'It's not school refusal it's EBSA' - and when your child has difficulties going in here's what you can try, from an educational psychologist

GoodToKnow expert panellist Dr Patricia Britto explains 'Emotional Based School Avoidance'

Girl in red uniform sat sad
(Image credit: Getty Images)

Your kid is not 'refusing' to go to school; it's not that simple. They are more likely to be experiencing EBSA, which stands for Emotional Based School Avoidance. And here's what that means, as well as tips on how to deal with it from educational and child psychologist Dr Patricia Britto.

Most parents want to see their children skipping into school and building on their resilience and confidence so they can ultimately get through life and be happy. So when a child is clearly struggling with going to school each day, it can feel hard and leave the adults at a loss with what to do to help. That's where Dr Britto comes in - in this piece, she explains at length what your child might be going through that means they can't physically go into school.

If you have a child struggling to attend school, please know that you are not alone and that your child is not 'broken'. Research from the Children's Commissioner shows that school attendance figures have dropped across the UK in recent years, which was exacerbated by COVID-19 restrictions and the return to school after the lockdown period. What initially appears as a general reluctance to attend school can later be revealed to be deeply rooted in emotional factors and other associations, such as having mental health issues and sensory processing difficulties. According to the government statistics published in March 2024, 20.3% of children in the UK are reported to be persistently absent from school.

In my experience as an educational psychologist, children do not skip school persistently without a valid reason, and some may start by consistently sharing physical symptoms associated with anxiety, such as stomach aches and headaches, to avoid attending school if they are likely feeling unsafe in such an environment. Often, the setting (i.e. some children struggle to cope with being in a large classroom) or, at times, the adults have limited understanding of their needs, which are some of the possible reasons why your child struggling to attend school is a way of communicating feelings of distress. Let's look into this a bit further...

What is EBSA?

Emotional School Avoidance (EBSA) is an adopted broad term that is widely used within research to highlight that children are not just simply choosing NOT to attend school but that they CAN'T due to difficulties such as having unmet needs, anxiety, bullying, trauma, depression, undiagnosed and diagnosed neurodiverse needs, and other complex medical issues (Gulliford & Miller, 2015).

Also, it's worth noting that unmet needs and anxiety are not always on a 'grand scale'. What we, as seasoned adults, don't see as a 'big problem' can feel insurmountable to a child, and it can look different between ages. For example, a reception-aged child not knowing where the toilets are can be a teenager needing the toilet but not being allowed to go during lesson time - both of these can cause anxiety as well as a basic need - the toilet - not being met.

EBSA is why terms such as 'school refuser, non-attendance, school withdrawal, and school phobia' are no longer helpful in describing the experience of children who have prolonged difficulties attending school. It is estimated that EBSA affects between 5% and 28% of children at some point in their schooling journey (Kearney, 2001). Therefore, a range of factors associated with EBSA should be explored before adults judge or conclude on possible reasons for a child's persistent non-attendance to school.

How can I support my child to want to go to school?

  1. Notice patterns (e.g., frequently feeling unwell when it is time to attend school and difficulties leaving home) and changes in behaviour associated with school absence.
  2. It's essential to listen to the child's voice and ensure they are involved in developing support plans; their participation is more likely to make the plan effective.
  3. Children often respond well to a clear and consistent routine and opportunities for predictability, which can likely reduce anxiety. For example, a morning routine could begin with a calming activity such as colouring or listening to music rather than rushing straight to the bathroom and getting dressed.
  4. Plan with your child and explore what to do when they become anxious or upset and school no longer feels like a safe space. This could involve using breathing techniques or seeking comfort from a key adult at school who can provide nurturing support.
  5. Encourage your child to identify what they like about school, such as making positive friendships with peers. And listen, try not to interrupt with what you *think* they might consider positive.
  6. Have there been any specific triggering events such as bullying, world events (e.g., COVID-19), changes in family dynamics such as divorce and other family members feeling unwell?
  7. Identify the push and pull factors. 'Push' factors are linked to reasons children want to attend school, and 'Pull' factors are associated with reasons to withdraw from school and reinforce the push factors (reasons to attend).
  8. Discuss with the school's Special Educational Needs Coordinator (SENCO) to create an individualised support plan for your child, such as a key adult building a trusting relationship. An individualised support plan can involve parents working with their children's school to implement support around the morning transition to school. For example, children may need support to get into the building and prefer a side entrance to avoid a crowd of their peers.

Can children begin to feel more secure to attend school even if they have experienced EBSA?

Absolutely yes, children can settle into school even if they have experienced EBSA. Parents must feel empowered to speak up and work in partnership with schools to allow consistent use of approaches. Parents can seek professional support from agencies such as their local or independent educational psychology services, CAMHS, and children and Adolescents' mental health services, such as Mind.

Why is EBSA is not commonly used but ‘school refuser’ is?

The confusion about the terms EBSA and school refusal exists because there is a misunderstanding between children who truant (unexcused absence) and those who cannot attend school because of their reduced mental well-being and other complex factors. Often, children experiencing EBSA may have a neurodiverse need that ought to be supported by the adults around them.

Recent studies (O'Hagan, Bond and Hebron 2022) reported that attending school can be more challenging for autistic children in comparison to their neurotypical peers. Social relationships become more complicated as children grow, and it becomes increasingly difficult for children on the autistic spectrum to maintain friendships and, therefore, become more anxious about being in social situations (e.g., school). For example, difficulties such as interpreting subtle social cues of interaction can cause much distress for a child with autism, negatively impacting their desire to be in social situations and busy environments such as school. O'Hagan et al. conducted a study with girls in the autistic spectrum (aged 13-15). They found that they were more at risk of internalised anxiety, which led to difficulties attending school, reduced educational attainment and exacerbated mental health difficulties. Although this study links EBSA and autism, it is important to note that just because your child is struggling to attend school does not mean they are autistic. Each case is unique, and no one size fits all.

We have lots more school content, check out Teachers reveal the best ways to get your children back-to-school ready – and why you should never pack their bags for them and Confessions from parents about what they’re most looking forward to once the kids go back to school as well as tips for how to support your child on A-level exam results day, we've got it all covered.

Dr Patricia Britto
Educational Psychologist (HCPC Registered)

Dr Britto's qualifications include a Doctorate in Professional Educational, Child and Adolescent Psychology, an MSc in Mental Health in Learning Disabilities and a BSc in Psychology.