School Distress, EBSA, EBSNA

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.

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. For most it becomes a physiological and neurological response where their anxiety pathways combined with their nervous system responses, are telling mind and body that this is not a safe option anymore.   

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. This can be because their amygdala anxiety pathway is creating an alert that this is not safe. They may not be able to name it. But with support, a trusting, safe, therapeutic relationship, time and patience we can normally uncover the root cause. 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.

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 it’s at the little bird house. But always the first tiny step is building trust in me, as someone who is here to listen and walk by their side. Some children want to explore their feelings about school or their anxiety 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, lego, fiddle toys, 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. 

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.

But there is hope.

If your child is suffering from anxiety preventing them from going to school, I recommend.

• Try to create a good relationship with school. Ensure that they are aware that this is severe anxiety and if you can, get a letter from the GP or a professional letter of recommendation from a psychologist or psychotherapist, trained in psychological formulations.

• Work with the school try to identify the unmet needs, these need to be addressed or there will be no improvement. What reasonable adjustments need to be put in place?

• Join an EBSA FB group- they often have templates of letters you can use which quote the legal requirements for schools. Schools have to accept non attendance for mental or physical reasons.

• Until the root causes of the anxiety are understood and addressed the distress is likely to continue. And due to how anxiety works, many children when their systems are being hypervigilant cannot identify why it feels so unsafe.

• Reduce demand in every aspect of life, especially on school mornings and after school. Research low demand communication. This does not mean forgetting boundaries. You can have your non negotiables, but these need to be clear, consistent and safe. You may need to support a lot more in aspects such as dressing, breakfast and chores.

• Be flexible. If they are in distress, forcing them in, having them manhandled may create further embedded distress. Always question school if they say they are fine in school- they may be just surviving.

• Once out of school any type of reintegration has to be led by what the child feels safe with. 12 week plans set by school, or parent work commitments, are generally not psychologically informed and often create more distress. Tiny steps, created with the child's voice being heard, one at a time, at the child's pace.

• Always remember that anxiety pathways in the brain create behavioural responses. These include sensory overload. These need to be understood and actioned on so that the child's needs are met in school. Without this it is likely the anxiety and distress will continue.

• To the adults around them the anxiety may seem illogical. To the anxious brain logic is not possible, when their amygdala, their alarm system, is screaming this is unsafe. Unfortunately this is one of the biggest disservices and psychological harm schools can create for a child. The emotional pain of being told you are ok when you are not, can become embedded in a child's nervous system, creating long term impact.

• No child can learn when their nervous system and amygdala are in a state of distress, fear and anxiety.

• It can be hard to accept that your child's education journey may not be taking the path you hoped for them. But education can come in many different forms, and if you can ease the anxiety, they can begin to learn again. It is about finding the pathway where they can thrive, not just survive.

• You know your child, listen to your intuition.

  
  

• I work with children and young people experiencing anxiety and school distress, online and face to face. Please get in touch if I can be of support to you and your child.

• I am trained in and offer psychological evaluations and professional evaluations and letters of recommendation to support school absences due to anxiety. Please contact me at littlebirdhousetherapy@gmail.com