We all experience worry or anxiety from time to time. This is a normal feeling which can help keep us safe and manage difficult situations. However, this can sometimes become a problem if it stops us doing the things we want or need to do. Sometimes, worry, anxiety and overwhelm can lead to difficulties in attending school. This is often referred to as Emotionally Based School Avoidance (EBSA). EBSA is also known by other names including Emotionally Based School Non-Attendance (EBSNA) and school refusal.
EBSA can look different for each pupil, however, parents, carers and school staff often report the following:
- Frequent absences for minor illnesses or circumstances
- Often feeling unwell
- Difficulty separating from parent or carers
- Difficulties sleeping
- Friendship issues
- Changes in personality and mood
- Emotional volatility including tearfulness, irritability and anger
- Poor academic attainment
If we pick up on these things early there is a good chance that we can intervene successfully leading to positive outcomes for the child and young person.
What causes EBSA?
EBSA is typically the result of a combination of predisposing risk factors which are largely unique to the individual pupil, their family and school context, and which interact with a particular trigger. Triggers can include transition between primary and secondary school, loss or bereavement within the family, a change in friendship groups or bullying. Pupils can find it harder to return to school following a prolonged absence, due to illness, or a school holiday. Patterns of non-attendance during the first weeks of the academic year can predict attendance over the remainder of the year.
For many pupils experiencing EBSA, school non-attendance serves a function. The four key reasons as identified in research are:
- Avoiding difficult feelings that come about from attending school such as anxiety.
- Avoiding difficult or stressful situations at school. This may include social pressures, aspects of the school environment and academic demands.
- Reducing separation anxiety and/or receiving attention from parents, carers and other family members.
- Gaining rewards, fun and stimulation outside of school such as playing computer games or spending time with friends.
How does EBSA relate to anxiety?
Anxiety can become problematic if it stops a person from doing the things that they want or need to do. If a person is experiencing anxiety, a response to manage this is often to avoid the anxiety-provoking situation which relieves uncomfortable feelings. However, this relief is temporary, and the next time, the anxiety can feel worse, leading to continued avoidance of the situation. This is the anxiety cycle.
The anxiety cycle
The anxiety cycle is a pattern where anxiety leads to avoidance of certain situations, which in turn reinforces the anxiety. For example, a pupil might feel anxious about attending school, leading them to stay at home. This avoidance provides temporary relief, but can ultimately increase their anxiety about returning to school, which can create a vicious cycle.
Understanding the anxiety cycle, triggers and maintenance factors is essential to support pupils experiencing EBSA. Only by understanding the underlying causes of anxiety and EBSA can a child be supported in taking small steps to gradually face anxiety provoking situations.
How common is EBSA?
The 2022 Attendance Audit conducted by the Children’s Commissioner found that in Autumn 2021, that 1 in 4 children were persistently absent from school. This figure was up from 1 in 9 in the 2018/19 academic year. Within this figure the frequency of EBSA can be difficult to measure accurately. Research within the last twenty years has suggested 1-5 % of Children and Young People experience EBSA (Elliot, 1999; Gulliford & Miller, 2015), however the 2022 Attendance Audit suggests this figure is now much higher.
Research suggests that there are higher rates of EBSA amongst secondary school aged pupils (Elliot, 1999; Kearney, 2008). There are peaks in rates of EBSA linked to times of transition (King & Bernstein, 2001).
What impact does EBSA have on outcomes for children and young people?
School non-attendance can significantly impact a pupil’s academic, social and emotional outcomes. Research indicates that non-attendance is associated with lower academic achievement, reduced engagement in school activities and reduced long-term educational and employment prospects (Thomas, 2020). Non-attendance can also exacerbate any pre-existing needs which the child or young person may have. For example, increasing feelings of anxiety and depression, and contributing to social isolation and difficulties in peer relationships.
EBSA and COVID-19 Pandemic
The conditions that led to the increase in EBSA during and after the Covid-19 pandemic weren’t a sudden crisis, but rather a convergence of psychological and contextual factors that compounded existing risks (Lester & Michelson, 2024). The pandemic has been described as creating a ‘perfect storm’, heightening feelings of isolation, loneliness, disrupting social interaction and severing relationships between home and school (Fairclough, 2024). These disruptions combined with broader societal upheaval, with implications for both child and adult mental health. For many pupils the impacts of the pandemic continued to be felt once schools reopened, prolonging and increasing EBSA.