Subscribe
Share
Share
Embed
Welcome to the Nimble Youth podcast, where we provide expert insights and valuable resources for parents navigating the complexities of their children's mental health. We empower parents to nurture healthy minds in children, teens, and young adults through real conversations.
Our team of seasoned professionals, including physicians, therapists and educators, delve into pressing topics, share research-based strategies, and offer practical advice for fostering mental and emotional well-being within your family.
Welcome back to Nimble Youth, the podcast where we explore what's really going on with kids today and how we can better support their mental health, learning, and lives. I'm your host, Matt Butterman. Today, we're tackling a topic that's been quietly growing into a national crisis, chronic school absenteeism. Our coverage was inspired by an article in the New York Times by reporters Sarah Mirvash and Francesca Paris entitled Why School Absences Have Exploded Almost Everywhere. We will provide the link to this article in our show notes, for this episode available at the Nimble Youth website.
The numbers are dramatic, and they tell a story. Before the pandemic, about nineteen percent of US Students were chronically absent, defined as missing 10% or more of the school year. Fast forward just a few years, and that number has nearly doubled. According to the US Department of Education and the National Center for Educational Statistics, twenty eight percent of students nationwide were chronically absent in the twenty twenty one-twenty two school year. Some estimates even put that number as high as thirty one percent.
And while there's been a small dip, we're still far from pre pandemic levels. Here in North Carolina, we're seeing similar trends. In the twenty twenty two, twenty three school year, twenty seven percent of students, over a quarter of them, were chronically absent. State leaders have set an ambitious goal to bring that number down to eleven percent by 2030. But to do that, we have to understand why so many students are missing school and what families, educators, and communities can do about it.
In this episode, we'll dig into the root causes of absenteeism. Among them are mental health struggles, school avoidance, family stress, disengagement, and the systemic barriers. We'll share practical strategies for reconnecting students to learning, not just by enforcing attendance policies, but by addressing the deeper needs that kids stay home for. Because when students aren't showing up, it's not just a school issue or an education issue. It's a mental health issue, and it deserves our attention.
Joining me today is doctor Gretchen Hoyle, a pediatrician with twenty five years of clinical experience. She's here to help us make sense of what's going on and what parents, schools, and communities can do. Before we get into it, we remind you that the content of this podcast is intended for informational purposes only and should not be construed as medical advice. While we aim to provide valuable insights on pediatric mental health, it's important to consult with a qualified health care professional for any concerns or questions regarding your child's mental well-being. Always seek the advice of your doctor or other qualified health provider with any medical concerns.
So, doctor Hoyle, let's start with the big picture. We keep hearing the term chronic absenteeism. What does that actually mean? Yeah. So chronic absenteeism is defined as missing, like, 10% of the school year.
So most schools are set up on a hundred and eighty day calendar, and so that means eighteen days where they're absent. But in clinical practice, I will say that, I have some kids in my practice who are chronically absent, and they have blown away the past eighteen days. Like, they are missing way more than that. And so, I think it's difficult to really even capture what's happening out there with this problem. Right.
So before the pandemic, about fifteen percent of US Students were chronically absent and now it's twenty eight percent. So Yeah. Why why such a huge jump? Right. So I definitely think that several things happened, like, when we were in the shutdown, and I think that those things are gonna continue to resonate for some time.
Okay. So the kiddos who I'm taking care of now, and let's say they're in high school, they would have been in, like, in late elementary school or maybe middle school during COVID. I totally understood why we did it. We had to do it, but at the same time, we made it so that school was not did not have to be an embodied experience. Right?
So when we talk about embodied experiences and, you know, in previous podcasts, those are qualitatively different for our brain. Right? And and, and being in person doing something is different from, you know, being online. And, of course, the younger you are, the more, you know, impact that has. And so I do think for kiddos who are, who who were affected by the pandemic, they had a period of their education that was, sort of is was was disrupted and that the pattern and the habit of school being an in person experience was disrupted and now it can be it can be looked at as sort of it's optional as to whether or not it has to be in person.
Right. During the pandemic, it was a necessity. Correct. It was born of necessity Yep. Doing online school.
But now, unfortunately, many students are choosing that option. Right. Right. It is, you know, for them, it's, it's easier. Right?
They don't have to face situations that make them uncomfortable. Correct. I mean, that's a big part of it. And I will say, like, you know, there are tons of folks who have opted into, like, a virtual experience for school, whether that be just a homeschool, like, setup or whether they are in a virtual, like, synchronized school experience. Sometimes those are being provided by the school system.
And those folks are not gonna be captured in these absentee, you know, data because they're not absent. Right? They're they're and so so when we're looking at these numbers that have gone up, those are folks that are still opting in to being enrolled in in person school. And so it's, you know, it's pretty alarming as to, like, how many kids are absent for such a significant period of time during the school year and how much that has really, really shifted. And so kids get into a pattern where they'll, they'll opt to miss school.
You know, they'll find a convenient excuse, for missing school and staying home. And then when they have to go back, you know, it becomes, to use a $5 word, a Sisyphean task. They're they're at the bottom of the hill again. They're faced with rolling this boulder up the hill, and every time they miss, periods of days, you know, they start at the bottom of the hill again. Right?
Right. And the hill keeps getting bigger. And so, so so definitely, like the absenteeism data, there are lots of different reasons for kids to miss school. Some portion of that is health related. And so, but not all of it.
So some of it is like logistical stuff and transportation and stress on the family and responsibilities for younger siblings and lots of social things that are happening that are keeping kids out of school. But of course what I take care of in the clinic is kids who are out of school for quote unquote health reasons. And you know, fortunately for me that sort of batched into just a generic term and so it doesn't really distinguish between physical health or mental health. But my experience has been that there is a ton of overlap between those two things. And so what I will often have happen is that I'll be seeing kids who are missing a good deal of school for, for health reasons that are typically framed as physical ailments.
So often abdominal pain, GI distress and troubles, such as, you know, nausea, vomiting, diarrhea, and or headaches. Sometimes it's menstrual pain. Lots of different physical ailments that can cause a child to want to stay home from school. But then somewhere along the line, if that goes on for some period of time, it then becomes a real problem for them to get back, to be willing to go back to school because they have now set themselves up to be in a really tough position. They've missed so much of their academic work.
They've missed so much of what's been going on socially, and they feel very out of step. And the thought of even going back feels overwhelming to them. And so, it can often be, the problem is complicated by the fact that when kids stay home from school, they're oftentimes not really, you know, resting, sleeping, but they're, they're immersed in gaming, watching TikTok or or things like that. Right. Or they're occupying their mind with more pleasurable pursuits.
Correct. So that becomes a really, really hard problem to tackle. So the parent who, you know, has a child who maybe is starting to to fall into this pattern, how do you, how do you approach that? You don't wanna be obviously, doing something that's gonna cause them, you know, pain and suffering. Right.
But, you also wanna be, you know, firm enough. Compassionate by firm, I guess, is the key phrase here. Right? Right. Right.
And so and so typically, the scenario is that they are presenting to me about their physical symptoms. Right? So abdominal pain or headaches or menstrual pain or whatever it is that is, you know, bringing them into me as a physician. And they are, and the idea here is that we need to try to figure out if there is something that is the source of this pain that we need to address sort of emergently. Like, do they need to be in the hospital, or do they need some, you know, additional, like, subspecialty care to help figure it out?
What kind of things do we need to do diagnostically to try to, to try to evaluate the problem that they're presenting with. But there are some things that can tip parents off to not that the child is not having this pain or discomfort or whatever symptom it is that they're describing, but that the symptom may be more driven by their psychological or emotional state than it is by their physical state or some combination of both. So a lot of times what I will see is kids who will have significant difficulty with, you know, some sort of bodily pain, but that's happening, you know, only on school days. During the day, they tend to be able to recover in the afternoon or evenings. They're able to do other things.
On the weekends, they seem, you know, fine. And then when it's time to go to school, that symptom recurs. And so, that is often the thing that sort of tips me off to the idea that, you know, this may be more about, school avoidance or sort of school phobia, anxiety that's driving this problem and that maybe we need to look a little bit deeper into into what's happening in that, you know, realm. Right. So it's a battle of behavior.
Right? It's changing these, these cycles that kids get into. Mhmm. And so parents and families really are on the front lines of that battle. So what do you recommend, Yeah.
So so and and the other way to look at this too is that this is kinda like that push pull that we were talking about in a previous podcast, that was sort of set up in the anxious generation that kids are being pushed out of the embodied world. And so school, in person school, is an embodied experience. And there are things about school that for a lot of kids feel overwhelming or make them feel anxious or the social environment, or just the pressure academically. Those are things that they are feeling that are pushing them, you know, out of the in person school. And yet at the same time, they are getting pulled into the virtual world by the things that we had sort of, you know, also discussed and keeping in mind that the virtual world, meaning, like, being on their phone or gaming, those are kind of the two big things where they get pulled into that.
And there is a multibillion dollar industry that is, you know, that that's what they do. Right? That is their whole financial model is to engage your child on their platform for as long as possible. And so whether or not your child goes to school or is functioning in their day to day life is really of no interest to them. It's just a matter of trying to keep them engaged.
And so that is a hard those two things together have set up a real challenge for kids to be able like if you are presenting their that child's brain with a choice between going to an embodied experience in school that that carries with it, you know, some positive things but also some scary things versus a virtual experience where they can stay home and enmeshed and, you know, the exact thing that they, you know, that their brain, you know, wants to be doing, not needs to be doing, but wants to be doing, then they it's really not a hard choice for them. They're pretty much always going to choose that path of, you know, staying out of school and at home, you know, engaged in virtual experiences. Right. Because this is not only a mental health issue or it's a nuanced mental health issue. It's really, in many cases, an addiction issue.
Right? It is. Yeah. And that, I think, is what we're starting to grapple with. I mean, I think that, you know, I I think it is important for folks to recognize that what is happening with kids on their phones and with all of us and on our phones is that the same pathways that other substances trigger, so that dopamine reward pathway system in your brain that's in sort of the lower part of the brain that gets rewarded when you're doing something that you find intrinsically interesting or rewarding to you, that gets activated and that is the same like pathway that happens in other addictions.
So anybody who has, you know, taken, like had a child who, you know, you like, I'm gonna give you the iPad so that we can sit nicely in the restaurant and when your food comes, I'm gonna, you know, I'm gonna take it and we're gonna eat. And then to have that child then throw an enormous fit when you try to take that away, I think that that resonates with families and with parents that, like, yeah. There's an addictive quality to these devices. They're designed that way. And that if you put that up against going to school in person then that's going to be a very hard sell.
Right? And so, I do think that what I will tell parents is that okay, generally speaking it is like the expectation is that the child needs to be going to school. And that expectation needs to be explicitly stated and clear. Right? Correct.
And we need to sort of take it out of the child's hands so that they don't even have to be anxious about trying to make the choice about it. Like, they need to feel like this has already been decided and and and you are going to school. We're gonna figure out how to make this work. Right? And so that and I and I think the concern that parents have is that they are going to send a child to school who is really sick.
And that happens all the time. Okay. So, like if you're, you know, kid's like, okay, well, you know, I don't feel well this morning. And then you're like, well, you're going to school. And then you send them and then they spike a fever or they throw up at school and then you bring them into us and we, you know, check them over and find out that they have strep throat.
And you're like, oh, you know, yeah, I feel bad that I sent you to school. You told me this morning that you weren't feeling well and now you're sick. And, and, you know, that that is okay. You know? I'm sorry.
It happens all the time. Yeah. It happens all the time. And so I think that folks get a little really concerned about making that error. Like, the error being, like, sending their child when they shouldn't.
My contention would be that the bigger error is to allow a child to stay home when they potentially could go to school. And so that is probably a super popular opinion, under, you know, in some circumstances. I think that the schools are somewhat ambivalent about it. Right? Because for so long, we were telling people, if your child is at all sick or during COVID, we were like, do not send them because, you know, we don't want an outbreak.
But, of course, you know, all that happened kinda anyway. But, you know, now the now with the absenteeism crisis, it is more that schools, I think, are aware that they're going to have the occasional kid who came in looking puny actually turn out to be sick, and the parent's gonna have to come pick him up. And that is just happens all the time. Right. It's just normal parenting, and, and just a a normal part life.
And, you know, it's a bummer, but it also is something that's, you know, that is, is not I think that that error, I think parents get really worried about that error. And in my opinion, that error, the worst error to make is to allow them to stay home when they really probably could go. Right. But for the child who does have a legitimate reason to stay home, they're running a fever, they're they have the flu or something, what parents can do is just limit the use of Yeah. Of technology.
Yeah. So this is a tough one too. So you're like, okay. So, yes, there are definitely times when I will see people in the clinic and, like, you have strep throat or some other illness that, you know, you have a fever and you do need to be. I even make criteria for isolation. Like you should not be around other people for their benefit and for your own benefit.
Okay. So you do need to stay home from school and that is, you know, a rational absence. But I would also say that under those circumstances, the child should not be allowed to have virtual experiences while they're home. Right. From school during that school time because it is going to set up in their brain the connection between being at home and being able to engage in that very addictive quality activity.
And that can be a real problem because what will happen is or for some kids is that the next day they'll wake up they're like, oh, I'm still not feeling great. They really wanna stay home another day. And then like, well, okay. Well, you know, let me get you another day to rest. And, and then now they're two days behind in their work.
And then all of a sudden you're out for like a week and now you're in this process of, oh goodness, you know, we're we're really behind. So now every day is some other complaint that makes it hard for them to go to school and you've gotten into a pattern. And that pattern is very, very easy to fall into. It happens all the time. And I do think that it is contributing to these numbers that are, coming out about how many people are absent, you know, in a on a in a given school year.
Yeah. And and so the schools have a role to play in breaking the cycle as well, don't they? And some schools have started to move to restrict or even prevent phone use in the classrooms. You have a couple of personal anecdotes about that. Right?
Right. Right. So I really feel like there's very good evidence that shows that people feel better when they have had a break from their phone. Okay? And so I really think that one of our best options to address this problem is to make it so that classrooms are a phone free environment.
And this is supported by lots of data, and also supported by, you know, my son who is a first year teacher teaching ninth grade, and talking about how challenging it is to teach and to get anything done in a classroom setting where kids are, you know, kind of constantly on their phones. And so, there is starting to be, you know, rules and legislation that is happening out there to make this process more doable, in the classroom setting. And so one of the things that parents can do is to be supportive of whatever policy the school's classroom or the teacher comes up with to be able to restrict phone use during class time, we really need parents to support that. Right. And sometimes parents have not actually not been on the same page.
Right? They've Right. They've actually encouraged the use of phones at schools. Yeah. So the way that this goes is typically like this.
So the parents are like, well, you know, that that phone is our property. I want my child to be able to have that phone on their person. It's often a very expensive item. Sometimes these are thousand dollar phones that kids have and that the parent does not want them to want to be able to reach the child at all times. And the logic behind that I think, is, you know, so much challenging because, like, you know, of course, in previous generations, you couldn't do that, but now the expectation is that you are able to reach your child at all times.
What if it's an emergency? Well, it used to be that you had an emergency. You call the office. I mean, all of the logic there, I get. I do think that there is some concern from parents' perspective if there is something tragic happening at the school and they want to be able to have immediate contact with their child.
And so that's a whole separate issue to discuss as to why that is happening. But, I think that that is some of the fear that is driving this for parents about wanting their child to have constant access to their phone. But if you like push back on the idea that we're gonna use either or the child would not bring the phone to school typically, we're gonna use either or the child would not bring the phone to school. Typically, parents are not able to kinda handle that and kids are not able to handle that. And they will say all sorts of things about how well I need to be able to, you know, take a picture of the board as to what the assignments are and make sure that, you know, I'm able to communicate with the friends that I'm studying with.
And I get all that. All that does not necessarily mean that you need access to your phone throughout the class time. Okay. So a lot of times what's happening is people are using teachers, like, phone lockers in the classroom where you can put your phone into that locker and you are still able to see it, but you just can't get to it. So that you know that no one has stolen it, that it has not been, you know, broken, and that no one is going through it.
But you can still see it and you know that it is safe, but that you are not able to access it. And that is really, I think, where we want to be going because as it turns out, it's not just good for the kid who is not on their phone, but it is great when none of the kids are on their phones. Right? Especially during class time, they can have actual authentic embodied experiences with other kids that their brains really need. So if you think about your phone as something that you really want, but what you need is those in person embodied experiences.
And when you get more of what you need then you're actually happier. Right? So that's because if you are in a setting like especially in a classroom setting where everybody's on their phone then it's basically kinda like, you know, it's and it has an addictive quality to it. So you're with people who are basically using an addictive substance, right, or or, experience. And so when you try to interrupt them from doing that, they become irritable.
There is lots of arguing about who can do what at what time. It's pushing back on the teacher about trying to get their attention to be able to proceed with the classwork that needs to get done and the lesson plan. And so getting the phone out of that equation has been proven to be effective and helpful in a classroom setting. And so I would really encourage us to see this set up up as school as being an embodied experience that developing brains need and that especially in the classroom if they're not gonna be on their phone then it will start to connect in their brain that they're actually happier in that setting and that may be a big part of getting them to be willing to be in school on a regular basis. Right.
We've all heard and perhaps experienced, stories about children going to a summer camp that's tech free. Mhmm. Dragging their feet, whining about, you know, being sent to the camp, on the way up. And then parents come to pick them up a few weeks later and they're happy and beaming and Yeah. Just so much healthier.
Overall. It is. It is so much healthier for them to be in embodied experiences and it really is, it just tells us that we need to have a better plan for them because their brains are not gonna be able to make the right choice here. Right? So as adults and, you know, as folks who are taking care of kids, we need to be able to facilitate that correct choice for them.
And certainly, you know, limited phone exposure and especially being able to do that, like, in a school setting is, I think, extremely important. And I think it's part of what might help us right the ship as far as absenteeism. Right. For the kids who have fallen into the chronic absenteeism spiral, we're often seeing a comorbid rise in anxiety and depression, which makes sense. Sure.
If you miss school, you're gonna be more anxious about going back and, you know, possibly depressed about it as well. So sometimes, getting a child into a therapist can be a useful solution. Right? Absolutely. So we do wanna treat like we wanna deal with whatever the underlying health condition is that is keeping them out of school.
And so sometimes that is making sure that we have evaluated and worked up the, whatever somatic complaint it is that they have. I will also caution parents to say that, unless a child is physically sick enough for us to look at them and say, oh, you need to be in the hospital, then there is going to be some lag time between being able to start the workup for something like abdominal pain or headaches, and when we're actually going to be able to potentially get into a specialist or get labs back or get imaging back or whatever it is that we're gonna do to work it up, there's gonna be some lag time. It is crucial that the child is attending school during that time. So it is not the kind of thing where I think in the past we've been like, okay. Well, if you're gonna if you're gonna land on the idea that this is what we used to call psychosomatic and that it's a psychological problem that's driving their physical symptoms.
If you're gonna land on that as a diagnosis, then that needs to be a diagnosis of exclusion where you have ruled out anything possibly physically wrong with them and landed on it being a psychosomatic problem. But I would say that that rule out period is often fairly substantial and that if at all possible they still need to be going to school during that time. And so most of the time these evaluations that we will do under these circumstances are not going to yield a medical diagnosis or a conventional medical diagnosis. Occasionally, that will happen. There if we need the child to try to be in school during the process of working this up.
Because otherwise, it's just gonna get harder and harder to go. So let's be that sort of, the approach with our somatic complaints, physical complaints for anxiety and depression. And also possibly ADHD can play play a big role too because, you know, so much of school is executive functioning that if you're struggling with being able to, you know, pay attention to what they need you to do and keep up with all of your assignments and be able to function on the, in the academic world that you're in, then dealing with those conditions, treating the underlying problem there is really important. And we would sort of then revert back to the, you know, previous discussions that we've had about how we evaluate those problems and manage them. But, certainly for kids who have missed a lot of school, seeing a therapist can be extremely helpful in trying to get to the root cause of what is the origin of their distress and how to deal with it.
-Right. Right. So, when absenteeism becomes a big issue, you are seeking a solution from the perspective of a medical professional. The parents have their role to play in terms of helping to change the behaviors. And with the understanding that you're not a, you know, a policy expert or or an education professional, What's your take on how schools are responding to this?
Right. So I'm very optimistic. It looks like there has been a good deal of movement on this, on this front with different, like, legislation that's starting to pop up. And a lot of legislation is just like, okay. We need to have a policy about phones in the classroom.
Like, how are we gonna handle this? And making it so that the recognition is there that this is, you know, causing a significant amount of trouble. And so, and honestly, like, I don't think that it has taken up until now or fairly recently for us to really understand the impact that this is having on young people, and the impact that it's having on their learning. And so, you know, I'm optimistic. I think that the concern that I have at least from, you know, from the folks that I know in education is that the pushback is gonna come to some degree from the kids themselves, and then also potentially from the parents.
And we really need to have a unified front for everybody to recognize that we wanna support this idea of minimizing phone use and especially during class time. Right. Yeah. And I guess over, you know, a a long period of time, chronic absenteeism potentially can become, you know, illegal or or a truancy issue. Most school systems want to avoid going down that road of punishing parents.
Right? Yeah. That's their last, you know, that's their last, like, option there. Yeah. Last resort.
They they they you know, it it has been really challenging because we we would get, like, during COVID, we all got really used to, testing people for, you know, COVID and then giving them a note that says that their test was negative so that they could go back to school. And that was like, if they didn't have that note from us, then they couldn't go back to school. And now it feels like, when kids miss these significant number of days of school, that they now need a note from us to say, like, that they are in order for these absences to be excused. Right? Right.
So it it just feels like the, you know, the priority has has shifted it, and I feel like that, that probably that is a little bit hard for folks to get used to, that we're really trying to push kids back into the classroom setting when for a while there, we were very restrictive of who could go to school. Right. And so, you know, I I think that as we, you know, continue to figure out how to set policy around that, that there while there are some thresholds that you can meet that then triggers, like the like, truancy letters and, you know, really strongly worded letters from schools about, you know, the potential repercussions for parents if children aren't attending. That is, you know, but definitely their sort of last resort. And frankly, you know, what I'll see more often is that, like, you know, when they typically, when they turn 16, if this if it's a high school situation, then when they turn 16, they kinda stop chasing them.
So sometimes it's just like running out the clock where you're trying to get, you know, as much engagement as possible and before they, kinda age out of the system in which they're, they're required to have compulsory attendance. And so while that is a strategy, I think that, the more probably effective strategy is to try to do the things that a lot of schools are doing, which is trying to engage with the community to get kids back into school by, by focusing on, like, family engagement. Right. And then certainly that's your role as a medical professional is to help the families, break the cycle. So for the parents who are in this cycle, I guess the bottom line is, first of all, know that this is a common problem.
You're definitely not alone. Try to break the cycle early on, by keeping routines and setting clear expectations, and then, you know, ask for help. Yep. Absolutely. Whether it's coming to you, then you can set the ball rolling in terms of interventions that will help the cycle.
Right? That's correct. That is a big part of what we're doing nowadays. We're using a lot of our collaborative care strategies to do this because it's a chronic condition. And so, you know, that can be really helpful.
But, yeah, that's a big part of what's happening in the pediatrics clinic. And because it's because of the numbers that you're, you know, quoting, it's like a quarter of kids are in this position of meeting the threshold of having chronic absenteeism. Right. As with so many of the issues that we discuss, getting an early start makes a big difference Yep. In, you know, effectuating a positive outcome, for the situation.
Well, thank you, Doctor Hoyle, for your insight and help, and I hope this gives your family some guidance for how to tackle this problem. That wraps up this episode of Nimble Youth. If you found it helpful, please subscribe, leave a review, and share it with someone who might need it. You can find all the recordings, transcripts, and show notes from past episodes at our website, www.nimbleyouthpodcast.com. And until next time, please be well and take care of each other.