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Why do children experience EBSA?

Children can have anxiety about different aspects of school. This can be due to factors such as friendship issues, difficulties understanding the learning, or the sensory environment (for example, noise), which a child feels unable to cope with. For some children, it may be that they experience separation anxiety. Often, there are multiple factors that contribute to the anxiety that a child experiences.

The diagram below shows how EBSA behaviours can develop.

Two circles, one within the other. The outer circle: Anxious feelings about school - Negative thoughts and feelings about ability to cope - Avoid the situation that is invoking the anxiety - Immediate anxiety reduces - Increased school avoidance - back to Anxious feelings about school. The inner circle: Decrease in motivation - Loss of friends and feeling isolated - Falling behind in school work - Increased anxiety about school - Pleasurable activities at home - back to Decrease in motivation.

While EBSA is typically identified when a child has been absent from school for an extended period, there can be a gradual build up to this. This can start with full attendance at school but experiencing anxiety before and/or during school, to patterns of non-attendance for specific days, to extended periods of absence. This is shown in the diagram below:

From left to right: School attendance with anxiety (somatic symptoms), Behaviour in the mornings to avoid school, Repeated lateness followed by attendance, Periodic absence or missing classes, Repeated absences/missing classes mixed with attendance, Complete absence from school for a period of time, Complete absence for an extended period of time. From left to right: Difficulties transitioning into school, In school, school avoidance, Severe and sustained absence ('entrenched EBSA').

While some young people may gradually move along the above continuum, there may also be cases where there is a sudden onset of non-attendance as a result of a difficult or distressing event, or due to a build-up of anxiety over-time which may have gone undetected due to ‘masking’. ‘Masking’ refers to when an individual hides or suppresses symptoms, behaviours, or difficulties they are experiencing.