Emotionally Based School Avoidance (EBSA): Everything You Need to Know

Emotionally Based School Avoidance is a term first used in 1932 by Broadwin. It has also been called ‘school phobia’, ‘school anxiety’, and ‘school refusal’. In this article, we give you the latest research about it and a guideline to deal with it.

What is Emotionally Based School Avoidance?

Emotionally Based School Avoidance ⁽¹⁾, refers to a situation where a child or adolescent consistently resists school. They cannot physically attend school due to emotional distress and anxiety surrounding the school experience. 

Occasional reluctance to go to school is common among children. However, Emotionally Based School Avoidance is different. It is marked by a persistent and intense fear or anxiety that significantly hinders or prevents a student from attending school. This fear or anxiety might arise from social interactions, academic demands, neurodiversity, or specific triggers such as a certain teacher, subject, or event. 

It is estimated ⁽²⁾ that approximately 1-2% of the UK school population is experiencing EBSA (around 30,000 children). It seems to affect males and females equally, but it is more common during secondary school.

What Are the Symptoms of Emotionally Based School Avoidance?

Children suffering from EBSA frequently report physical symptoms, including headaches, stomach aches, nausea, or fatigue, which are more pronounced on school days. These symptoms usually subside or disappear when the child stays home. 

When a child experiences high levels of emotional distress due to school avoidance, it often manifests in intense reactions that can be distressing for both the child and their caregivers. These reactions can include: 

• Crying: The child may cry uncontrollably at the thought of going to school. 

• Tantrums: Particularly in younger children, distress may lead to tantrums. This can involve yelling, screaming, and physical resistance like refusing to get dressed or leave the house. 

• Panic Attacks: In more severe cases, a child might experience panic attacks, which are sudden episodes of intense fear accompanied by physical symptoms like a racing heart, shortness of breath, dizziness, or a feeling of impending doom. This can occur when they are about to leave for school or even when they just think about going to school. 

These emotional and physical responses are indicators of the intense anxiety or fear the child is experiencing. It is not simple reluctance or stubbornness but are signs of deeper emotional difficulties that need to be addressed through appropriate support and interventions.

Consequences of Emotionally Based School Avoidance

Children who experience EBSA are more likely to: 

• Struggle at school. 

• Have fewer friends or poor quality friendships. 

• As adults, their employment opportunities ⁽³⁾ decrease. 

• Experience depression and anxiety in adulthood ⁽⁴⁾. 

• Have suicidal thoughts ⁽⁵⁾.

How Can Schools Help?

If your child is experiencing EBSA, it is crucial that you work with the school to put measures in place. 

When dealing with Emotionally Based School Avoidance (EBSA), schools are expected to take a supportive and collaborative stance, helping your child address their issues and smoothly transition back into the school environment. 

• The school may carefully track your child’s behaviour and attendance to identify any anxiety-related patterns or triggers. 

• They might perform assessments or suggest external services to gain a better understanding of the root causes of your child’s school avoidance. This process could involve meetings with educational psychologists, school counsellors, or other specialists. 

• Expect the school, or arrange with the school yourself, regular meetings to review your child’s progress, address concerns, and refine strategies. This collaborative approach is key to creating an effective plan. 

• It is important to involve your child at all discussions where possible, making sure their feelings and preferences are considered. 

Some ideas to consider: 

• Having a safe person to meet the child in the morning to help the transition to school. 

• A reduced timetable, on the child’s terms and needs, collaboratively with the school to help the child have control over their worries and needs. 

• If in school, offer a slow start, access to a pass to go to lunch early, or being able to step out of the classroom when in times of overwhelm. 

• Also, consider an EHCP (education, health, and care plan) and a neurodiversity referral. Always collaborate with your doctor, as they may be able to support you with the school. 

• The school may refer your child to external services, such as Child and Adolescent Mental Health Services (CAMHS), educational psychologists, or other specialists if more intensive support is needed. 

• In some cases, a multi-agency approach might be necessary, where the school works closely with health professionals, social services, and other agencies to provide comprehensive support. 

• The school may provide resources or workshops for parents on how to support a child with EBSA at home, including strategies for managing anxiety and promoting school attendance Schools may connect you with parent support groups where you can share experiences and gain insights from others facing similar challenges.

Do Not Forget Your Child Needs Support but You Do, Too

Parents of children experiencing EBSA, often feel blamed and judged by other parents and teachers. They also report feeling guilty and ashamed. If this is your case, please get in touch with us. Our REC Parenting therapists are here to support you. You are not alone and certainly you do not need to do this alone. We also recommend you read: “Can’t Not Won’t” by Eliza Fricker. 

Lorraine Quinlan

About the Author

Lorraine Quinlan is a certified and qualified counsellor and therapist. She worked for 13 years in the London Ambulance Service before studying Integrative Counselling and Psychotherapy. She then went on to work as a counsellor in a college counselling students from age 16. Three years ago, she set up her own private practice, Quinlan Counselling.

References

(1) Halligan C, Cryer S. Emotionally Based School Avoidance (EBSA): Students’ Views of What Works in a Specialist Setting. Contin Educ. 2022 May 18;3(1):13-24. doi: 10.5334/cie.38. PMID: 38774292; PMCID: PMC11104314. 

(2) Elliott, J. G. (1999). Practitioner review: School refusal: Issues of conceptualisation, assessment, and treatment. Journal of Child Psychology & Psychiatry, 40(7), 1001–1012. DOI: 10.1111/1469-7610.00519 

(3) Taylor, C. (2012). Improving attendance at school. London DFE 

(4) Walter, D., Hautmann, C., Rizk, S., Patermann, M., Sinzig, J., Lehnmuhl, G., & Doepfner, M. (2010). Short term effects of impaired cognitive behavioural treatments of adolescents with anxious-depressed school absenteeism: An observational study. European Child and Adolescent Psychiatry, 19, 835–844. DOI: 10.1007/s00787-010-0133-5 

(5) Bjarnason, T., & Thorlindsson, T. (1994). Manifest predictors of past suicide attempts in a population of Icelandic adolescents. Suicide and Life-Threatening Behavior, 24(4), 350–358.