Sleep Education in Primary School Prevents Future School Refusal Behavior, 2019, Miike et al

Andy

Andy

Retired committee member
Abstract
Background
Sleep disorders, along with extreme difficulty awakening, have been reported as one of the main causes of school refusal. The accumulation of chronic sleep deprivation accompanied by a late‐night lifestyle is considered the basic inciting factor.

Methods
From 2007, we initiated a sleep education program (Min‐Iku) in Fukui, Japan, with the aim of improving pupils' lifestyles and prevent future school refusal. All grade M primary school (PS) pupils participated in this program and gave their informed consent. The Min‐Iku included 1) implementation of a “daily life rhythm survey” by recording the sleep‐awake rhythm in a table for 14 days, 2) evaluation of the sleep table in four stages (A to D), 3) interviews of stage D children and their guardians, 4) lectures on “The importance of daily life rhythms” for parents and teachers, and 5) 45‐min classwork for all participating pupils.

Results
In 2007, 10% of M‐PS graduates developed school refusal behavior after entering K junior high school (JHS). However, the incidence of school refusal decreased each year after the implementation of the Min‐Iku program and finally reached 0 by 2012. The sleep onset time of pupils improved each year, with the most common sleep time reaching 9:30 p.m. on both weekdays and holidays. With an earlier sleep time, the nighttime sleep duration was significantly extended (P<0.0001 vs. data observed in 2007).

Conclusion
The Min‐Iku program for primary school pupils successfully achieved a more routine night‐time sleep pattern and a regular life rhythm, which prevented school refusal during the subsequent JHS years.
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Paywall, https://onlinelibrary.wiley.com/doi/abs/10.1111/ped.13976
Sci hub, https://sci-hub.se/10.1111/ped.13976
 
I was going to say oh dear, but then I remembered that during my A-Levels*, there were a couple of times when I missed school due to being exhausted from staying up late working on my coursework or on my university applications. I don't think that "sleep education" would have prevented that though.

*I did not have ME at this time
 
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Hmm. "School refusal, or school avoidance, is a term used to describe the signs of anxiety a school-aged child has and his or her refusal to go to school." (I got this definition from the Internet.) Surely that is different to somebody having difficulty awakening due to a sleep disorder?!
 
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I think you've summed up this study very well @Sarah94. edit and James ML.

The authors might have a valid point; i.e. that poor sleep habits account for a significant proportion of the young people who fail to get to secondary school. But this small study and the way the data is presented isn't enough to prove that, and certainly isn't enough to prove that some sleep education fixes the problem.

The authors seem to mix wild speculation into their arguments. For instance they observe that the program in one primary school where sleep education was given to children and their families in all grades was more successful than the program in two other primary schools where only the older children and their families were targeted. They then conclude that
The Min-Iku program should be applied in earlier stages of life, such as the fetal stage during pregnancy and/or for newborn babies.
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They also seem to be suggesting that all problems that might be causing school refusal stem from lack of sleep, and that chronic fatigue syndrome = chronic sleep deprivation.
Interestingly, the daily expression of clock genes in the whole blood cells of students who exhibited school refusal behavior were found to be significantly altered in comparison to control cases. Furthermore, the greater the deviation in clock time, the more difficult the road to clinical improvement....

Based on these results, in 1993, significant similarities between school refusal behavior and adult chronic fatigue syndrome were noted.In fact, a further analysis of the relationship between the laboratory data and clinical symptoms in school refusal behavior led to adoption of the term childhood chronic fatigue syndrome.
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And they write approvingly of some pretty intrusive suggestions for approaches to solving this problem of deranged sleep:

Moreover, the Min-Iku program gradually spread to the local community. For example, the principal meeting, which included six PSs and three JHSs in the town, recommended that town gymnasiums—such as those used for volleyball practice by mothers with their children—be closed after 8 p.m. (no babysitter system is available in Japan).
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Yes, quite clearly it's the fault of the volley-ball playing mothers, because it seems the fathers can't be expected to get the children to bed when the mothers are out.
 
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Their definition of CFS isn't even close to any the definitions we use:
In fact, a further analysis of the
relationship between the laboratory data and clinical symptoms in school refusal behavior led
to adoption of the term childhood chronic fatigue syndrome.25,27,46,47
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It's the same misuse of the term CFS when applied to mice that are forced to swim to exhaustion.

This study is about sleep disruption leading to poor school attendance leading to "school refusal behavior" that is given the inappropriate term CFS.
 
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