Patient Presentation
A 9-year-old male came to clinic for his health supervision visit. His mother had no concerns and the past medical history was non-contributory. The social history revealed that he had been previously homeschooled and had made a good transition to 4th grade when he had moved into the area and both parents were now working outside the home. He had good friends at school and at his church activities. His mother said that he did have some trouble with organizing his time as he had less free time now after school. He spent more than 2 hours on the computer and wasn’t very physically active. His diet history was normal.

The pertinent physical exam showed a happy male with normal vital signs and growth parameters in the 10-50%. BMI was 25%. His physical examination was normal. The diagnosis of a healthy male with a more sedentary lifestyle was made. The pediatrician recommended to decrease the computer use and discussed options at home and in the community to increase his physical activity such as community sports teams, swimming pool and bike paths.

Discussion
Homeschooled children are a diverse group of students who are not participating in the traditional model of a children going off to a separate school location 5 days a week for instruction by educational professionals. If homeschooled, children may not be subject to all or some of the regulations for traditionally-schooled children regarding curricular measures, record keeping, reporting, and testing. Children in homeschooled environments also may not have access to other services that are provided through traditional schools such as special education services. Some research data shows positive academic and social/behavior outcomes, while others are mixed or not as positive. The literature on homeschooling can be difficult to compare as it can be unrepresentative or have small sample sizes, often without an appropriate control group. There is also the issue of the study informant that is parent or student reporting. In some studies parents report similar socialization and engagement and academic abilities, while student findings may not be as positive.

There may also be some differences in studies depending on the student and family characteristics. The idea of homeschooling ideologues and pedagogues has been discussed for the past generation. “Ideologues object to the secular content of traditional education, so while maintaining its structure, they seek to modify the schooling content to reflect their beliefs. Pedagogues homeschool in order to shed the structure of formal schooling. Sometimes referred to as “unschooling”, this child-directed perspective prioritizes intrinsic motivation. Such curricular flexibility might be attractive for parents whose children have special educational needs, either from giftedness to disability.” It may also attract families who perceive traditional schooling as having already having failed their child.

According to the US Department of Education, in 2012 (which are the latest statistics) the number of homeschooled children ages 5-17 year olds is estimated to be 1,773,000 in the United States or ~3.4% . This has increased from ~850,000 or 1.7% in 1999. This is according to a national survey of parents and is an estimated number. Homeschooled was defined as children who are not schooled in traditional locations/systems and for children who may also be involved in these systems but only do so < 25 hours/week. Student may be participating in certain curricular activities (e.g. band program, sports teams) but not all of the traditional school programs. This is sometimes referred to as dual-enrollment. Homeschooled children live within all types of homes and locations. They tend to live in rural (41%), suburban (28%) or urban (21%) locations. Parents have all types of educational levels from less than high school degree to graduates degrees but more have a post-high school vocational or some college education. About 25% of parents took some type of course to prepare themselves for homeschooling. The race/ethnicity is more commonly white (83%) or Hispanic (15%). Most homeschoolers (80%) are not living in poverty.

The most common reasons for homeschooling were (families could choose more than 1 reason):

• 91% – concerns about safety, drugs, negative peer pressure
• 77% – desire to provide moral instruction
• 74% – dissatisfaction with academic instruction at child’s school
• 64% – desire to provide religious instruction
• 44% – desire to provide non-traditional approach to child’s education
• 37% – other includes family time, finances, travel and distance
• 16% – child with special needs
• 15% – child with physical or mental health problem

About 1/3 of middle and high school homeschooled students take online courses (35% and 34% respectively), with 11% of elementary students doing so. Various math levels were taught including algebra (88.5%), geometry (54%), advanced algebra (35%), probability (14%), and calculus (10%). Declining percentages does not necessarily mean that fewer students will be exposed to these subjects as in the survey there were also fewer students who would be of the age where they appropriately would have taken them (i.e. there are fewer 12th grade equivalent students who would be taking calculus or probability). Similarly in science students were taught biology (69%), earth sciences/geology (69%), scientific inquiry or experiments (47%), chemistry or physics (34%) and computer science (32%).

Learning Point
Homeschooled children have been found to have similar or lower physical activity compared to traditionally-schooled children in studies. In 2018, a cross-sectional study of fitness in homeschooled children with children 5-11 years (n=143) found homeschooled children to have normal fat mass and body mass index levels, but elevated levels of central adiposity. Central adiposity is a more direct measure of visceral fat and may be a better measure of cardiovascular disease than body mass index. The authors recommend that schools and other communities’ businesses and organizations can assist homeschooled families by offering fitness screening and testing in a variety of settings where children are in attendance regardless of how they are being educated.

The 2014 National Survey on Drug Use and Health which is a national representative sample of households with children >12 years of age. Parents and teens were surveyed and were divided into four groups based on being traditionally-schooled or homeschooled, and those with a stronger or weaker religious affiliation. In this sample 0.6% were homeschooled. More homeschooled children reported a stronger religious affiliation. A stronger religious affiliation for both homeschooled and traditionally-schooled children was associated with less delinquency and substance abuse. Students being homeschooled or having a stronger religious affiliation was also associated with more students reporting that they were 2 years or more behind in academic grade level. When looking at participation in extracurricular activities, weaker religious homeschoolers were more likely to report fewer activities, with 23.4% of this group reporting no extracurricular activities in the past 12 months and therefore are more likely to be socially isolated. However, stronger religious homeschoolers were much less likely (60% less likely compared to reference group) to report being socially isolated and were engaged in extracurricular activities. These stronger religious homeschoolers were more likely to report that all of their extracurricular activities were faith or church centered (20.7%) while stronger religious traditionally-schooled adolescents reported exclusive faith or church based activities much less frequently (3.4%).

Homeschooled children have protective factors for delinquency. Homeschooled children may be at risk for decreased physical activity, social isolation or restriction, and academic issues. This does not mean all students will be, but like any risk factor within a particular population, these issues should be screened for.

Questions for Further Discussion
1. What are the regulations for homeschooling in your location?
2. What local resources are available to increase physical activity?

Related Cases

Disease: Homeschooling | School Health

Symptom/Presentation: Health Maintenance and Disease Prevention

Specialty: General Pediatrics | School

Age: School Ager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: School Health

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Green-Hennessy S. Homeschooled adolescents in the United States: developmental outcomes. J Adolesc. 2014 Jun;37(4):441-9.

Kabiri, Laura S; Mitchell, Katy; Brewer, Wayne; Ortiz, Alexis. How Healthy Is Homeschool? An Analysis of Body Composition and Cardiovascular Disease Risk. Journal of School Health Vol. 88, Iss. 2, (Feb 2018): 132-138.

Redford, Jeremy; Battle, Danielle; Bielick, Stacey. Homeschooling in the United States: 2012. (NCES 2016-096) National Center for Education Statistics; National Center for Education Statistics, U.S. Department of Education. Washington, DC.

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa