Is EBSNA caused by anxiety?

EBSNA and anxiety are frequently spoken about interchangeably. It is important to conduct a thorough analysis of all the needs that might underpin anxiety.

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.

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.

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.

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.

To be able to prevent, pre-empt and protect children and young people at risk of EBSNA we need to: