[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100659031":3},{"organization":4,"outcomesModule":7,"designInfo":50,"detailedDescription":56,"studyPopulation":49,"armGroups":57,"interventions":70,"overallOfficials":49,"centralContacts":78,"locations":49,"responsibleParty":84,"collaborators":49,"id":86,"slug":87,"hasResults":88,"nctId":89,"briefTitle":90,"officialTitle":90,"acronym":91,"eligibilityCriteria":92,"healthyVolunteers":88,"sex":93,"minAge":94,"maxAge":95,"enrollmentInfo":96,"targetDuration":49,"studyType":99,"phases":100,"briefSummary":102,"conditions":103,"keywords":106,"overallStatus":108,"whyStopped":49,"lastUpdateSubmitDate":109,"lastUpdatePostDateStruct":110,"startDateStruct":113,"completionDateStruct":115,"leadSponsor":117,"locationsCount":49},{"fullName":5,"class":6},"Lund University","OTHER",{"primaryOutcomes":8,"secondaryOutcomes":13,"otherOutcomes":49},[9],{"measure":10,"description":11,"timeFrame":12},"Abseteeism","School absenteeism, assessed using parent-reported and school-reported attendance data.","From baseline, prior to the start of the EAGLE intervention, and immediately through study completion, at 10weeksto and at the end of the school term following completion of the intervention that is 20 weeks post basline.",[14,18,21,24,27,31,34,37,40,43,46],{"measure":15,"description":16,"timeFrame":17},"POM-11 - Parents overprotective measure","POM-11 - Parents overprotective measure. POM-11 can be used in both basic and intervention research to examine links between anxiety and overprotection, and as an outcome or mediation measure. Clinically, it helps identify overprotective parenting behaviors.","Baseline and immediately through study completion, at 10weeks",{"measure":19,"description":20,"timeFrame":17},"SEQ-SS","Self-efficacy Questionnaire for School Situations (SEQ-SS) is a short self-report measure assessing students' confidence in coping with challenging school-related situations.",{"measure":22,"description":23,"timeFrame":17},"Inventory of School Attendance Problems, Swedish","The Inventory of School Attendance Problems (ISAP) is a validated self-report measure assessing a broad range of factors associated with school attendance problems and absenteeism in children and adolescents.",{"measure":25,"description":26,"timeFrame":17},"Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP)","The Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP) is a brief self-report measure assessing parents' confidence in their ability to respond effectively to and manage their child's school attendance problems.",{"measure":28,"description":29,"timeFrame":30},"Qualitative interviews","Semi-structured qualitative interviews examining parents' experiences of participating in the intervention, their relationships with school personnel, and their own experiences and perceptions of school during their school years.","Immediately through study completion, at 10weeks",{"measure":32,"description":33,"timeFrame":17},"School-home relationship evaluation","Grading perceived relationship with school staff 1-10.",{"measure":35,"description":36,"timeFrame":17},"Schedule assessment","For evaluating the child's experience of its' school week. The child colors its school schedule in the colors green, yellow or red to show how each class during the week is perceived.",{"measure":38,"description":39,"timeFrame":17},"Four moments during the day.","Four questions regarding child's feelings when leaving home to go to school.",{"measure":41,"description":42,"timeFrame":17},"SDQ - The Strengths and Difficulties Questionnaire","SDQ - The Strengths and Difficulties Questionnaire is a brief screening tool that assesses emotional and behavioral problems as well as strengths in children and adolescents. It is available in multiple versions for parents, teachers, and young people and is widely used for clinical assessment, research, and early identification of psychosocial difficulties.",{"measure":44,"description":45,"timeFrame":17},"Impementation measures","Implementation measures will be used to assess the feasibility, acceptability, and fidelity of intervention delivery.",{"measure":47,"description":48,"timeFrame":17},"Pediatric Misophonia and Hyperacusis Questionnaire (PMHQ-4)","Questionnaire regarding childrens possible misophonia and hyperacusis",null,{"allocation":51,"interventionModel":52,"interventionModelDescription":49,"primaryPurpose":53,"observationalModel":49,"timePerspective":49,"maskingInfo":54},"RANDOMIZED","PARALLEL","TREATMENT",{"masking":55,"maskingDescription":49,"whoMasked":49},"NONE","Breaking patterns of absenteeism: An Evaluation of the EAGLE Model in Primary Education.\n\nBackground School attendance problems (SAPs) have serious negative effects on children's lives and have been linked to negative outcomes such as psychiatric disorders (particularly anxiety and depression), social isolation, internalizing and externalizing behavior problems, as well as long-term issues in adulthood that include psychiatric, occupational, and marital problems (Kearney, 2011). The absence also entails a loss of positive, developmentally supportive factors in the child's life-such as social relationships and daily routines, routines that might otherwise serve as protective factors against mental health problems, particularly for children in vulnerable environments (Selman, 2023).\n\nSAPs are often viewed as a complex issue, with many different contributing factors. Because of this complexity, schools frequently miss the opportunity to intervene early and instead adopt a \"wait and see\" approach. As illustrated in the figure below, this corresponds to acting in phase 6 (the darker orange square), when the problem is already well established. By that stage, absenteeism is more difficult to reverse and more likely to develop into a long term pattern (Gren-Landell, 2016).\n\nTo meet the need for a simple and accessible early intervention, school psychologists in Malmö developed EAGLE - a structured model aimed at helping schools respond at the earliest signs of absenteeism. Instead of waiting until absenteeism becomes deep-rooted, the framework supports schools in acting proactively in phase 4 (see illustration). It is intended for younger children (ages 6-12) and their parents\u002Flegal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included.\n\nFigure 1. The gradual progression of absenteeism.\n\nCo-operation between school and family is the key The EAGLE model focuses on building a cooperative relationship between the school and the family. To support the parents, guidance is offered in the form of psychological counseling with a school psychologist. EAGLEs main goal is to help adults around the child - both parents and school staff - to understand the child's difficulties and make the necessary adjustments to support attendance. The child's perspective is gathered through conversations with the school counselor, but the EAGLE meetings are for adults only, as they hold the responsibility for making the necessary changes-not the child.\n\nAim The aims of the current study are to examine the effects of the EAGLE intervention, including both qualitative and quantitative data.\n\nStudy site The study will take place in Malmö city, Sweden, in 24 primary schools. The project is supported by Malmö City, which contributes by providing school staff and school psychologists to assist in the implementation of EAGLE and data collection.\n\nResearch questions • To what extent is EAGLE effective in reducing children's school absenteeism at an early stage compared to TAU?\n\n* To what extent is the effect of EAGLE moderated by school-home relationship, parental overprotectiveness, child characteristics at baseline, gender or age?\n* To what extent does participation in the EAGLE intervention influence parents' self reported levels of overprotectiveness, parental self efficacy, and the quality of the school-home relationship?\n* To what extent does EAGLE improve the quality of relationships between school staff and parents compared to TAU?\n* To what extent does EAGLE affect children's school-related self-efficacy?\n* How do parents' own school experiences relate to children's attendance patterns and engagement with the intervention?\n* To what extent is the EAGLE intervention feasible and acceptable to school staff, psychologists, and parents, in terms of time requirements, workload, and their perceptions of the content and amount of intervention components?\n\nMethod\n\nParticipants Study participants will be children aged 6-12 with an absence of 10-60%, and their legal guardians.\n\nEach child's teacher will fill in form regarding the child's strengths and difficulties.\n\nControl group Because we expect a lower response rate in the control group, participants in the control group will receive a shorter version of the post-intervention assessment battery, and families will be offered a gift card (20 Euro) after the completion of post-intervention assessment and again after follow-up.\n\nSchools in the control group will be offered lectures by researchers on child psychology and absenteeism.\n\nProcedure We plan a study using stratified randomization. To control for socioeconomic differences, we will use Malmö's resource allocation index, based on Statistics Sweden (SCB) data such as parental education and time in Sweden. All 65 primary schools in Malmö will be divided into three strata according to their values on this index. Within each stratum, schools will be randomly assigned to either the intervention group or the control group. This stratified randomization reduces confounding bias related to socioeconomic status. Each school will then offer participation to three students and their legal guardians.\n\nSignificance of the study The EAGLE study addresses an important gap in the field of school absenteeism by evaluating an early, structured intervention aimed at preventing emerging attendance problems among primary school students. In Sweden, no comparable early stage intervention has been systematically evaluated; existing programs target only students who are already completely out of school (Strömbeck, 2021). By testing a psychologically informed, school based model implemented in collaboration with parents and school staff, this study has the potential to provide evidence for a preventive approach that could change national practices for managing school absenteeism.\n\nSample size Based on results from a previous pilot study (Ethics approval number 2024-07949-01), an a priori power analysis was conducted. To achieve 80% power to detect a statistically significant (p ≤ 0.05) small to moderate effect (standardized mean difference = 0.4), the study requires a total sample of 90 children, with 45 allocated to the intervention group and 45 to the control group. To accommodate this sample size while allowing for practical recruitment across study sites, participants will be distributed across 30 schools, with three children recruited per school (30 × 3 = 90).\n\nInclusion criteria\n\n* Children with 10-60 % absence during the past semester.\n* Parents\u002Flegal guardians can speak and read sufficient Swedish\n\nExclusion criteria\n\n* Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and\u002For significantly affects daily functioning\n* Social conditions known to the school staff that would obstruct from participation (e.g. ongoing custody dispute, domestic violence, ongoing investigation of child neglect through social services)\n\nTimeplan\n\n2026 January-June Preparing study, writing manual, and submitting ethics application.\n\nAugust Randomizing schools and give information about the study. September-November Identify children with 10-60% absenteeism. Select children based on absence statistics and inclusion criteria.\n\nDecember Contacting parents, collecting signed informed consent. 2027 January Collecting pre-measures. February EAGLE intervention starts at all schools. May EAGLE intervention ends. June Post-measures. Qualitative interviews. July- Writing articles, publishing and communicating results. 2028 Jan-Dec Writing articles, publishing and communicating results. February Follow-up attendance data\n\nFigure 2. The randomization process EAGLE: Early Absenteeism Guide for Lifelong Education. Session guide. Week Meeting Participants Content Purpose\n\n1 Joint assessment Legal Guardian, Teacher, School Psychologist, SSW\u002FSN\u002FP A structured, joint assessment across three domains-Child, School, and Home-where participants explore what helps the child attend school and what makes attendance difficult.\n\nUse a whiteboard or similar tool for a shared and transparent overview.\n\nCreate shared understanding\n\nTask allocation\n\nChild interview Child, School Social Worker Schedule evaluation Other suitable questionnaires, based on assessment the week before Getting the child's point of view\n\n2 Counseling session I Legal Guardian, School Psychologist Map out home situations that affect the child's ability to attend school. Do situation analysis of morning situations.\n\nAdress issues in child's home environment that were raised in assessment meeting.\n\nSupport legal guardians in making necessary changes.\n\n3 Carry out assigned tasks.\n\n4 Carry out assigned tasks.\n\n5 Follow-up meeting Legal Guardian, Teacher, School Psychologist SSW\u002FSN\u002FP\n\nFollow up on agreed tasks and interventions, assess their effects, and update the assessment with the child's perspective and any issues raised by the guardians.\"\n\nEvaluate interventions; adjust them if needed\n\n6 Counseling session II Legal Guardian, School Psychologist Follow up home situations that affect the child's ability to attend school.\n\nHelp legal guardians make changes needed for better attendance.\n\n7 Carry out assigned tasks.\n\n8 Carry out assigned tasks.\n\n9 Carry out assigned tasks.\n\n10 Final meeting LG, T, SP, SSW\u002FSN\u002FP Follow up on agreed tasks and interventions, evaluate their effects and adjust if needed.\n\nSummarize situation and intervention thus far. Make plans for future.\n\nLG=Legal Guardian, T=Teacher, SP=School Psychologist, C=Child, SSW=School social worker, SN=School Nurse, P=Principal\n\nMeasures Parents\n\n* POM-11 - Parents overprotective measure. POM-11 can be used in both basic and intervention research to examine links between anxiety and overprotection, and as an outcome or mediation measure. Clinically, it helps identify overprotective parenting behaviors.\n* SDQ - The Strengths and Difficulties Questionnaire is a brief screening tool that assesses emotional and behavioral problems as well as strengths in children and adolescents. It is available in multiple versions for parents, teachers, and young people and is widely used for clinical assessment, research, and early identification of psychosocial difficulties.\n* Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP). Measures how the parents perceive their ability to support the child or young person with problems related to attachment to school and schooling.\n* School-home relationship evaluation. Grading perceived relationship with school staff 1-10.\n* Qualitative interviews regarding relation to school staff and participation in intervention and own perceptions of their schooling.\n\nChildren\n\n* Daily attendance data from school registry.\n* Self-efficacy Questionnaire for School Situations (SEQ-SS) is a short self report measure assessing students' confidence in coping with challenging school related situations.\n* ISAP Inventory of School Attendance Problems\n* Schedule assessment- for evaluating the child's experience of its' school week. The child colors its school schedule in the colors green, yellow or red to show how each class during the week is perceived.\n* Four moments during the day. Four questions regarding child's feelings when leaving home to go to school.\n\nTeachers\n\n* SDQ The Strengths and Difficulties Questionnaire\n* Implementation measures\n\nEthics review The ethical application is scheduled to be submitted in April 2026.\n\nResearch group PhD student - Malin Olsen Malin Olsen is a licensed psychologist with 15+ years of experience working with children and families. She developed the EAGLE intervention and is responsible for study design, implementation, data collection and writing.\n\nMain supervisor - Emma Claesdotter-Knutsson Emma Claesdotter-Knutsson is a senior consultant and associate professor in child and adolescent psychiatry with over 50 scientific publications. She leads the project as main supervisor and contributes to study design, analysis, and writing.\n\nAssistant supervisor - Martin Karlberg Martin Karlberg is a Senior Lecturer and associate professor in Education at Uppsala University. His research focuses on absenteeism and effective teaching. He supports the project as co supervisor, contributing expertise in school based research and study design, and writing.\n\nAssistant supervisor - Mitchell Andersson is a psychologist and a PhD level researcher at the Faculty of Medicine at Lund University.\n\nResearch group member - Dariush Djamnezhad is a doctoral student at the Faculty of Medicine and works as a licensed psychologist in the City of Malmö.\n\nReferences Elfström, S., \\& Åhlen, J. (2025). Psychometric evaluation of the Parental Overprotective Measure: Toward a reliable and practical assessment tool. Journal of Child and Family Studies, 34, 164-173.\n\nGren Landell, M. (2016). Saknad! Uppmärksamma elevers frånvaro och agera (SOU 2016:94). Statens offentliga utredningar, Regeringskansliet.\n\nHeyne, D., King, N., Tonge, B., Rollings, S., Pritchard, M., Young, D., \\& Myerson, N. (1998). The self-efficacy questionnaire for school situations: Development and psychometric evaluation. Behaviour Change, 15(1), 31-40.\n\nHeyne D., Maric M., Westenberg P. M. (2007). Self-Efficacy Questionnaire for Responding to School Attendance Problems. (unpublished). Översättning Alanko Katarina och Langenskiold Jakob.\n\nKearney, C. A., Dupont, R., Fensken, M., \\& Gonzálvez, C. (2023). School attendance problems and absenteeism as early warning signals: Review and implications for health-based protocols and school-based practices. Frontiers in Education, 8, Article 1253595. https:\u002F\u002Fdoi.org\u002F10.3389\u002Ffeduc.2023.1253595 Kearney, C. A., Haight, C., Hendron, M., \\& Schafer, R. (2011). Confirmatory analyses of the School Refusal Assessment Scale Revised: Replication and extension to a truancy sample. Journal of Psychopathology and Behavioral Assessment, 33, 196-204.\n\nMalmberg, M., Rydell, A.-M., \\& Smedje, H. (2003). Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe). Nordic Journal of Psychiatry, 57(5), 357-363.\n\nSelman, S. B., \\& Dilworth-Bart, J. E. (2024). Routines and child development: A systematic review. Journal of Family Theory \\& Review, 16(2), 272-328.\n\nSkolverket. (2025). Frånvaro i skolan. https:\u002F\u002Fwww.skolverket.se\u002Fstyrning-och-ansvar\u002Fregler-och-ansvar\u002Fansvar-i-skolfragor\u002Ffranvaro-i-skolan Strömbeck, J., Heyne, D., Ferrer-Wreder, L., \\& Alanko, K. (2025). Reliability and validity of the Swedish version of the Inventory of School Attendance Problems (ISAP). European Child \\& Adolescent Psychiatry, 34(7), 2069-2082.\n\nStrömbeck, J., Palmér, R., Sundberg Lax, I., Fäldt, J., Karlberg, M., \\& Bergström, M. (2021). Outcome of a multi-modal CBT-based treatment program for chronic school refusal. Global Pediatric Health, 8, 2333794X211002952.",[58,64],{"label":59,"type":60,"description":61,"interventionNames":62},"Treatment as usual (TAU)","ACTIVE_COMPARATOR","Treatment as usual (TAU) that is the intervention for absenteeism given at the school",[63],"Behavioral: Treatment as usual (TAU)",{"label":65,"type":66,"description":67,"interventionNames":68},"Intervention","EXPERIMENTAL","Intervention EAGLE",[69],"Behavioral: Intervention , EAGLE",[71,76],{"type":72,"name":73,"description":74,"armGroupLabels":75,"otherNames":49},"BEHAVIORAL","Intervention , EAGLE","EAGLE - a structured model aimed at helping schools respond at the earliest signs of absenteeism. Instead of waiting until absenteeism becomes deep-rooted, the framework supports schools in acting proactively in phase 4 . It is intended for younger children (ages 6- 12) and their parents\u002Flegal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included.",[65],{"type":72,"name":59,"description":61,"armGroupLabels":77,"otherNames":49},[59],[79],{"name":80,"role":81,"phone":82,"phoneExt":49,"email":83},"Emma Claesdotter-Knutsson, PhD;MD","CONTACT","0046768871765","emma.claesdotter-knutysson@med.lu.se",{"type":85,"investigatorFullName":49,"investigatorTitle":49,"investigatorAffiliation":49,"oldNameTitle":49,"oldOrganization":49},"SPONSOR","100659031","early-absenteeism-guide-for-lifelong-education-100659031",false,"NCT07857603","Early Absenteeism Guide for Lifelong Education","EAGLE","Inclusion criteria\n\n* Children with 10-60 % absence during the past semester.\n* Parents\u002Flegal guardians can speak and read sufficient Swedish Exclusion criteria\n* Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and\u002For significantly affects daily functioning\n* Social conditions known to the school staff that would obstruct from participation (e.g. ongoing custody dispute, domestic violence, ongoing investigation of child neglect through social services)","ALL","6 Years","13 Years",{"count":97,"type":98},90,"ESTIMATED","INTERVENTIONAL",[101],"NA","School absenteeism is a problem that can be caused by several different factors, such as difficulties within the family, problems in the school environment, or mental health difficulties. Absenteeism can, in turn, lead to negative consequences such as poorer mental health, social isolation, and long-term difficulties later in life. For children, school absenteeism has negative consequences for their education, social relationships, and important daily routines-routines that can otherwise serve as a protective factor against, among other things, mental health difficulties, particularly for children in vulnerable environments (Selman, 2023). It is therefore important that problems are identified at an early stage and that schools, parents, and pupils work together to reduce absenteeism (Kearney, 2008; Gren-Landell, 2021).\n\nAbout EAGLE EAGLE (Earle Absenteeism Guide for Lifelong Education) is a collaborative model between schools and families aimed at preventing school absenteeism at an early stage, before absenteeism becomes extensive and therefore more difficult to address. Primary schools are organisations with limited resources and a need for simple, practically oriented working methods. EAGLE therefore has a simple basic structure, with the aim of being implemented quickly when pupils begin to show problematic absenteeism.\n\nHere, problematic absenteeism refers to absenteeism that is caused by something in the child's life that is not functioning well or needs to change-for example, difficulties at school, at home, or in everyday life-and not by a straightforward cause such as a common cold. The target group is children in the early and middle years of primary school. An important component is to strengthen collaboration between parents and school staff, as well as to provide parents with guidance on parenting in relation to the child's difficulties attending school.\n\nThe Gradual Development of Absenteeism Absenteeism does not begin from one day to the next; rather, it develops gradually. Unfortunately, it is common for interventions to be introduced only when absenteeism has become extensive, by which point it is more difficult to reverse. EAGLE, on the other hand, is implemented earlier, increasing the possibility of, so to speak, turning the ship in the right direction and helping children and parents establish a positive experience of school attendance.\n\nIn brief, EAGLE consists of three collaborative meetings between the school and the child's parent(s)\u002Fguardian(s), two sessions providing psychological guidance to the parents, and two shorter conversations with the child to obtain their perspective. The basic principle is that, when it comes to school absenteeism among young children under the age of 12, adults-both at school and at home-should collaborate and drive the change, rather than placing this responsibility on the child. Nevertheless, the child's perspective must be taken into account throughout the entire process.\n\nSchool absenteeism is often described as a complex phenomenon involving an interaction between different factors that mutually influence one another (Swedish National Agency for Education, 2021). These factors may vary, but they generally concern three main areas: 1) school-related factors, 2) individual-related factors, and 3) family-related factors. The EAGLE working model provides a method for mapping these three areas and subsequently implementing appropriate interventions. Considerable time is devoted to establishing good collaboration between the school and the family and to helping parents manage the difficulties that arise when a child does not want to attend school.\n\nAim\n\nThe research project aims to:\n\nEvaluate the effectiveness of the EAGLE intervention. Understand which factors influence children's absenteeism, including factors related to both parents and pupils.\n\nMaterials and Methods The research project will use both qualitative and quantitative data. The primary outcome measure will be school attendance.\n\nWe will also investigate factors in the child's life that may influence absenteeism, such as symptoms of anxiety and depression, as well as their parents' attitudes towards school based on their own experiences as children.",[104,105],"Absenteeism","School Absenteeism",[105,107],"Children","NOT_YET_RECRUITING","2026-09-30",{"date":111,"type":112},"2026-10-05","ACTUAL",{"date":114,"type":98},"2027-01-01",{"date":116,"type":98},"2027-09-30",{"name":5,"class":6}]