AbsenteeismEAGLENCT07857603
Early Absenteeism Guide for Lifelong Education
A study testing Intervention , EAGLE and Treatment as usual (TAU) in people with Absenteeism and School Absenteeism, run by Lund University.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 6 to 13 years
- Conditions the study is for
- Absenteeism, School Absenteeism
- What is being tested?
- Intervention , EAGLE and Treatment as usual (TAU)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 90 participants
- Where
- No sites listed yet
- Study dates
- 1 Jan 2027to 30 Sep 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 6 to 13 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- Children with 10-60 % absence during the past semester.
- Parents/legal guardians can speak and read sufficient Swedish Exclusion criteria
- Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and/or significantly affects daily functioning
- 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)
Who cannot join
None listed.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
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).
About 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.
Read more
Here, 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.
The 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.
In brief, EAGLE consists of three collaborative meetings between the school and the child's parent(s)/guardian(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.
School 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.
Aim
The research project aims to:
Evaluate the effectiveness of the EAGLE intervention. Understand which factors influence children's absenteeism, including factors related to both parents and pupils.
Materials and Methods The research project will use both qualitative and quantitative data. The primary outcome measure will be school attendance.
We 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.
Read the detailed description
Breaking patterns of absenteeism: An Evaluation of the EAGLE Model in Primary Education.
Background 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).
SAPs 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).
To 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/legal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included.
Figure 1. The gradual progression of absenteeism.
Co-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.
Aim The aims of the current study are to examine the effects of the EAGLE intervention, including both qualitative and quantitative data.
Study 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.
Research questions • To what extent is EAGLE effective in reducing children's school absenteeism at an early stage compared to TAU?
- To what extent is the effect of EAGLE moderated by school-home relationship, parental overprotectiveness, child characteristics at baseline, gender or age?
- 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?
- To what extent does EAGLE improve the quality of relationships between school staff and parents compared to TAU?
- To what extent does EAGLE affect children's school-related self-efficacy?
- How do parents' own school experiences relate to children's attendance patterns and engagement with the intervention?
- 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?
Method
Participants Study participants will be children aged 6-12 with an absence of 10-60%, and their legal guardians.
Each child's teacher will fill in form regarding the child's strengths and difficulties.
Control 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.
Schools in the control group will be offered lectures by researchers on child psychology and absenteeism.
Procedure 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.
Significance 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.
Sample 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).
Inclusion criteria
- Children with 10-60 % absence during the past semester.
- Parents/legal guardians can speak and read sufficient Swedish
Exclusion criteria
- Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and/or significantly affects daily functioning
- 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)
Timeplan
2026 January-June Preparing study, writing manual, and submitting ethics application.
August 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.
December 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
Figure 2. The randomization process EAGLE: Early Absenteeism Guide for Lifelong Education. Session guide. Week Meeting Participants Content Purpose
1 Joint assessment Legal Guardian, Teacher, School Psychologist, SSW/SN/P 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.
Use a whiteboard or similar tool for a shared and transparent overview.
Create shared understanding
Task allocation
Child interview Child, School Social Worker Schedule evaluation Other suitable questionnaires, based on assessment the week before Getting the child's point of view
2 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.
Adress issues in child's home environment that were raised in assessment meeting.
Support legal guardians in making necessary changes.
3 Carry out assigned tasks.
4 Carry out assigned tasks.
5 Follow-up meeting Legal Guardian, Teacher, School Psychologist SSW/SN/P
Follow 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."
Evaluate interventions; adjust them if needed
6 Counseling session II Legal Guardian, School Psychologist Follow up home situations that affect the child's ability to attend school.
Help legal guardians make changes needed for better attendance.
7 Carry out assigned tasks.
8 Carry out assigned tasks.
9 Carry out assigned tasks.
10 Final meeting LG, T, SP, SSW/SN/P Follow up on agreed tasks and interventions, evaluate their effects and adjust if needed.
Summarize situation and intervention thus far. Make plans for future.
LG=Legal Guardian, T=Teacher, SP=School Psychologist, C=Child, SSW=School social worker, SN=School Nurse, P=Principal
Measures Parents
- 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.
- 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.
- 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.
- School-home relationship evaluation. Grading perceived relationship with school staff 1-10.
- Qualitative interviews regarding relation to school staff and participation in intervention and own perceptions of their schooling.
Children
- Daily attendance data from school registry.
- Self-efficacy Questionnaire for School Situations (SEQ-SS) is a short self report measure assessing students' confidence in coping with challenging school related situations.
- ISAP Inventory of School Attendance Problems
- 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.
- Four moments during the day. Four questions regarding child's feelings when leaving home to go to school.
Teachers
- SDQ The Strengths and Difficulties Questionnaire
- Implementation measures
Ethics review The ethical application is scheduled to be submitted in April 2026.
Research 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.
Main 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.
Assistant 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.
Assistant supervisor - Mitchell Andersson is a psychologist and a PhD level researcher at the Faculty of Medicine at Lund University.
Research group member - Dariush Djamnezhad is a doctoral student at the Faculty of Medicine and works as a licensed psychologist in the City of Malmö.
References 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.
Gren Landell, M. (2016). Saknad! Uppmärksamma elevers frånvaro och agera (SOU 2016:94). Statens offentliga utredningar, Regeringskansliet.
Heyne, 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.
Heyne D., Maric M., Westenberg P. M. (2007). Self-Efficacy Questionnaire for Responding to School Attendance Problems. (unpublished). Översättning Alanko Katarina och Langenskiold Jakob.
Kearney, 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://doi.org/10.3389/feduc.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.
Malmberg, 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.
Selman, S. B., \& Dilworth-Bart, J. E. (2024). Routines and child development: A systematic review. Journal of Family Theory \& Review, 16(2), 272-328.
Skolverket. (2025). Frånvaro i skolan. https://www.skolverket.se/styrning-och-ansvar/regler-och-ansvar/ansvar-i-skolfragor/franvaro-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.
Strömbeck, 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.
- Conditions
- Absenteeism, School Absenteeism
- Being tested
- Intervention , EAGLE, Treatment as usual (TAU)
- Keywords
- School Absenteeism, Children
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Intervention , EAGLEBehavioural
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/legal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included.
Treatment as usual (TAU)Behavioural
Treatment as usual (TAU) that is the intervention for absenteeism given at the school
| Study group | Role | What they receive |
|---|---|---|
| Treatment as usual (TAU) | Active comparator | Treatment as usual (TAU) that is the intervention for absenteeism given at the school Receives: Behavioral: Treatment as usual (TAU) |
| Intervention | Experimental | Intervention EAGLE Receives: Behavioral: Intervention , EAGLE |
What is being measured
The primary outcome is the main question the study is designed to answer.
Abseteeism
School absenteeism, assessed using parent-reported and school-reported attendance data.
Measured: 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.
Secondary outcomes (11)
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.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Immediately through study completion, at 10weeks
School-home relationship evaluation
Grading perceived relationship with school staff 1-10.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Baseline and immediately through study completion, at 10weeks
Four moments during the day.
Four questions regarding child's feelings when leaving home to go to school.
Measured: Baseline and immediately through study completion, at 10weeks
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.
Measured: Baseline and immediately through study completion, at 10weeks
Impementation measures
Implementation measures will be used to assess the feasibility, acceptability, and fidelity of intervention delivery.
Measured: Baseline and immediately through study completion, at 10weeks
Pediatric Misophonia and Hyperacusis Questionnaire (PMHQ-4)
Questionnaire regarding childrens possible misophonia and hyperacusis
Measured: Baseline and immediately through study completion, at 10weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Oct 2026
- Study start1 Jan 2027 (estimated)
- Primary completion1 Sep 2027 (estimated)
- Study completion30 Sep 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for AbsenteeismStudies of the same condition, open and under way.
- More trials run by Lund UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 90 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Lund University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07857603
- Sponsor's protocol ID
- 2026-03214-01
- Acronym
- EAGLE
- Status last verified
- Sep 2026
- First submitted
- 23 Sep 2026
- Last updated
- 5 Oct 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Access to trial IPD can be requested by qualified researchers engaging in independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). For more information or to submit a request email the PI Emma Claesdotter-Knutsson.
Study at a glance
From the registry record, last updated by the sponsor on 5 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early Absenteeism Guide for Lifelong Education
- ClinicalTrials.gov ID
- NCT07857603
- Acronym / sponsor ID
- EAGLE / 2026-03214-01
- Conditions
- Absenteeism, School Absenteeism
- Keywords
- School Absenteeism, Children
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 90 participants (estimated)
- Lead sponsor
- Lund UniversityUniversity, hospital or other
- Study start
- 1 Jan 2027 (estimated)
- Primary completion
- 1 Sep 2027 (estimated)
- Study completion
- 30 Sep 2027 (estimated)
- First posted
- 5 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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).
About 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.
Here, 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.
The 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.
In brief, EAGLE consists of three collaborative meetings between the school and the child's parent(s)/guardian(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.
School 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.
Aim
The research project aims to:
Evaluate the effectiveness of the EAGLE intervention. Understand which factors influence children's absenteeism, including factors related to both parents and pupils.
Materials and Methods The research project will use both qualitative and quantitative data. The primary outcome measure will be school attendance.
We 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.
Detailed description
Breaking patterns of absenteeism: An Evaluation of the EAGLE Model in Primary Education.
Background 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).
SAPs 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).
To 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/legal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included.
Figure 1. The gradual progression of absenteeism.
Co-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.
Aim The aims of the current study are to examine the effects of the EAGLE intervention, including both qualitative and quantitative data.
Study 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.
Research questions • To what extent is EAGLE effective in reducing children's school absenteeism at an early stage compared to TAU?
- To what extent is the effect of EAGLE moderated by school-home relationship, parental overprotectiveness, child characteristics at baseline, gender or age?
- 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?
- To what extent does EAGLE improve the quality of relationships between school staff and parents compared to TAU?
- To what extent does EAGLE affect children's school-related self-efficacy?
- How do parents' own school experiences relate to children's attendance patterns and engagement with the intervention?
- 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?
Method
Participants Study participants will be children aged 6-12 with an absence of 10-60%, and their legal guardians.
Each child's teacher will fill in form regarding the child's strengths and difficulties.
Control 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.
Schools in the control group will be offered lectures by researchers on child psychology and absenteeism.
Procedure 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.
Significance 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.
Sample 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).
Inclusion criteria
- Children with 10-60 % absence during the past semester.
- Parents/legal guardians can speak and read sufficient Swedish
Exclusion criteria
- Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and/or significantly affects daily functioning
- 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)
Timeplan
2026 January-June Preparing study, writing manual, and submitting ethics application.
August 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.
December 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
Figure 2. The randomization process EAGLE: Early Absenteeism Guide for Lifelong Education. Session guide. Week Meeting Participants Content Purpose
1 Joint assessment Legal Guardian, Teacher, School Psychologist, SSW/SN/P 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.
Use a whiteboard or similar tool for a shared and transparent overview.
Create shared understanding
Task allocation
Child interview Child, School Social Worker Schedule evaluation Other suitable questionnaires, based on assessment the week before Getting the child's point of view
2 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.
Adress issues in child's home environment that were raised in assessment meeting.
Support legal guardians in making necessary changes.
3 Carry out assigned tasks.
4 Carry out assigned tasks.
5 Follow-up meeting Legal Guardian, Teacher, School Psychologist SSW/SN/P
Follow 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."
Evaluate interventions; adjust them if needed
6 Counseling session II Legal Guardian, School Psychologist Follow up home situations that affect the child's ability to attend school.
Help legal guardians make changes needed for better attendance.
7 Carry out assigned tasks.
8 Carry out assigned tasks.
9 Carry out assigned tasks.
10 Final meeting LG, T, SP, SSW/SN/P Follow up on agreed tasks and interventions, evaluate their effects and adjust if needed.
Summarize situation and intervention thus far. Make plans for future.
LG=Legal Guardian, T=Teacher, SP=School Psychologist, C=Child, SSW=School social worker, SN=School Nurse, P=Principal
Measures Parents
- 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.
- 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.
- 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.
- School-home relationship evaluation. Grading perceived relationship with school staff 1-10.
- Qualitative interviews regarding relation to school staff and participation in intervention and own perceptions of their schooling.
Children
- Daily attendance data from school registry.
- Self-efficacy Questionnaire for School Situations (SEQ-SS) is a short self report measure assessing students' confidence in coping with challenging school related situations.
- ISAP Inventory of School Attendance Problems
- 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.
- Four moments during the day. Four questions regarding child's feelings when leaving home to go to school.
Teachers
- SDQ The Strengths and Difficulties Questionnaire
- Implementation measures
Ethics review The ethical application is scheduled to be submitted in April 2026.
Research 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.
Main 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.
Assistant 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.
Assistant supervisor - Mitchell Andersson is a psychologist and a PhD level researcher at the Faculty of Medicine at Lund University.
Research group member - Dariush Djamnezhad is a doctoral student at the Faculty of Medicine and works as a licensed psychologist in the City of Malmö.
References 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.
Gren Landell, M. (2016). Saknad! Uppmärksamma elevers frånvaro och agera (SOU 2016:94). Statens offentliga utredningar, Regeringskansliet.
Heyne, 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.
Heyne D., Maric M., Westenberg P. M. (2007). Self-Efficacy Questionnaire for Responding to School Attendance Problems. (unpublished). Översättning Alanko Katarina och Langenskiold Jakob.
Kearney, 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://doi.org/10.3389/feduc.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.
Malmberg, 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.
Selman, S. B., \& Dilworth-Bart, J. E. (2024). Routines and child development: A systematic review. Journal of Family Theory \& Review, 16(2), 272-328.
Skolverket. (2025). Frånvaro i skolan. https://www.skolverket.se/styrning-och-ansvar/regler-och-ansvar/ansvar-i-skolfragor/franvaro-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.
Strömbeck, 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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Treatment as usual (TAU) | Active comparator | Behavioral: Treatment as usual (TAU)Treatment as usual (TAU) that is the intervention for absenteeism given at the school |
| Intervention | Experimental | Behavioral: Intervention , EAGLEIntervention EAGLE |
Who may qualify
- Ages
- 6 to 13 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (4 listed)
- Children with 10-60 % absence during the past semester.
- Parents/legal guardians can speak and read sufficient Swedish Exclusion criteria
- Child has serious somatic illness, defined as a medical condition that requires ongoing specialized medical treatment and/or significantly affects daily functioning
- 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)
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Intervention , EAGLEEAGLE - 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/legal guardians. The model is designed so that cooperation with external agencies, such as social services, can easily be included. | Behavioural | Intervention |
| Treatment as usual (TAU)Treatment as usual (TAU) that is the intervention for absenteeism given at the school | Behavioural | Treatment as usual (TAU) |
Primary outcome
Abseteeism
Time frame: 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.
School absenteeism, assessed using parent-reported and school-reported attendance data.
11 secondary outcomes
POM-11 - Parents overprotective measure
Time frame: Baseline and immediately through study completion, at 10weeks
SEQ-SS
Time frame: Baseline and immediately through study completion, at 10weeks
Inventory of School Attendance Problems, Swedish
Time frame: Baseline and immediately through study completion, at 10weeks
Self-Efficacy Questionnaire for Responding to School Attendance Problems (SEQ-RSAP)
Time frame: Baseline and immediately through study completion, at 10weeks
Qualitative interviews
Time frame: Immediately through study completion, at 10weeks
School-home relationship evaluation
Time frame: Baseline and immediately through study completion, at 10weeks
Schedule assessment
Time frame: Baseline and immediately through study completion, at 10weeks
Four moments during the day.
Time frame: Baseline and immediately through study completion, at 10weeks
SDQ - The Strengths and Difficulties Questionnaire
Time frame: Baseline and immediately through study completion, at 10weeks
Impementation measures
Time frame: Baseline and immediately through study completion, at 10weeks
Pediatric Misophonia and Hyperacusis Questionnaire (PMHQ-4)
Time frame: Baseline and immediately through study completion, at 10weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Oct 2026.
- Individual participant dataSharing planned: Yes. Access to trial IPD can be requested by qualified researchers engaging in independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). For more information or to submit a request email the PI Emma Claesdotter-Knutsson.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A study testing Intervention , EAGLE and Treatment as usual (TAU) in people with Absenteeism and School Absenteeism, run by Lund University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Emma Claesdotter-Knutsson, PhD;MD (0046768871765, emma.claesdotter-knutysson@med.lu.se), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Abseteeism (time frame: 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.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Oct 2026.