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pie chart: school engagement among CSHCN pie chart: school engagement among Non-CSHCN pie chart: number of school days missed due to illness by CSHCN pie chart: number of school days missed due to illness by Non-CSHCN bar graph: CSHCN who are engaged in school by household income bar graph: CSHCN who are engaged in school by race, ethnicity, and language

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School Engagement and Attendance

School achievement and involvement in school activities are important predictors of long-term child and adolescent health outcomes.1,2 Parents of school-aged children (aged 6-17 years) were asked two questions to assess their child's engagement in school: whether the child cares about doing well in school and whether the child does all required homework. Among CSHCN, 69.5 percent were reported to usually or always be engaged in school, compared to 83.7 percent of children without special health care needs. This difference remained significant even after statistical adjustment for other differences between CSHCN and non-CSHCN. The percentage of CSHCN who are usually or always engaged in school ranged across States from 58.4 percent to 77.3 percent.

Among CSHCN, a lower percentage of boys than girls was reported to usually or always be engaged in school (62.4 percent versus 79.7 percent, data not shown). School engagement was also lower among children in low-income households. There was also considerable variation in school engagement by race/ethnicity and language, with the lowest rate found among Black CSHCN (59.6 percent) and the highest found among English-speaking Hispanic CSHCN (over 72 percent). Of CSHCN with emotional, behavioral, or developmental conditions, only 54.4 percent were reported to be engaged in school, compared to 82.6 percent of CSHCN without these conditions (data not shown).

One factor that may be either a cause or a consequence of school engagement is regular school attendance. On average, CSHCN miss at least 2 more weeks of school (11+ days in the last year, assuming a 5-day school week) due to illness when compared to non-CSHCN. Likewise, 31.0 percent of CSHCN missed more than 1 week of school (6+ days), compared to 14.3 percent of children without special health care needs. CSHCN with emotional, behavioral, or developmental conditions were particularly likely to miss 11 or more days of school: 16.9 percent did so, compared to 10.7 percent of CSHCN without these conditions (data not shown). Among CSHCN, the percentage who missed 2 or more weeks of school in the past year (11 or more days) due to illness ranged across states from 6.0 percent to 26.5 percent.

1 Carter M, McGee R, Taylor B, Williams S. Health outcomes in adolescence: associations with family, friends and school engagement. J Adolesc. 2007;30(1):51-62.

2 L. Bond et al. Social and School Connectedness in Early Secondary School as Predictors of Late Teenage Substance Use, Mental Health, and Academic Outcomes. Journal of Adolescent Health. 2007;40:357. e9 –357.e18.


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