Emotionally Based School Avoidance (EBSA)
Emotionally Based School Avoidance (EBSA) is the term used to describe children and young people who find it difficult to attend school due to emotional factors and distress. The term ‘school refusal’ is commonly used to describe this group, although it has been discredited since it implies that those not able to attend school have just decided not to attend, whereas in fact, it is rarely as simple as this.
Among children and young people with identified EBSA, the degree of school avoidance can vary, as can reasons why they are unable to attend school. Some struggle to attend school consistently, while others aren’t able to attend at all. Some feel ‘pushed’ away from the school environment by various factors within it, while others are ‘pulled’ to something more appealing outside of school. Maynard et al (2015) highlight that EBSA is an umbrella term and that what works for one child or young person may not work for another. There are usually a number of factors at play, all of which need to be supported as well as the interaction between those factors.
It is important to note that some children and young people who have difficulty attending school are not experiencing EBSA, such as those with significant or long-term physical illness, those in situations in which parents have formally or informally withdrawn them from school, or those facing challenging social circumstances (such as homelessness or family crises) which impact on their ability to attend school.
Kearney and Silverman (1990) suggest that there are four main groups of children and young people who experience EBSA:
Those avoidant of something at school which makes them feel anxious or depressed;
Those avoidant of school due to their perception of difficult social situations and/or being evaluated by others;
Those seeking to gain attention from parents or caregivers by not attending school;
Those motivated not to attend in order to gain tangible rewards outside of school.
Children and young people experiencing EBSA can show factors of more than one of these and can move from one group to another over time. For example, a child might initially stop attending school because of social anxiety but then become motivated by the attention they receive for being at home.
How does anxiety factor?
Everyone experiences anxiety at times, and in certain circumstances anxiety is helpful and healthy, such as in the lead up to an interview or exam. We feel anxiety when we are under threat and when we anticipate danger, our bodies release adrenaline to prepare to face the danger through the ‘fight or flight’ response. The physical signs we will notice usually include an increased heart rate, sweating, a dry mouth and fluttering sensations. These are not comfortable feelings and we are programmed to reduce them by avoiding the danger that initiated them.
Sometimes, we think things are dangerous, even when they’re not. At these times, our bodies still release adrenaline and we will have the same physical reactions so that we can make sure we are safe and protected, even though they will be a false alarm. This isn’t logical. We instinctively avoid situations which trigger these anxious sensations in our bodies, as they feel unpleasant. The problem is that every time we avoid the thing we are worrying about, we reinforce our own belief that we need to avoid that thing in order to make ourselves feel safe. We don’t allow ourselves to learn that we are able to cope, or that the situation is usually not as bad as we thought it would be.
A cycle of avoidance
For children and young people experiencing EBSA, anxiety about school can become entrenched in a cycle of avoidance. Anxious thoughts and feelings cause them to avoid school. This reduces their anxiety which reinforces their desire to avoid school. This increases their anxiety and consequently their school avoidance. This turns into a vicious spiral in which anxiety about school leads to negative thoughts about school which reinforces school avoidance, and so on.
Research suggests that early intervention is six times more likely to produce successful outcomes for children and young people experiencing EBSA, therefore it is very important to intervene as quickly as possible when the earliest signs of EBSA are noticed (Reid, 2002). Schools are usually best placed to intervene quickly to achieve the most positive outcomes for children and young people who are struggling to attend for emotional reasons.
So how should schools approach students with EBSA?
Research indicates that the best outcomes for children and young people experiencing EBSA are achieved when schools:
Intervene as early as possible;
Work closely with the family throughout and beyond the period of school avoidance;
Actively engage the child or young person in discussion about their needs, and what support they feel is necessary for them;
Work with the child or young person to develop a clear action plan to support their return to school or to increase their attendance, and review it regularly with the child and family;
Accept that things will be very difficult, especially at the start of the plan.
Here are 9 strategies schools should put in place to support children and young people experiencing EBSA:
Allocate the child or young person two or three key adults in school. This is vital in order to ensure that the child continues to feel connected to the school through strong relationships they know they can go to for help if they have a problem. These relationships need to be built so that the child feels they matter. If the child is not attending school, key adults should maintain contact through home visits, letters, emails or remote meetings. Key adults should listen to the child so that they understand them, using their preferred language and method of communication.
Establish clear routines to ensure that the child is warmly welcomed to school. They should feel welcomed and see that their key adults are glad they are there, verbally and non-verbally. Think in advance about what the routine will be and make sure that the child knows in advance where they will enter, who will greet them, what they will do and where they will go. It may be important to vary the start time or alter which entrance the child will use to come into the school building.
Ensure that the child knows what will happen during the day, including unstructured times such as breaks and lunchtime. Key adults should go through the routine and plans for the time in school when greeting the child and warmly welcoming them in. It may be useful to use a visual timetable for the child to refer to during their time in school. The child’s anxiety might peak around unstructured times, particularly if they have been absent from school for a while or have social anxiety, and planning will need to take place in advance to mitigate this in terms of where they can go and who will support them. All relevant staff should be aware of any such plans and actions taken in advance in the event that key staff are absent or unavailable.
Teach the child how to manage their feelings and help them learn to self-regulate. Children and young people experiencing EBSA need support to understand their emotions and increase their capacity to manage them. Schools should introduce sessions, either individual or in small groups, focused on emotional literacy which explicitly teach how to understand and manage feelings.
Manage the environment to minimise any anxiety triggers for the child or young person. Through forming a strong, trusting relationship with key adults, it will be possible to understand what triggers the child or young person to feel anxious and to take steps to mitigate them whenever possible. Staff should allow the child or young person to reduce their anxiety level throughout the day, for example by building in short breaks in the form of ‘down time’ in a quiet space, a movement break or a short walk. It will be helpful for key staff to ‘check in’ with the child throughout the school day, demonstrating that they are keeping them in mind and care about them.
Work with the child to plan in advance what will happen if they start to feel anxious. Adults should carefully monitor the child for increasing levels of anxiety and offer support as early as possible. A plan should identify what the warning signs might be, alongside strategies that can be used by staff and by the child themselves to help them calm down. The plan should be devised with the child themselves and all relevant staff should apply it consistently.
Help the child to increase their resilience and ability to manage their anxiety. Many children and young people experiencing EBSA have a strong belief that they can’t do things. Find out what they can do and build on this as much as possible. Teach them about the concept of growth mindset and emphasise that these are not fixed, but are flexible and dynamic. It will be possible for them to overcome their EBSA and attend school - teach them this and show them examples of how difficult situations can change and be overcome.
Increase the child’s motivation to attend school. Focus their attention on what they like or enjoy about school, instead of the things they don’t. It may be helpful to remind them that it is important to attend school, through thinking about what they see for their future career path, although this must be approached sensitively to avoid increasing pressure. If the child is not in school, share school experiences with them that they may enjoy, for example by sharing newsletters or recording any interesting activities either formal or extra-curricular. Make sure that opportunities for the child to engage and maintain relationships with others (staff and peers) are provided. It is very important to strengthen their link to the school and promote their sense of belonging, to motivate them to go back to school and feel welcome. Peers could also act as a support network for the child.
Ensure that regular and supportive contact is maintained with children who are not attending school at all. We know that anxiety can be reduced when the child or young person experiencing EBSA feels connected to the school, even if they are not there. Key staff should make it a priority to stay in touch (via phone call, email, online chat or postcard) to ‘keep the door open’ for their return.
