This page has been medically reviewed by Dr Marielle Quint, March 2025.
Emotionally based school avoidance (EBSA), also known as school refusal, occurs when a child or teenager is unable to attend school due to significant emotional distress. This is different from truancy — EBSA is not about defiance, but rather about fear, anxiety, or overwhelm. EBSA can develop gradually or suddenly, and often reflects deeper challenges such as anxiety, sensory sensitivities, low mood, or social difficulties.
EBSA can affect emotions, physical health, behaviour, and academic performance. Symptoms often appear before or during school hours.
Emotional signs
High anxiety or panic attacks about going to school
Feelings of dread or fear about specific situations (e.g. lessons, assemblies, breaktimes)
Depression, low mood, or feeling hopeless about school
Emotional outbursts or meltdowns when school is mentioned
Fear of failure, being judged, or making mistakes in class
Physical signs (often anxiety-related)
Headaches, nausea, stomach aches or dizziness in the mornings
Difficulty sleeping the night before school
Rapid heartbeat, shallow breathing, or other signs of panic
Behavioural signs
Frequent lateness or missing school entirely
Avoiding tasks like packing a bag or putting on uniform
Hiding school letters or refusing to discuss school
Clinging to parents or refusing to leave the house
Excessive reassurance-seeking about school-related worries
Social and academic signs
Withdrawal from friends or avoiding social activities
Drop in academic performance or refusal to complete homework
Loss of confidence in academic ability
Avoiding participation in class or fear of speaking up
EBSA can be triggered or worsened by:
Anxiety disorders (e.g. social anxiety, generalised anxiety, phobias)
Sensory sensitivities or autism
Previous trauma, bullying, or school-based stress
Academic pressure or perfectionism
Mental health difficulties such as depression
Challenges at home, such as family stress or separation
Identifying the root cause is essential to providing the right support.
Diagnosis involves a holistic understanding of the child’s emotional, behavioural, and environmental context. This may include:
Discussions with the child, caregivers, and school staff
Assessment of emotional wellbeing, anxiety, and stress triggers
Screening for conditions such as anxiety, autism, or low mood
Reviewing school attendance records and academic performance
Collaboration between parents, schools, and mental health professionals is key to making a plan that works for the child.
Early support can make a significant difference. Treatment is tailored to each child’s needs and underlying challenges.
Psychological support
Cognitive behavioural therapy (CBT) – Helps children understand and manage anxious thoughts and fears about school
Exposure therapy – Gradual reintroduction to school with emotional coping strategies in place
Emotion regulation strategies – Techniques such as mindfulness, relaxation, and journaling
Family therapy – Helps families work through challenges together and support the return to school
School-based support
Liaising with school staff to create an individualised reintegration plan
Adjustments such as part-time attendance, quiet spaces, or a trusted adult in school
Reducing academic pressure during the return phase
Encouraging peer connection or pastoral support within school
Parental guidance
Strategies to manage morning routines and reduce distress
Support around boundaries, reassurance, and managing emotions
At Kidswell Health, our experienced in-house team of child psychologists and therapists specialise in helping children and teenagers experiencing school-related distress. We work closely with families and schools to identify the root cause, develop a structured return plan, and build emotional resilience.
If your child is in crisis or at risk of harm, seek immediate help via emergency services or visit Mind’s crisis support guide.
Book an appointment with one of our experienced professionals today.
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