Swimmingupstream, I am interested in your observations. You are clearly working with some difficult cases. I have become convinced that the help of friends – in one form or another – is needed to get absent children get back to school. I reckon most of the time parents and counsellors cannot succeed without help from friends. You say the kids that you work with don’t have friends. I know there are lot’s of lonely children out there that don’t have friends but I wonder if it would be possible to use the strategy described by Sue Young whom I have interviewed on Youtube, where you actually recruit “friends” (read classmates) to act as friends to help the student go back to school (in her case to be happy in school) – or the other option, you collect several youngsters and ask them to support one another to get back to school. This is a strategy that is sometimes used in Kids’Skills with kids who have severe behavioural problem but no friends – so we summon the kids into a group and coach them in helping each other. https://www.youtube.com/playlist?list=PLAVpnwnZWVJLOzTSSYvKlgPbwfmuZb3Kt Here is the link to Sue Young’s interview if you are interested. I’m curious to hear your take on these strategies, if they perhaps seem unrealistic in your experience. I can imagine that the problems are quite big when kids are already medicated and have perhaps even begun to buy into the idea that there is something inherently wrong with them.