Giorgia Carlucci

Background: Problematic school attendance in adolescence is a heterogeneous phenomenon with academic, emotional, and developmental consequences. Although relational factors are increasingly recognised, the literature remains conceptually fragmented, with overlapping constructs such as social isolation, loneliness, social withdrawal, and peer difficulties examined under partially distinct frameworks. Objective: This systematic review aimed to synthesize empirical evidence on the association between social isolation, related constructs, and problematic school attendance during adolescence. Methods: Following PRISMA 2020 guidelines, searches were conducted in PubMed, Scopus, and Embase (final search: 20 January 2026). Eligible studies were observational or qualitative empirical investigations involving adolescents aged 11–18 years and examining at least one relational construct (objective/subjective social isolation, loneliness, social withdrawal, peer rejection) together with at least one school attendance outcome (school refusal, withdrawal, truancy, avoidance, dropout). Risk of bias was assessed with design-specific JBI tools and findings were synthesized narratively. Results: Eleven studies met the inclusion criteria: six cross-sectional, four longitudinal/cohort, and one qualitative. Loneliness, bullying, school alienation, and social isolation at school were most consistently associated with school refusal and absenteeism, whereas peer acceptance, reciprocal friendships, teacher emotional support, and school belonging were associated with reduced dropout intentions, higher graduation rates, and better school transition. Longitudinally, loneliness and low teacher support preceded increases in intention to quit, while supportive relationships appeared to protect against later disengagement. Conclusions: Social isolation and related constructs are meaningfully associated with problematic school attendance in adolescence. Social isolation and related constructs appear to be meaningfully associated with problematic school attendance in adolescence, although the evidence base remains limited and heterogeneous. These findings suggest that a relational perspective may usefully complement existing approaches to attendance difficulties, and point to the need for longitudinal, multi-informant studies disentangling subjective, interpersonal, and institutional disconnection across distinct attendance profiles.

Background: Primary headaches in children and adolescents impose emotional, cognitive, and functional burdens beyond pain. This review synthesizes their psychopathological and neuropsychological dimensions and outlines implications for assessment and care. Methods: We performed a comprehensive review with systematic searches of PubMed, Scopus, and Embase (2015–2025). We included observational/experimental studies and evidence syntheses on 0–18-year-olds with migraine, tension-type, or cluster headache; treatment-only reports were excluded. Results: Across population and clinic samples, primary headaches co-occur with elevated anxiety/depression, frequent ADHD/learning problems, and pervasive sleep disturbances with likely bidirectionality. Interictally, small to moderate neurocognitive differences are most consistent in attention/executive control, processing speed, and verbal memory. Quality of life and school participation are reduced. Standardized tools (e.g., PedMIDAS, PedsQL/KIDSCREEN, SDQ/CBCL, SDSC±actigraphy, NEPSY-II/BRIEF) support multidisciplinary assessment. Conclusions: Care should look beyond pain counts, integrating routine screening of mood, sleep, and cognition; active family involvement; and school–healthcare coordination within stepped-care pathways (education and sleep hygiene for all; targeted CBT for catastrophizing/avoidance) with monitoring that pairs headache frequency with functional outcomes.