Åhslund, I. (2021). How students with Neuropsychiatric Disabilities understand their absenteeism International Online Journal of Education and Teaching (IOJET), 8(4). 2665-2682. Received : 26.07.2021 Revised version received : 11.09.2021 Accepted : 14.09.2021 HOW STUDENTS WITH NEUROPYCHIATRIC DISABILITIES UNDERSTAND THEIR ABSENTEEISM (Research article) Ingela Åhslund ingela.ahslund@miun.se Department of Education, Mid Sweden University, Sweden Correspondence: ingela.ahslund@miun.se Biodata: Ingela Åhslund, licentiate in Education at the Department of Education in Mid Sweden University, Sundsvall. Her major research areas are special education, gender issues, teaching and learning. Copyright © 2014 by International Online Journal of Education and Teaching (IOJET). ISSN: 2148-225X. Material published and so copyrighted may not be published elsewhere without written permission of IOJET. mailto:ingela.ahslund@miun.se mailto:ingela.ahslund@miun.se https://orcid.org/0000-0002-8349-570 Åhslund 2666 HOW STUDENTS WITH NEUROPYCHIATRIC DISABILITIES UNDERSTAND THEIR ABSENTEEISM Ingela Åhslund ingela.ahslund@miun.se Abstract Although school attendance in Sweden is mandatory, there are numerous absentee students. Research studies have recognized that several of the absentee students have neuropsychiatric disabilities. However, few studies have focused on the voices of these specific students. Therefore, this study focused on their experiences of being out of school. In-depth interviews were performed with an interpretive phenomenology approach. Three themes emerged. The first was a need for supportive structures and relationships; all of the students had long histories of problematic schooling and described supportive structures and relationships with to teachers and peers as important to them. The second theme was a gendered understanding of the school absences; there were gender differences in the students’ understanding, and the students described their self-image and confidence as having been harmed by their failures in school, which caused the boys especially, to develop defence strategies. The third theme was a need to have only a few secure relationships and to be taught in a smaller context. The study also illustrates the value of listening to students, partly because they know themselves best but mostly to show them respect and give them power over their own lives (i.e., empower them). The results are important for researchers and practitioners since the study provides in-depth knowledge on which areas the students felt were important and increased understanding of how the students experienced their situations. Keywords: belonging, neuropsychiatric disabilities, risk and protection, school absenteeism 1. Introduction School absenteeism and school refusal behaviour are growing and highly challenging problems in Swedish schools. The Swedish school system is designed to be a school for all students regardless of the student’s requirements and needs (The Education Act. 2010). Few special schools exist, but are often available only for students with sight, hearing, or intellectual disabilities. The increasing number of absentee students poses a major challenge to the entire school system and is drawing the attention of educators, politicians, and the media (SOU, 2016). For a long time, researchers have pointed out that high rates of absentee students and dropouts in countries with compulsory school are a grave problem and often an important predictor of the existing and future problems of the educational system (SOU, 2016; Strand, 2013). Absence from school is an important issue, and many researchers have demonstrated a strong connection between successful schooling and young people’s health and development (Finning et al., 2019; Minkkinen, 2013; Vinnerljung et al., 2010). Vinnerljung et al. argued that it is not only at an individual level that school absence has consequences when those who in adulthood live in drug abuse, delinquency and with mental illness almost always have a history of school failures and absenteeism. Even in moderate form, when a young person enters the labour market a couple years late, it presents a painful human cost to the individual and the family and a substantial economic cost to society (Vinnerljung et al., 2010). mailto:ingela.ahslund@miun.se International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2667 Skolinspektionen [the Swedish Schools Inspectorate] reported the latest statistics on student absences in Sweden in 2016. The report revealed that approximately 1,700 students could be counted as absentee students, but the number of unreported cases was considered large (Skolinspektionen, 2016). Despite the uncertain data, researchers have identified that students with neuropsychiatric disabilities (NPDs) stand out as a group with a higher risk of long and problematic absenteeism (Kearney, 2008). Kearney found that different NPD diagnoses occurred in over 50% of the absent students in the United States. When a student has extensive and problematic absence, there are often many and complex reasons behind it. Historically, but also in contemporary research on absent school students, the focus has been on individual difficulties such as different diagnoses, family situations, and disabilities (Boylan & Renzulli, 2014). It can be difficult to discern what in the history of individual students has been the root cause of their dropping out of school; however, most absent students have complex histories. There are often several interacting reasons, both individual and organizational, the students leave school (Boylan & Renzulli; Forsell, 2020). The next section provides an introduction of the research field regarding school absenteeism and what causes the absences. The research is divided into two categories: causes related to the individual and the family and causes related to the school environment. 1.1. Reasons for School Absences That Can Be Linked to the Individual and the Family Among the causes and difficulties related to the individual and the family are different psychiatric diagnoses, such as anxiety and NPDs (for example, ADHD and autism) and insufficient and nonworking family relationships. One of the risk factors many studies pay attention to is the home conditions of students absent from school. Researchers have learned many of the students who had high absenteeism also had vulnerable life situations with, for example, difficult conflicts within the family and/or parents with substance abuse problems or mental illnesses (Kim & Page, 2013). Kim and Page found not only that the absentee students’ home conditions involved substance abuse and mental illness, but also that in these homes, the children often had less attachment to the parents. Other studies have shown that in addition to having difficult home conditions, the majority of students with extensive and problematic school absenteeism have an increased prevalence of neuropsychiatric and psychiatric diagnoses (Ek et al., 2012; Kearney, 2008; Strand 2013). Some of the diagnoses identified were autism spectrum disorder, depression, ADHD, and separation anxiety (Kearney, 2008). Specifically, Kearney (2008) found that longer absences— especially those associated with neuropsychiatric diagnoses—can lead to delayed completion. 1.2. Reasons for School Absences That Can Be Linked to the School Environment The reasons for students’ absences that can be linked to the school environment include themes such as insufficient support both socially and in the learning situation and the trauma that can arise from bullying and harassment. The relationship between the student and their teachers affects the student’s engagement in schoolwork and conditions their performance. Goodenow and Grady (1993) and Wentzel (2002) found that students’ perceptions of how much their teacher cared for them significantly affected the students’ motivation, engagement, and academic effort. These relationships are particularly important during adolescence, when students begin to explore their personal identities beyond the boundaries of their parents and families. Strand and Granlund (2014) stated that many students with high and problematic school absenteeism have stressful Åhslund 2668 relationships with their teachers. Boys especially depend on good relationships with their teachers to be able to succeed in school (McWilliam et al., 2003). Hamm and Faircloth (2005) stated that the sense of belonging relies on positive interactions with others and a perception of being accepted and valued by others in school (both teachers and peers). Goodenow and Grady (1993) defined school belonging as “the extent to which students feel personally accepted, respected, included, and supported by others in the school social environment” (p. 80) and argued that the sense of belonging is an essential condition for student’s motivation. Goodenow and Grady also suggested that if the basic need for belonging is not fulfilled, most students will have difficulty achieving academic success. Belonging is thus fundamental to human motivation and critical to the success of all students, and research has highlighted relationships as a factor of utmost importance in schools that, nevertheless, many absentees feel they lack (Corville-Smith et al., 1998; Patrick et al., 2011; Slaten et al., 2016; Strand, 2013). For example, absentees often experience more abuse, harassment, and bullying than other students (Gastic, 2008; Ingul & Nordahl, 2013). This increased risk of being subjected to harassment, bullying, and abuse is also found in students with various NPDs (Cappadocia et al., 2012; Dean et al., 2014; Kasari et al., 2011). One question that arises is if these two groups coincide and consist of the same individuals because students with NPDs often have more challenging social behaviours and difficulty reading the social codes (which can make them easy prey for bullies). Many students have a hard time at school due to social positioning and the complex and sometimes contradictory demands their peers and teachers place on them. Boys’ school situations, in particular, are affected by harsh power games and even harassment to which the individual student must relate (cf. Björnsson, 2005; Wernersson, 2010). Boys who deviate from this norm often risk social exclusion, abuse, and harassment (Jackson, 2006). One study even showed that many boys are ashamed to have been exposed to harassment and have a hard time talking about their vulnerability and exposure (Eriksen & Lyng, 2017). Eriksen and Lyng identified the invisible relational aggression among boys as a blind spot of the teachers that risks reinforcing and reproducing it. Furthermore, Niemivirta (2004) found that boys’ learning strategies are not as successful for their learning as girls’ strategies are. More boys than girls also avoided demanding tasks that could lead to comparisons with other students’ work. Studies also have shown that boys especially display avoidant behaviour more often than girls. Jackson (2006) suggested avoidance behaviour may reflect a fear of failure, both academically and socially, which is a protection strategy for self-esteem and social position. Jackson also argued that according to traditional gender discourse, it is more socially acceptable for girls to show fear and anxiety than it is for boys, which may further reinforce the avoidant behaviour and need for protective strategies in many boys who feel similar emotions. Several studies have investigated the causes of school absences (e.g., Strand, 2013). However, few studies have focused on how students who are outside the school system perceive and understand their situations (Cappadocia et al., 2012; Forsell, 2020; Kasari et al., 2011). Havik et al. (2014) argued that including the students’ perspectives would enrich and improve the understanding of problematic school absences and help develop strategies for resolving the issue. Although only a limited number of studies have highlighted students’ perspectives on school absences, even fewer have concentrated on students with NPDs, even though they have high representation among the group of absentee students. Despite the fact that students with different NPDs have an elevated risk of school absences, qualitative research in the field of school absenteeism is minimal, and research regarding absentees with NSDs is almost negligible (Kearney, 2008). This study emphasizes the problem from the students’ experiences of school absences. The research questions for the study were as follows: International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2669 1. How do the students’ understand their school absences? 2. What was the students’ understanding of what could have helped them stay in school? This study is important because it provides additional perspective on a complex and highly challenging problem. Furthermore, the study provides an in-depth knowledge of how students with NPDs experienced their absences and what they experienced as important areas to address within the school organization and for researchers. 2. Method This study was conducted within the framework of a project between the school and social services in a small municipality in the middle of Sweden. The study focused on nine students in the ninth grade who had a long history of absenteeism. All the students had, in addition to their absences, different NPDs such as autism spectrum disorder or ADHD, and some also had social phobias. This study, aimed to acquire a deeper understanding of how the students experienced their school absences and described the reasons for the periods of absence they had during their school years. How did they perceive their way back, and which efforts were valuable in their experiences? The method used in this study was a interpretative phenomenological analysis (IPA). IPA is a qualitative method that investigates human experiences based on the individual’s perspective, and subsequently, IPA studies are often conducted on small samples. IPA is based on both phenomenology and hermeneutics, allowing the researcher not only to describe but also to interpret the data (Smith et al., 2009). IPA is used to understand how individuals, in this case, the absent students, experience and apply meaning to their absences and their possible ways back to school. In this study, all of the students were first interviewed and then three of them were interviewed a second time to obtain thicker descriptions. 2.1 Participants The students who participated in the study often had a long histories of failure, and their schools had put in extensive work to try to support them. However, for some of the students, the causes of the difficulties had not been fully explained. An overall picture of the participating students and their initial position is presented in Table 1. The selected categories provide only a general picture of the students but can provide a background that can help readers understand these students’ specific circumstances. This is important because the used method aimed to gain insight on a particular experience from an individual’s perspective. All of the students were in the ninth grade and had extensive absences. Their aspirations for entering upper secondary school were low. The support they received during this project made it possible for them to continue their studies. However, one boy had a different story. He was entered the project after having a breakdown at a boarding school. Being there created the opportunity for him to manage school, but he could not manage being away from home. Consequently, he received assistance through the project for only a few months, and he could not get the grades he needed to enter upper secondary school. Åhslund 2670 Table 1. Presentation of the Students Name Numbers of grades at the start of the project Absence % School year Number of grades at completion of the project Line Erica Peter Catharina Charles Silas 3 0 6 3 3 0 70% 100% 100% 70% 75% 88% 9 9 9 9 9 9 13 6 6 13 8 12 The participants, three girls and three boys, who gave their consent were 15–16 years of age. Because they were minors, their parents’ permissions also were obtained. The students’ answers were coded, and they were given different names. 2.2 Data Collection Data for the study were collected through in-depth semistructured interviews with the students. As a support for the interviews, an interview guide with open question themes was created. The guide’s outlines were constructed with the ambition of capturing the students’ personal stories but still supporting us in the areas I intended to explore (Lindseth & Norberg, 2004; Smith et al., 2009). The interviews took place in the Central Student Support office, a place the students had visited several times during the project and in which they were comfortable. The interviews’ lasted approximately 25 to 60 minutes depending on what the individual students could manage due to their disabilities. For this reason also, complementary interviews were done with three of the students. All of the interviews except one were audio recorded and transcribed verbatim. Before the interviews were started, all of the students were informed of how the ethical principles of research, such as voluntariness and confidentiality, and their right to terminate the interview at any point applied in this study. I estimated the internal validity of the study to be high due to the operationalization of relevant concepts and the theoretical framework. The credibility also could be high because the research process was transparently described, the aim was met, and the research questions were answered. 2.3 Data Analysis The empirical data were analysed according to IPA outlines, which are similar to other types of qualitative research and search for understanding through coding the informants’ stories as analytical themes. Nevertheless, in IPA, the emphasis lies on the experience of the informant and their personal understanding of everyday life (Smith et al., 2009). In the analysis, I strove to keep the themes as close to the students’ stories as possible, with a primary focus on the similarities and differences. The analysis followed the basic steps of an IPA as Smith et al. (2009) described them. The empirical analysis was carried out in six steps. International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2671 First, the analysis started when the interviews were transcribed verbatim and were followed by a naive reading. Reading, rereading, listening, and transcribing the collected material comprised the first step. For a complete analysis, it is important that the respondents’ statements are in focus. Furthermore, one should search the transcript for relevant themes, categories, and subcategories in what has been said and keep notes. The rereading provides an opportunity to develop further thoughts on one’s first notes, and by going back and reading the material again, a deeper empirical analysis of the empiricism can be achieved for a clearer review. Second, we made introductory notes. The categories and themes we captured during the transcription in the first step and they were gradually transformed for a deeper analysis with more substantiated and precise interpretations, which are anchored in the theoretical framework. The third and fourth steps were the development of themes. In this step, we used the hermeneutic circle, alternating our focus on different parts for our context and trying to view the whole with in-depth insight but also searching for connections between the different themes. In the fifth step, we formed descriptive categories with condensed meanings, divided the categories into meaning units, and finally sorted them into analytical themes and subthemes. Lindseth and Norberg (2004) argued that the process of understanding a text is like following its movements from sense to reference—from what it says to what it talks about. 2.4 Ethical Considerations This study was conducted within the framework of a project between school and social services in a small municipality in the middle of Sweden. The ethical approval was made by the projects board of directors, which entailed the heads of administration within the education administration and within the social administration. Furthermore, in this study, Vetenskapsrådets [the Research Council] (2017) rules for good ethical research in social sciences were considered and followed carefully. Vetenskapsrådet stated that researchers should carefully consider voluntariness, utilization, and confidentiality performing studies on humans, especially on the basis that the research should not harm participants. We did extensive work to ensure that the students really understood all possible implications of participating in the study. The students’ names were excluded, and anything that would make it possible to identify any of them was removed. Therefore, the background information on the students in the article may seem meagre, but it was carefully chosen. 3. Results In this section, we describe our findings, with an emphasis on the students’ personal stories, according to the IPA method. Each student who was interviewed had different circumstances surrounding their absenteeism yet similar experiences. Their absenteeism could be interpreted as the most severe attribute of a resistance to overpowering demands combined with inadequate support, leading to strains and pressures that make the students believe they have few options but being absent from school. 3.1 Supportive Structures and Relationships The students’ responses appeared to show their absences had not come suddenly but often began after the third grade and escalated as they aged. Above all, the students felt that the Åhslund 2672 deficiency in adjustments, adaptations, and secure relationships in school ultimately made it impossible for them to attend. 3.11 A Long History of Problematic Schooling When the students were asked about their school situations prior to the project, they all started to describe the struggles they had experienced in school so far. For most of them, the first years in school had been happy and unproblematic. They described teachers they liked and who understood them. One participant, Erica, described how her problems began when she started fourth grade and changed teachers: First to third grade were simple, but fourth grade was harder when I got another teacher. In addition to losing my teacher, the children in my class got the idea that now we are in fourth grade, and now we are big. They began to behave differently. It totally stressed me. (Erica) Another girl, Catharina, went through her first years of school in a small village school where everyone knew everyone. The entire school had about 30 students from preschool through the sixth grade. Catharina really liked her primary school teachers. She said emphatically that one of them had also been her father’s teacher: “Ellen had my father. . . . That is, Ellen even had been my father’s teacher when he was little” (Catharina). Catharina continued to praise her primary teachers and described how much they made her like school when she was younger: to look forward [to] going there (school). Looking forward [to] meeting my teachers and going to the lessons. That they (the teachers) made the lessons fun. They kind of gave us a reason to want to go to the lessons. (Catharina). For Peter, the struggle began at the beginning. In preschool, he had difficulty adapting to the rules and conditions that applied there. Peter’s teachers often contacted his parents and were concerned. After a while, the teachers started sending home a diary in which they described what had happened around Peter during the day. The teachers did this in good faith, but for Peter, the diary became a book of shame that he had to carry between home and school. 3.2 Relationships With Teachers Were Essential Participating in social interaction is a complex act; students have to understand many unwritten social rules and norms to conform to their peers in school and cope with classroom requirements. This could be a difficult balancing act for students with NPDs. The school has to know how to compensate for students’ difficulties in social interactions, concentration, and the sorting of information. Previous research has described the lack, or nonexistence, of relationships as a strong risk factor regarding problematic school absenteeism. This was confirmed in several of the students’ stories. Two kinds of relationships were of particular concern to the students: their relationship with their teachers and their relationship with their peers. The students’ descriptions of their relationships with several of their teachers could be described as feeble or fragile, conflicted or absent, and showing a lack of understanding of the students’ situations. Line described how she needed to stay home when the requirements in school were too much and then how she needed support to make up what she missed when she was gone. She felt that the teachers did not understand the support she needed. International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2673 I have trouble coping with all the requirements of all teachers and friends. All sounds, colors, and smells. All because I cannot deal with it. I needed an individual study program. Then I just miss a lot and cannot take it back the same way as the others. They (the teachers) can’t run the same lesson for the whole class just because I’ve been away, but it would have been necessary. (Line) Line also pointed out how important it was that she got help creating order and structure, but she also wanted to be liked and to feel a commitment from the teacher: “I need structure and personal commitment from the teacher, to feel that someone cares about me. I know if someone doesn’t like me, and then I feel bad.” Catharina was more disappointed with the teachers she met after primary school. She felt that when help came, it was directed at the wrong thing and made her feel even more alienated. When we asked how she would have liked the teachers to act, she replied; They should have met me with respect! Listened to what I had to say! Listened when I had a bad day. . . . The teachers saw what problems I had, they should have helped me at once; they should have done it at once, done something. I do not know. (Catharina) Peter and Charles described feelings similar to Catharina’s feeling of not really being understood: If a teacher stands in front of a class of 20 to 25 students, I should try to concentrate. I can’t hear what they are saying. They really need to come to me if they want me to understand what to do. Otherwise, I have no idea . . . otherwise, I get allowed to freebase and it doesn’t feel good. (Peter) They just wanted to know why I didn’t go to school, but I didn’t know why, and I still don’t know. When I didn’t know what was wrong, they pushed me. I just felt bad then, and it got worse. (Charles) Good and secure relationships and supportive structures are often a prerequisite to enjoying school for all students, and the descriptions in these interviews show that this also applies for students with various NPDs who experience school as problematic. The students often find it difficult to create relationships for themselves because of their disabilities. In addition to needing supportive structures and secure relationships to meet the demands created by their disabilities, the students described a need for adjustments and adaptations for them to be able to be in school. 3.3 Relationships with Peers and Friends Were Important Silas enjoyed school as long as he stayed in the small village school where he knew everyone. When he started Year 7, he would move to the high school located in the central town a few miles further away. Suddenly, it became more and more difficult for Silas. “It was really hard to get to high school, where everything was bigger” (Silas). He felt that he had to like and be good at football to fit in with his classmates, which Silas absolutely turned against. Not fitting in and living up to the norm made it harder for him to step into his classrooms. In the semester we met him, he had almost 300 hour of absences. Peter described his friends and classmates as very important for him to be able to cope with school “because I usually go to school to socialize not to work. If I am not in school, I am afraid I lose my social skills, quite significantly also.” However, Peter was also aware of the Åhslund 2674 difficulty for him to be in a setting with many other children. “I want to be in the class because there are other students there, but it is also so messy there that I do not get anything done” (Peter). Peter’s answer shows the great importance he attaches to being with friends. Being able to belong in the social context overshadows how hard he feels it is to be at school. Catharina described the importance of peers in a similar way: “Ah, but then when I was alone, it felt like I had a thousand kilos on my shoulders. But when someone was beside me, it felt like everything was much simpler; it was more fun in some way.” The students’ answers illustrate the great importance they place on being with friends, even though they often find it difficult to understand social interactions, codes, and norms. 3.4 A Gendered Understanding of the School Absences 3.4.1 Self-Image and Confidence Affected by Failures in School The students, especially the girls, associated their failure to be in school with their lack of abilities and not being smart or motivated enough. Both Line and Catharine said they started to think badly about themselves. “I thought I was stupid. . . . It kind of hasn’t . . . like . . . school has not been top notch for me at all, until now at least” (Line). “I thought was stupid, but now I know I only needed different methods to learn” (Catharina). These statements suggest the students had negative school experiences that led to negative attitudes towards schoolwork and ultimately negative images of themselves. There were differences between the boys and the girls. Although they all indicated, their experiences at school had affected their confidence and self-image, the girls’ descriptions show they were angrier and felt that school had let them down. 3.4.2 Self-Worth Protection Strategies The students’ statements suggest that the resultant negative self-image was most significant for the boys, who saw themselves as indifferent and idle. The boys’ describes that the school absence was on them, that it was only their fault they dropped out of school. The boys’ describes that they were tired of school and not motivated to be there. They said they saw no reason for being in school, that it felt useless. “Succeeding in school is my responsibility; school is a job. . . . Well, the responsibility is really only mine” (Silas). Charles blamed his absence on being tired of school: “I do not know, but it was that I did not want to do it. It was because I was tired of school.” Peter argued it was his fault school did not work and the teachers could not have done anything because he was so unmotivated: It has nothing to do with the teachers or so really, because they could not have done anything better when they did not do anything wrong from the beginning. It was only that I was so terrible unmotivated. I have always thought of school as so very boring. (Peter) Similar to Silas and Charles, Peter could not comprehend that the teachers had a responsibility to make school bearable. He thought his lack of motivation was the only reason for his absenteeism. His answer indicated that he saw himself as having the sole responsibility for his problematic schooling, which did not begin with him not coming to school. This could be understood as a school failure incorporated into him and the others that has now become an individual failure of which they are ashamed. 3.5 A Need to Have a Few Secure Relationships and Be Taught in a Smaller Context All students described that an important factor of success for them has been that they initially received teaching in a smaller context and with only an educator whom they liked and felt International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2675 confident in. If knowledge and understanding of the students’ prerequisites and needs do not exist, the school risks setting demands too high and putting too much pressure on the students, causing strains that eventually ended up making it impossible for the students in this study to go to school. When the interviewed students were asked about the impact the project had made on their perceptions of school, it became clear that school and academic achievements were important to all of them, and through their work in the project, they had started to believe in a future and, in some cases, an ability to enrol in higher education. When we asked Line how she felt about school now, like several of the other students, she described how everything changed when she enrolled in the project and could study in a smaller setting: School means to me now . . . Schoolwork is fun; it feels much more fun than it was before anyway. Now, now I can, so now I get things done when I sit down at home, for example, and have to work with something, then I do it, too. Also, it does not feel impossible in the same way as before when it really felt like I was going to die. (Line) The work in the project was done together with the students, with a great emphasis on the students’ personal experiences of what they needed and how they felt about school. Often, big adjustments were not needed. The students just needed the feeling of being listened to, being respected as experts on themselves, and, foremost, having teaching and didactics that were adapted to their needs. Our findings indicate that with adapted education, the students started to experience successes in school and gained more self-esteem and brighter prospects. 4. Discussion A gap was identified in the review of previous research relevant to absentee students with neuropsychiatric diagnoses. Few studies have been performed on this particular group, even though they have high representation within the group of absentee students. This study emphasizes the problem from the students’ experiences. The answers to our first research question—How do the students’ understand their school absences?—show the students felt that they were missing supportive structures and relationships as they grew older. The analysis also indicated gender differences in students’ understanding of their absences; all of the students described their self-image and confidence as being hurt by their failures in school; however, the boys displayed more defence strategies. The answers to our second research question—What was the students’ understanding of what could have helped them stay in school?—were close to the reverse of the answers to the first research question, showing that if the things the students felt were lacking had been available, they could have endured school. These included support from and relationships with both teachers and friends, understanding, and, above all, a feeling of being listened to. The students also described how valuable they thought a smaller teaching context had been when they came back to school. Finally, we discussed the protection and risk factors that emerged in the students’ stories in relation to previous research. 4.1 Relationships and Supportive Structures All students who participated in this study had various NPDS. Previous research has shown that students with NPDS are overrepresented among absentee students. The reasons behind this group’s high representation included a general combination of poorly adapted learning environments, lack of understanding from both peers and teachers, and sometimes even harassment (Cappadocia et al., 2012; Dean et al., 2014; Gastic, 2008; Ingul & Nordahl, 2013; Åhslund 2676 Kasari et al., 2011). For students with various NPDs, it is perhaps more challenging but just as important to sense a feeling of belonging from others in school (both teachers and peers). For all students in this study, the loss and/or lack of secure relationships with teachers and peers ultimately made them unable to go to school. They felt that they were not listened to and that they had difficulties understanding and coping with the social games between the students, the complexity and degree of difficulty of which grew as they aged. The students in this study talked about being unable to understand the unwritten rules and norms. The students do not generally lack knowledge and language skills, but they have trouble expressing themselves if they are not given support. Furthermore, these students, similar to many students with NPDs, have difficulty understanding the complex interactions that develop during adolescence (Corville-Smith et al.,; Strand, 2013). Participating in social interactions in school can be a difficult balancing act for students with NPDs. Unwritten rules and norms and the cognitive requirements of the classroom are some of the barriers they have to handle, challenges that for the interviewed students became too overwhelming. Difficulties in social relationships with other people are common for children and youth with NPDs, and these problems often increase just before and during the teenage years (Gillham et al., 2000; Humphrey & Lewis, 2008). Previous research has identified that students with NPDs are absent from school more often than other students. They also have a hard time connecting with educators and their peers, compounding the fact that students with NPDs often see themselves as being alienated, harassed, and bullied (Corville-Smith et al., 1998; Gastic, 2008; Haynes et al., 1997; Ingul & Nordahl, 2013; Strand, 2013). The results from our interviews indicate that these factors interact due to the experiences of being disrespected, being ignored, and feeling isolated and contribute to making school unbearable. How badly adapted and anchored solutions from the school became additional burdens to the student’s and even increased their lack of motivation. The students desired to take part in the social context of school, even though their friends started to behave differently and they drifted apart. Being in school means being able to relate to a complex social situation that places high demands on a student’s social and cognitive abilities, so the interventions in school need to be multifaceted. This requires general knowledge of the specific student’s disability together with an understanding of their needs and wishes. If these conditions are not fulfilled, students with NPDs are more vulnerable to and at risk of problematic absenteeism than other students are. The participants in this study had many things in common: Their school absenteeism could be described as a journey that began relatively early and was reinforced by a lack of support that led to experiences of failure and ultimately to becoming completely absent and having a problematic relationship with school. This is a slippery slope on which their individual difficulties entwined with a school system that did not provide appropriate support, leaving the students with a sense of not having many options other than not going to school. Consequently, we are making the assumption that the students’ difficulties in understanding and being able to create positive and comfortable relationships with their peers and teachers are lessening the students’ abilities to experience success in school. Even if this could be considered a failure of the schools’ obligations to prevent and compensate for the students’ difficulties, the feeling of being excluded and not belonging are incorporated into the students’ self-conceptions and negatively affect the students’ motivation in school. 4.2 A Gendered Understanding of School Absences Both the boys’ and girls’ stories indicate that their difficulties in school affected how they saw themselves and their chances of succeeding in school. The girls expressed that they felt stupid and useless, whereas the boys hid behind descriptions of being tired of school and being unmotivated. The students’ stories suggest they incorporate negative school experiences into International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2677 their self-conceptions and negative attitudes towards schoolwork. This was most significant in the boys. Previous research has shown that it is important for students in general, especially boys, to feel personally accepted, respected, included, and supported by others and particularly by their teachers (Finn, 1989; Goodenow & Grady, 1993; McWilliam et al., 2003; Strand & Granlund, 2014). According to Hamm and Faircloth (2005), this feeling of belonging relies on positive interactions with others and a perception of being accepted and valued. In addition, boys’ school situations are often harder than girls’ regarding tough social positioning, power games, and harassment (Björnsson, 2005; Wernersson, 2010). In this study, one of the boys (Peter) had no comprehension of the responsibilities the educators have to make school bearable for him. He thought it was unquestionably only his fault that he could not endure being in school. He, along with the other boys, perceived himself as unmotivated and idle. He saw himself as being solely responsible for a school failure that started in preschool and ended in him being completely absent from school for several semesters, even though he easily learns things and has no particular difficulties with school subjects. 4.3 Factors of Risk and Protection: A Summary Previous research has shown a variety of underlying reasons that students may have problematic absenteeism. Various individual prerequisites such as NPDs (e.g., autism or ADHD) and anxiety in combination with school-related factors such as a poorly adapted learning environments, weak attachments to teachers and other school personnel, or troubled relationships with peers have been identified. Previous research also has described alienation that are caused by the student´s difficulties dealing with social rules and also school settings not adjusted enough to support the student’s needs. A number of factors also appear in the stories of the students in this study that could act as protection but were not sufficient for various reasons, though the need for belonging is the most prominent. In summary, the students we interviewed described their way into absenteeism through several painful situations that occurred in their schooling. These included situations where they felt alone and did not comprehend what was expected of them in addition to not having the ability to cope with the requirements on their own. The way back for these students was determined to be a smaller setting and a great emphasis on the students’ understanding of what they needed to succeed in school. Many of the students’ cases did not need big adjustments, just the feeling of being listened to, being respected as experts on themselves, and, foremost, having teaching and didactics that were adapted to their needs. Figure 1 shows a summary of the factors of risk and protection according to this study’s results and the results from previous research concerning absentee students. Åhslund 2678 Figure 1. Summary of Risk and Protection Note. These data were aggregated from this study’s results and the results of previous research. The weighted powers of the risk and/or protective factors affect students’ development and make them either resilient or vulnerable in the school system. The school can constitute an important protection factor but also an enormous risk when it does not work. The students in this study described how having a school that begins to function caused other parts of their lives to also change and they went from feeling hopelessness to some optimism concerning their futures. This study shows that there is healing power in school success, that school, if it works, is medicinal. Another conclusion is that school is important for all students, but it is especially important for children and young people who need it as a compensatory arena. Investing in successful schooling for these students produces benefits from both humanistic and economic perspectives. This provides a strong incentive for why it is so important to work to ensure participation, belonging, and success for all students but especially for students living in vulnerable situations. 4.4 Implications In this study, we have identified a number of implications for the professional practices of schools and educators. First, school personnel need to enhance their knowledge concerning NPDs; otherwise, the school risks setting demands too high for its students, causing strains that eventually could make it impossible for the students to attend school. Educators must also be prepared to make the effort and take responsibility for students who have difficulties creating good and secure relationships by themselves. An understanding of the students’ needs and knowledge of the social context and its conditions are important and may increase schools’ abilities to build inclusive environments for all students, not only those with NPDs. International Online Journal of Education and Teaching (IOJET) 2021, 8(4), 2665-2682. 2679 Few studies have focused on the students’ voices and utilized their perspectives, despite researchers having pointed out that this is important in the development of methods and strategies. There is a need for other types of studies that not only seek the answer to the dilemma of individual difficulties and needs but also examine the conditions that students with NPDs encounter in the classroom and in school. 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