need to be supported in their capacity to support peers, as well as families and students, as EBSNA was viewed as complex, resource intensive and emotionally demanding (Finning et al., 2019).”
Result
Exploring the implementation of whole school emotionally based school non-attendance (EBSN) guidance in a secondary school
Ward, S., & Kelly, C. (2024) · Educational and Child Psychology · doi:10.53841/bpsecp.2024.41.1.111 · Cited by 5 · see citing works
Capacidad predictiva del rechazo escolar sobre la alta ansiedad social en adolescentes chilenos
Giménez-Miralles, M., Martín, N. L. S., & Gonzálvez, C. (2022) · European Journal of Education and Psychology · doi:10.32457/ejep.v15i2.1967 · Cited by 5 · see citing works
The effect of anxiety on working memory and language abilities in elementary schoolchildren with and without Additional Health and Developmental Needs
Pickering, H. E., Parsons, C., & Crewther, S. G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1061212 · Cited by 5 · see citing works
[Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior].
Knollmann, M., Waltz, E., Reissner, V., Neumann, U., & Hebebrand, J. (2022) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000884 · Cited by 4 · see citing works
State Minimum Wage and Mental Health Among Children and Adolescents
Kavanagh, N. M., McConnell, M. A., & Slopen, N. B. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.40810 · Cited by 4 · see citing works
The Association Between Social Outsiderhood and School Absence is Mediated by Internalizing Symptoms
Alanko, K., Söderberg, P., Lagerström, M., Laakso, M., & Junttila, N. (2025) · School Mental Health · doi:10.1007/s12310-025-09793-8 · Cited by 4 · see citing works
A systematic review identifying factors associated with emotionally based school non-attendance in autistic children and young people
Prosser, R., & Birchwood, J. (2024) · Educational and Child Psychology · doi:10.53841/bpsecp.2024.41.1.31 · Cited by 4 · see citing works
Therapist perceived active ingredients of school-based dramatherapy for children and young people with emotional distress
Keiller, E., Hutchinson, T., Ougrin, D., Carr, C. E., & Lau, J. Y. F. (2024) · The Arts in Psychotherapy · doi:10.1016/j.aip.2024.102190 · Cited by 6 · see citing works
Exploring Absenteeism in Medical Education: Perceptions of Students and Professors at the University of Granada
Rodríguez, M. I., Torres, C., Amaro‐Gahete, F. J., Hernandez-Torres, F., Alonso, M. Á. M., Núñez, M. I., & Luis, A. (2025) · Medical Science Educator · doi:10.1007/s40670-025-02482-w · Cited by 4 · see citing works
“This is of particular concern in medical schools, where attendance is often considered essential for the acquisition of both basic and clinical knowledge [3, 4].”
A Study of Risk Factors Predicting School Disruption in Children and Youth Living in Ontario
Sun, L. X., Semovski, V., & Stewart, S. L. (2021) · Canadian Journal of School Psychology · doi:10.1177/0829573521991421 · Cited by 4 · see citing works
“Additional benefits could result in fewer students in conflict with the law, reduced unemployment rates, and improvements in quality of life (Finning et al., 2019).”
Background
Trait anxiety, dispositional hope and mental well-being: examining longitudinal mediation
Akat, M. (2025) · BMC Psychology · doi:10.1186/s40359-025-02864-0 · Cited by 3 · see citing works
“However, anxiety has comorbidity with psychosocial problems such as depression [68] and school refusal [69].”
School attendance matters: co-occurring trajectories of school attendance and academic achievement from elementary to secondary school in a Canadian context
Brittain, H. L., & Vaillancourt, T. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2026.1729744 · Cited by 3 · see citing works
“Consistent with research linking peer difﬁculties and emotional problems to school engagement (7, 72, 73, 86–88), students in classes marked by increasing or chronic absences and declining grades reported higher depression and, to a lesser extent, anxiety symptoms.”
Emotion Matters: Understanding the Role of Achievement Emotions in High School Students’ Decision for Tertiary Education
Yim, J. S.-C., Sedhu, D. S., & Abdul-Rahim, P. R. M. (2023) · Journal of Psychoeducational Assessment · doi:10.1177/07342829231211044 · Cited by 3 · see citing works
“This is in line with studies that found test anxiety in instigating behavioural outcomes such as low motivation, school absenteeism and school refusal (Wuthrich et., 2020; Kearney, 2008; Finning et al., 2019).”
Result
A model of community youth mental health support services in the global South: A description and use of school-based services delivered by a non-governmental organisation in South Africa
Human, S., Loades, M. E., Gericke, H., Laning, G., Bartlett, M., & Coetzee, B. (2024) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.107967 · Cited by 3 · see citing works
Mental Health Assessment of the Frequent Visitors in the School Setting—Part 1: An Overview
Perron, T., Jakubowski, T. L., Razzi, C., & Kartoz, C. (2021) · NASN School Nurse · doi:10.1177/1942602x21996442 · Cited by 3 · see citing works
School Attendance: Terminology and Socio-political Considerations
Moore, D. A. (2022) · Mental Health and Attendance at School · doi:10.1017/9781911623151.003 · Cited by 3 · see citing works
Examination of Current Anxiety Problems with School Engagement and Volunteer and Paid Work among U.S. Adolescents
Gregory, K. A., Vidourek, R. A., King, K. A., & Merianos, A. L. (2022) · The Journal of School Nursing · doi:10.1177/10598405221121655 · Cited by 3 · see citing works
“Additionally, adolescent anxiety has been associated with increased truancy and school absences that are either unexcused or related to anxiety or emotional distress (Finning et al., 2019).”
Evaluation of an Adapted Version of the Screen for Child Anxiety Related Emotional Disorders for Secondary School Students
Martinelli, V., & Gatt, C. (2022) · Journal of Education and Training Studies · doi:10.11114/jets.v10i4.5701 · Cited by 3 · see citing works
“Students who experience higher levels of anxiety are also at risk of underachieving, truancy and dropping out of school, but some studies reported contradictory findings (Owens, Stevenson, Hadwin, & Norgate, 2014; Van Ameringen, Mancini, & Farvolden, 2003; Finning et al., 2019).”
BackgroundResultInfluential
Schulvermeidung: Eine gesamtgesellschaftliche Herausforderung wartet auf Antworten
Knollmann, M., & Reißner, V. (2022) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000909 · Cited by 3 · see citing works
The impact of the initial COVID-19 lockdown on the mental health and lifestyle of children in Turkey
Morgül, E. (2023) · Revista de Psicología Clínica con Niños y Adolescentes · doi:10.21134/rpcna.2023.10.3.4 · Cited by 3 · see citing works
Who is allowed to stay at home during school hours? An analysis of school withdrawal
Kruithof, E. H., & Keppens, G. (2024) · Educational Studies · doi:10.1080/03055698.2024.2369859 · Cited by 3 · see citing works
“Students with unexcused absences often deal with anxiety, symptoms of depression and low self-esteem (Finning et al. 2019; Ingul and Nordahl 2013; Wilson et al. 2008).”
Investigating the academic attainment and progress of children in receipt of individual counselling: A matched comparison study of primary school age children in England
Tóth, K., Golden, S., & Sammons, P. (2024) · Counselling and Psychotherapy Research · doi:10.1002/capr.12741 · Cited by 2 · see citing works
The resilience myth: relationships among mental health wellbeing, campus connection, and resilience in Queer community college students
Lynch, R. J., & Little, A. (2025) · International journal of LGBTQ+ youth studies. · doi:10.1080/29968992.2025.2572772 · Cited by 2 · see citing works
“Similarly, training faculty to use flexible attendance policies and transparent grading structures can reduce perceived threat and increase trust in the classroom (Finning et al., 2019; Vosoughian & Ramezani, 2024).”
Network analysis of school absence: central symptoms and their functions
Alanko, K., Heyne, D., Lagerström, M., & Knollman, M. (2025) · Frontiers in child and adolescent psychiatry · doi:10.3389/frcha.2025.1625164 · Cited by 2 · see citing works
Prevalence and correlates of truancy in the United States post-covid-19: results from a national sample
Vaughn, M. G., Chen, J., Maynard, B. R., Bandaru, Y. S., & Schweiger, A. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2025.108735 · Cited by 2 · see citing works
Longitudinal Surveys Are Texts: LLM-Enhanced Analysis of School Attendance in New Zealand
Qiao, T., Walker, C. G., Cunningham, C., Jang-Jones, A., Morton, S., Meissel, K., & Koh, Y. S. (2025) · Lecture notes in computer science · doi:10.1007/978-3-662-72243-5_18 · Cited by 2 · see citing works
The Relationship Between Emotion Regulation Difficulties and Comorbid Mental Disorders in Children and Adolescents with School Refusal Behavior
Yesilkaya, C., Gök, M. F., & Turan, S. (2025) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045251413014 · Cited by 2 · see citing works
“The presence of psychiatric comorbidities in children with SRB has been replicated quite frequently in previous research results (Finning et al., 2019; Fremont, 2003; Havik & Ingul, 2021).”

Anxiety-Based School Refusal in Children and Adolescents: A Literature Review
Abidi, A., Elmansouri, F., Elmaataoui, Z., & Kisra, H. (2026) · SAS Journal of Medicine · doi:10.36347/sasjm.2026.v12i09.027
The association between child and adolescent emotional disorder and poor attendance at school: a systematic review protocol
Finning, K., Moore, D., Ukoumunne, O. C., Danielsson-Waters, E., & Ford, T. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0523-6 · Cited by 22 · see citing works
Exploring the roles of anxiety, sleep and sense of belonging in school attendance and school refusal behaviour
McKenzie, S. A. (2017) · ePrints Soton (University of Southampton)
An exploration of the relationship between trait anxiety and school attendance in young people
Richards, H. J., & Hadwin, J. A. (2011) · School Mental Health · doi:10.1007/s12310-011-9054-9 · Cited by 58 · see citing works
School refusal and anxiety among children and adolescents: A systematic scoping review
Tekin, I., & Aydın, S. (2022) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20484 · Cited by 70 · see citing works

Authors: Finning, K., Ukoumunne, O. C., Ford, T., Danielson‐Waters, E., Shaw, L., Romero De Jager, I., Stentiford, L., & Moore, D. A.
Affiliations: University of Exeter (GB)
University of Bristol Medical School Bristol UK
University of Exeter Medical School Exeter UK
Corresponding author: Finning, Katie
ORCID: Finning, Katie
Ukoumunne, Obioha C.
Ford, Tamsin
Shaw, Liz
Stentiford, Lauren
Moore, Darren A.
Venue: Child and Adolescent Mental Health
Publisher: Wiley
Published: 2019-02-27
Volume: 24
Issue: 3
Pages: 205-216
ISSN: 1475-357X (ISSN-L)
1475-3588
DOI: 10.1111/camh.12322
OpenAlex: W2920440182
Cited by: 189
References: 50
Citations by year: 2026: 40 · 2025: 38 · 2024: 33 · 2023: 17 · 2022: 22 · 2021: 21 · 2020: 11 · 2019: 7
FWCI: 4.39
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: cc-by
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Child and Adolescent Mental Health (publishedVersion)
PubMed (publishedVersion)
Open Research Exeter (University of Exeter) (acceptedVersion, cc-by)
Figshare (submittedVersion, cc-by)
Minerva Access (University of Melbourne) (submittedVersion)
Funders: Wellcome Trust (104908/Z/14/Z)
Topics: Social Sciences › Education › Youth Substance Use and School Attendance
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords: anxiety disorders, school attendance, school absenteeism, truancy, school refusal, social anxiety, generalized anxiety disorder, separation anxiety, phobia, children and adolescents

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