Risk and resilience factors of EBSA
EBSA is a heterogeneous concept (Maynard et al, 2015). This means that it cannot be treated as a single condition. Different children will be hesitant to attend school for different reasons. It is usually a unique combination of various factors and their interaction rather than a single cause that leads to EBSA.
Risk: Just as with general mental health there have been factors identified that place children at greater risk of EBSA. It is usually a combination of predisposing factors interacting with a change in circumstances which leads to the pattern of behaviour described as EBSA. The predisposing factors may be present in the nature of the school, the child’s family or the child themselves.
The exact nature of the predisposing vulnerability and the precipitating events will vary according to an individual child’s unique set of characteristics, circumstances and experiences, but it is still possible to identify factors associated with that vulnerability and the potential triggers leading to EBSA. Being alert to these factors in relation to an absence from school can act as an early warning system enabling preventative action to be taken.
Factors associated with vulnerability of EBSA
|School Factors Family Factors Child factors||FAmily Factors||Child Factors|
|Bullying (the most common school factor)||Separation and divorce or change in family dynamic||Temperamental style- reluctance to interact and withdrawal from unfamiliar settings, people or objects|
|Difficulties in specific subject||Parent physical and mental health problems||Fear of failure and poor self confidence|
|Transition to secondary school, key stage or change of school||Overprotective parenting style||Physical illness|
|Structure of the school day||Dysfunctional family interactions||Age (5-6, 11-12 & 13-14 years)|
|Academic demands/high levels of pressure and performance- orientated classrooms||Being the youngest child in the family||Learning Difficulties, developmental problems or Autism Spectrum Condition if unidentified or unsupported|
|Transport or journey to school||Loss and Bereavement||Separation Anxiety from parent|
|Exams||High levels of family stress||Traumatic events|
|Peer or staff relationship difficulties||Family history of EBSA|
Resilience: When working with individuals it is really important to also identify and build areas of strength or resilience of the child, family and school which may help to ‘protect’ the child and promote school attendance.
This may include:
|Case study: Identifying risk and resilience factors|
Alison has not attended school for three months. When the school nurse visited Alison, she locked herself in the bathroom and refused to answer any questions. The last time that she left the house was one month ago and her parents are becoming increasingly concerned about how isolated she is becoming.
On reflection, Alison’s parents thought that her problems began when she made the transition to secondary school. Alison had always been one of the most academically able in her class in primary school, but now she found herself in the top classes where there were many more bright students to compete against. Alison’s friends from primary school had gone to another secondary school in the area. Being a shy individual, Alison had not developed close friendships with any of her peers and she tended to tag along with a group of girls from her year instead. However, she was beginning to form a close friendship with one of these girls. Alison often complained of stomach aches and would ask to stay home from school or come home early. Soon before she had stopped coming to school altogether, Alison had discovered that some of the other girls in the group were making fun of her behind her back and leaving her out of social events.
The previous year, Alison’s mum had received chemotherapy after a cancer scare. Although she had now been given the all-clear, she had noticed that Alison had become much more protective of her. She constantly checked where her mum was and became distressed if she was late coming home from appointments. She frequently woke up in the middle of the night after having nightmares about her mother getting into serious difficulty or becoming ill again and dying.
Now Alison stays at home all day. She does not do any work apart from some household chores for her mother. She enjoys playing with her younger brother when he returns from school and sometimes will help him with his homework. Recently, Alison’s mum arranged for Alison’s friend from secondary school to visit the house. This meeting went well, with Alison smiling and laughing a lot, nearly behaving like her old self.
‘Push’ and ‘Pull’
The literature suggests that these contributory factors of ‘risk and resilience’ can also be divided, and understood, in terms of ‘push’ and ‘pull’ factors.
The literature indicates that Emotionally Based School Avoidance is most likely to occur when the risks are greater than resilience, when stress and anxiety exceeds support, and when the ‘pull’ factors that promote school avoidance overwhelm the ‘push’ factors that encourage school attendance.
Example of ‘Push and Pull’ factors for Alison’s case study
|Push (towards attending school)
||Pull ( away from school, home factors)
|Pull (away from school, school factors)
||Push (towards staying at home)
- What is Emotionally Based School Avoidance?
- Anxiety and EBSA
- Information gathering and analysis
- Working with others (this includes child, parent carers and school staff)
- Interpreting the information and action planning
- Interventions, strategies and review
- Whole school good practice and transition
- EBSA and Autism Spectrum Condition (ASC)
- EBSA, school attendance and the law
- EBSA and Requests for Education Health Care Needs Assessments
- Further local support and resources
- EBSA Toolkit and Appendices