Is EBSNA caused by anxiety?
Last updated: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.