Recent statistics reported by the Guardian show an overwhelming amount of children being denied mental health treatment in the UK. On average, a third of children being referred to mental health services are being turned away, this figure is up to 60% in some areas. Some experts state that the pandemic has caused an insurgence in referrals, causing mental health services to tighten thresholds.
As part of this we are also seeing an increase in children experiencing Emotionally Based School Avoidance (EBSA) - sometimes referred to as school refusal, or school avoidance. In a system that pushes 100% school attendance, EBSA can have a huge affect not just on the child, but the whole family.
What is Emotionally Based School Avoidance (EBSA?)
EBSA is a term referring to reduced or nonattendance at school by a child or young person. We prefer the term EBSA, rather school refusal or school avoidance. This is because EBSA recognises that the reasons the child doesn't want to attend school are due to emotional or mental health issues. EBSA can have a drastic affect mentally on the whole family and network of support around the child - particularly when letters and threats of fines or prosecution rear.
We believe that supporting children and exploring their anxieties and reasons for avoidance is the best way to get children back into classrooms. Often, a teacher may have no idea that a child is experiencing EBSA or school-related anxiety, children can mask their emotions and thoughts at school, leaving caregivers to suffer the emotional outbursts and distressing consequences.
A lot of caregivers and even teaching professionals may not fully understand the emotional and mental affects of EBSA and how to explore these confidently with children. This is where we can help.
Causes and Symptoms
EBSA can be an accumulation of many different causes or reasons all interlinked together. These can be complex and interwoven and can relate to the school itself, a child's own anxieties and fears or their home environment.
It's important to remember that a child will have no control over the emotional issues affecting their absences. Therefore, schools and parents should seek to understand and support, rather than force or threaten.
Reasons a child may not want to attend school can include things like, social anxiety, bullying, social pressures, academic demands or separation anxiety. Often, the child is seeking to avoid things that make them anxious or stressed.
There can be many physical and emotional symptoms of EBSA, which typically worsen the nights and mornings before school, and can almost become entirely absent during school holidays and weekends.
Symptoms can include:
Anxiety symptoms such as racing heart, shaking, sweating, panic attacks, tummy aches, nausea or pins and needles
A child may often complain of being ill despite no signs of physical illness
Fearfulness, tantrums, outbursts of anger or frustration and panic when faced with attending school
Symptoms of low mood such as not wanting to take part in their usual activities, being more quiet than usual, expressing negative feelings and changes in appetite.
How can you support a child experiencing EBSA?
Be supportive and understanding
Acknowledge your child's fears and feelings and facilitate open communication around thoughts and emotions - whether at home or in the classroom. Try not to be forceful - don't tell them they must go to school or you will get fined for example. Be sensitive and reassuring and allow them to explore their worries with you. Get to know your child's support network and who they trust to speak to - is it you or someone else? It can be extremely stressful being a parent and feeling like you have to force your child to go to school - our advice is to do what is best for yours and their mental health.
Ask them what you can do to help
Ask your child to think of or list some things you can do to help. It could be something as simple as walking them into the classroom or asking their teacher if they can have a time out during the school day. Some ideas may not be feasible, but try to accommodate the ones that are by talking to your child's school. Try to get them to really think, instead of just saying, 'not going to school,' as this can give them a sense of control over something they feel they have no control over.
Arrange a meeting
Whether you're a teacher or parent, a meeting with all caregivers and professionals in the child's life is the easiest way to find out how best to support them. Together, you can come up with a list of changes to help the child return to the classroom - for example, would it help the child if they could arrive 10 minutes early with a parent to settle them into class? Could a buddy or mentor be assigned to them to help them during the school day? Or could the school allow more flexible start and finish times?
Create a safe space
A safe space can be created anywhere - at school or at home - or both. If the child has one at school, they can sit here before class or during break times. Fill their safe space with all the things they find comforting and calming. Sensory toys, teddies and calming worksheets and activities work well.
Encourage them to do things that help them relax
Help children to learn coping techniques and calming mechanisms that can help them feel relaxed inside and outside of school. Perhaps it is a taking a deep breath every time they pick up a pen or pencil or reading a book when they come home from school - ask your child what helps them to feel relaxed and build it into their daily routine.
Create and stick to routines
All children thrive from routine, but for children with anxiety, having a fixed routine can help them feel calm and prepared. Create a relaxing morning routine before school, try to avoid rushing or running around and try to do the same things in the same order each day. This can also reduce stress for you as the parent too.
Recognise small achievements
Recognise those small wins - is it getting out of bed on time? Getting dressed themselves? Doing their school work or improving in a subject? Be sure to give children praise and encouragement no matter how big or small.
Use our toolkit
Our EBSA and school anxiety toolkit has been designed to help children explore the reasons surrounding their school avoidance and learn how to identify and communicate their worries with their caregivers and professionals. Take a look at some of our activities below.
About the Activities
This toolkit features 21 specially designed EBSA resources to support children to explore, communicate and manage their worries. From helping children to learn about where they might feel worry, to exploring calming techniques and coping tools they can use at school.
Where I Feel Worry - The aim of this activity is to help children explore their physical responses to anxiety. Perhaps they may get a tummy ache before school, or their legs may feel like jelly. This activity helps children to realise that anxiety can cause lots of different physical symptoms and how to recognise these.
My School of Worries - When we are worried about something, it's always better to talk about it! But it might be hard to find out what we're worrying about or what is worrying us the most. This activity helps your children to get down all the thoughts out of their head onto paper. Then, it asks them to think about which worries are affecting them the most. Maybe they only have one worry, or maybe they have a few - this activity is all about exploring how each worry makes us feel. Once they have identified which worries are upsetting them the most, they can complete our Rate Your Worry activity.
Rate Your Worry - This activity is all about managing those worries and thoughts that are affecting your child. If it is a real worry - this is a worry that is happening right now, such as bullying - make a plan of action to do something about this worry. If it's a hypothetical worry - a worry that hasn't happened yet and may never happen - make a 'plan of actions' - things they can do when they feel this worry. For example, they could talk to a grown up and take some deep breaths.
Things That Make Me Feel Safe - This activity is about helping your child realise what things at school can comfort them if they are feeling anxious or upset. It also helps children to think of school as a safe and comforting place.
My Safe Place - Some children with EBSA may have a dedicated safe place at school, such as a calm corner or comfort area. If your child has one of these, this activity asks them to write and draw their safe place. This is a mindful activity, reinforcing the comfort this safe place gives them by using their senses.
My Weekly Top 3 - This activity is all about helping your child think positively about school and the good things that happen. We understand that for children with anxiety, it can be hard to think of positive things, your child may say for example that nothing good has happened. This can be a natural reaction. You can help your child realise their own positives - they don't have to be huge accomplishments, but small weekly wins that made them feel good.
Conversation Cards - Our Conversation Cards are fun ways to learn about your child's day. Have you ever picked your child up from school and instantly asked them if they had a nice day and they just say 'yeh' or 'can't remember?' When children finish school they are still processing the day's events, and for children with EBSA they may have spent the day masking. We would recommend you use our Conversation Cards when they have settled at home - they are designed to get your child thinking about the good things that happened in their day. Our Conversation Cards work both ways - it's much more fun when they get to ask the questions too!
My Coping Pencil Case - This fun craft activity is all about helping your child to learn about ways that help them feel calm when they are experiencing distress or panic. Have them cut out and create their Coping Pencil Case! We have suggested some tools and techniques in our toolkit to help your child learn about ways to feel calm.
Fun Things To Do On The Way to School - All our activities have been suggested from our expert contributors! But we know that your child may also have games they like to play - so we've included some blank cards for them to create their own. These can be used as a distraction technique to keep minds busy on the way to school.
My After School Bucket List - We're sticking with the theme of things to look forward to in this activity and helping your child through the school day. What's on their after school bucket list? Is it watching their favourite programme, making a fun craft or maybe it's having their favourite evening meal? Don't forget to have them tick each activity off as they do it!
Breathing Exercises - Deep breathing can help children bring their focus to something they can control - their breath - instead of thoughts and fears that can exasperate anxiety. Not only this, but deep breathing has many benefits for both mental and physical wellness. We've included two fun breathing exercises, combined with some mindful tracing in this toolkit.
Guide for Caregivers - We've provided a helpful guide for parents and caregivers at the back which guides you through each activity and helps you feel confident in supporting your child. We've also explained how each activity is designed to support your child's emotional and mental wellbeing.
Further information, support and reading:
To read more about EBSA, school avoidance or school anxiety and seek support we have provided some helpful websites below. If you are viewing this toolkit on a computer you can click the links that are underlined.
Your local government will most likely have a page about EBSA - simply search EBSA and the name of your local council.
The Anna Freud Centre - Addressing Emotionally-Based School Avoidance
You can also talk to your child's school and your GP.
Disclaimer: This toolkit is not a replacement for professional support. It may help your child in exploring and communicating how they are feeling and things that may be troubling them. We would recommend you share this toolkit with your child’s teacher or any professionals in your child’s life. If you have any concerns about your child's mental health, or you feel that their mental health may be worsening, please visit your GP or contact a mental health professional.
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