One limitation of this study was that specific information
about the reasons for school absences was not collected.
Therefore, the absences could be due to pain, other
physical symptoms, medical appointments, or other reasons.
Other limitations are the lack of a comparison group
and the small sample size of homeschooled adolescents.
Finally, the results are generalizable only to JPFS patients
seen in tertiary care pediatric rheumatology settings, and
may not be as applicable to those seen in primary care or
those who do not seek treatment.
Despite the limitations, this study found that difficulty
with school attendance can be a significant problem in
clinically referred adolescents with JPFS and depressive
symptoms were significantly associated with school
absences. The findings highlight the need for a greater
focus on reducing school absenteeism in adolescents
with JPFS. Behavioral and cognitive-behavioral treatments
should consider including a greater focus on comprehensive
planning and implementation of strategies to address
school absenteeism. More longitudinal research into the
long-term implications of early school-related disability is
needed, as well as research on peer and family factors that
can maintain or exacerbate school problems.