School Attendance and Health Care: Why Chronic Absenteeism Isn’t Just About Truancy

Editor’s Note: This is part 1 of a two-part conversation with Attendance Works Director Hedy Chang. Chang spoke to us about the critical role health care can play in closing the attendance gap. Attendance Works is a national initiative aimed at advancing student success by removing barriers and encouraging children to attend school regularly. A report Attendance Works released with Healthy Schools Campaign points out that health problems like asthma, dental pain and mental health issues are among the leading causes of absenteeism.

Q: Attendance Works and Healthy Schools Campaign just released an eye-opening report that focused national attention on the importance of school attendance. Can you share some of your findings and explain why we should all worry about school absenteeism?

A: We set out to diagnose the absenteeism problem in our nation’s school, what we call “mapping the early attendance gap.” We wanted to know the who, what, when, where and why of absenteeism.

We found some things that might surprise you, like the fact that kindergartners miss nearly as much school as teenagers. Other findings were more predictable, like the fact children from low-income families are more likely to be chronically absent, meaning they miss 10 percent or more of the school year. We also found, again and again, that health challenges are part of the problem and health providers are part of the solution.

Q: Your research suggests three chief causes for chronic absenteeism: misconceptions about the importance of regular attendance, aversion to showing up for class, and barriers to reaching school every day. What role does health play in these?

A: Health care challenges — whether physical or mental — play a part in all three. When we talk about absenteeism in this country, we tend to think about skipping school and truancy. But the reality is that illness and the lack of access to health care contribute to a whole lot of missed days. Many of these absences are excused, but the kids are still missing school and missing out on instruction.

In some cases, the illness is the barrier to attendance. Students with asthma, for instance, miss 14 million days of school a year. This is especially true for low-income children without access to a doctor who can help them manage the condition. A parent’s illness, whether related to physical or mental health, can also make it hard to get to school every day.

In some cases, aversion is connected to illness. The kindergartner who complains of a stomachache may actually be anxious about going to school. The high school student who skips school may actually be depressed.


In terms of misconceptions, these come into play in the early grades when families don’t realize how important attendance can be. They need help figuring out when they should still send their child to school because, for example, they just have a mild stomachache or if their child is truly too sick for school. Access to a doctor or a clinic can help with this.

This research summary from the Healthy Schools Campaign documents how health factors contribute to absenteeism.

Q:   I was astounded to read that a full 20% of children ages 5 to 11 have at least one untreated decayed tooth and that dental problems account for nearly 2 million lost school days each year. Even if a child with a toothache is able to get to school, I can imagine that the pain would interfere with concentration and learning.

A: That’s exactly right. The pain from toothaches can cause children to miss school or lose concentration when they’re in the classroom. Other students miss school for dental appointments. Prevention is key here. The fact is many low-income students don’t have regular access to a dentist. Some schools are dealing with this by bringing dental services to school campuses. A promising model in California, called tele-dentistry, involves a dental tech coming to schools for check-ups and X-rays and referring students with cavities to a dentist.

Q: Your report also mentioned the importance of mental health care. Lower income families have fewer resources available to address childhood anxiety and depression, and their children are often exposed to more stress and trauma in their lives that could trigger mental health issues. What improvements would you like to see in this area?

A: The absences that result from mental illness are harder to quantify but are just as significant as the physical problems that keep students from getting to school. You mentioned trauma. Children suffering from trauma because of violence in their communities or their lives sometimes act out in class, leading to suspensions and more missed days. As I said before, anxiety and depression keep some students home, as do their parents’ mental health challenges. And if they don’t have access to counseling services, the problems only get worse.

Schools are seeing some success when they partner with community providers to bring mental health counseling to school campuses. Mentoring by school officials, volunteers or older students can also be an effective strategy. Also there is a promising national trend toward creating more positive, supportive school environments sensitive to the needs of children suffering trauma.

Q: Can you comment on how early diagnosis and treatment for children is connected to school attendance?

A: Early diagnosis is key to getting children off to a strong start with attendance. If we can get ear infections under control early on, we can cut down on absenteeism. If we identity the children who need support for developmental delays and learning disorders, and provide treatment we can help them become stronger, more engaged students. Teachers tell us that some of the aversion-related absences come when children suffer undiagnosed learning difficulties and don’t feel like they can be successful in school. This is also true for children with vision and hearing problems.

It’s important to remember that absenteeism starts early and, if not addressed, leaves students struggling to catch up in the later grades. Our interventions need to start early, too.

Editor’s Note:  The second part of the interview with Hedy Chang of Attendance Works will be posted on Say Ahhh! tomorrow.