EBSA tips for parents and carers

Introduction

School can be a very stressful place for children and young people, though most are able to cope with this. However, for a small number, negative emotions relating to school result in difficulties with attendance and occasionally long periods of absence. This can sometimes be known as Emotionally Based School Avoidance ('EBSA').

Children and young people may have negative feelings about attending school for different reasons such as:

• they may be experiencing anxiety about specific aspects of school
• social situations and communicating with others can be challenging
• there may be difficulties in adjusting to changing school, year group or class
• children and young people can worry about academic pressures or finding work difficult
• it can be difficult for children and young people to concentrate due to other stressful things in their life

EBSA is a sign of emotional difficulties and can be stressful for you and your child. Pressures on increasing attendance can make things more difficult. Therefore, a team approach that focuses on making individualised adjustments to your child's routines and creating manageable goals to meet their needs, is vital to supporting your child at home and at school. This will help rebuild your child's feelings of safety, confidence and self-esteem.
 

Signs of negative feelings about school

It is important that we notice the warning signs for a child experiencing negative feelings about attending school, which may lead to EBSA, early on. This means we can put support systems in place at the initial stages and increase our chances of success. It may be quite difficult to notice a child's anxiety about attending school, as they may internalise their negative feelings, making them hard to see. We must be mindful of this possible internalisation. Sometimes, this inner-emotional distress can manifest into more obvious and visible externalising behaviours, particularly if a child or young person is desperately seeking to avoid school.

Here are some of the signs and symptoms a child experiencing negative feelings about school, which could lead to EBSA, may demonstrate. However, this list is not exhaustive and, as a parent, you know your child best. Therefore, it is important you voice any concerns you may have about your child, and discuss any changes in behaviour that you are worried about with your child's teacher or school.

• patterns in absences/expressions of not wanting to attend school, for example: not wanting to attend school on a Wednesday morning
• seeming reluctant to leave home on school days
• voicing their concerns about school
• overly worrying about people in the family
• increase of complaints about physical symptoms (for example: tummy ache, head ache) that don't appear to have a medical cause (always check with the GP)
• crying
• becoming argumentative
• sleep difficulties on school nights
• not wanting to get ready for school
• 'exploding' when they get home from school
• withdrawing - appearing quiet, low, tearful
• symptoms appearing worse after school holidays/weekends
• becoming clingy and needy to parent/carer

Tips for supporting your child

If you feel your child is experiencing negative feelings about attending school, here are some things you can do:

Discuss - speak as soon as possible with your child's school about the concerns you have. It is important that your communication with school is consistent and often so you can work together to improve your child's situation and make appropriate changes.
 

Consider - thinking about the WHY is a step towards knowing what we can do to help:

• have there been any significant life stressors that your child has experienced? (for example, bereavement, separation/divorce, illness (family member or child))
• is your child experiencing bullying, or are they experiencing difficulties in forming/maintaining peer relationships?
• does your child have any additional needs? (for example, Autism, Dyslexia)
• might your child be experiencing anxiety?
• has your child experienced trauma?
• does your child appear to struggle with particular school subjects or activities?

Listen - listen to your child's worries. Ask them what worries them. Try to find out from their perspective what is bothering them about attending school. Using visual supports may help your child to explain the problem. Or, asking your child to rate different events/places in school from 'stressful' to 'not stressful' could give you an indication of the aspects of school that are most worrying to them. Your child's school may be able to help you with this.
 

Reassure - reassure your child you want to help them and that you aren't going to shout or tell them off.
 

Diary - keep track of the days/times that your child does not attend school, or the days/times that they appear most anxious. Keep a record of the things they say/the symptoms they show to help determine if there are any patterns in your child's behaviour.
 

Try - encourage your child to explore different activities that might help reduce their stress and anxiety. This could be watching TV, listening to music, reading a book, exercise, mindfulness, spending time with friends. The Great Dream (Action for Happiness) provides ideas of activities to try to help to improve emotional wellbeing. 

Plan - make a regular routine. This could be a morning routine from waking up, having breakfast, getting dressed, packing their bag, leaving the house, arriving at school. Ensuring this is consistent will give your child much needed predictability and familiarity. Work with school to help create a time-tabled routine for their school day.
 

Adjust - it may be necessary to work with school to make your child's school day less daunting. This could be in the form of a reduced timetable, extra breaks, being met in the playground by a preferred member of staff, having a quiet area for them to go to or reducing academic demands. It is important that you work with your child in a way that works for them. Break things down into manageable steps.
 

Positive feedback - Give positive feedback to your child when they've made progress, acknowledging even the smallest of efforts made. When we are experiencing negative emotions or anxiety, even the tiniest of steps forward can take a huge amount of effort and commitment, and it is important that we acknowledge how hard our child is trying.
 

Review - Ensure that the support you offer your child, and that which is offered by school is regularly reviewed. Take note of things that work, and things that don't, so you can adapt support.
 

Seek - Consider seeking help or support from one of the organisations detailed below if you feel you need further support.
 

Tips for supporting your child to reduce anxiety about school

The following strategies may be helpful in supporting your son or daughter to manage any worries they have about school, and to reduce signs and symptoms of anxiety that they experience.
 

Noticing their worries - with their age in mind, think about ways that your child might identify and capture their worries: having these recorded or noted in some form can really help them to feel more manageable.

For primary school aged children, this might involve using a Worry Monster. Your child, perhaps with your support, will write/draw their worries down on slips of paper, zipping them into the mouth of the Worry Monster to 'look after' for them. With the Worry Monster responsible for the worries, the child is encouraged to leave their concerns behind. It is recommended that parents remove the worries at regular intervals.

For teenagers, a worry journal might be a useful approach. Writing on a daily basis is known to help us clarify our thinking and to find difficult thoughts more manageable. Your child should be encouraged to spend 10 to 15 minutes writing down (or drawing/recording in another format) their worries, allowing their thoughts to leave their mind and be held on the page. Whatever their age, it can be helpful to designate a set 'worry time' each day, when their concerns will be explored, encouraging any thoughts about concerns or worrying to take place in this time rather than spilling into the rest of their day.
 

Creating a 'calm kit' - with your son or daughter, fill a box or bag with items that they find soothing or calming. Perhaps activities that help them to find calm (for example: mindful colouring books, music) or comforting objects (for example: photos of happy memories, favourite toys). For some children, certain fabrics and textures will be soothing and so these could be included. At difficult times, encourage your child to access their calming box or bag, exploring the items to find things that help them to calm on that day.
 

Using a transitional object - this might be a photo or small object that your child takes with them into school, or to other situations that they find challenging. Perhaps a friendship bracelet or note from a parent or trusted adult, a photo of a pet, or a hankie with mum/dad's perfume or aftershave. These items can bring comfort and reassurance when things are feeling tough.
 

Carrying out calming activities - practicing calming activities at home can help to increase your child's inner calm, and can leave them feeling better equipped to face the challenges that life brings. Known to have a calming effect on the nervous system (therefore helping us to feel more grounded and in control), activities such as yoga and mindfulness can bring many benefits, both in the moment and in day to day life more generally. The Teen Yoga Foundation can be accessed here, and for mindfulness activities for CYP, try Mindfulness for Teens.
 

Using breathing techniques - these can help to slow our heart rate, and bring our nervous system under control. They can be particularly helpful in the moment where we feel anxious or worried (if practiced) but can be helpful at increasing our general sense of wellness at other times too. Try supporting your child with 'Square Breathing': Look for a square in the room you are sitting in, or imagine one in your mind. You are going to draw an imaginary line around the square. As you draw along the top of the square, breathe in to a count of 3, as you draw down the side of the square, hold that breath for the count of 3. Along the bottom of the square breathe out to a count of 3 and then hold for 3 as you draw up the last side. Repeat this ten times.

'Strawberry Cake' breathing can also work well, particularly for younger children: breathe slowly in through your nose (smell the strawberry) and gently out through the mouth (blow out the candles). Whilst you're doing this, say this phrase in your head "smell the strawberries and blow out the candles". Try also breathing out slowly and gently so that the flames flicker.
 

Take care of yourself

As well as supporting your child, it is also very important you look after yourself. Think of the reminder we hear when taking a flight: "put your own oxygen mask on first". Your child will be able to pick up on your anxiety and stress, so keeping yourself mentally well will also help your child. Seek support from your own friends and family, ensure you find things to do that relieve you of anxiety, and speak to your employer who may be able to offer flexible working.

Please see The Great Dream above; this can be a helpful reminder for all of us in ways to improve our own wellbeing.
 

Other sources of support:

• visit Young Minds website, where you can find a range of resources to support your child's mental health - in particular, their pages on supporting children and young people with school anxiety are worth a look
• visit Coping Skills for Kids for calming activities that you and your child can do at home
• visit MindEd for Families for advice about young people's mental health
• visit Action for Happiness for other ways you can take action to increase your child's happiness
• visit National Autistic Society for advice if your child has, or is suspected to have ASC
• visit Not Fine in School - parent-led organisation which is a parent-led organisation that offers peer support to families, shares informative resources and raises awareness of EBSA experiences

West Berkshire Educational Psychology Service have produced a "Wellbeing and Recovery Guidance" document in response to the COVID-19 pandemic. This features a range of activities that may be used in supporting children and young people as they return to school. Ask your child's school for a copy of the parent version.

Remember, your child's GP may be able to offer advice or support, particularly in relation to early signs of anxiety or low mood, sleep difficulties, or in relation to physical complaints that you feel may be associated with anxiety.

Speak with your child's school about other teams in the local authority who may be able to help (for example, the Mental Health Support Team), or for external services such as the Child and Adolescent Mental Health Service (CAMHS).