Exclusion, restraint and school attendance problems

In a total-population study of every pupil aged 7 to 16 in Wales, children with an autism diagnosis were about two and a half times as likely to be excluded as children with no recorded diagnosis (adjusted odds ratio 2.6).¹ Record-linkage studies in Scotland and England find the same direction: autistic pupils are excluded more often than pupils with no special educational needs.^2,3

How common exclusion is depends on how it is counted. Studies that use school records count formal exclusion only. In Wales, 4.7% of autistic children aged 7 to 11 had been excluded, and the proportion rose with age.¹ In England in 2016/17, 4.5% of autistic pupils had at least one fixed-period exclusion, and the rate of fixed-period exclusions was about three times that of pupils with no special educational needs.³

Studies that ask parents count more. In the UK Millennium Cohort Study, 25% of autistic 14-year-olds had been temporarily or permanently excluded at least once, by parent report.⁴ The authors say this is higher than school-record figures because their measure includes informal and unrecorded exclusions, and because it asks whether the child was ever excluded rather than counting a single school year.⁴ In an Ontario survey, 42.3% of caregivers said their autistic child had been excluded at some point.⁵ Fifteen percent of the autistic 14-year-olds in the UK cohort said they had truanted at least once in the past year.⁴

Co-occurring conditions add to the likelihood. In the Ontario survey, autistic children who also had ADHD were about one and a half times as likely to be excluded as those without.⁵

Autistic students miss more school than their peers.⁶ In a New Zealand study of all children aged 5 to 12, 49.3% of autistic students attended regularly, against 61.2% of matched non-autistic students, and 7.7% were chronically absent, against 3.2%.⁷ In one survey of parents of 486 autistic students, 43% had persistent absence, meaning they missed more than 10% of school days.⁸ In an Australian survey of 77 families, over 40% of autistic children had persistent absence, and child anxiety was the strongest predictor.⁹

The reasons differ from those for school absence in general. In the survey of 486 families, school refusal or avoidance accounted for 43% of absences, ordinary illness and medical appointments for 32%, school exclusion for 9%, and withdrawal by parents for 9%; truancy was almost absent.⁸ In a Norwegian study of 78 autistic students and 138 classmates, all aged 9 to 16 and without intellectual disability, teachers reported school refusal behavior in 42.6% of the autistic students, against 7.1% of the others.¹⁰ A UK study of 947 families whose children were struggling to attend school found that 83.4% of the children were autistic.¹¹

The studies that ask autistic students and their families why exclusion and absence happen most often name school-level factors: the sensory and social demands of school, support that does not match need, bullying, and inadequate staff training.^12,5,13 A systematic review of 18 studies found most risk factors at the level of the school, with child, family and school factors interacting.¹⁴ Child mental-health difficulties also go with exclusion and absence, as they do for students generally.⁴ In a UK study that interviewed autistic pupils, parents and professionals, the same pupils attended and even enjoyed school when the right support was in place.¹²

One survey found that parents who were more satisfied with their child's individualized education plan were less likely to report exclusion.⁵ That is an association, and the direction cannot be settled from a single survey.

United States schools report the use of restraint and seclusion to the Civil Rights Data Collection. In the 2023-24 collection, schools reported physically restraining 61,146 students who were served under the Individuals with Disabilities Education Act (IDEA) and secluding 21,868.¹⁵ Students served under IDEA made up 14.5% of enrollment but 72.5% of the students physically restrained and 67.8% of those secluded.¹⁵ The figures are self-reported by districts. A US Government Accountability Office review in 2019 found the federal restraint figures were substantially incomplete, with most districts reporting none.¹⁶

The Civil Rights Data Collection groups students by disability status, not by diagnosis, so it does not show how often autistic students in particular are restrained.¹⁵ No study found as of October 2026 has measured how often autistic students are restrained in school.

Exclusion and absence go with worse outcomes later. In the UK Millennium Cohort Study, exclusion during secondary school partly explained the link between autism and externalizing difficulties, such as conduct and hyperactivity problems, at age 17; there was no evidence that it explained internalizing difficulties, such as anxiety and low mood.¹⁷ In the Avon Longitudinal Study of Parents and Children, a general-population birth cohort, boys excluded by age 8 already had higher mental-health scores at age 3, and the gap widened over time; teenage girls excluded by 16 showed worsening mental health afterwards.¹⁸ An analysis of two UK national surveys found that children with psychiatric difficulties were more likely to be excluded whether or not the difficulties had been recognized, and the authors concluded that exclusion may reflect a failure to provide timely support rather than a failure to recognize the problem.¹⁹

These are associations from cohort studies. They do not show that exclusion causes the later difficulties, although the mediation analysis was designed to estimate how much of the link runs through exclusion.^17,18

Autistic writers describe school as the environment that did the most damage. Pete Wharmby, who taught for ten years, calls it "the harshest environment", and writes that schools "have been designed with aims and ambitions in mind that are not well suited to the neurodivergent minority".^c1 Writers describe being disciplined for autistic traits that staff did not understand. Julia Bascom recalls being taught "quiet hands" in preschool, her hands held down "for a count of three until they learned to restrain themselves".^c2

The words people use matter to them. The clinicians Donna Henderson, Sarah Wayland and Jamell White write that school avoidance is the better term, because refusal suggests a deliberate choice when the child is often afraid or overwhelmed; many autistic writers use the same term.^c3 Carly Jones describes a girl whose occasional absence "progressed into complete school refusal", which was burnout rather than rebellion.^c4 Bianca Toeps writes that she stayed home because she "simply couldn't cope anymore" at school, after "constant adjusting and masking".^c5

Restraint and seclusion are described in community writing as abuse rather than care. Ashburn, Edwards and Onaiwu write that students with disabilities "are restrained, secluded, and expelled at much higher rates than those without disabilities", and call for schools "free from restraint and seclusion".^c6 Bascom's collection records restraint equipment sent to schools for a seven-year-old.^c2 Amy Pearson and Kieran Rose write that restraint and seclusion are used frequently in education, not as a last resort, and that this causes lasting harm.^c7 A collection for educational psychologists argues that school exclusion is linked to later involvement with the criminal justice system, and that improving engagement is the alternative.^c8