title: Which children and young people are excluded from school? Findings from the Avon Longitudinal Study of Parents and Children (ALSPAC).
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  National Institute for Health Research Academic Clinical Fellowship.
authors: Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: amelia.holme@bristol.ac.uk.
authors: Amelia
authors: A
authors: Paget
authors: University of Exeter Medical School, Exeter, UK.
authors: Claire
authors: C
authors: Parker
authors: University of Exeter Medical School, Exeter, UK.
authors: William
authors: W
authors: Henley
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Jon
authors: J
authors: Heron
authors: University of Exeter Medical School, Exeter, UK.
authors: Tamsin
authors: T
authors: Ford
authors: Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: Alan
authors: A
authors: Emond