EBSNA guidance for parents and carers
This information was co-produced with parents/carers, schools, and professionals.
Understanding EBSNA
Worrying or anxiety is a normal feeling that we all experience from time to time. It can even keep us safe from harm or help us perform in difficult situations. However, sometimes anxiety or excessive worrying can become a problem especially when it stops someone doing what they want or need to do.
Sometimes anxiety and worries may lead to difficulties attending school. If your child has high levels of anxiety and does not want to attend school, they may be experiencing what is known as Emotionally Based School Non-Attendance (EBSNA). EBSNA is also known as Emotionally Based School Avoidance (EBSA).
EBSNA is not:
- truancy
- deliberate non-attendance.
- refusal to attend school
Factors that influence EBSNA, according to research, include the four functions of school non-attendance. These are:
- to avoid uncomfortable feelings brought on by attending school, such as anxiety or low mood. This may include not feeling connected or a sense of belongingness to school
- to avoid situations that may be stressful, such as academic demands, social pressures and/or aspects of the school environment
- to reduce separation anxiety or to gain attention from significant others, such as parents or other family members
- to pursue physical rewards outside of school, such as going shopping or playing computer games during school time
Recognising which function/s apply to your child can help you to support them.
Anxiety has been identified as a key feature of EBSNA. Although a certain level of anxiety is considered a normal and natural part of growing up, some young people may experience heightened levels of anxiety which impact on their day to day and school experiences.
When the anxiety is linked to school avoidance, the child or young person may experience anxious and fearful thoughts around their ability to cope with school.
You can find out more about anxiety and how to support your child on the Child and Adolescent Mental Health Service (CAMHS) website.
There are many different signs and symptoms of anxiety. If your child experiences EBSNA, they may have anxious thoughts, feelings, behaviours, or physical symptoms,
The symptoms are often worse on weekday mornings before school, and are less or absent at the weekends and during the school holidays.
| Thoughts | Feelings | Behaviours | Physical |
|---|---|---|---|
| Frequent self-criticism or feeling bad about themselves | Sadness | Crying | Lack of energy |
| Impaired or poor memory and concentration | Anxiety | Withdrawal from others | Substance abuse |
| Indecisiveness | Guilt | Neglect responsibilities | Loss of motivation |
| Confusion | Anger | Changes in personal appearance | Weight gain or loss |
| Thoughts of death and suicide | Mood swings | Moving more slowly | Unexplained aches and pains |
| Feelings of hopelessness or helplessness | Agitation or unable to settle | Sleeping too much or too little | |
| Irritability | Avoiding friends or going out | Not looking after themselves | |
| Feeling less motivated |
There are no diagnostic criteria for EBSNA. A tool called the 'School Refusal Assessment Scales' may be used to assess the child/young person. This tool was developed when EBSNA was known as 'School Refusal', but this is not wording that is in current use as children with EBSNA are not ‘refusing’ to attend school.
There are common characteristics that have been identified among children and young people who experience EBSNA, these are know as 'risk factors.'
| Individual | Family | School |
|---|---|---|
| Social anxiety | Parental mental ill health | Learning needs not identified or met |
| Difficulties with emotional literacy (awareness and regulation) | Siblings being educated at home due to illness or EBSNA | Need to take part in activities the child can't cope with, for example, talking in front of others, assemblies |
| Separation anxiety (current or historic) | Absence of a parent | High noise levels |
| Being a young carer | Family transitions | Difficulties with peer relationships |
| Low self-confidence or esteem | Bereavement and loss | Bullying |
| Previous exclusions | Limited social interaction | Poor relationship with staff |
| Parents appear easily stressed by child's anxiety or are over-protective | Poor organisation or unpredictability in the child's classroom | |
| Conflict or family dynamics | Harsh or unfair consequences from teachers |
Supporting your child
School staff can support your child with anxiety when they are at school, but they cannot support them when they return home after the school day or in the morning before school starts. At these times, you can address worries in the home setting.
Both school staff and parents / carers have vital roles to play in helping children experiencing EBSNA. Close collaboration is likely to lead to the best outcome for the child.
When your child avoids a situation they fear, they are relieving uncomfortable feelings of anxiety. This relief is only temporary. When they face a similar anxiety-provoking situation, the anxiety can feel even worse. They might think about the last time they avoided the situation and how much better it felt. The desire to avoid the situation then becomes more and more difficult to resist. This is the anxiety cycle.
In EBSNA, a child experiences negative thoughts and feelings about school. Things may happen in school which cause anxiety that may lead to school avoidance, such as:
- academic concerns
- peer-related concerns
- difficulties with separation
Secondary maintaining factors arise as a child continues to miss school, which can increase their anxiety about going to school.
- The child avoids a particular lesson that makes them feel anxious, avoiding school altogether can make things worse.
- Not going to school, or any lessons, they fall further behind with their schoolwork.
- They miss time with their friends.
The anxiety cycle continues, as negative thoughts about not being able to cope in school become fixed, and the child avoids school more.
When you identify that your child is at risk of or experiencing EBSNA, early help is important. Avoidance behaviours can become fixed if not addressed early. It can be difficult to intervene when the child has been out of school for some time.
There can be a temptation by the school, parents, or carers to remove the child from school to provide emotional relief. This relief is only short-term and so the longer the child is out of school, the more difficult it can become for them to return.
Separation anxiety is excessive fear or worry about separation from home or someone such as a parent or carer. A child may withdraw from the situation to avoid becoming overwhelmed. It can lead to school avoidance.
Separation challenges are one of the four functions of EBSNA (see Factors influencing EBSNA above).
To support your child, it is important that they:
- feel safe and secure at home
- have trust for people other than a parent or carer
- know that their parent or carer will come back to them
| Have regular opportunities to experience small separations | Begin with a small situation and build over time at a pace that is right for your child. This will increase confidence over time. |
| Make goodbye normal | When handing over to a trusted adult, say goodbye with loving words or a hug. Let them know when you will be back and what you will do together. Keep goodbyes calm and brief, and tell them they will be ok. |
| Leave a reminder | Give them an object that will comfort them such as a small toy, note or photo. |
| Come back on time | If you are unable to come back on time, try to call and let your child know so that they are not anxious |
| Playtime | Help your child to play with toys or dolls that can be an adult who makes them feel safe. |
If your child attends school but shows signs of EBSNA, it can help to have evening and morning routines to get them ready for the school day. The plan could be made with your child so they can give you their thoughts and ideas. You can make plans visual with pictures or photographs if this helps.
The following suggestions have been adapted from Tina Rae’s “Sunday evening / Monday morning” plan is described in her YouTube video CPD coffee time with Tina Rae 21. Supporting those with emotionally based school phobia.
| Soothe | Think about calming activities you can do with your child before they go to bed, such as naming 3 positive things about their day or listening to a sleep story / gentle music. Breathing exercises or mindfulness meditation can also help to calm the nervous system before going to sleep. |
| Understand | Reassure your child that you understand how difficult it is and that their feelings are valid. |
| Neutralise | Encourage your child to share their worries (ideally a few hours before bed) and talk through each one of them together. Drawing or writing in a journal or worry book can support this. Help them come to solutions or just listen and comfort them. Challenge any irrational thoughts by highlighting the evidence against them. |
| Decide | Discuss what a successful day would look like and consider with your child what needs to happen in the evening to make it successful. Look through their schedule together, step-by-step, and make sure they have everything ready and laid out for the morning, for example, books, uniform, and PE kit. |
| Attend | Be aware of your child’s emotional state and be more attentive to them if needed. Consider using a transitional object with a younger child. |
| Yourself | Ensure you feel calm and schedule time for your own self-soothing activities. |
| Organise | Ensure you feel organised and ready in the morning. For example, your own bag is packed, and breakfast is set out so that you are available to support your child in a calm way. |
| Neutralise | Allow time to speak with your child about their worries. Help them come to solutions or just listen and comfort. Challenge any irrational thoughts by highlighting the evidence against them. |
| Decide | Go through the morning plan with them to get them into school. Clearly tell them how they will go to school, for example, the form of transport, who they will go with, and the route they will take, so they feel prepared and certain about what will happen when they leave for school. |
| Accept | Attune to your child’s emotional state and reassure them that they are loved and safe. Remind them that their feelings are valid, and it is okay to feel worried. Let them know that you will help to manage their worries. You might consider having a transitional object. |
| Manage | Take time out to manage your own emotional state and use self-soothing strategies. Remind yourself of the following script ‘if I stay calm, I will make him / her feel safe.’ |
Increasing motivation to go to school helps a child with EBSNA. Strong 'pull' factors may keep the child at home which increases their desire to avoid school. These ‘pull’ factors could be:
- spending more quality time with parents during school hours than outside school hours
- engaging in fun and exciting activities at home, that can be addictive, such as video gaming
By increasing 'pull' factors to go to school, your child may be motivated to attend. You can work with your child's school to make the school day more rewarding for them. Examples are:
- spending time with friends or a favourite teacher
- doing a favourite activity while in school, such as Forest School or an art club
- completing schoolwork that they enjoy or have a particular interest in
Home based rewards
A home-based rewards system may help to increase the child's motivation for attending school. A rewards chart that gives them stickers for specific behaviours, such as putting on their school uniform or being brave for getting the bus.
Rewarding small achievements helps to break down the bigger task of attending school. If your child is brave and attends school for the full day, you could reward them with something they enjoy. For example, they could have an extra 30 minutes of video gaming after school.
Children are more likely to open up and share their worries with adults who make them feel safe and comfortable.
If your child is pre-verbal or non-verbal, to help you understand what is causing them anxiety, or what worries them, you can use communication tools such as:
- Social Stories
- pictures
- toys
When speaking to your child about their worries:
- say that you would like to know what they think and feel so that you can help if they’d like you to.
- let them know that it may be difficult for them to share and that it is okay if they feel this way.
- ask them specific questions which might help them sort through their feelings, for example, what two things are you most worried about?
- ask them to draw, write down or text you their feelings if they find this easier.
As a parent or carer of a child with EBSNA, it is important to look after yourself. You may feel anxious too and have emotions relating to your child's school avoidance. If you ignore your own needs, you could be at risk of becoming burnt out or having a lack of energy.
The NHS website has useful resources to help you support your wellbeing.
Working with your child's school
School staff can support children with anxiety when they are on the school site. At school, a child may not always show they are experiencing EBSNA. It is important that the school is aware that your child is showing signs of EBSNA, and that you work together to help the child.
Ask for a meeting with the school staff who can support you, or send an email or speak to the school if you do not know who can help.
You should expect your child's school to:
- identify a key member of staff to take the lead in supporting your child
- gather information from you, your child, and staff to find out why your child is worried about going to school
- make an assessment to find out what is making your child's attendance difficult
- work with you and your child to come up with a plan to support your child to manage their worries and feel better about coming to school
Following the school's assessment of your child, you should ask what support there is to help them.
Support can be:
- small reasonable adjustments
- general support available to all pupils
You can ask your child's teacher:
- what needs your child may have
- if the school thinks your child may have a Special Educational Need (SEN)
If the school meets the child's needs through existing help available, they may not need to be on the SEN register.
What are reasonable adjustments
- learning that helps your child to understand and progress
- letting your child take a test in a different room, or not take it at all
- letting your child start a few minutes earlier or later than their class
Provision that may be ordinarily available
- safe spaces for time out when your child is overwhelmed
- lunchtime clubs away from the playground
- a named person for your child to talk to about their worries
Examples of SEN provision
- targeted learning support, such as, literacy small group work
- social skills support group
- nurture groups or emotional literacy support assistants (ELSA)
The Ordinarily Available Provision guidance provides information on how a school can support a child's emotional needs.
Absence coding
It is the legal duty of parents/carers to:
- ensure that their children receive an education
- ensure regular attendance if this education is in a school
- ensure an education other than at school
If a child does not attend school, then the school has to use a specific code to record the absence. The Department of Education's School Attendance: Guidance for Schools (2013) advises schools on how to record absences. It does not provide specific guidance for EBSNA.
In some cases, a school can code a child’s absence due to EBSNA as ‘I’ (illness) due to:
- the significant levels of anxiety that they experience
- the negative impact of their attendance on their mental health
Absence notification
In most cases, schools should accept a parent’s notification that their child is ill. A school should not ask a parent/carer to provide medical evidence.
Schools should only request medical evidence where there is genuine concern about the validity of the illness. If our child's school requests evidence of ill health this can include:
- appointment cards
- prescriptions
- reports from professionals
If you have trouble getting medical evidence, then ask to speak with the Head Teacher.
What a school should do when your child cannot attend school
There is no legal EBSNA guidance. You can refer to the GOV UK guidance on illness and your child's education. If a child is unable to attend school due to illness (including mental ill health) then the school should:
- let the local council know if your child is likely to be away from school for more than 15 school days
- give the council information about your child’s needs, abilities, and schoolwork
- help them when they return to school
- let them know about school events and clubs
- encourage them to stay in contact with other pupils, for example through visits or videos
In exceptional circumstances, there may be a need for a temporary part-time timetable to meet their individual needs. A reduced timetable requires written agreement from parents or carers.
The aim of a part-time timetable is to help the child return to full-time education. Longer-term plans for reduced hours are for recognised medical needs only.
In relation to pupils experiencing EBSNA a reduced timetable might be useful to allow:
- time for rest and recovery from significant anxiety.
- reasonable adjustments, for example, to allow your child to avoid the lessons or situations they find most challenging.
A reduced timetable will not resolve EBSNA. Avoiding tricky situations can maintain and increase feelings of anxiety. There must be clear steps towards returning to school. These steps must work towards what your child finds difficult not the number of hours in school.
Schools usually offer alternative provision to children and young people experiencing EBSNA. This is because they have or can develop a long-term relationship with your child. They will be able to bridge the gap between home and school.
In a few cases, it may be necessary to consider alternative provision. This may be through a secondary provider (such as a medical unit or home tuition service).
Schools are responsible for making referrals for alternative provision. They may ask for guidance from Local Authority professionals.
Government guidance is that all children should have a ‘good education.’
Provision should consider social and emotional needs as well as attainment.
Your child should receive communication and have the same opportunities as their peers. This will ensure that they feel part of their school community and stay in contact with their classmates.
If your child can engage with after-school clubs, trips or any part of the school day school should encourage this. This should:
- maintain your child’s inclusion
- reduce the likelihood of secondary maintaining factors increasing their anxiety
- keep their world as large as possible.
If a child needs an Education and Health Care Plan this depends on:
- the level of presenting need
- the provision (targeted intervention) that a child needs
Go to the help and support section or see the guidance about EHCPs.
A school or parent/carer can make a request for an Education, Health, and Care needs assessment (EHCNA). You can make a request if a child requires a high level of long-term provision based on their underlying needs.
Useful support, websites and books (EBSNA)
Find out the support available locally and information that can help you on our list of recommended websites, YouTube videos, and books.
The Local Authority (LA) has a pathway of support for children and young people who experience EBSNA.
Local authorities are responsible for arranging suitable education for children of compulsory school age who, because of health reasons, would otherwise not receive suitable education. This additional support to continue education can be an alternative provision.
Educational Psychology
The Educational Psychologists (EPs) offer drop-in sessions to schools and consultations by request.
If you feel that your child should access support via this service please email the EBSNA team at [email protected]
The EBSNA toolkit provides guidance and resources for professionals working in or with schools to develop an understanding of what leads children and young people to feel that they must avoid school.
Early Help and Buckinghamshire Family Information Service
Buckinghamshire's Early Help and Family Information Service can support you and your family in the early stages, to help you with the challenges you are facing. The service provides support:
- on a range of topics on their website including money and benefits, special educational needs, parenting advice, and more
- by requesting support through a referral yourself or in collaboration with your child’s school
- directly through our Information and Outreach Officers, who can help identify the right support. You can contact them at 01296 383293 or [email protected]
- if you are being supported by professionals, they can make a referral for additional support to help you and your child at home
If you live in another Local Authority, you can check their Local Offer for SEND information to see what support is available locally.
SENDIAS
The SEND Information, Advice and Support (SENDIAS) team is at arm's length from Buckinghamshire Council. They can help you to find accurate and impartial information about SEND and the law.
The Bucks SENDIAS Service has a range of information available. If necessary they can be contacted via their clickable contact form.
In addition to their contact form there is also a live web chat available during the following times during school term time:
- Mondays 1pm to 3pm
- Fridays 10am to 12pm
The live chat will be available by clicking the red button on their webpages during the times stated above.
Educational Entitlement Team
The Educational Entitlement team ensures that all children receive a full-time education that is right for them.
The team includes the County Attendance team who provide help to families, schools, and professionals with irregular school attendance.
Websites
YouTube
Books
- Understanding School Refusal: A Handbook for Professionals in Education, Health and Social Care by Thamirajah, Grandison and De-Hayes
- Overcoming School Refusal: A Practical guide for counsellors, caseworkers and parents by Joanne Garfi
Websites
Books
Reading with your child can be a great way to help them understand feelings and emotions, including anxiety. Here is a list of useful books that you can read with your child and use to start discussions about anxiety, and other feelings.
- Starving the Anxiety Gremlin by Kate Collins-Donnelly
- Think Good-Feel Good by Paul Stallard
- The Huge Bag of Worries by Virginia Ironside
- Don’t Worry Be Happy by Poppy O’Neill
- The Anxiety Workbook for Kids by Robin Alter
- The Worry Workbook for Kids by Muniya S Khanna
- You are Awesome book and Journal by Matthew Syed
- What to do when you worry too much by Dawn Huebner
- A Volcano in My Tummy by Eliane Whitehouse and Warwick Pudney
- The Incredible 5-Point Scale by Kari Dunn Buron and Mitzi Curtis
- How to Catch a Star by Oliver Jeffers
- Moppy is … (Angry / Sad / Scared), series of books by Jane Asher
Some autistic children find the demands of school, and the school environment, almost unbearable, leading to absence or ‘school refusal’. It’s a term that some people feel unfairly implies the child or young person has a choice, when in fact they may not be simply unwilling, but actually unable to tolerate school.
The NAS has an informative guide for parents called 'What can I do if my child won't go to school?'