Understanding EBSNA

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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

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) 

1. To avoid situations specific to being in school which elicit high levels of stress (push from school) 


Noise, crowds, the playground, smells and sounds.


Reading, processing, general learning difficulties and the work being too hard.


Exams, homework, attainment and behaviour.


Between groups, rooms and teachers.

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.


Working in different groups and public speaking.

Negative interactions:

Bullying and poor relationship with a teacher.

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. 


Parents or siblings are at home. 

4. To spend time doing something that is more fun or stimulating (pull to home) 


Watching television and playing computer games.


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.

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