School attendance problems and absenteeism as early warning signals: review and implications for health-based protocols and school-based practices
Open accessAbstract
School attendance has been historically linked to healthy states of functioning, whereas school attendance problems/absenteeism have been historically linked to unhealthy states of functioning. Indeed, school attendance and its problems are deeply embedded within multiple domains of functioning at both analytic and systemic levels. This article utilizes complex systems theory and the concept of early warning signals to illustrate how changes in school attendance could indicate instability and perhaps sudden transitions to unhealthy states of functioning for students, families, schools, and communities. The article reviews how school attendance problems/absenteeism intersect with functioning at analytic (academic, social–emotional, mental health, physical health, family) and systemic (school and community) levels. The article also includes recommendations for how viewing changes in school attendance as early warning signals could improve health-based protocols (enhancing access to care; integrating systems of care) and school-based practices (developing multi-tiered systems of support models and community asset maps; modifying educational and policy perspectives). A primary theme involves more streamlined efforts to identify movement from healthy to unhealthy states among individuals to assign proactive and personalized treatment avenues (health-based protocols) and among systems to enact needed intervention supports and reforms (school-based practices).
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Absence from school impedes social-emotional development and academic performance and increases future risks such as unemployment, school dropout, and social exclusion.
“Conversely, the absence from school impedes socialemotional development, academic performance and poses future consequences such as unemployment and school dropout, increasing the risk of social exclusion”
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 Kearney et al., 2023
Sections 3.1 and 3.2 link absenteeism to poorer academic achievement, later dropout, and hindered social development. The Introduction describes occupational difficulties as a long-term consequence of dropout, but the copy does not specifically identify unemployment as a consequence of absence. It discusses social isolation and alienation, rather than establishing the claimed progression to social exclusion. (LLM, conf=0.86)
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“…often in conjunction with such disruption, school absenteeism is related to problematic parenting behaviors such as inaction, ineffective response strategies, overprotectiveness, vague commands, aggression, and reinforcement of attention-seeking behavior (Kearney, 2019; Chockalingam et al., 2022).”
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OECD, & Centre for Educational Research and Innovation (2009) · Educational research and innovation · doi:10.1787/20769679 · Cited by 129 · see citing works
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
Kreitz-Sandberg, S., & Fredriksson, U. (2023) · European Education · doi:10.1080/10564934.2023.2281394 · Cited by 12 · see citing works
“This could be seen from the perspective raised by Kearney et al. (2023), in which they describe “changes in school attendance as early warning signals” (p. 1) that may help professionals to better see what actions to take in order to prevent absenteeism.”
BackgroundEnderle, C. (2025) · School Mental Health · doi:10.1007/s12310-025-09764-z · Cited by 12 · see citing works
“Conversely, the absence from school impedes social-emotional development, academic performance and poses future consequences such as unemployment and school dropout, increasing the risk of social exclusion (Ansari et al., 2020; Kearney et al., 2023; Keppens, 2023; Liu et al., 2021).”
Kearney, C. A., Fensken, M., & Dupont, R. (2025) · Frontiers in Education · doi:10.3389/feduc.2025.1553528 · Cited by 11 · see citing works
Self-citationClimate change injustice and school attendance and absenteeism: proximal and distal ecological links
Kearney, C. A., Ellis, K., & Arcaina, V. J. (2024) · Frontiers in Education · doi:10.3389/feduc.2024.1455430 · Cited by 8 · see citing works
Self-citationKearney, C. A., Blanco, A. M., & Dugan, R. B. (2025) · The Family Journal · doi:10.1177/10664807251360787 · Cited by 8 · see citing works
“SAPs are closely linked to problems in functioning at multiple levels, including student academic, social – emotional, and mental and physical health domains as well as school and community domains (Kearney et al., 2023).”
Self-citationThe Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth
Kearney, C. A. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01253-2 · Cited by 8 · see citing works
“School absentee-ism is considered a key marker of mental health problems in children and adolescents, particularly for emotional, disruptive, and traumatic disorders but other psychiatric disorders as well (Kearney et al., 2023).”
Self-citationMiddleton, A. S., Watson, M., & Anderson, J. K. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1603680 · Cited by 13 · see citing works
Hamadi, S. E., Klippen, M. I. F., & Havik, T. (2024) · Education Sciences · doi:10.3390/educsci14010066 · Cited by 8 · see citing works
Quality of Life in Children with Celiac Disease: An Observational Study
Rozensztrauch, A., & Mostyńska, P. (2025) · Nutrients · doi:10.3390/nu17061085 · Cited by 7 · see citing works
Framing chronic absenteeism and emotionally-based school absenteeism as public health problems
Kearney, C. A. (2025) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1662093 · Cited by 5 · see citing works
Self-citationParental perspectives on school attendance problems and the role of municipal support systems
Hansen, U. I., Munkhaugen, E. K., & Larsen, K. (2025) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2025.1589988 · Cited by 5 · see citing works
Liu, H., Yang, Y., Zhang, Y., Gao, Q., Zhang, L., Liang, W., & Zhou, Y. (2024) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.107949 · Cited by 4 · see citing works
The Current State of School Attendance Research and Data in Canada
Whitley, J., McBrearty, N., Rogers, M., & Smith, D. (2025) · Education Sciences · doi:10.3390/educsci15080964 · Cited by 4 · see citing works
Early Identification of School Refusal from Parents’ Perspectives
Møller, G. (2025) · Education Sciences · doi:10.3390/educsci15091211 · Cited by 3 · see citing works
Brittain, H. L., & Vaillancourt, T. (2026) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2026.1729744 · Cited by 3 · see citing works
“Kearney et al. (108) highlighted the potential early warning sign that school attendance problems play in identifying students at risk for academic failure, mental health difficulties, and school dropout, emphasizing the importance of early detection and intervention to prevent these cascading adverse outcomes.”
Bania, E. V., Nilsen, T. S., Thastum, M., Ingul, J. M., & Havik, T. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1608184 · Cited by 2 · see citing works
“However, determining appropriate actions when a student struggles with problematic school absenteeism poses significant challenges for many teachers and other school personnel (Kearney et al., 2023).”
InfluentialFord, N. D., Simeone, R. M., Pratt, C., & Saydah, S. (2025) · Emerging infectious diseases · doi:10.3201/eid3114.251035 · Cited by 2 · see citing works
“Schools might consider health-related factors in their ongoing efforts to improve school attendance ( 41 ) and could collaborate with healthcare systems to provide integrated systems of support to address complex needs for children with disabilities and health concerns ( 42 ).”
What Works to Keep Students in School? A Meta-Analysis of Interventions to Reduce School Absenteeism
Li, D., Singh, S., Jeldi, N., Chang, S., Zhu, M., Dailey, K., Karabukayeva, A., & Cai, C. (2026) · Behavioral Sciences · doi:10.3390/bs16050697 · Cited by 3 · see citing works
“Chronic absenteeism emerges from intersecting individual, family, school, and community factors (Kearney et al., 2023), including structural barriers like poverty, housing instability, and limited healthcare access (Edwards, 2023; Sosu et al., 2021).”
InfluentialSorrenti, L., Caparello, C., Meduri, C. F., & Filippello, P. (2026) · Education Sciences · doi:10.3390/educsci16071074 · Cited by 2 · see citing works
Inglés, C. J., Gómez‐Núñez, M. I., & García-Fernández, J. M. (2025) · Current Psychology · doi:10.1007/s12144-025-07590-9 · Cited by 2 · see citing works
“This educational stage, which ranges from 6 to 12 years old, represents one of the starting points for attendance problems such as school anxiety (Kearney et al., 2023 ).”
School Functioning Among Norwegian Children With a History of Maltreatment
Næss, S. Ø., Sivertsen, B., Hysing, M., Dovran, A., Tobiassen, S., Hafstad, G. S., & Kjørstad, K. (2025) · Journal of Interpersonal Violence · doi:10.1177/08862605251351669 · Cited by 2 · see citing works
“However, absenteeism may also signal academic and mental health struggles, including trauma-related school avoidance, anxiety, and social disengagement (Kearney et al., 2023).”
Studi Kasus School Refusal pada Siswa Kelas Tiga Sekolah Dasar
Putrawan, G. D. (2024) · Jurnal Guru Sekolah Dasar. · doi:10.70277/jgsd.v1i4.1 · Cited by 2 · see citing works
Yu, S., Xu, Y., Li, Y., & Wang, C. (2026) · Educational Studies · doi:10.1080/03055698.2026.2629911 · Cited by 1 · see citing works
“Student absenteeism is a well-established barrier to academic success and educational equity, associated with lower achievement, grade retention, and subsequent educational and economic disadvantage (Balfanz and Byrnes 2012; Kearney et al. 2023).”
A scoping review of the research on school absences and return to school
Laurén-Knuutila, T.-R., Salminen, J., Junttila, N., & Alanko, K. (2026) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2026.2653832 · Cited by 2 · see citing works
Perfectionism and School Non‐Attendance Reasons in Adolescents: A Latent Profile Analysis
Fuster‐Rico, A., Vicent, M., Pérez‐Marco, M., & Gonzálvez, C. (2026) · Journal of Adolescence · doi:10.1002/jad.70173 · Cited by 1 · see citing works
“Theoretical studies have identified perfectionism as an anxiety‐related problem linked to school attendance problems since trying to be perfect to avoid potential failure may reinforce the reluctance to attend school (Di Vincenzo et al. 2024; Kearney et al. 2023).”
Self-citationReid‐Westoby, C., Duku, E., Gaskin, A., & Janus, M. (2026) · PLoS ONE · doi:10.1371/journal.pone.0345192 · Cited by 1 · see citing works
“High rates of school absenteeism are generally seen as an early warning sign for schools, suggesting that children might be struggling either at school or at home [50].”
Hux, G. E., Rice, S., Wicinski, L. B., & Rider, J. V. (2025) · Education Sciences · doi:10.3390/educsci15111501 · Cited by 1 · see citing works
Jones, T. M., Lea, C. H., III, López, A. P., Becker, K., & Malorni, A. (2024) · Contemporary School Psychology · doi:10.1007/s40688-024-00493-9
“Prior to the pandemic, these students were disproportionately affected by problems with school attendance compared to students from English-speaking households (Jones et al., 2021; Kearney et al., 2023; McDonald et al., 2022; Morrissey et al., 2014; Nathwani et al., 2021).”
InfluentialSchool Refusal pada Siswa Sekolah Dasar: Penyebab dan Gejala
Putrawan, G. D. (2024) · Jurnal Pendidikan Guru Sekolah Dasar · doi:10.47134/pgsd.v2i2.1274
“School refusal merupakan permasalahan kompleks yang dapat melibatkan faktor akademis, sosial emosional, kesehatan mental, kesehatan fisik, keluarga, sekolah, dan masyarakat (Kearney et al., 2023).”
Mori, H., Takahashi, M., Adachi, M., Nishimura, T., Shinkawa, H., Osada, M., Adachi, M., & Nakamura, K. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-00953-x
“Based on previous research [14], this study hypothesizes that depression mediates the association between the school environment and school absenteeism.”
InfluentialElouafi, A., Tammouch, I., Nouna, S., & Nouna, A. (2025) · International Conference on Optimization and Applications (ICOA) · doi:10.1109/icoa66896.2025.11236843
“These results underscore the importance of early identification and coordinated school–community responses to prevent long-2025 term disengagement and reduce the risk of school [3].”
Geetha, S., Nanjundiah, G. S., Tikotikar, S. S., & Shravya, P. (2025) · Annual International Conference on Data Science, Machine Learning and Blockchain Technology (AICDMB) · doi:10.1109/aicdmb64359.2025.11277582
“Key factors such as socio-economic status, mental health, family circumstances, and community involvement significantly influence a student's educational path[10].”
Missing Classmates and Attendance Patterns in Elementary Schools
Kirksey, J. J., Gottfried, M. A., Ansari, A., & Lansford, T. (2025) · American Educational Research Journal · doi:10.3102/00028312251400716
“Likewise, health-related issues—both acute illnesses (e.g., flu) and chronic medical conditions (e.g., asthma)—are significant contributors to student absenteeism, particularly when healthcare access is limited (Allison et al., 2019; Kearney et al., 2023).”
Gómez‐Núñez, M. I., García-Fernández, J. M., & Inglés, C. J. (2026) · Psicologí a Educativa · doi:10.5093/psed2026a3
Dahlqvist, H. Z. (2026) · European Journal of Educational Research · doi:10.12973/eu-jer.15.2.497
Associations of distal elementary school characteristics with prekindergarten student
Bratsch‐Hines, M., Kuhn, L., Witte, A., Franco-Jenkins, X., Abdul-Masih, M. Y., Ansari, A., Koziol, N. A., Lin, T., Purtell, K. M., & McCormick, M. (2026) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2026.101928
Adynski, H., Huus, K., Granlund, M., Hoffman, T., Pakpour, A. H., & Eriksson, M. (2026) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2026.02.022
Advancing socially just and anti-racist approaches for school attendance problems
Kearney, C. A., Ellis, K., & Arcaina, V. J. (2026) · Social Sciences & Humanities Open · doi:10.1016/j.ssaho.2026.102779
Self-citationPhenomenising school refusal – when long-term school absence turned into school refusal
Knage, F. S., & Frydenlund, J. H. (2026) · Scandinavian Journal of Educational Research · doi:10.1080/00313831.2026.2662232
Will attendance-based grading improve school absenteeism?
Whitley, J., Rogers, M., McBrearty, N., & Smith, D. (2026) · doi:10.64628/aam.skdwchrp6
Graham, P., Carrick, A., Littlefair, D., Melo, D., Mulholland, K., Graham, P., Bradley, G., Davies, C., Speyer, R., & Cordier, R. (2026) · Educational Research Review · doi:10.1016/j.edurev.2026.100791
Dong, X., & Zhou, M. (2026) · BMC Psychology · doi:10.1186/s40359-026-04834-6
“Identifying the causes of chronic absenteeism and developing intervention strategies are of considerable practical importance [7]; however, a more critical question lies in revealing how absenteeism gradually accumulates and recurs.”
Disengaged Responses, Distorted Risks: Evaluating Effort on Student Risk Assessments
French, B. F., Gifford, L. P., Herr, R. D., Finney, S. J., & Galangue, D. (2026) · Journal of Psychoeducational Assessment · doi:10.1177/07342829261455562
“Screening systems in education frequently prioritize sensitivity when the cost of missed risk is high, and support early identification (e.g., Kearney et al., 2023; Wu et al., 2026).”
Santiago‐Rosario, M. R., Falcon, S. F., Austin, S. C., Nese, J. F. T., Sullivan, M. M., Daza, T., Calhoun, T., Cerdan, H., & Nese, R. N. T. (2026) · Behavioral Sciences · doi:10.3390/bs16060984
“This is critical, as nineth grade course performance and attendance are among the strongest predictors of graduation and dropout (Kearney et al., 2023).”
Using routine school data to support adolescent well-being in resource-limited settings
Nguyen, N. P., Nguyen, T. H. A., Ha, A., & Nguyen, P. L. (2026) · Discover Public Health · doi:10.1186/s12982-026-02482-0
“This approach aligns with evidence that effective responses to student risk signals require functional, context-sensitive assessment [38].”
Yalçın, S., Kazak, E., & Er, O. (2026) · Boğaziçi Üniversitesi Eğitim Dergisi · doi:10.52597/buje.1883210
Smucny, J., Lesh, T. A., Niendam, T. A., & Karcher, N. R. (2026) · Psychological Medicine · doi:10.1017/s0033291726105121
“Mood and anxiety disorders have been associated with school absenteeism, lower grades, and withdrawal from peer relationships (Achterbergh et al., 2020; Dalforno, Wengert, Kim, & Jacobsen, 2022; Finning et al., 2019a, 2019b; Kearney, Dupont, Fensken, & Gonzálvez, 2023; Kupferberg & Hasler, 2023).”
Social relationships to stimulate students’ learning
Gidlund, U., & Ivarsson, L. (2026) · Educational Studies · doi:10.1080/03055698.2026.2700349
“Graduation from upper-secondary school has become increasingly important for students’ future employment and lives (Ekstrand 2015; Kearney et al. 2023).”
Ren, Y., Feng, M., Jia, S., & He, L. (2026) · Journal of School Health · doi:10.1111/josh.70194
Bokelmann, L. (2026) · Absentismus und Dropout · doi:10.1007/978-3-658-51711-3_7
Aidonopoulou‐Read, T., Pyer, M., Bodycote, B., Campbell, J. A., & Pyer, K. (2026) · British Educational Research Journal · doi:10.1002/berj.70222
Vanneste, Y. T. M., Drost, N., Neves, S. C., Roseval-Splinter, J., Pruis, M., der Wind, M. V. E.-V., & Mathijssen, J. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-15175-w
Ahmad, S., Anwar, A. I., Khan, A. A., & Ahmad, A. (2026) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20262699
Masquete, A. J., & Genton, E. A. (2026) · Psychology and Education A Multidisciplinary Journal · doi:10.70838/pemj.600803
Teachers’ Well-Being and School Culture: A Mixed-Method Approach to an Action Plan
Basister, P. (2026) · Psychology and Education A Multidisciplinary Journal · doi:10.70838/pemj.610404
Turner, J., Kyobutungi, V., Ayozu, H., D’Sa, N., & Jordans, M. J. D. (2026) · PLoS ONE · doi:10.1371/journal.pone.0357215
“Compounding the issue of dropout is low and irregular school attendance, which is considered an indicator or “early warning signal” of wider system instability at the student, family, school and community levels [8].”
How chronic absenteeism shifted in Canadian kindergarten after COVID-19
Reid‐Westoby, C., & Janus, M. (2026) · doi:10.64628/aam.4qjgxj3x5
Olsen, M., Andersson, M. J., & Claesdotter‐Knutsson, E. (2026) · Scandinavian Journal of Educational Research · doi:10.1080/00313831.2026.2733213
Meduri, C. F., Caparello, C., Imbesi, M., Gonzálvez, C., & Sorrenti, L. (2026) · Behavioral Science · doi:10.3390/bs16091664
“…of preventive intervention, which lies precisely in the gap between psychological vulnerability and behavioral manifestation, allowing professionals to act while students are still attending school, rather than after absenteeism has already taken root (Kearney et al., 2023a; Li et al., 2026).”
InfluentialSelf-citationAmparo, M. B. (2026) · International Journal of Sustainable and Integrated Studies · doi:10.65339/ijsis.v1.i2.105
“Attendance problems are multifaceted and require systematic assessment rather than punitive responses (Havik & Ingul, 2021; Kearney et al., 2023).”
PERTENCIMENTO ESCOLAR, VÍNCULOS, INFREQUÊNCIA E DESENGAJAMENTO NA ADOLESCÊNCIA
Silva, J. A. A. D. M., da Silva, L. J., Santos, E. S. L., Veras, K. P., Araújo, R. D. S., Pinheiro, S. M. B. D. S., de Oliveira, C. L. D. C., Campos, S. B., Oliveira, A. T. S., Mesquita, I. M. D., et al. (2026) · South American Sciences · doi:10.63330/sasciencesv6n2-214
Ljungblad, A.-L., & Hellström, L. (2026) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2026.2740237
“One visible manifestation of these challenges is rising school absenteeism, where increasing absence may signal underlying struggles with well-being and belonging (Kearney et al., 2023).”
Tibane, C. C., & Mafa-Theledi, O. N. (2025) · Education and human development · doi:10.5772/intechopen.1014068
Ke, S., Kearney, C. A., & He, J. (2026) · The Asia-Pacific Education Researcher · doi:10.1007/s40299-026-01143-9
Self-citationFensken, M., & Kearney, C. A. (2026) · Community Development · doi:10.1080/15575330.2026.2746098
Self-citationElouafi, A., Tammouch, I., Eddarouich, S., & Laassar, I. (2026) · Large-scale Assessments in Education · doi:10.1186/s40536-026-00327-5
“…identify health problems, disengagement, family constraints, socioeconomic disadvantage, school climate, and features of the educational environment among the factors associated with attendance difficulties (Gubbels et al., 2019; Sosu et al., 2021; Kearney & Graczyk, 2020; Kearney et al., 2023).”
The short- and long-term outcomes of student absenteeism – a systematic literature review
Demir, E. K., & Henrekson, E. (2026) · Educational Research Review · doi:10.1016/j.edurev.2026.100863
A qualitative meta-synthesis of adolescents’ perceptions of school attendance problems
Kalvatn, A. S., Inglingstad, M., & Rasalingam, A. (2026) · Frontiers in Education · doi:10.3389/feduc.2026.1892533
- Authors
- Kearney, C. A., Dupont, R., Fensken, M., & Gonzálvez, C.
- Affiliations
- University of Nevada, Las Vegas (US)
- University of Alicante (ES)
- Corresponding author
- Kearney, Christopher A.
- Venue
- Frontiers in Education
- Publisher
- Frontiers Media SA
- Published
- 2023-08-30
- Volume
- 8
- ISSN
- 2504-284X (ISSN-L)
- OpenAlex
- W4386330902
- Cited by
- 71
- References
- 233
- Citations by year
- 2026: 42 · 2025: 18 · 2024: 8 · 2023: 2
- FWCI
- 51.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Education (publishedVersion, cc-by)
- RUA, Repositorio Institucional de la Universidad de Alicante (Universidad de Alicante) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Universidad de Alicante
- Topics
- Social Sciences › Education › Youth Substance Use and School Attendance
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- school attendance, absenteeism, early warning indicators, complexity theory, mental health, social-emotional functioning, family functioning, school-based practice, multi-tiered systems of support, community asset mapping, systems of care, health care access, education policy
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