In the present study, the identification of subjects with school fear and truancy was based on a large community sample of adolescents who took part in a longitudinal survey. Certainly, the origin and the size of the samples are an advantage over many previous studies that had been based on rather small and selected sample. However, comparisons to the literature are also hampered by the different design of the present study.
The two subsamples were defined only by two self-reported proxy items rather than a full clinical assessment or school reports on real absences from school. Whereas self-reports by the adolescents themselves have to be considered a more reliable information rather than parental reports, the present study does not contain information on the extension, duration, and motivation of school-absenteeism in the subjects of the various subsamples because these data had not been collected in the original survey. Furthermore, the YSR index of truancy probably is better than the YSR indicator of school fear. These restrictions of the present study have to be born in mind for the following discussion of the findings.
With frequencies for school fear of 6.9% at a mean age of thirteen years and 3.6% at a mean age of sixteen years, the present study is reporting figures that are not significantly deviating from other reports in the literature with frequency rates between 1 and 5 per cent [1, 2]. The declining trend over a mean interval of three years is also matching findings in these previous studies. Similarly, both the frequencies for truancy of 4.9% at a mean age of thirteen years and of 18.5% at a mean age of sixteen years and the increasing trend with age are consistent with previous findings . The high rate of stability of truancy is also matching these findings.
There is some controversy in the literature whether or not there are significant gender differences in the manifestation of school refusal and truancy with some studies denying any differences [1, 2], whereas others are pointing to trends for females showing school refusal and males showing truancy more frequently [7, 15]. In the present study, there was a significantly higher rate of females in the school fear group at both times and in the truancy group at time 2. To some extent, this finding may be influenced by a reporting bias with females perhaps being more willing to confess both forms of school absenteeism. On the other hand, the present findings contribute to observations of marked recent societal changes in adolescent behaviour with females behaving very similar to males or even exceeding the rates of abnormal behaviour of males when it comes to behaviours like smoking, self-mutilation, or even conduct problems including truancy.
The group comparisons at time 1 and time 2 across the various domains of emotional and behavioural problems were largely in accordance with what could be expected from clinical findings. Findings from both times of assessment show that school fear is predominantly associated with a pattern of various internalizing problems and additional social problems, whereas there is a strong link between truancy and delinquent behaviour as well as externalizing problems. At a younger age around a mean of thirteen years school fear showed also an association with aggressive behaviour that was different from controls and later at a mean age of sixteen years truancy was amalgamated with some features of internalizing problems that again were different from controls.
Taken together, these findings based on a community study are very much in accordance with clinical findings pointing to a predominant association of school refusal with internalizing problems [6–8], and truancy with externalizing problems [10, 11] in children and adolescents. However, it should be noted that the mean YSR scores of the subsamples of the present study are not in the clinical range of functioning emphasizing the differences between community and clinical samples.
Further differentiation of school fear and truancy came from the comparison of a large group of other psychosocial variables. However, the pattern of differentiation at the two times of assessment was different. There was no contribution of life events at time 1. However, at time 2 in both groups of school absentees life event variables were significantly increased both in terms of frequency and negative impact. Thus, with a decrease of the numbers of subjects with school fear and an increase of the numbers of truants across time during adolescence the association with life events became stronger. Given the very limited knowledge about the contribution of life events to school absenteeism, the present finding is noteworthy. It converges with the finding by Huffington and Sevitt  indicating a significant though not specific increase of life events in these subjects. One may speculate that with increasing age adolescents showing some form of school absenteeism become more sensitive to life events and their impact or are at least more reliably reporting their life events. The general increase of life events in maladjusted children and adolescents is a well-known fact and has been found also in the ZAPPS both as a general risk factor  and as a specific risk factor for various groups of subjects suffering from depression , suicidal ideation [33, 34], eating disorders , and substance abuse [36, 37].
The two personality variables reflecting self-related cognitions showed that subjects with school fear had less self-esteem than the other two groups at both times and both students with school fear and truants displayed increased amounts of self-awareness at both times when compared with controls. These findings correspond well to the pattern of internalizing problems of school refusers and reflect the component of critical introspection and depressive features that is inherent to the syndrome of school refusal in many clinical cases. The increase in self-awareness in students with school fear matches these features. The fact that truancy was also associated with higher scores in self-awareness in older adolescents with a larger proportion of females at time 2 should guard against stereotyping these subjects as being neither reflective nor introspective.
The perceived parenting behaviour did not contribute at all to the differentiation of the younger adolescents at time 1 and more to the differentiation of truants than of subjects with school fear from controls later in adolescence at time 2. The former felt less accepted and more rejected by both parents, whereas students with school fear experienced only more paternal rejection than controls. Thus, in the present study an association between school absenteeism and perceived parental behaviour became obvious only later in time at the height of adolescence and predominantly in truants. This perceived deficit of the parents may well be a correlate of the actual neglecting and rejecting parent behaviour in truants that has been described by others [15, 21]. A criticizing father has also been described as being significant for school refusers .
Finally, the perceived school environment allowed some important differentiation of the students with school fear at the two times of the study. Although the pattern of distress was not identical at the two times, they were the group who suffered most from the school environment. They were suffering from more distress than controls due to increased performance stress and lacking possibility to participate and in comparison to truants from a lack of peer acceptance at time 1. Later in adolescence at time 2, these subjects had greater problems with competition at school than the two other groups and together with truants felt more controlled by the teacher than the controls. Thus, these differentiating characteristics do not only fit well into the clinical picture of school refusal with perceived distress coming from the school environment as described by others [22, 23] but also serve as a validation of the group definition that has been taken in the present study.
Limitations of the present study are due to the restricted definition of school absenteeism with no actual figures of the actual amount of school refusal and truancy. These figures could have been obtained only by information coming from the schools because parents often are ill-informed about school absenteeism of their youngsters. However, collecting data about actual school absenteeism was not a part of the original study design. Thus, information by the adolescents was considered to provide the best evidence that was available.