Understanding EBSNA
Last updated:Understanding EBSNA
Before embarking on intervention, it is essential to understand what we mean by Emotionally Based School Non-Attendance (EBSNA) and the principles underpinning intervention design. You will find guidance on descriptions, causes and progression of EBSNA in this toolkit. It is recommended that schools conduct training with all staff using this toolkit which is designed as an introductory course for all staff. Additional resources are also available from the EBSA team by emailing EBSA@buckinghamshire.gov.uk.
What is EBSNA
EBSNA is a term used to identify a group of children and young people who are facing challenges in attending school. EBSNA is apparent where difficulties with attending are the result of emotional factors. Children and young people (CYP) presenting with EBSNA experience significant levels of both physical and emotional distress.
The emotional element of EBSNA is what makes it distinct from other forms of non-attendance (truancy). It is also not ‘refusal’ to attend (though this term has been used in the past).
Often children want to attend school. It is the overwhelming experience of stress, anxiety and other emotions that make a child feel that they must stay away or ‘avoid’ school.
What causes EBSNA
It is important to remember that EBSNA is not a diagnosis. There is not one underlying need or collection of needs common to all children and young people who experience EBSNA. The overwhelming emotions, thoughts and feelings that children and young people experience may be the result of many different needs including:
- underlying special educational needs (SEN),
- adverse life experiences,
- and developmental needs.
Researchers describe EBSNA as happening when: “stress exceeds support, when risks are greater than resilience and when ‘pull’ factors that promote school non-attendance overcome the ‘push’ factors that encourage attendance” (Thambirajah et al, 2008: p. 33).
It is only through understanding the individual experience of each child or young person that we are likely to help them improve, or manage their EBSNA.
Noticing EBSNA early
Many researchers identify EBSNA as being when difficulties with school attendance have escalated to the point where the child or young person has stopped attending for a period of time.
We have chosen to describe EBSNA across a continuum of needs, which includes those who are showing early signs or are at risk of becoming non-attenders. It is hoped that by doing so, children and young people are given support in a timely way that may prevent chronic non-attendance and the associated impact on their attainment, inclusion and well-being.
EBSNA continuum of need. Reference: Thambirajah M,S., Grandison K.J., and De-Hayes L. (2008) Understanding School refusal: a handbook for professionals in Education, Health and Social Care.
Children and young people will often show early signs of EBSNA such as:
- not wanting to get ready for school
- feeling unwell on school days
- missing occasional lessons
- avoiding particular activities in school
For some children and young people, their internal coping skills or the external support put in place for them may be sufficient for them to be able to attend. However, they continue to face daily struggles with their emotions and the demands that are placed on them both in and out of school.
It is therefore important to document concerns about EBSNA early so that sufficient monitoring and support are maintained over time.
How many children are affected by EBSNA
EBSNA may well be more common than you realise. Particularly if we consider children across the continuum from emerging negative associations with school rather than just the chronic non-attendance stage. The second tends to be the focus of researchers.
It is thought that between 1% and 5% of the school population are experiencing EBSNA at any one time. It affects between 5% and 28% of children at some point in their academic journey. (The wide range is due to the measures that researchers take from conservative estimates focussed on chronic non-attendance to those where EBSNA is only just beginning to be documented by a school).
As schools code the absence of children experiencing EBSNA in different ways it can be hard to understand the full picture. Research conducted by the ‘Square Peg’ parent organisation highlighted that between 2018 and 2019 10% of the school population had recorded absences with no given reason. This may indicate that figures are higher than those captured in research.
We want schools to understand that a significant percentage of their students might have needs that are currently, or likely to cause EBSNA if not supported.
Children who avoid school are likely to have poor outcomes in their education, well-being and inclusion in society. As such, prevention and early intervention are imperative to limit the impact of EBSNA on our children and young people’s lives.
What leads children to feel unable to attend school
It can be helpful to think of all behaviour as being functional rather than unhelpful. If we can understand the reasons for behaviour then we stand a better chance of eliciting change. There are 4 likely functions that underpin school avoidance. By considering how they apply to each child experiencing EBSNA, they should be the starting point for developing intervention.
Possible functions of school avoidance
(adapted from Kearney and Silverman, 1990)
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1. To avoid situations specific to being in school which elicit high levels of stress (push from school) |
Environmental:Noise, crowds, the playground, smells and sounds. Learning:Reading, processing, general learning difficulties and the work being too hard. Expectations:Exams, homework, attainment and behaviour. Transitions:Between groups, rooms and teachers. |
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2. To escape social situations which cause feelings of discomfort (push from school) |
Interaction difficulties:Difficulties making and maintaining friendships. Inclusion needs:Social isolation and lack of belonging to a group. Expectations:Working in different groups and public speaking. Negative interactions:Bullying and poor relationship with a teacher. |
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3. To spend more time with significant people (pull to home) |
Family dynamic:Recent change, bereavement, separation and divorce. Well-being concerns:Physical and mental needs of parent or sibling. Safety concerns:Domestic abuse. Engagement:Parents or siblings are at home. |
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4. To spend time doing something that is more fun or stimulating (pull to home) |
Activities:Watching television and playing computer games. Engagement:Spending time with a friend. |
It is important to note that if only function 4 is present then we would not consider this to be EBSNA. Children and young people experiencing EBSNA present with a combination of the above functions. These functions can be thought of as things that push and pull a child from school and towards home.
By understanding the individual functions/push and pull factors for a child or young person we can begin to think about how to re-dress the balance and create factors that pull them towards attending school. This might be through providing more support, making reasonable adjustments or putting specific interventions in place.
Is EBSNA caused by anxiety?
Anxiety and unmet SEND
EBSNA and anxiety are frequently spoken about interchangeably. It is important to conduct a thorough analysis of all the needs that might underpin anxiety.
Anxiety is frequently an emotional presentation that arises when needs are not met. It is not true that all children experiencing EBSNA have general anxiety needs. Consider a situation where an adult is in a job where the work is too hard, colleagues bully them and they have to work in uncomfortable physical conditions.
Exposure to this situation over time may lead to anxiety. However, increasing the capacity to cope with anxiety is merely treating the symptoms and may not lead to longer-term change.
It is only by understanding the things someone needs to avoid and making adjustments that things will improve in the longer term. Anxiety will likely reduce once the right things are in place. For example, when the work is really hard, reduce the workload or increase the support. It is for this reason that we advocate for functional analysis as a starting point. This is to understand the needs that underpin avoidance.
Why anxiety management is helpful
Though there are many different underlying special educational needs (SEN), adverse life experiences and developmental needs that can lead to EBSNA, anxiety is often the end result. Some would therefore consider anxiety to be a defining feature of EBSNA.
Even once appropriate provision has been identified and put in place, it may still take time for a child or young person to trust that their needs will be met and to experience relief from their anxiety without the need for avoidance.
It is therefore important to understand anxiety and how it develops over time. Interventions and reintegration plans are also generally built upon the principles that underpin treatments for anxiety. The anxiety cycle is a helpful model for understanding how chronic non-attendance can arise following a period of not having individual needs met.
What do schools need to understand about anxiety?
“Anxiety is what we feel when we are worried, tense or afraid – particularly about things that are about to happen, or which we think could happen in the future. Anxiety is a natural human response when we feel that we are under threat. It can be experienced through our thoughts, feelings and physical sensations.” (Mind.org, nd).
It can be helpful to have an understanding of what anxiety is and how it can develop, in order to support children. Anxiety is a normal and helpful emotion in the right place. It can help us by giving us the physical and mental resources that we need to prepare and respond to a novel situation.
However, anxiety can overwhelm us and lead to both thoughts and feelings which are unpleasant. For example, feeling sick or worrying that people don't like us. 'The Happiness Trap: Evolution of the Human Mind' video explains this. You may find it helpful to show this to children and young people you are working with to help them understand what is happening to them.
Our natural response to thoughts and feelings which are unpleasant is to avoid the triggers or situations in which they arise. This response will lead to some short-term relief. However, it does not address the underlying thoughts and emotions. Anxiety can grow due to ‘unhelpful thinking styles’ which psychologists call ‘cognitive distortions’. For example, we might:
- ruminate on our worries (constantly think about how we look),
- magnify them (think we are really ugly and unlovable)
- overgeneralise (everyone is looking at me)
When we avoid something, the negative thought patterns linked to it go unchallenged. When we are anxious we are also primed to notice dangers in our environment. We might selectively notice things which unfortunately can confirm our negative thoughts/feelings. In this way, we become entrenched in a cycle of growing anxiety and more extreme avoidance of situations that elicit it. This set of responses is known as an ‘anxiety cycle’.
Anxiety cycles are maintained because avoidance means that they go unchallenged. In the case of Sarah (below), by not attending school she doesn’t have the opportunity to find that other children do like her. Or that over time she can learn to manage feeling shaky.
Additionally, over time, secondary or maintaining factors can increase feelings of anxiety. These are factors that may not have been an initial trigger, but now increase the likelihood of wanting to avoid a situation. Some maintaining factors for children and young people who avoid school are ‘falling behind in their work’ and ‘loss of contact with their friends’.
Sarah has always been a little shy and finds it hard to be in a large group. She has just started a new secondary school. When Sarah enters a room full of students she feels a little sick and shaky. This is really bad if the teacher asks her a question, her voice is wobbly and she feels sweaty. Sarah starts to worry that other students notice this. She thinks that they won't like her and that she is stupid for not being able to answer a question.
Sarah starts to feel sick most mornings and takes days off school due to illness. When she is at home she doesn't feel sick and worried. She wants to be able to go to school like everyone else.
On the days Sarah does go in she 'notices' that other students look at her when she arrives. She believes this is because they can see how shaky and sweaty she is. Sarah begins to avoid school more frequently and falls behind in her lessons.
Sarah worries that her peers think that she is stupid, that nobody likes her and that she will never have friends. Over time she begins to avoid other situations where she is exposed to other young people and spends an increasing amount of time in her room.
What should schools do to reduce EBSNA?
To be able to prevent, pre-empt and protect children and young people at risk of EBSNA we need to:
- know our children well
- be confident in the adjustments and provisions required to meet their needs
The next sections in this toolkit are designed for parents and schools to work through together to map the needs of their children. This toolkit contains:
- information
- online training sessions and activities
- links to resources
- advice produced by external organisations
The journey for children, young people and families experiencing EBSNA can be a traumatic one. By working together and developing a joint understanding, schools and families are able to break the cycle of anxiety avoidance. This helps children and young people to develop resilience in the face of their individual needs.
if you are responsible for day-to-day decisions around SEND and attendance you may want to read advice for managers next.
If you are a teacher or auxiliary staff you may want to move on to the sections about prevention or identification.