Emotional Based School Avoidance (EBSA)

One of the key things I hear from parents, carers and the children experiencing EBSA is ‘I don’t feel they really listened, I don’t think they are hearing what we are saying’. In my experience, if any support is going to work and be helpful, it has to be individualised with the child’s voice at the centre, and the parent/carers voice supporting them.

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Children and young people tell me similar things about EBSA. They often describe it like a wall which they cannot get over, under, around. It’s a block, a wall preventing them from getting dressed, out the door, engaging with school, even finding the words to talk about school. That block creates anxiety. What we know about anxiety is big goals and big targets don’t work. They are too overwhelming.

 

We need tiny steps that can be celebrated, even if they fall back, each step is celebrated. But these tiny steps need to come from the child. Not from the school, who may have a 12 week plan in mind. Not from the parent, who have their own fears and pressures feeding their plan. It needs to come from within the child. That first tiny step of helping themselves, making things better, that feel a tiny bit possible for them, in their own hearts and minds.

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When children experiencing EBSA visit me, we work on building trust, safety, connection and co-regulation. Then we explore their understanding of the mind body connection as with all my clients.

Once there is understanding of the mind body connection and how these impact emotions we gradually begin to explore their core fears and subsequent emotions around school.

 

For every behaviour around school, there will be a story. That story may not be to do with school.

 

It may that the child does not feel safe enough in the world to be able to sit in a classroom and learn. Some children tell me that they feel alone in their experience.  Many children come to see to me when their distress is great, but have not had an emotionally safe adult pause to understand why they are so distressed.

 

Research tells us that difficult things happen to everybody, but mental health issues can start when the mind experiences them alone. Children with EBSA need emotionally safe adults to help them to explore their pain. But many children tell me that the adults around them treat them like they are a criminal, with accusations, threats and judgements, instead of emotionally safe curiosity.  I hear children tell me of being dragged into school, or school staff banging on their door at home, their safe space. I hear from parents and carers of fines, threats of court and prison, of court cases. I work with children and their parents who are living in terror and unsupported, which often adds to the EBSA.

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Exploration of the cause may take time, but it is only when children have explored this safely, that we can start to think about how to move the child from the state of helplessness to where they can manage, feel safe, feel nurtured and know there are people to talk to. And each step comes from the child.

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There are many reasons why a child who seemed to manage in school changes and finds it too difficult, and there are many reasons why a child might not find school a safe place from the start. But from what I have learnt from the children and young people I work with, is that each will be individual to each child, to their experiences, perceptions, support and nervous system and psychological response.

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Many children experiencing EBSA tell me that they want to go to in to school, there are things about school that could be ok, but they just can’t, because the things that are not ok are too big for them to cope with.  That wall of anxiety makes it impossible. Children, parents and carers tell me it can affect eating, sleeping, enjoyment of life outside school, their ability to concentrate, travel, and for many leave their room or house. They tell me about the overwhelm, distress, shame, embarrassment and fear that often develops, creating a vicious cycle. There are themes that are similar, but each individual child has a different experience. For some children, in year 3 and 4 it is the change from keys stage 1 to the expectations of KS2. For others it is the transition from primary to secondary; workload, change of routine, change of expectations, changes of teacher, all can create huge worries and overload. For others, it could be the other children around them, it may be bullying, or how they perceive other children react to them. It may be sensory overload and overwhelm of transitions and expectations.

 

Sometimes it can be nothing to do with school, but an experience being remembered or re-experienced, or a bereavement, a loss of somebody very special, or a medical issue. Social media or the news and the sense of lack of safety that these can bring can also create a fear that creates anxiety. For others there may be worries at home, and the need to be at home is too great to manage when at school. For some there may be no apparent reason and it is only with exploration that we uncover experiences. These are just a few examples that from children I have worked with, but there are many, many different reasons, each individual to the child.

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Many parents and carers share that due to policy and attendance laws, their child’s individual needs are ignored and  there I no opportunity for  the reasons behind the EBSA to be explored, supported and healed. They tell me that many children with EBSA are expected to meet the expectations of school and the child’s needs, view and anxiety causes are not listened to or taken into account in a plan to address the EBSA. And neither are the views or needs of the parents. Parents tell me of being demonised, accused of making their child anxious and their views and knowledge of their child ignored or shamed. Parents tell me about their fear that their child will not achieve, or succeed, they tell me of the fear of fines and their own anxiety around their child’s EBSA. They tell me they need help not blame and judgement. They share that they need to feel that they belong, to feel safe and have to hope that they and their child can move forward through and from EBSA.

 

And there is hope.

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There are evidence based therapeutic support processes that can support children and young people experiencing EBSA and their parents and carers. The support for the parents and carers is very important too and the impact on them should not be underestimated. But it needs to be made clear that these interventions around EBSA should be a team effort, including school, other health professionals and psychological support. And it takes time. I as the psychotherapist can offer the therapeutic relationship where the child is supported to gently and gradually explore the emotions, feelings and behaviours creating the anxiety preventing them from attending school. Eventually, with the child’s permission we can create a letter/plan to share with school other professionals offering recommendations on the child’s needs in school.​

 

When working therapeutically with children and young people experiencing EBSA, I take a tiny step by step approach. Sometimes that starts with some online sessions, if leaving the house is too much, sometimes its at the little bird house. But always the first tiny step is building trust in me, as someone who is hear to listen and walk by their side. Some children want to explore their feelings about school straight away and some children don’t. We go at the pace that they feel able to cope with. I use a range of approaches including games, sand tray, art, drawing, clay, slime, emotion cards paint depending on the child and how they are on the day. The child may choose or I may make an offering. 

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I regularly support children and young people who are unable to form the words to talk about themselves or about school. Sometimes a child may not want to engage at all with me but be independent in the space whilst they get used to it,  and explore for themselves if it feels safe. Some children may need their parent in the room to start, and it may be that the parents talk with me or engage with activities whilst the child stays within their safe space. There is no right or wrong of how a child engages. If they are safe and I am safe, then we go with their needs until they are ready to engage with me. For some children that is in our first session together, but for others it may be after a number of sessions. Everything is about them feeling safe, co-regulated with me and knowing that they are welcomed, accepted and celebrated as they are. And the key is that all involved recognise that it can take time, and each child is different.

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But there is hope.