Supporting a Student With School Absenteeism Through to Employment: A Case Report of Long-Term Home-Based Occupational Therapy for Emotion-Related School Attendance Challenges.

In Japan, rising school absenteeism underscores the need for effective support systems. Students with neurodevelopmental disorders, such as autism spectrum disorder and attention-deficit/hyperactivity disorder, are highly vulnerable to prolonged absenteeism due to difficulties in interpersonal relationships and adaptation to their environment. However, existing literature primarily focuses on adaptation up to school reintegration or progression to higher education, with few studies examining the long-term transition from high school graduation to employment. This report describes the case of a 12-year-old boy with a neurodevelopmental disorder presenting with emotion-related school attendance challenges (ER-SAC). He received continuous home-based occupational therapy one to three times per week as part of a multidisciplinary support network and ultimately reached employment. The intervention began by building rapport through his interests, subsequently addressing his daily life rhythm, activities of daily living, academic needs, and social participation, alongside concurrent support for his mother, who had a psychiatric disorder. Adaptive behavior was assessed using the Japanese version of the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), focusing on the Socialization and Maladaptive Behavior domains. Although no marked improvement was observed at high school entry, socialization domain v-scores subsequently increased (e.g., coping skills from 6 to 15, interpersonal relationships from 9 to 14), and maladaptive behavior domain scores decreased (internalizing and externalizing both from 22 to 14) after graduation, in conjunction with employment transition support. Following continuous support spanning his school years through the prevocational period, he currently remains employed. This case suggests that for students with neurodevelopmental disorders presenting with ER-SAC, changes in daily functioning that are not captured by short-term outcome measures can facilitate long-term competitive employment and social participation. In supporting these students, goals should extend beyond school reintegration. Continuous, uninterrupted support that anticipates future employment and social participation across transitional milestones, such as advancement to higher education and graduation, is essential.