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Anxiety is a feeling of stress, fear or panic which can affect a person’s life in both physical and psychological ways. All children will experience some anxiety, e.g. about trying new foods, separating from parents or moving schools but untreated anxiety in children can result in extreme forms of avoidance, panic attacks and self-harm.

Anxiety is an evolutionary mechanism to help us adapt, when we feel unsafe, like a useful alarm bell. It helps us find out what we are afraid of, recognise a danger and tells us that action is needed. Initially anxiety may lead to freezing, intense focus and physiological changes: the body releases adrenalin, breathing changes and blood is channelled to muscles, for ‘flight’ or ‘fight’. Dangers which cause anxiety may be real, e.g. a physical danger like fear of needles, or social, e.g. speaking up in front of the class or imaginary, e.g. triggered by memory of past trauma, such as witnessing a car accident. 

Emotionally Based School Avoidance (EBSA)

Causes of Anxiety are very individual, but in severe cases children’s emotional wellbeing will be impacted and they develop Emotionally Based School Avoidance (EBSA) which affects their attendance, academic attainment, confidence and friendships and can lead to mental health issues in other areas of life, such as self-harm

EBSA occurs when a child has a significant difficulty attending school due to emotional factors. It can be sporadic, affecting a child with relatively good school attendance, by creating physical symptoms, e.g. butterflies before a PE lesson, or long-term, leading to a child failing to access school altogether.  Both are accompanied by high levels of anxiety. It is no longer seen simply as school refusal, which suggests a child is choosing to be anxious. 

EBSA affects 1-2% of the school population, girls and boys in equal number, of primary and secondary age and across all socio-economic levels. It can have a sudden onset or be a gradual experience, but is rarely due to a single factor. 

Causes of anxiety

Anxiety about school impacts learning, so recognising and breaking the cycle that supports it is key. Negative thoughts about school might be caused by specific subjects, e.g. games lessons, or might be part of a larger condition, e.g. anxiety as part of autism. Transition to a new school at year seven is a common time in triggering EBSA as well as family change, e.g. divorce. Children with a family history of EBSA, are known to repeat the behaviours themselves.  Other risk factors include attachment disorder, and bullying.  The resulting stress leads to a child avoiding participation in school, either with physical symptoms, e.g. tummy ache, or psychological, e.g. selective mutism.  

Push and Pull cycle 

Many elements decrease the ‘push’ towards participation at school and so exacerbate a poor school experience, which in turn risks further complications for academic attainment and mental health. Conversely, by staying home a child may increase time with a favourite family member, get to participate in enjoyable activities, e.g. gaming on the ipad, which in turn increases the ‘pull’ towards home. As the non-attendance develops, so the push and pull factors diminish and grow respectively.  

Treatment for EBSA

What can be done to break the cycle and alleviate EBSA? 

  • School-based mental health support 
  • PSCHE curriculum to cover subjects such as eating disorder, bullying, gender and race discrimination 
  • School readiness and transition to new school support 
  • Family liaison with a family-link officer 
  • Building up a child’s resilience characteristics, e.g. by developing social skills, hobbies and interests outside school 
  • Establishing a relationship with a trusted teacher or adult. 

Further advice on EBSA from Support Services for Education

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