Emotionally Based School Avoidance (EBSA) Support Strategies

What is Emotionally Based School Avoidance (EBSA)

Emotionally Based School Avoidance (EBSA) is a broad umbrella term used to describe children and young people who experience severe difficulties attending school due to emotional factors, often leading to persistent or prolonged absences. The term EBSA is intentionally used in place of older labels such as school refusal, which can be misleading. But it is driven by emotional distress, such as fear of failure in school, anxiety from peers being better at a particular subject, etc. Young people experiencing EBSA find it very challenging to even think about attending school and classes.

Children and young people experiencing EBSA typically want to attend school but feel unable to do so because the emotional demands of school attendance exceed their current coping capacity. Emotionally based school avoidance has been included as a complex area of need, requiring support from professionals.

Prevalence of EBSA

UK literature estimates approximately 1–2% of the school-aged population experience school non-attendance primarily due to emotional factors, with a slightly higher prevalence among secondary-aged pupils. Emotionally based school avoidance is reported to be equally common in males and females, with little consistent evidence of a direct link to socio-economic status.

Attendance difficulties are not experienced equally across all pupil groups. Evidence indicates that children and young people with special educational needs and disabilities (SEND), as well as those facing social and economic disadvantage, are at increased risk of persistent difficulties engaging with school. In addition, young people who struggle to attend school are more likely to experience co-occurring emotional and mental health needs, with anxiety and low mood frequently identified alongside patterns of non-attendance. These interlinked factors reinforce the importance of viewing attendance through a mental health and inclusion lens, rather than as a purely behavioural or compliance issue.

How to Identify EBSA

EBSA identification is a proactive, graduated, and formulation-led process, rooted in early recognition, attendance pattern analysis, and listening carefully to the lived experience of the child or young person and their family.

Early Identification & Intervention

EBSA often emerges gradually and may not initially present as complete school refusal. As such, schools are encouraged to maintain ongoing vigilance and to notice subtle changes over time, particularly where attendance begins to fall below expected levels or becomes increasingly fragile. Тhe longer EBSA remains unaddressed, the more entrenched and complex it can become, leading to poorer outcomes for young children or young people. Schools are positioned as central to early identification, with multi-agency collaboration as required.

EBSA is identified through a combination of attendance data, observed behaviour, emotional indicators, contextual risk factors, and lived experience, rather than through a single threshold or presenting feature. Early identification depends on professional curiosity, relational practice, and a whole-school commitment to understanding barriers to attendance, ensuring that emotional distress is recognised before avoidance becomes entrenched.

Identifying patterns within non-attendance may include:

Increasingly frequent absences for minor or unexplained illnesses
Partial or sporadic attendance (e.g. attending only certain days, lessons, or times of day)
Absence following weekends, holidays, or transitions
Avoidance of specific lessons, activities, or parts of the school day
Reliance on high levels of support or reduced timetables to attend

These patterns often indicate that the child is experiencing emotional distress linked to specific aspects of school, rather than disengagement from education itself. Early intervention must involve meaningful engagement with the child or young person and their family. EBSA is more likely to be recognised early when:

Children feel listened to and believed
Parents feel understood rather than blamed
Communication between home and school is open, consistent, and relational

Examples of early intervention approaches include:

Adjusting expectations temporarily to reduce immediate pressure
Making small, targeted environmental changes within the classroom or wider school
Providing predictable routines and clear communication
Identifying a trusted adult for regular check-ins
Supporting emotional regulation and coping skills

Underlying Reasons Why EBSA May Develop

EBSA does not arise from a single identifiable cause. Instead, it reflects the highly individual ways in which children and young people experience and respond to pressure, stress, and emotional demand. Because each child’s circumstances, needs, and environment differ, the factors that contribute to EBSA are unique to the person, shaped by their personal history and current context.

The four main reasons are:

To avoid discomfort or distress at school, such as crowded corridors, overwhelming noise, unmet sensory needs, fear of toilets, or frequent changes.
To escape stressful or challenging social situations, including academic pressures, social expectations, or other aspects of the school environment.
To reduce separation anxiety or gain attention from important figures, such as parents or family members, especially during times of family change or when a parent’s well-being is a concern.
To engage in preferred activities outside of school, such as playing computer games or pursuing other rewarding experiences during school hours.

School-Based Factors

Each child has a unique journey, and experiencing EBSA can be acknowledged through a different narrative. Children’s stories and views need to be recognised and acknowledged equally, because different experiences can be more helpful to parents and other professionals in spotting the behaviour and discovering why it’s happening. Therefore, school-based factors are among the most potent contributors to emotional-based school avoidance, shaping a child’s daily learning, belonging, and emotional regulation. These school factors can be understood as risk factors (push factors that discourage attendance) or protective/supportive factors (that encourage attendance and resilience).

The most common school-based factors:

Bullying at school
Peer relationship difficulties.
Academic pressure and curriculum demands. Children can feel overwhelmed by workload, performance anxiety, and fear of failure, especially where high expectations are placed on exams, tests, or public performance. Examples include: heavy homework load, fast-paced or difficult lessons and anxiety about testing environments.
Lack of predictability, psychological safety and belonging.
Ineffective SEN provision.
Staff relationships and teacher support. The quality of teacher–student relationships matters: supportive, understanding, and flexible teachers can act as protective anchors.
School structure and daily routine. Elements of the school day itself can be distressing for some children, such as structured timetables, large class sizes, noisy corridors and crowded spaces, fixed attendance expectations, and fear of public performance during lessons or assemblies. Such structures can heighten sensory overload and stress, especially in children with sensory sensitivities, autism, or ADHD, making avoidance a relief from intense environmental stimuli.
School transitions and environment changes. Transitions, such as moving from primary to secondary school, changing classes, or shifting to a new environment, are high-risk periods for EBSA onset. These changes increase uncertainty, disrupt routine, and often demand new social and academic skills, which may be overwhelming for some students.

Child-Specific Factors

Child-specific factors refer to the internal experiences, characteristics, and developmental vulnerabilities of the child or young person that increase emotional distress in relation to school.

Anxiety is the most consistently identified child-specific factor underpinning emotionally based school avoidance. This may include:

generalised anxiety
social anxiety (fear of judgement, rejection, embarrassment)
separation anxiety
health-related anxiety
panis responses linked to school attendance

Besides anxiety, many children experiencing EBSA struggle with:

emotional regulation difficulties (identify and articulate emotions, regulate intense emotional responses, or recover after periods of distress)
low self-esteem and fear of failure (feeling ‘not good enough’, fear of getting things wrong, fear of disappointing adults, negative self-beliefs linked to learning or behaviour)
autistic and neurodevelopmental differences (sensory processing differences, intolerance or uncertainty, executive functioning difficulties, communication differences, and high cognitive load from masking).
social communication and peer interaction difficulties (difficulty reading social cues, fear of social judgment or ridicule, challenges initiating or maintaining friendships, and social exhaustion)
sensory sensitivities (noise, crowded spaces, movement, lighting, touch)
physical health and somatic symptoms (nausea or vomiting, frequent headaches or stomach aches, fatigue and sleep difficulties).

Certain risk factors are associated with a higher likelihood of occurrence, including autism, children and young people with SEN/disabilities, and a lower socio-economic background.

Read more about neurodiversity in children.

Family and Home Factors

Family and home factors influence EBSA by shaping how safe, contained, and manageable the world feels for a child. When a child is experiencing anxiety, the home can become a place of emotional regulation and relief, while school may feel unpredictable or overwhelming. Changes within the family system, such as parental illness, mental health difficulties, separation, bereavement, or increased stress, can heighten a child’s sense of responsibility, worry, or fear of separation. Some children become preoccupied with a parent’s well-being or feel unsafe leaving home, particularly if they perceive their caregiver as vulnerable.

Family and home factors examples)

Parental anxiety or mental health difficulties
Separation anxiety or strong attachment to caregivers
Changes in family circumstances (e.g. illness, bereavement, separation)
Parental health concerns or caring responsibilities placed on the child
Home is becoming a place of emotional safety and avoidance of school-related anxiety

The Push and Pull Model

The ‘Push’ and ‘Pull’ factors help us understand why a child or a young person feels unable to attend school. These contributory factors of ‘risk and resilience’ that occur across the child’s system push the child towards attending school, or staying at home, or pull the child away from school. Emotionally based school avoidance occurs when the ‘risk’ factors are greater and more powerful than the resilience, and when the factors that need to ‘push’ the child towards school are overpowered by other push-and-pull factors in a child’s life. To better understand the factors, we will explore the push-away and pull-towards factors operating within both the school and home environments.

Push Factors

(Factors that push a child towards school/encourage attendance)

Push factors are the protective, motivating, or supportive experiences that make school feel manageable, safe, or worthwhile for the child.

At School:

Push factors (toward attending school) refer to protective and motivating experiences that encourage attendance. These might include positive relationships with peers, enjoyment of specific lessons or activities, participation in extracurricular interests, or feeling supported and understood by a trusted member of staff.

At Home:

Push away from school factors linked to the home environment may include worries or emotional burdens, such as parental illness or family stress. In these situations, a child or young person may feel responsible for a caregiver’s well-being or fear that something negative could happen in their absence, which can increase reluctance to leave home for school.

Pull Factors

(Factors that pull a child away from school/reinforce avoidance)

At school:

Pull to factors at school refer to the protective and motivating experiences that encourage attendance. These might include positive relationships with peers, enjoyment of specific lessons or activities, participation in extracurricular interests, or feeling supported and understood by a trusted member of staff.

At home:

Pull factors (toward remaining at home) within the home often relate to emotional safety and regulation. Remaining at home may reduce anxiety, allow the child or young person to avoid distressing situations, increase time with caregivers, and provide a greater sense of emotional containment and predictability.

Who Can Provide Support to Children and Young People with ESBA?

Support for children and young people experiencing Emotionally Based School Avoidance (EBSA) should be multi-agency, graduated, and collaborative, including:

The child/young person themselves
Parents and carers
School staff, such as class teachers, form tutors, learning mentors, well-being staff, SENCOs/inclusion leads.
Special educational needs, such as SEN support services, educational psychologists, inclusion and advisory teachers, and specialist outreach teams.
Community-based well-being services
Mental health and well-being services include CAMHS (Child and Adolescent Mental Health Services), Mental Health Support Teams (MHSTs) in schools, school nurses, counsellors, or therapists.
Local authority and multi-agency services (social care, support workers, early help services)

No single professional is expected to manage EBSA alone. At the centre of all EBSA guidance is the voice of the child or young person. Documents set the importance of listening to children’s lived experience, understanding what feels difficult about school and involving children in planning, decision-making, and next steps.

Support should be co-produced, developmentally appropriate, and emotionally validating.

Read more about why the focus will always stay on integrated care and coming together to improve people’s care, local health, and well-being.

How Should Schools, Parents and Healthcare Professionals Work Together?

Practical support for children and young people experiencing Emotionally Based School Avoidance (EBSA) relies on strong partnership working between schools, parents/carers, and healthcare professionals, with a shared understanding that EBSA is emotionally driven rather than wilful non-attendance. All parties should agree on a child-centred, compassionate approach in which the child’s or young person’s voice informs assessment and planning. Collaboration should be based on open communication, shared information (with consent), and clearly defined roles, ensuring consistent support across home, school, and health services. Schools play a central role by providing a named key adult, implementing reasonable adjustments, and creating an emotionally safe school environment. At the same time, parents contribute essential insight into anxiety, routines, sleep, and emotional well-being at home. Healthcare professionals support the partnership by identifying and addressing underlying emotional or mental health needs, anxiety management, and emotional regulation strategies.

Support is most effective when it follows a graduated and coordinated plan, with a clear focus on reducing anxiety before increasing attendance expectations. Joint planning should prioritise emotional safety, predictability, and flexibility, with regular review and adjustment as the child’s needs change. This may include:

Phased or flexible attendance rather than full-time expectations
Consistent strategies across home and school to avoid mixed messages
Regular review meetings to reflect on progress and emerging needs

Through shared efforts, balance can be restored between the push and pull factors, distress reduced, and sustainable re-engagement with education supported over time.

Person-Centred Approaches to Fully Support Children and Young People with EBSA

In practice, person-centred EBSA support involves listening to the child’s voice, understanding what school feels like from their perspective, and identifying their specific push and pull factors across home and school. Plans are co-produced with the child, family, and professionals, and are flexible, strengths-based, and reviewed regularly.

Trauma-informed Approach

Trauma is understood as a response to events or experiences that overwhelm a child’s sense of safety, leading to feelings of intense fear, helplessness, loss of control, or emotional dysregulation. Understanding how trauma affects the brain, nervous system, and emotional regulation is essential when working with children who are unable to attend school due to significant anxiety or distress.

From a trauma-informed perspective:

School avoidance itself can be traumatic for both the child and their family. It often feels outside their control, leaving families feeling stuck and in need of clear, compassionate guidance to rebuild safety and confidence.
Children with lived experiences of trauma may find aspects of the school environment triggering, pushing them beyond their window of tolerance and making emotional regulation and attendance extremely difficult.
Autistic children and young people are at increased risk of EBSA, as school environments can feel traumatic due to sensory overload, social demands, intolerance of uncertainty, and sustained anxiety. For these children, avoidance is frequently a protective response.

Many schools are increasingly committed to trauma-informed practice, using therapeutic and neuro-affirming approaches that prioritise emotional safety, regulation, and relational support, including frameworks such as Therapeutic Thinking and autism-inclusive practice.

Implementing a Gradual Return-to-School Plan

A carefully paced return to school should be introduced as early as it is emotionally safe to do so, alongside meaningful support and appropriate adjustments within the school environment. For children and young people experiencing Emotionally Based School Avoidance (EBSA), reintegration must be deliberately gradual, shaped by small, achievable steps and informed by the views of both the child or young person and their parents or carers. Attempts to accelerate attendance too quickly can unintentionally increase anxiety and lead to setbacks, reinforcing avoidance rather than reducing it. When expectations rise faster than the child’s coping capacity, the pressure of attendance itself can become another barrier. The goal is therefore not a short-term return, but a sustainable level of engagement that the child or young person can manage consistently over time.

Putting the Plan into Practice:

Co-produce an individualised reintegration plan with the child or young person, their family, and relevant professionals, ensuring everyone understands the agreed pace and priorities.
Start with a brief, predictable school contact, focusing on activities, lessons, or times of day the student feels most comfortable with, such as preferred subjects or trusted staff.
Where possible, include unstructured times such as lunch or breaks, as these provide opportunities to rebuild peer relationships, which are a key protective factor for well-being in school.
Expand attendance gradually, allowing the child or young person to guide the pace as their confidence increases.
Use an anxiety-rating scale (e.g. 0–10) to support decision-making; experiences rated above 6/10 are unlikely to be sustainable, whereas lower-rated situations, with appropriate support, often lead to growing confidence over time.
Offer additional relational support, such as a mentor, buddy, or key adult, to provide reassurance and continuity during the early stages of re-engagement.

Therapeutic Thinking Schools Approach

Therapeutic Thinking is a whole-school philosophy that places emotional well-being and mental health at the heart of education. It is rooted in the belief that all children and young people should experience school as a safe, supportive, and inclusive environment, particularly those who may communicate distress through behaviour. Rather than viewing behaviour as something to be controlled, Therapeutic Thinking promotes understanding behaviour as a form of communication, shaped by lived experience, unmet needs, and emotional states.

At its heart, Therapeutic Thinking prioritises the prosocial (positive) emotional experiences of everyone within the school community. It is based on a simple but powerful understanding:

Negative experiences lead to negative feelings, which can result in negative behaviour
Positive experiences foster positive feelings, which support positive behaviour

Adopting Therapeutic Thinking leads to several positive outcomes, including:

A shared language and consistent approach used by all professionals
Increased staff confidence in meeting diverse emotional and behavioural needs
Emotionally safe, welcoming environments built on respect and dignity
A reduction in restrictive practices, including physical intervention
A clear understanding of the interconnection between learning, teaching, and behaviour
Improved attendance and engagement in learning
Greater inclusion of children with multiple needs or behaviours of concern
Fewer fixed-term and permanent exclusions

Transition Support

Moving from primary to secondary school can be a particularly stressful period for some children and young people. Research indicates that vulnerable students often benefit from additional support before and during this transition, as challenges at this stage can impact academic progress, self-confidence, and overall motivation.

Person-centred transition support may involve:

Introducing children to the new school environment to build familiarity.
Offering a more flexible approach to rules during the initial weeks of the term.
Implementing structured procedures to help pupils adjust.
Organising school visits, induction sessions, taster days, and providing helpful information booklets.

Conversely, factors that can make transitions more difficult include:

Bullying, with around three in ten children experiencing it, according to parent reports.
Anxiety about academic performance and meeting work expectations.
Concerns about forming new friendships and social connections.

About Leaf Complex Care

With support services grounded in PROACT-SCIPr-UK® person-centred practices and autism-informed care, we are a provider that cares about people’s choices, freedom and outcomes. Our CQC-regulated services provide support to people with multiple needs in complex situations, primarily for autistic young people and adults, and people with a learning disability.

To find out more about us, please visit the following links:

If you need extra information, please don’t hesitate to contact us today.

Offices in: Bristol, the South East, the Midlands and Somerset.