Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
University of Exeter Medical School, Exeter, UK.
Lancet. 2015 Feb 26;385 Suppl 1:S76. doi: 10.1016/S0140-6736(15)60391-9.
School exclusion is a disciplinary method used to remove a child from the school environment. It is known to affect certain groups disproportionately, including boys, some ethnic minorities, children in care, children in poverty, and children with special educational needs. Population-based studies on wider characteristics of excluded pupils are scarce. The aim of this study was to describe factors associated with school exclusion in the Avon Longitudinal Study of Parents and Children (ALSPAC), focussing on neurodevelopment and mental health.
ALSPAC is a prospective population-based British birth cohort study, with the initial sample consisting of 14 541 pregnancies. The study has data for whether a child has been permanently excluded from school up to the age of 8 years as reported by parents and also permanent and fixed period exclusions in the preceding 12 months as reported by parents and young people at age 16 years. Upstream risk factors were assessed for associations with exclusion on univariable analysis. The association with social communication difficulties was investigated with multivariable logistic regression.
Data for exclusions up to the age of 8 years were available for 8245 ALSPAC participants and 4482 participants for exclusion at age 16 years. 53 pupils (0·6%) were excluded from school by age 8 years, and 390 (8·7%) at age 16 years. The odds of exclusion by 8 years and at 16 years were increased with male sex (p=0·001 and p<0·0001, respectively), low family income (p=0·014 and p<0·0001), family adversity (p<0·0001 for both), maternal psychopathology (p=0·013 and p=0·004), low intelligence quotient (p=0·041 and p<0·0001), mental health difficulties (p<0·0001 for both), psychiatric disorder (p<0·0001 for both), social communication difficulties (p<0·0001 for both), antisocial activities (p=0·004 and p<0·0001), bullying or being bullied (p=0·005 and p<0·0001), low educational attainment (p<0·0001 for both), and increased special educational needs (p<0·0001 for both). On multivariable analysis, having social communication difficulties above a clinical threshold on the Social Communication Disorders Checklist was strongly associated with exclusion by 8 years (odds ratio 7·4, 95% CI 3·6-15·4) and at 16 years (2·3, 1·5-3·5), after adjustment for relevant confounders.
Although cohort attrition and small numbers of exclusions at 8 years are limitations, this study suggests that school exclusion is associated with numerous risk factors identifiable at or before primary school entry. Child health professionals have an important role in the holistic assessment of children who are excluded, or who are at risk of school exclusion. There is particular need to ensure that mental health and neurodevelopmental difficulties are appropriately recognised and supported.
National Institute for Health Research Academic Clinical Fellowship.
学校开除是一种将孩子从学校环境中开除的纪律处分方法。众所周知，它会不成比例地影响某些群体，包括男孩、某些少数族裔、受照顾的儿童、贫困儿童和有特殊教育需求的儿童。关于被开除学生更广泛特征的基于人群的研究很少。本研究旨在描述在阿冯纵向研究父母和儿童（ALSPAC）中与学校开除相关的因素，重点是神经发育和心理健康。
ALSPAC 是一项前瞻性的基于人群的英国出生队列研究，最初的样本由 14541 例妊娠组成。该研究有数据记录表明，儿童是否因父母报告的永久性开除而被开除，以及父母和 16 岁的年轻人报告的在过去 12 个月内的永久性开除和固定期限开除。在单变量分析中，对上游风险因素进行了与开除相关的关联评估。通过多变量逻辑回归调查了与社交沟通困难的关联。
8 岁时的开除数据可用于 8245 名 ALSPAC 参与者和 4482 名 16 岁时的参与者。截至 8 岁时，有 53 名（0.6%）学生被学校开除，16 岁时有 390 名（8.7%）。8 岁和 16 岁时被开除的几率随性别（p=0.001 和 p<0.0001）、家庭收入低（p=0.014 和 p<0.0001）、家庭逆境（p<0.0001）、母亲精神病理学（p=0.013 和 p=0.004）、智力低下（p=0.041 和 p<0.0001）、心理健康困难（p<0.0001）、精神障碍（p<0.0001）、社交沟通困难（p<0.0001）、反社会活动（p=0.004 和 p<0.0001）、欺凌或被欺凌（p=0.005 和 p<0.0001）、教育程度低（p<0.0001）、特殊教育需求增加（p<0.0001）而增加。在多变量分析中，在社交沟通障碍检查表上存在社交沟通障碍的临床阈值以上与 8 岁时的开除（优势比 7.4，95%CI 3.6-15.4）和 16 岁时的开除（2.3，1.5-3.5）强烈相关，在调整了相关混杂因素后。
尽管队列流失和 8 岁时的开除人数较少是限制因素，但本研究表明，学校开除与许多可在小学入学前或入学时识别的风险因素有关。儿童健康专业人员在对被开除或有被开除风险的儿童进行全面评估方面发挥着重要作用。特别需要确保适当认识和支持心理健康和神经发育困难。
国家卫生研究院学术临床奖学金。
