Struggling to go to school (EBSNA)

There are many reasons why a child may not be going into lessons or going to school. These can include difficulties with the curriculum and school work, or problems getting to school because of transport or caring responsibilities. Emotionally based school non-attendance (EBSNA) is a term that’s used to describe children who are struggling to go to school, or to stay in school or lessons, because of an emotional need.

Some professionals still call it school refusal. But there is now a clearer understanding that it isn’t about a child refusing to go to school or being defiant. Instead, it’s about emotional, mental health and well-being issues.

EBSNA can start suddenly or build up gradually. It’s more likely to get worse during big moves (transitions), such as moving from primary to secondary school or starting a new school year. It’s equally common in boys and girls. It’s also more likely to develop in young people in secondary school, though the signs of it can be seen when a child is in primary school too.

Some children don’t go into school at all, others may have a pattern of missing some days, such as Mondays. Some children gradually attend less and less. EBSNA doesn’t just mean not going to school. Children and young people may also

• not go into class
• not stay in lessons
• avoid some places or people at school
• avoid going in, telling you they can’t go in, but still going into school
  
  

If your child isn’t going to school fully, you’re not alone. The Children’s Commissioner for England estimated that in the Autumn and Spring term 2021/22, two out of every nine school children were persistently absent. That’s 1.6 million children who missed at least 10% of possible school sessions.

All children of compulsory school age have the right to an education. Compulsory school age is when your child’s education starts and finishes. In the UK it’s from the start of the school term following your child’s fifth birthday, until the last Friday in June in the school year when they reach 16.

The law also entitles every child to an efficient, full-time education suitable to their age, aptitude, and any special educational need they may have. All parents have a legal duty to make sure that their child has that education and, if they are not being electively home educated, that they are going to school.

There are only certain reasons why a child might miss school, for example, due to ill health. You can find out more about this in our information about going to school (attendance).

If your child’s mental health is affecting whether they go to school, school staff should work with you from the start to try and resolve this. That would include confirming that it’s your child’s mental health that is stopping them from being in school and developing a clear plan of support. If your child misses 15 school days in a row due to illness, then the school must tell the local authority. Then the local authority has a legal duty to work with you and the school make sure that suitable, full-time alternative education is in place.

The Department for Education has guidance for schools and local authorities to follow called ‘Summary of responsibilities where a mental health issue is affecting attendance’. The guidance applies to any child or young person showing any social, emotional or mental health issue that is affecting their attendance. It’s not just about children who have a diagnosed mental health condition, disability or special educational need. The guidance sets out the school’s responsibilities to

• support positive mental health across the school
• to identify possible difficulties with going to school and act early
• to put support in place if a child is not attending school
• work with parent carers
• to make reasonable adjustments to support a child in school

The guidance also gives some good practice examples, showing how schools have supported children to build up their confidence and feel more able to be in school regularly.

There is no one thing that causes EBSNA. Instead, it’s a complex issue caused by several things happening together – this is sometimes called multi-factorial. Anxiety is a key feature though.

A certain level of anxiety is a natural part of growing up so children and young people can learn how to cope with it in everyday life. But sometimes the level of stress for a child or young person gets so big that it cannot be managed by the support that’s available to them. The anxiety builds up to the point where they cannot go to school, or be in lessons.

There are many reasons why a child or young person might develop EBSNA, but these are some of the things that might play a part.

Behaviour, such as not going to school, doesn’t exist on its own – there is always a reason for it. You might hear the phrase ‘behaviour is a form of communication’. That means that children and young people are telling you what’s going on for them, and what they need, through their behaviour. It’s important for adults to see beyond what children and young people are saying and doing.

When anxiety is linked to school, your child is likely to have anxious and fearful thoughts around going to school and coping once they are there. Looking back, parents sometimes see that the early signs of difficulties going to school were there in their child’s behaviour.

In order to avoid overwhelming feelings of anxiety and the fear related to school, the ‘fight, flight or freeze’ response is triggered. Once that has been set off, a child is in ‘survival mode’ and the part of the brain that does the thinking for them switches off.  These are some of the possible signs you might see.

• Becoming socially isolated and avoiding friends.
• Increasingly distressed or challenging behaviour at school and at home, such as emotional outbursts, anger, crying and feeling very scared.
• A depressed or low mood, low self-esteem and low confidence.
• Concentration and ability to focus gets worse.
• Overly worrying about school work, homework or tests.
• Your child seems withdrawn in class, for example, resting their head on the desk, wearing a hoodie with the hood up and avoiding work or interaction with teachers or support staff.
• Hiding in school – in the toilets or out in the school grounds, for example
• Running away from or leaving school.
• The times when they are not in school get longer and happen more often.
• Younger children may not want to leave you or get out of the car to go into school.
• Increasingly not going to school because of minor illnesses.
• Not wanting to, or not going on, school trips or activities outside school.
• Wanting to go into lessons, but not being able to.
• Underachieving in their learning.
• Taking a long time to get ready for school in the morning.
• Contacting you a lot more often when they are at school, for example, sending you lots of texts over several weeks.

Alongside feelings, physical symptoms are also common. These might start the night before or the morning of school or even a few days before. These can include:

• feeling sick or being sick
• shaking, sweating and panic attacks
• aching arms and legs
• headaches
• abdominal pain
• change in appetite, losing or putting on weight quickly
• difficulty sleeping
• peeing often, or bedwetting when they have previously been dry at night

Children and young people can find it difficult to talk about their feelings and distress about school in a way that others can understand. They may not know why it’s difficult, they may find it hard to express themselves or sort out their thoughts and feelings.

It’s really important to listen carefully to what they have to say and encourage them to find ways to tell you how they feel or what they need. There is information on our website about how to support a young person to share their views, or gather the views of a child. DiAS also has two children and young people’s workers who work directly with children and young people.

If they cannot talk to you about it, and many children and young people can’t, then you could suggest other options. There is information on the Devon County Council schools’ website about using a solutions-focused approach to help a child think about and talk about school. There are some practical tools set out in detail and one of them may work for your child.

Other ideas include: 

• Getting others involved. Are there other trusted people who support them who they might be more comfortable talking to, such as a mentor, Teaching Assistant, grandparent or older sibling?
• Drawing thoughts and feelings about school. Young Minds suggest drawing an anxiety iceberg or you could try the Three Houses tool. You could suggest your child draws their worries about school as a ‘thing’ and ask what would it say. Other suggestions are to ask them to draw how their body feels when they are worried. Or drawing the school day, where they are, what they’re doing and what they’re thinking.
• Using picture cards to show what they’re feeling. There are picture cards sets you can buy, or borrow from school, that can help children and young people who find it hard to express themselves. Examples include ‘Helping teenagers talk about their lives’ cards and ‘School Wellbeing cards’.
• Recording their views in another way, such as in a voice message, text or film.
• Using Zones of Regulation. This is a way of organising feelings, states of alertness, and energy levels into four coloured Zones – Blue, Green, Yellow, and Red. Your child can sort every day activities into colours and the feelings linked to them can be unpicked further.
• RAG rating the school day. RAG stands for Red Amber G Look at different parts of the school day with your child, including lessons, breaktimes, other children and staff. Ask them to colour code them red, amber or green. Green means they like it or it’s good, amber means it’s OK some of the time, and red is a definite dislike or a thing they actively avoid. It can help you see the positive things and the things they are struggling with.

Choose whatever option is most comfortable for your child or young person.

Once your child or young person has been able to say how they feel about school, and life in general, it’s important that their views are shared. Ask your child if it’s OK to share them with school staff and other support staff and professionals. Tell them that what they have said will be at the heart of plans to support them back into school or education.

Anxiety is an important part of life for everyone. It helps us learn to navigate the world, cope with possible threats and understand how we feel about different situations. It can become a problem though when it becomes more severe and starts having an impact on everyday life. This is when it

• stops your child doing the things they enjoy
• happens when there is no real threat
• becomes overwhelming and constant

Anxiety works as a cycle. If something makes a child anxious, they often try and avoid it. That will give them a feeling of relief and might work in the short-term. But in the long-term, avoiding situations only makes the anxiety about them feel bigger.

If your child is avoiding school, other worries can start to develop on top of their already increasing anxiety. That could be things like worrying about falling behind with work, not understanding what’s going on in lessons and missing out on time with their friends. These things make the anxiety load bigger too. Eventually it reaches a tipping point where the amount of stress is bigger than their ability to cope with it and that’s when EBSNA starts.

The key to supporting a child or young person is to find a way to break that cycle. Young Minds have information about how you can support your child, as do the NHS and Place2Be. You can find more information about how you and staff at school can help them to do that in the sections below.

Autistic children and young people are more likely to develop high levels of anxiety and more likely to have EBSNA. The National Autistic Society has information about what to do if your child can’t go to school. They suggest some reasons why school may be more difficult. These include:

• sensory difficulties which make being in the school environment difficult, such as increased noise, smells and lighting
• struggling with the complex social skills that come naturally to others, which may make friendships more difficult and increase the chances of them being bullied
• difficulty coping with school work, processing information and understanding questions
• difficulty organising and prioritising
• taking things literally, which might mean that they misunderstand a teacher’s instructions
• difficulties managing the many transitions and changes involved in the average school day
• feeling different from everyone else and feeling like they don’t fit in
• other people not understanding or accepting their behaviour

These challenges mean that some autistic children and young people try and manage their anxiety by avoiding school altogether. The Autism Education Trust has a guide for parents about school stress and anxiety.

Helping your child to get back to school, or back to education in some form, is achievable. With the right support, happening consistently, children can and do successfully return to school. Try and hold that in mind when things are difficult. 

There is no doubt however, that EBSNA can have a huge impact on parent carers and family life, as well as on the child. Guilt, shame, frustration, sadness, anger and despair are common feelings and it can be highly stressful for everyone involved. Parent carers can find themselves going to extreme lengths to get their child into school and that can have a huge impact on their relationship. Parents often feel really pressured to get their child into school, can feel like they’re being blamed or that their parenting is being criticised. Worries about getting into trouble and possibly facing prosecution also add to the emotional load.

It’s vital for you to look after yourself and get proper support. Being in this situation can feel very isolating. Some parents find it helps to talk to others in the same situation or to get information and support from national organisations. Not fine in school offers peer support. If your work is being affected, talk to your employer about whether there is any option to work more flexibly to take some of the pressure off. You can contact us for advice and information about your situation too.

The longer the difficulties go on, the bigger they become and the more difficult it is to resolve them. So, if you’ve spotted the signs early, then get help early, using the services available at school and in your wider community.

If not going to school has been an issue for a while, and your child’s absence is severe, you’re going to need extra and more specialist support. You can find out more about what school can do in the section below.

There are lots of things that you can do at home that will help your child to manage their anxiety and return to education.  Parents have told us that sometimes it can be really difficult to keep trying to get their child into school and it feels like a mountain to climb. Progress can be slow and you’ll need to work with what your child can manage. There will be some setbacks and you should have a plan prepared for what you will do if that happens.

General tips

Here are some tips that may help, whatever stage you’re at and whatever the circumstances.

• One of the most important things you can do is to be there for your child and focus on supporting and looking after your relationship. When your child isn’t in school it’s a worrying and stressful time for everyone and it’s easy for relationships to become strained and difficult.
• Keep communication open with your child. Be curious about what they’re doing or saying, notice when they’re at their best and encourage them to do the things they’re good at and enjoy. Ask questions, encourage them to talk about their worries and listen carefully.
• Your child may often feel low and negative about themselves. Praise the progress they make and help them to see what they have achieved.
• It’s important for your child to stay engaged with other things in life, even if school is difficult. If your child isn’t in school, encourage them to still stick to a routine as much as possible, do basic daily activities and stay healthy. This means things like eating healthy food, being active, playing any sport and seeing their friends.
• Be involved. Work with professionals to explore what’s affecting your child’s behaviour and be a part of the discussions about how to move forward or prevent things getting worse. That means going to meetings, taking part and sharing your views. We have lots of information about how you can do that.
• Have a clear plan. Work with the school to create a plan that’s led by what your child can manage. Be realistic and plan for if progress slows or takes a backward step.
• Help your child manage their anxiety. There are lots of self-help tools, apps and activities that you can do with them or they can do themselves. Lumi Nova is an app for 7-12 year olds, which helps them manage worries and it’s available through Children and Family Health Devon (CFHD). CHFD also have an area on their website with resources about mental health, wellbeing and anxiety. Happy Maps has a collection of apps about mental health and wellbeing for teenagers, but there are lots of other sources of help and support too.
• Ask school for work your child can be doing. Keep your child in touch as much as possible with academic work. School should be able to give your child work to do online or they can print off and send work to you.
• As a parent, you can refer your child for support from the Mental Health in Schools team. Not every school has access to it, but many do. You can find out more and find the form on the Children and Family Health Devon website.

When you first notice anxiety or problems going to school

• If you notice signs that your child is struggling to be in lessons or at school, start those conversations early. Keep talking to school staff and let them know what’s happening at home. Ask for a clear plan about how they will get your child’s views and use them to give support.
• Plan well for the school week. A visual planner of the week and checklists for school work, homework, sports kits and equipment can sometimes help. It’s important to try and build on a sense of momentum and things may be easier to keep going if there is a firm routine in place.
• Have a plan for when things change. Many parents find that it’s harder for their child to engage with school on a Monday, after a period of illness or after a holiday. Make a plan with school about what you’ll do if things take a backward step and how you’ll get back on track again.
• For some children, it can help to have a transitional object to take from home to school and back. This could be a teddy, photo, keyring or other object that reminds them of someone or somewhere safe.
• Some parents find it helpful to keep a diary for a while to see if there are any patterns to going or not going to school or lessons. There might be particular subjects, teachers, days or times when your child is more likely to avoid school. This can help everyone to understand why your child might be missing school.
• Ask your child’s school for support through their mental health resources or ask them to refer your child to the Mental Health Support Team in schools. This is NHS support in schools, but it’s not available in every school. It’s an early intervention service that provides Low-Intensity Cognitive Behavioural Therapy (LI-CBT) interventions focused on guided self-help.
• Take your child to see their GP and explain what has been happening. Your GP should be able to refer your child for support. Some GP surgeries have a children’s wellbeing practitioner who can offer support.

When your child has been off school for a while

• Keep in touch with school about what’s happening and ask them to keep in touch with you. Each day, if your child hasn’t gone into school, make sure you report them as absent, giving the reason why. In the long-term you may come to a different arrangement for reporting absence.
• If you’re worried about your child’s mental health, go and see their GP or talk to the SENCO. Any professional, including your child’s GP, can refer your child to CAMHS (Child and Adolescent Mental Health Service) if they feel it’s needed. You can also refer your child to CAMHS using the referral form that’s on the Children and Family Health Devon website.
• Pass any medical information, reports, assessments and details of any referrals or appointments onto school staff. If your child is not in school because of their mental health, that should be clear to all the professionals. Otherwise, their absence at school will be recorded as unauthorised and that can lead to possible sanctions for you. You can find out more in our information about going to school (attendance).

Parental Minds in a Devon based organisation that gives support to families who are struggling with their mental health. They have produced a directory of support that’s available for children who are struggling to be in school. It can be a good place to start. It includes resources available in the community, in school and through wider support services. The support is grouped together based on the stage your child is at, from early support through to support for children who have not been in school for some time.

Devon’s SEND Local Offer also has a family well-being page with details of more resources, support and services.

EBSNA is complicated and usually involves a number of different factors at work together, such as mental health issues, sensory overload and friendship difficulties. So, it needs a joined-up approach to support, where you, school staff, other professionals and your child work together.

There is support available in Devon, and nationally, to help school staff support children and young people with EBSNA.

These are some of the main things that school staff can do.

• Understand what is motivating your child. You might hear professionals talk about push and pull factors. These are things that push a child away from school and pull them towards home, and vice versa. For example, moving classes, bullying or important relationships changing could all push a child away from school. A parent who is unwell or needs caring for could pull a child towards home. There are several different ways for professionals to see what these push and pull factors are, such as questionnaires and surveys, wellbeing cards and assessment tools.
• Communicate regularly. School staff should set up regular communication between themselves and your child and also with you. That could include things like emails, phone calls, postcards or meeting your child outside of home or school.
• Create a clear plan for getting back to education and/or school. School staff can work with you and your child to make a clear plan that sets out how your child will return to education and to school, if that’s what the goal is. It should describe support that’s based on what your child feels they can manage and a step-by-step approach to being in school. If your child is finding the idea of going back to school particularly difficult, the plan could focus on smaller steps – like meeting a friend from school or completing a piece of work at home. For children who have been out of school for a while, school staff may need to think first about how they will get back into learning and not necessarily into school. School staff may consider putting things like tutoring or online learning in place. Ask for a copy of the plan that you can share with your child or young person, so that they are clear what is happening.
• Help your child build good relationships. Relationships at school are likely to be one of the most important things that will help your child to make a successful return. If you child doesn’t already have a few trusted adult relationships with staff, school can work on developing these with them. If there are difficult relationships then school staff can help your child repair these where possible. School staff can also develop a relational support plan with your child. This usually includes the things that they’re good at and that make them feel safe, the best ways for staff to connect with and understand your child and what can help them feel cared for and supported.
• Give extra educational support and tutoring. School staff should be able to arrange extra support and learning. Schools should have access to funding and resources to help them do this.
• Do an Early Help assessment. This is a way of working out what the challenges are and putting a plan in place to support you. One professional will usually lead the Early Help Assessment and process and make sure the right people are involved. You’ll work together with school staff and other professionals to plan the things you want to achieve as a family. The plan will be reviewed regularly to see what is working and what might need to change. That’s usually done at a regular Team Around the Family (TAF) meeting.
• Make changes to life in school. Adjustments can be made to your child’s school day to make it easier to manage. That could include things like:
• Extra breaks, sensory or brain breaks and a safe place to go in school when they need it.
• Time spent with a trusted adult, building and strengthening important relationships.
• A reduced curriculum or timetable, with specific time set aside to do other activities in or outside of school.
• Working outside of the classroom environment, such as in a quiet room, learning support or library.
• Support to manage emotions and develop coping strategies. That might include help with understanding feelings and what triggers them and using calming strategies for anxiety.
• Opportunities to go to after school activities or one-off activities in school, such as the school Christmas play or sports day.

Get support from specialists. That might include support from

• Young Devon– this is a Devon wide service that supports young people
• school nurses
• the social emotional and mental health (SEMH) team
• the Mental Health Support Team in Schools or Child and Adolescent Mental Health Service (CAMHS)
• counselling or mentoring
• the educational psychology service
• education key workers – you can find out more about these below
• Devon inclusion team
• wider services, such as the family intervention team or social care
  
  

Important to know

For a child with special educational needs, the same processes should still be happening whether they are in school or not. That means meetings with the SENCO about their support should still go ahead, as should team around the family or team around the child meetings. If your child has an EHC plan, that should also still be reviewed once a year.

It’s normal for children to sometimes be anxious and have difficult feelings about going into school. The expectation is that they should still be in school, but with support and reasonable adjustments to help them manage.

If your child is not in school because of anxiety it’s important to tell school that each day they are not in. This should be classed as ‘illness’ and their absence then becomes ‘authorised’. Department for Education guidance says that “School staff must record absences as authorised where it is not possible for a pupil to attend due to illness (both physical and mental health related).”

If your child’s absence is ‘unauthorised’, then that leaves you open to fines and prosecution as it’s a parent’s responsibility to make sure their child is in school. You can find out more about this in our information about attendance.

Each school will have someone responsible for attendance, often called the attendance officer. Keep in contact with them to let them know what’s happening. In Devon there are also School Attendance Support teams. They offer advice and support to schools.

If your child is regularly not going to school for mental health reasons, it’s a good idea to speak to your GP. Encourage your child to go with you if they can manage it. Department for Education guidance says however that “there is no need to routinely ask for medical evidence to support recording an absence for mental health reasons.” In the long-term, if EBSNA continues, getting medical evidence to say that your child can not go to school for health reasons can be useful to help you get the right support.

In Devon there is an education key worker service. It’s a team of professionals who work with children and young people to help them get back into school. It’s aimed at those with special educational needs who have been missing school for around a term or less. The service is not able to support children who have been out of school for a long time and who have complex needs, such as severe mental health difficulties.

They offer support for around six weeks, usually seeing a child or young person for an hour, three times a week. This is usually in school if the child is attending at all, but can also be at home. They can help understand the barriers stopping your child being in school. They give also support and make recommendations to school about support.

Your child’s school can refer them to the service and if they do that, you and your young person should be involved. If you think having an education key worker might help your child, talk to their SENCO.

If your child has EBSNA and has not regularly been in school long-term, your SENCO or other professionals might talk to you about a ‘Section 19’ referral. Section 19 refers to part of the Education Act 1996  which says

“Each local authority in England shall make arrangements for the provision of suitable education at school or otherwise than at school for those children of compulsory school age who, by reason of illness, exclusion from school or otherwise, may not for any period receive suitable education unless such arrangements are made for them.”

It means that where a child cannot go to school because of a physical or mental health need, and cannot access suitable full-time education, the local authority is responsible for arranging suitable alternative support and education.

In Devon there is educational and sometimes mentoring support for children who meet this condition and it’s often called a ‘section 19 referral’. Schools and other professionals can apply for this kind of support by filling out a referral form. It includes online education and sometimes tutoring in core subjects including maths and English.

This can be a complex area, so it’s a good idea to get advice if you’re in this situation.

If your child has an EHC plan but is still struggling to attend school, the first thing to do is to find out if the support that’s in it is in place. If it is, or has been, and it’s not working then it’s likely that their plan needs to be looked at. Your child may need extra or different support, and/or a different school or setting. The support that’s in your child’s plan should carry on in the meantime and it’s the local authority’s duty to make sure that support happens.

You can ask for an early review of the EHC plan, especially if your child’s mental health needs are recent and are not covered in the plan. If you think your child needs to be at a different school you can raise that at the review meeting.

Another option is to ask for a reassessment of your child’s needs if you think that things have changed significantly. A reassessment is essentially like doing another EHC needs assessment and it takes the same amount of time.