How can Speech and Language Therapists support a child with EBSA?

In recent years, there has been an increasing focus on Emotional Barriers to School Attendance (EBSA), a condition where children refuse to attend school due to emotional difficulties. It is a complex and multifaceted issue, often linked with various mental health concerns such as anxiety, low mood, and low self-esteem. This blog will explore EBSA in the context of school refusal and its connections to speech, language, and communication needs (SLCN). 

What is EBSA?

EBSA occurs when children experience heightened emotional distress which prevents them from attending school regularly. This distress is often triggered by underlying anxiety or emotional difficulties. In children under the age of 10, anxiety can manifest in various ways, including reluctance or refusal to go to school, often leading to prolonged absence. 

School refusal is different from truancy; it is typically driven by emotional struggles rather than a desire to avoid responsibilities or mischief. School anxiety, school phobia, or avoidance anxiety are terms often used interchangeably with EBSA, but all describe a child’s deep-seated fear or worry that prevents them from engaging with the school environment. 

How is EBSA linked to children’s emotional and social difficulties?

1. Anxiety and Low Mood: Children with EBSA often exhibit signs of high anxiety, especially related to school. This may include worries about academic performance, social interactions, or separation from their parents. Anxiety can manifest physically (e.g., stomach-aches or headaches) or emotionally (e.g., feeling overwhelmed or fearful), which can worsen the child’s overall mood. 

2. Social Difficulties: Children with social difficulties may struggle with interactions and relationships at school, which can contribute to feelings of loneliness or rejection. These challenges may manifest as withdrawal or refusal to attend school due to a perceived lack of safety or acceptance. 

3. Low Self-Esteem: Children with EBSA often face low self-esteem, which can be linked to difficulties in school. When a child feels inadequate in their abilities or unworthy of positive social interactions, their school anxiety can intensify. Low self-esteem exacerbates the emotional barriers to learning and socialising, making the thought of attending school even more unbearable. 

How EBSA presents as SLCN

The emotional and psychological factors associated with EBSA often overlap with SLCN. Children who are dealing with heightened anxiety or low mood may present with difficulties in verbal communication, comprehension, and social interaction. These challenges might include: 

• Difficulty Expressing Needs or Emotions: Anxious children might struggle to articulate what they are feeling or what they need, which can be misinterpreted as stubbornness or behavioural issues. 
• Limited Social Interaction: Children with low self-esteem and social anxiety may avoid conversations, preferring to stay isolated. Their communication skills might not develop as they would in a more socially engaged environment. 
• Difficulty Understanding Social Cues: Children who experience anxiety or school phobia may struggle to read or respond appropriately to the social cues of their peers or teachers, making school a more intimidating place. 

Supporting children with EBSA

Chronic absenteeism due to EBSA can have far-reaching consequences. The longer that a child is absent from school, the more likely they are to struggle with low academic attainment, poor social skills, and a negative perception of school. This can also contribute to long-term mental health issues in adulthood, family strain, and an increased sense of isolation for the child. 

However, there are several protective factors that can help reduce vulnerability and support a child dealing with EBSA: 

Good teacher-pupil relationships, loving and supportive parents, a stable home life, family involvement in school life, clear school transition policies, social and emotional support at school, and additional academic support all work together to help children feel safe, secure, and supported, reducing anxiety and boosting their ability to manage challenges both academically and emotionally. 

Resilience factors that can help manage risk

Resilience factors such as empathy, independence, asking for support, an interest in school, responsibility and initiative, problem-solving skills, and healthy habits can help children with EBSA better manage their emotional challenges, build confidence, and improve their ability to cope with difficult situations, ultimately reducing anxiety and fostering emotional growth. 

Warning signs of EBSA include less engagement in lessons, negative talk about school, changes in behaviour, increased anxiety, crying or pleading to go home, separation anxiety, and refusal to attend certain lessons, all of which indicate the child is struggling with emotional distress related to school. 

Common triggers of EBSA include school transitions, exams, changes in friendship groups, loss or bereavement, bullying, and prolonged illness, all of which can exacerbate anxiety and lead to school avoidance. 

The impact of EBSA on SLCN

If EBSA is left unaddressed, it can have a significant impact on a child’s SLCN. Chronic school avoidance can limit opportunities for social interaction, which is essential for the development of communication skills. As children miss school, they may struggle to engage in verbal exchanges, practice social cues, and develop vocabulary in group settings, all of which are crucial for building effective communication skills. Additionally, anxiety and emotional distress often associated with EBSA can affect a child’s ability to express themselves clearly or ask for help when needed. This lack of communication may result in further isolation and a decline in their social language skills, making it harder to engage with peers or participate in academic discussions. Over time, this can create a cycle where the child’s communication challenges intensify, further exacerbating their avoidance behaviours and emotional struggles. 

How SaLT can support a child with EBSA

To help a child with EBSA, strategies such as working with the family to create a supportive home environment, using gradual steps for reintegration into school, maintaining positive contact for emotional support, addressing emotional issues early, creating a predictable school environment, and offering a welcoming space with both emotional and academic support can be highly effective. 

SaLT (Speech and Language Therapy) professionals can play a key role in providing targeted interventions to support children with EBSA. By addressing both the emotional and communication difficulties, SaLT can help the child develop coping strategies, improve their social communication skills, and reduce the impact of anxiety on their ability to attend school and interact with others. 

EBSA, while challenging, can be managed with the right support, care, and understanding. Early intervention and consistent support from both home and school can help children overcome their anxiety and thrive in an environment that feels safe and nurturing. 

Get in touch to find out how our experts can help your pupils.