# data[].attributes.headline
Helping Your Child With Fears And Worries

# data[].attributes.subject
Helping Your Child With Fears And Worries

# data[].attributes.body
A guide for parents for children with anxiety and worries.

# data[].attributes.attachment_link.readable_text
Skip to content

Home / Books / Overcoming Series / Helping your Child with Fears and Worries by Cathy Creswell and Lucy Willetts

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies. X
ACCEPT REJECT Cookie settings

# data[].attributes.attachment_link.title
Helping your Child with Fears and Worries by Cathy Creswell and Lucy Willetts - Anxiety UK

# data[].attributes.attachment_link.description
Fears and worries are very common among children with around 15% thought to suffer from anxiety disorders; the most commonly identified emotional or behavioural problems among children. However, if left unchecked, they can cause more serious problems such as school avoidance, difficulties in making friends and long-term problems with anxiety and depression.

# data[].attributes.body
A CBT-style workbook which can be completed alone or with your child to support their understanding of anxiety.

# data[].attributes.attachment_link.readable_text
Skip to content

Home / Children and Anxiety / Starving the Anxiety Gremlin

Starving the Anxiety Gremlin A Cognitive Behavioural Therapy Workbook on Anxiety Management for Young People by Kate Collins-Donnelly.

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies. X
ACCEPT REJECT Cookie settings

# data[].attributes.attachment_link.title
Starving the Anxiety Gremlin - Anxiety UK

# data[].attributes.attachment_link.description
Starving the Anxiety Gremlin A Cognitive Behavioural Therapy Workbook on Anxiety Management for Young People by Kate Collins-Donnelly.

# data[].attributes.body
This is a science based programme for parents to help understand your own behaviours and reactions to your child's anxiety and think about reframing how you might approach their anxiety. It is a 30-40min free online course which you can do at your own pace, anytime.

# data[].attributes.body
Perhaps you prefer to learn and understand more about EBSNA through listening to a video. This is a helpful webinar by Sommerset EPS.

# data[].attributes.attachment_link.title
Parents/ Carers EBSA Guidance | Support Services for Education

# data[].attributes.attachment_link.description
This webpage is designed to help parents/carers to support children who have concerns about going to school, known as Emotional Based School Avoidance.

# data[].attributes.body
Sommerset EPS have come up with a lovely self-care leafet to remind you how important it is to look after yourself and tips and tricks to help you to that in order to best help your child.

# data[].attributes.body
There are a range of services that are recommended on the Local Offer to explore.

# data[].attributes.attachment_link.readable_text
What is EBSNA?

Emotionally Based School Non-Attendance (EBSNA) is a term used to describe the difficulty children and young people experience in attending school due to emotional reasons, such as stress, anxiety and/ or feeling overwhelmed. This can result in prolonged periods of absence from school.

Other terms EBSNA is known by include:

Emotionally Based School Refusal (EBSR)

Anxiety Related Non-Attendance (ARNA)

Emotional Based School Avoidance (EBSA)

School refusal

In Surrey we use the term Emotionally Based School Non-Attendance (EBSNA) to include children who are unable to attend school, rather than choosing not to attend, because of increased feelings of fear and anxiety that may make school feel unsafe.

If you are looking for support for your child or for someone you care for or support, please know that you are not on your own. We hope this webpage will provide you with the information you need.

What are the signs of EBSNA?

Spotting the signs of EBSNA and taking action quickly can enable a child or young person to remain in education and achieve their aspirations.

Children and young people can display a range of behaviours, which on their own may not be a sign of EBSNA. However, Parents/ Carers of children and young people with EBSNA have reported the following behaviours:

Frequently feeling unwell

Separation anxiety

Frequent minor absences

Tearfulness and general irritability

Sleep difficulties

Emotional volatility

Lack of appetite

Friendship issues

Changes in personality

Poor academic attainment

Autistic young people are also described as experiencing 'Autistic Burnout'.

What is the impact of EBSNA on children?

The impact of EBSNA on children is far reaching and can include:

poor academic attainment

reduced social opportunities

limited employment opportunities

an association with poor mental health in adulthood

EBSNA absence can often lead to long periods of time away from school. EBSNA is different from absence for physical illness and truancy. Most young people experiencing EBSNA can be highly anxious and show significant distress about attending school. In many instances, they remain engaged with education and want to return to school even though they feel unable to do so. Often, the young person's anxiety will reduce during weekends or school holidays.

EBSNA is complex and the issues are specific to each individual so there is not one way to resolve the situation for all children and young people. It is likely to be a gradual process to support a child to return to school particularly when it may feel that the EBSNA is well established, but there are many avenues of support available. This webpage offers information, advice, and a range of strategies gained from Surrey families' lived experiences.

How can EBSNA impact families?

Supporting your child with EBSNA can impact on families in different ways, we've listed some of these below, along with potential sources of support.

Parent Carer mental health and wellbeing

Caring for a child with EBSNA might impact on your mental health and wellbeing. You may feel lonely or isolated, but please know that you are not to blame, and you are not on your own. Family Voice Surrey have created a School Anxiety group for parents and carers.

It is important to look after yourself. If you find that your mental health and emotional wellbeing is poor, there are services that can offer advice or emotional support:

The Child Mind Institute offer information on why Self-Care is essential to parenting on their website

Mindworks Surrey information for Parents/Carers - Every child or young person is different and may require different services. Mindworks Surrey will guide you through each step you need to take as a parent or carer, from your initial concerns to being introduced to the Mindworks service

Healthy Surrey Wheel of Well-being - The Wheel of Well-being is a handy way to think about things you can do to help improve your mood, reduce the risk of depression, strengthen your relationships, and even add up to seven years to your life

Relate - services include relationship counselling, family counselling, mediation and children's and young people's counselling

Parent and Carers Group - The Hope Service - The Hope Service is a multi-agency service for young people aged 11-18 who are experiencing complex mental health, emotional, social and behavioural needs.

Barnardo's Parent Wellbeing Service - The Parent Wellbeing Service offers support to parents or carers whose children are experiencing poor mental health and wellbeing such as anxiety, depression, stress, self-harm and eating disorders. The service will enable parents and carers to be a protective factor for their child/young person in their wellbeing recovery. Increasing their confidence to support their child/young person

This shortlist of Helplines and online support services for parents has the details of further services who may be helpful to refer to.

Parenting support and advice:

For more general parenting support and advice, the following may be helpful.

Family Lives - provides targeted early intervention and crisis support to families who are struggling. The issues they support families with include family breakdown, challenging relationships and behaviour, debt, and emotional and mental wellbeing

Surrey Family Information Service's parenting courses and advice web page

Surrey Family Learning offer a wide range of free courses which are offered online, from parenting and wellbeing to Maths and English for parents who speak English as an additional language

The Free online parenting guides which are available to all Surrey residents that include top tips from childcare, education and NHS health experts.

Finances:

Supporting a child experiencing EBSNA can also have a financial impact on families if for instance, parents have given up work or reduced their working hours to support their child or have paid privately for education provision, counselling, therapy and assessments. There is a range of financial assistance that may be available to you.

Siblings:

EBSNA may also have an impact on siblings, if for instance they are often late for school or mirror their sibling's behaviour. The Local Offer Support for sibling and young carers web page, provides details of activities that siblings can do together, help for young carers and financial assistance.

Ways you can support your child

Unfortunately, there are many children and young people across the UK struggling with school-based anxiety and other difficulties that can impact on school attendance.

Such difficulties should not be viewed as a behavioural or parenting problem. There are many different things that can trigger anxiety and attendance difficulties including bullying, academic pressure and sensory issues in the school environment.

It is common for children to pretend or hold in their distress until they get home from school - this is called "masking". This can lead to misunderstandings and differences in opinion between home and school. It is important that professionals work in partnership with parents and listen to the voices of children and young people.

What you can do if your child is struggling to go to their education setting?

Believe your child's distress is real, listen to what they say and trust your instincts as a parent

One of the most important ways you can support your child is to calmly listen to them and acknowledge that their fears are real to them. Remind them how important it is to access education and reassure them that you and the education setting will try and make it a happier place for them.

Listen to and talk with your child

Consider when and where you will talk. Think about what communication method might be easiest for your child e.g. text messaging, letters, brainstorming key words and feelings. You may find ' mapping the landscape visuals', to be a useful method of communication for your young person. Your young person can 'drag and drop' their thoughts.

Agree an appropriate time and place with your child, e.g., this could be in the time after school and before dinner if your child is attending school. For children who are not attending, agree with them the best time to talk for instance, in the middle part of the day or after they have had breakfast. Try to avoid first thing in the morning before they are fully awake or just before bed as they may be tired or it might disrupt sleep.

When you speak to your child, try to remove any distractions (such as family members, TV or electronic devices) and also set a limit on how long you speak to them for.

You may like to refer to the NHS Talking to your child about feelings web page for support in approaching this conversation.

Focus on listening

If your child has opened up to you, it is because they trust you and feel a need to share their difficulties. Let them talk and try to ask open questions that encourage a fuller response than 'yes' or 'no'.

Examples of open conversation starters:

What is going well for you at the moment?

What would you be doing differently if it wasn't for these difficulties?

What is going well in school?

If things get better, how would that look?

How are things with friends?

If you woke up tomorrow and knew it was better, what would have changed?

What do you want to change?

When things where better than they are now, what was happening then to make it better?

When did this start?

What ideas do you have about what you need to feel better at the moment?

How does it affect you?

What kind of support would help you?

What is this stopping you doing......?

Are there things or people that help?

Let them know if you do not understand or need clarity

Answers can get muddled as children try to explain feelings they may not understand, asking clarifying questions shows you are listening and trying to understand.

Examples of ways of clarifying might include:

"Did I understand you when you said?"

"Did I hear you correctly when you said?"

"Let me check [...] you feel angry/ frustrated/ sad because [...]"

At the end of your conversation validate their feelings, acknowledge their strength and clarify priorities.

Examples of how to do so:

"I can see that things are difficult at the moment. However, you managed to share/ talk about a lot of things today. So, let us recap/ see where we've got to..."

Empathise and acknowledge how hard it is

It is important to let your child know that overcoming anxiety is hard, and that you are proud of their efforts. Let them know you are trying to understand their experience, are listening to what they have to say and want to help. Try not to validate their fears. The message you want to send is, "I know you're scared, and that's okay, and I'm here, and I'm going to help you get through this."

Make yourself available to talk again if needed

It can be a relief to talk, but ongoing anxiety is not solved with just one conversation. Let them know they can speak to you again. Explain that you will look at how you can help them. Never leave this kind of conversation without agreeing next steps, this will help the child to realise that you are working with them to move things forward.

A support plan can be used to support your child/young person think through how support can be individualised to support their own needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

It is crucial that all adults, at home and in school, work together to understand the reasons for EBSNA and find solutions together. As soon as signs are spotted parent/carers should tell the school there is a problem and request a meeting.

If you have a younger child who is experiencing anxiety with accessing a pre-school environment you may find the NHS Learning to talk resources following resource helpful to support the development of language.

Activities outside of an education setting

You may like to look at encouraging participation in activities outside of an education setting to support social interaction and reduce isolation. Some suggestions of how to do so include:

The Local Offer Directory contains details of both one off and ongoing leisure and social activities.

Club 4 holiday activities run during the longer school holidays and offer healthy food and fun activities for eligible children aged 5 to 16. The Club 4 website also includes a number of holiday ideas for children.

The video below aims to support parents and carers to develop plans to manage the anxiety of getting into school.

Who can you contact for support?

There are a number of services who can offer support if and when you feel you need it.

Support from School or education setting

It is important to communicate any concerns regarding EBSNA with your child's school/setting. They can help to find out what's worrying your child and what you and they can do to help. A support plan can be created that could include:

Home-school meeting to understand the reasons for the non-attendance.

An allocated named key adult who can maintain daily communication, to include a wellbeing check and ensure work is set, if not in class

Meeting with the pupil to gain their views around the non-attendance or participation

Jointly creating a support plan with you, your child and the school/setting.

Making reasonable adjustments according to your child's needs and the reasons for their non-attendance/participation.

Schools in Surrey can take a Surrey Healthy Schools approach to wellbeing and health and can access a range of resources and services to support your child. Support can include mental health support, counselling, and access to a School Nurse, they can also ask Specialist Teachers for Inclusive Practice (STIPs) to assess your child's difficulties.

Children and Young People with Additional Needs

An underlying Additional Need or Disability can contribute to anxiety levels; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia. These can make school feel like a difficult place to be for a child, even if they do want to attend school. It is worth noting that additional needs includes Social, Emotional or Mental Health Difficulties. These can affect a child's ability to make friendships and cope with strong emotion.

You may therefore also wish to discuss with the school if they feel an assessment of your child for any relevant additional needs is required.

If you need a bit more help

There are times when the challenges of family life become more difficult, and families may need some personalised support for a period of time. Targeted help focuses on the specific needs of the family to help them make positive changes. Requests for support (we used to call these referrals) can be made by all health, education and social care practitioners. Parent/carers can also request support via the Children's Single Point of Access (CSPA).

Helpful resources and services

You may also find the information and support offered by these services is helpful to you. The details of further services can be found on our Local Offer Directory.

Define Fine
A small UK parent led organisation that support families affected by EBSNA.

Not Fine In School
A UK based organisation set up to support parents, young people and professionals impacted by EBSNA: They also have a family support group on Facebook.

Young Minds
Have a parent's guide to School Anxiety and Refusal.

Every Mind Matters- Children's Mental Health
This is important for children of all ages, but in particular if the child is transitioning from one school to another, or to another class, which may make them more anxious about school.

SEND Advice Surrey
Offer impartial, confidential, free advice and support to parents/carers of children and young people with special educational needs and/or disabilities.

Family Voice Surrey
Champions the needs and rights of SEND families in Surrey: families with children or young adults up to the age of 25 who have special educational needs, chronic illnesses, including mental health conditions, or disabilities.

The National Autistic Society Surrey Branch
Is a volunteer-run support group founded by parents to support other parents. Volunteers offer a variety of local support group meetings, talks, parent programmes and activities for families that include autistic children or adults.

Are safe spaces for young people to drop into to talk about worries and mental health confidentially. There is also a phone service and virtual workshops operating alongside the face-to-face sessions. The opening times and phone number are listed on their website. They also offer two daytime projects for young people who aren't in school called 'Slow Grow' and 'Forests Skills'.

Children and Family Health Surrey

Have a number of sensory video workshops, on their website.

Your Child's GP can offer support which might include a referral to a Paediatrician or Mindworks who provide advice, help and support to children, young people and their families through a wide range of emotional wellbeing and mental health service,

You can also speak to your child's school nurse. The video below describes what a school nurse does and how they can help.

EBSNA information for young people

Everyone feels anxious or worried about school or college sometimes. This is normal, Anxieties are part of life and learning to deal with them is part of growing up However, sometimes anxiety or constant worrying can become a problem especially when it stops us doing what we want or need to do. If you have high levels of anxiety and worry about attending school, you may be experiencing Emotionally Based School Non-Attendance (EBSNA).

You most definitely are not alone and there is lots of useful information which can help you to find the best ways to help support yourself with this.

Some signs of EBSNA

Getting head or stomach aches

Feeling unsure

Feeling bad tempered

Worrying about relationships

Struggling to sleep

Feeling scared

Feeling depressed

'Autistic Burnout'

Remember you are not alone many children and young people feel this way.

We understand that it can be hard to start a conversation about how you are feeling sometimes as you may be worried about the reaction you will get. You may be surprised to know that your parent/carer or teacher may already have an idea that you are finding things difficult and it may be an easy conversation to have. It's important to tell your family and school how you feel so they can support you. There is no wrong way to do so and you might like to write a letter or send a text to say how you are feeling.

You may wish to complete a support plan which can be used to support you think through how support can be individualised to support your needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

You can also let them know about this webpage so they can come and look at the resources for parent/carers and schools.

Some of these services might also be able to help you:
Please remember, in the case of an emergency, call 999 or 112 from a mobile.
How can you support a child with EBSNA you are working with?

EBSNA is a complex issue, staying curious, feeling confident to try a different approach, remembering that no one is to blame for the situation, along with a culture that promotes staff and student well-being, can all support a successful reintegration.

It is important to remember most school-anxiety/ school refusing children do WANT to attend school however their difficulties and anxiety are overwhelming. They care about their education and want to succeed; however, they need understanding and support at home and at school to do so. They may need adjustments to their daily routines, timetables, or their school environment. Pressures to focus on attendance rather than the child's needs can make things even harder to 'fix'. As soon as concerns are raised, a designated member of school staff should reach out and connect with the parents/ carers. Preferably staff with a trusting relationship.

Many of the factors associated with positive outcomes will already be present within your education settings existing good practice and include:

Developing a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement

Early Intervention

Working with parents and staff as well as the child or young person

Working flexibly with a focus on understanding the function of the child or young person's avoidance behaviour

A focus on a rapid return to an education setting alongside intervention, support and adaptations within the school and home environment (be mindful that a focus on rapid return will not be appropriate for all children and young people).

Implementation of the 'Assess, Plan, Do, Review' Four part cycle:

Assess

As part of the 'Assess' phase you can identify EBSNA signs and risk factors, education setting push and pull factors to gather information to build a rich picture of the situation. You can use Surrey's Early Help Assessment form and Early Help Assessment practitioner guidance.

Plan

As part of the 'Plan' you can bring together all the information gathered and use it to inform a co-authored action and support plan.

Do

The 'Do' strand should describe strategies and interventions that have been effective in supporting the reintegration of a child or young person who is experiencing difficulties coming to an education setting. Carry out additional High Quality Teaching strategies and note differences made. Refine delivery of strategies to maximise the effect they have. Ensure that additional provision is delivered as it is meant to be. Think about what you need to adjust considering initial observations and feedback.

Review

Using assessment measures to monitor the progress of an intervention and adjust the plan for next steps will be part of your 'Review.'

Where can I receive advice or support with EBSNA?

Training and Webinars

Surrey Educational Psychologist Service and Mindworks School Based Needs Services are continually delivering training. The training is underpinned by research and provides extensive resources. Training for schools/settings can be booked on the training section of the Surrey Education Services. Third sector and wider partner EBSNA webinars have been uploaded to the Surrey Youth Focus webpage.

There is a progressive programme of training and support for schools to assist in the development and maintenance of a supportive and inclusive school culture. For more information visit Surrey Healthy Schools

Effective Family Resilience incorporating Early Help Assessment training is bookable through the Surrey Children's Services Academy: Training covers how to use the Family Resilience Windscreen and identify the range of services available to support families.

Resources

Individual support for children and young people

A Profile of Risk of EBSNA has been developed that looks at 5 key risk areas for EBSNA. The checklist is for use alongside the usual attendance monitoring systems in education settings, e.g., SIMS and consideration of patterns of attendance, to screen for possible EBSNA in relation to non-attendance. If the resultant profile suggests to you that the pupil is at risk of emotionally based school non-attendance, the next step is to obtain the views of the pupil, parent/carers and other staff within a setting. A support plan should be co-produced with the pupil, parent/carers and education setting using the EBSNA support guide for settings and the EBSNA Support Plan template provided by Surrey County Council and partners.

If the family need resources to be made accessible e.g., no access to technology or are not confident using it, are visually impaired or have English as an additional language you must ensure the resources available to families can be made accessible and families are supported to use them.

As part of any plan to support the child to attend well, education settings should facilitate relevant pastoral support. This should be done with the clear aim of improving attendance as much as possible while supporting the underlying EBSNA issue. The Department for Education have published examples of effective reasonable adjustments.

You may also like to refer to the Department for Education's summary of responsibilities where a mental health issue is affecting attendance.

Additional Support Services

The Inclusion Service provides support to schools, parents and young people in providing services on behalf of the Local Education Authority and deals with non-attendance, child Protection and making enquiries about children missing education.

Surrey's Education Psychology Service offer a weekly helpline for education settings that operates in every quadrant every Wednesday from 1-4pm (including school holidays).

Surrey County Council are developing a new support pathway for EBSNA via our Learners Single Point of Access (L-SPA), this will allow referrals for support to be made direct to our multi-professional team. More information COMING SOON

Whole School best practice

By asking "can we create an environment where EBSNA doesn't exists?" schools are already employing many strategies that support CYP who may experience school related anxiety. We suggest that schools develop a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement and use the Self-Evaluation Tool and training to assist the leadership and management of these areas. This can help to foster a compassionate, respectful and anxiety friendly environment.

Surrey Healthy Schools presents an opportunity for schools to actively promote physical, emotional and mental health and wellbeing. It is a commitment to encouraging personal, social and health development and supports the links between health, behaviour and achievement. It is not aimed merely at pupils' health or school curriculum development but centres around the whole school environment and all aspects of school life.

By looking at the systems already in place and creating opportunity for open discussion, you will develop a solid foundation that works for your school.

Where can you find support and advice?

This EBSNA Padlet website has an EBSNA resource bank designed for professionals.

Surrey Educational Psychology Service EBSNA Whole School Initial Audit Tool for Schools is a useful tool to gain a whole school understanding of EBSNA awareness and will help to identify areas of development.

Graduated Response Early Years information and documents to help special educational needs coordinators (SENCOs), early years practitioners, home-based childcarers and playworkers support children with Special Educational Needs and Disabilities (SEND) and their families.

Surrey Inclusion & Additional Needs service schools a document designed to schools and settings understand Surrey County Council service offers available to support schools to meet pupils needs as they emerge.

Ordinarily available provision (schools) this guidance aims to support settings, practitioners, families, and carers to work together to ensure that children's additional needs are met at the earliest opportunity.

Surrey Wellbeing Partnership (SWP) is a formal joint venture of local and national charities of various sizes with a common goal: to work with children and young people in the community to improve wellbeing and mental health so that they can live full, fun and confident lives.

Mindworks School Based Needs Team: offers advice and signposting for children, young people, parents and school staff, 1-1 support and group work for children, young people and parents (both within school and out of school settings).

Mindworks - Complex Mental Health Needs Teams (Community Teams)- work across Surrey and are made up of health and social care professionals. These multi-disciplinary teams promote good mental health and provide assessment and treatment to children and young people up to the age of 18 with a mental health condition. The teams assess and treat children and young people who are struggling with difficulties associated with neurodevelopment conditions where these are having a significant impact on the child's development and quality of life and causing them and/or their carers distress.

Mindworks - Mental Health Support Team for Specialist Schools in Surrey - a school-based service, which supports the mental health of children and young people in specialist schools across Surrey. The team offer support and advice to key people (teacher and or parent/ carer) around the child or young person to enable them to identify any concerns, understand what has happened for that child or young person and support any developing mental health needs.

The Mindworks 24/7 mental health crisis line, is available for children and young people who are worried about themself, a friend, or for parents worried about their child or young person. It can be contacted on 0800 915 4644, is open all day and all night, seven days a week.

Transitioning from primary to secondary school or changing schools in-year is a particularly significant change for children. Learning about change and how to cope with it will help them with transition and prepare them for many other changes and challenges they will face in life. Young Minds have a section of resources related to supporting school transitions.

Youth Engagement Scheme (YES) - is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system.YES is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system. You can email yes@surreycc.gov.uk for more information.

You may also find the details of further services who offer information and support on our Local Offer Directory.

# data[].attributes.attachment_link.title
Emotionally Based School Non-Attendance (EBSNA)

# data[].attributes.attachment_link.description
Emotionally Based School Non-Attendance (EBSNA) refers to children who are unable to attend school, rather than choosing not to attend because of increased feelings of fear and anxiety that may make school feel unsafe. Support for EBSNA is available.

# data[].attributes.body
Kooth is an online community that your young person can access independently to gain support with their mental health.

# data[].attributes.attachment_link.description
Kooth is your online mental wellbeing community. Access free, safe and anonymous

# data[].attributes.body
Mindworks offers a range of advice and resources for parents and can support with interventions for young people too.

# data[].attributes.attachment_link.description
Emotional wellbeing and mental health services for children and young people, including the CAMHS service, now known as Intensive Interventions.

# data[].attributes.body
Offer free mental health advice for you or your child

# data[].attributes.attachment_link.description
Samaritans works to make sure there's always someone there for anyone who needs someone. Read more.

# data[].attributes.body
Many young people with autism experience difficulties attending school due to the neuro-normative expectations placed on them. This guidance provides more information about how to spot autistic burnout and ways to reduce it.

# data[].attributes.attachment_link.readable_text
Dr Dora Raymaker, Research Assistant Professor at Portland State University, discusses research exploring autistic people's experiences of autistic burnout. This includes what autistic burnout feels like, why it might happen and what can be done to prevent it.
Autistic people often talk about autistic burnout as a source of distress, but it's just starting to be recognised in wider conversations. Academic Autism Spectrum Partnership in Research and Education (AASPIRE) conducted a qualitative study to better understand and define autistic burnout (Raymaker et al. 2020). The study involved interviews with autistic adults and analysis of public internet sources.

Definition of autistic burnout

From what we learned we created the following definition of autistic burnout.

Autistic burnout is a syndrome conceptualised as resulting from chronic life stress and a mismatch of expectations and abilities without adequate supports. It is characterised by pervasive, long-term (typically 3+ months) exhaustion, loss of function, and reduced tolerance to stimulus.

Characteristics and impact

The research participants describe the experience of autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus. They described it as affecting every part of their lives and lasting for long periods of time. Many first experienced autistic burnout during puberty, graduation from secondary education, or at other times of transition and changes in developmental expectations.

Autistic burnout had many negative effects on their lives. Many highlighted difficulties with their health, especially their mental health. They talked about struggling with independent living, loss of self-belief, and being frightened that the loss of skills from the autistic burnout might be permanent. They also talked about a lack of empathy from neurotypical people, who had difficulty understanding or relating to the autistic person's experiences. Some people related an increase in suicidal ideation and suicidal behaviour.

Reasons why autistic burnout might occur

People described a collection of life stressors.

Masking their autistic traits, for example by suppressing autistic behaviours, pretending to be non-autistic, or working very hard to act in a non-autistic way.

Difficult or unreachable expectations from family, school, work, or society in general.

Stress from living in a world not set up to accommodate autistic people, for example managing the stress of having to be in noisy environments.

Life-changes and transitions that are stressful for anyone, for example transitioning from school to work, experiencing a mental health crisis, or the death of someone close.

They also described barriers to getting support or relief from the stress.

Gaslighting or dismissal when attempting to describe the autistic burnout, for example being told that everyone has these experiences, that they just need to try harder, or that they are making it up.

Poor boundaries or self-advocacy with respect to saying no, taking a break, or asking for help. This may be due to trauma, fear, lack of assistance in learning how, and a history of negative responses from others when they tried.

Inability to take a break from stress that is so pervasive ("How do you take a break from life?").

Insufficient external resources and supports, for example inadequate disability services, lack of useful social support.

Together, the life stressors contributed to a cumulative load of stress and the barriers to support meant they were unable to get relief from the stress. At some point, the expectations on the person far exceeded anything they were able to do. Every part of them gave up and autistic burnout resulted. Or, as one study participant summarised:

''Autistic burnout is a state of physical and mental fatigue, heightened stress, and diminished capacity to manage life skills, sensory input, and/or social interactions, which comes from years of being severely overtaxed by the strain of trying to live up to demands that are out of sync with our needs.''

Reducing or Preventing Autistic Burnout

Participants told us about ways that they found to relieve or prevent their autistic burnout, and advice they have for others.

Acceptance and support - interacting with others who could accept them for who they were, without any need to masking or pretend. This could be one-on-one with family members or friends; on a community level of groups with accepting cultures; or on a peer level, especially finding other autistic people who could validate their experiences and offer information and emotional/social support from lived experience.

Being autistic - attending to autistic needs like stimming and spending time with intense interests and comfort items, unmasking, using autistic strengths or doing things in an autistic way.

Formal supports - receiving reasonable adjustments at school or work, physical support like someone to provide groceries, and mental health support.

Reduced load - taking time off, more breaks, reducing social activity or other types of more stressful activities.

Self-advocacy and health - learning how to set healthy boundaries and expectations from others, and what to do when others aren't respecting boundaries. Learning how to ask for help in a way others might be responsive to, and leading as healthy a lifestyle as possible (for example participants described how exercising, sleeping, eating well, and doing things that made them happy helped them out of autistic burnout once they had enough energy to do them).

Self-knowledge - learning how to recognise and act on the early signs of autistic burnout (for example by cancelling social plans to have more rest), having an autism diagnosis, and understanding one's own patterns of behaviour and feelings.

Recommendations and next steps

We recommend increasing awareness about autistic burnout, and connecting with the autistic community and peers that understand autistic burnout. The experiences of people who describe being in a state of autistic burnout should be validated, whether they use the term or not. We recommend that therapists and clinicians learn to recognise autistic burnout in clients and offer strategies for relief.

In general, we recommend others be aware of the potential dangers of teaching autistic people to mask or suppress their autistic traits. Suicide prevention programs may want to consider the potential role of burnout. We strongly support interventions to decrease the discrimination and stigma associated with autism and disability in society, and to improve access to reasonable adjustments and acceptance.

Though an important start to the conversation, our findings are from a small qualitative study of a non-random sample. They are also limited to autism; we feel that this may be a broader experience of people who experience disability. Therefore we highly recommend more research in this new and urgent area, especially in collaboration with autistic people who can contribute the expertise of their lived experience.

# data[].attributes.attachment_link.description
Dr Dora Raymaker discusses research into autistic burnout

# data[].attributes.body
Define Fine offers a range of practical guidance and advice for parents whose child is experiencing EBSNA.

# data[].attributes.attachment_link.readable_text
Children unable to attend school should be able to access a broad and balanced education suitable for their needs, to enable them to maintain academic progression and allow them to thrive and prosper. Schools should welcome pupils back following an absence, provide good catch-up support to build confidence and bridge gaps in learning.

The LA are responsible for arranging education for children who, because of illness or other reasons, would not otherwise receive suitable education, as soon as it is clear that the child will be away from school for 15 days or more.

# data[].attributes.body
This questionnaire can be completed by your child to help get a clearer idea of the school non-attendance.

# data[].attributes.body
A guide to creating your own calm plan, which you can then share with your child as an example of how you cope with difficult situations.

# data[].attributes.headline
Emotionally Based School Non-Attendance (EBSNA)

# data[].attributes.subject
Emotionally Based School Non-Attendance (EBSNA)

# data[].attributes.body
On the Surrey Local Offer, there is guidance for parents on what EBSNA is, the impact of EBSNA and support for families.

# data[].attributes.attachment_link.readable_text
What is EBSNA?

Emotionally Based School Non-Attendance (EBSNA) is a term used to describe the difficulty children and young people experience in attending school due to emotional reasons, such as stress, anxiety and/ or feeling overwhelmed. This can result in prolonged periods of absence from school.

Other terms EBSNA is known by include:

Emotionally Based School Refusal (EBSR)

Anxiety Related Non-Attendance (ARNA)

Emotional Based School Avoidance (EBSA)

School refusal

In Surrey we use the term Emotionally Based School Non-Attendance (EBSNA) to include children who are unable to attend school, rather than choosing not to attend, because of increased feelings of fear and anxiety that may make school feel unsafe.

If you are looking for support for your child or for someone you care for or support, please know that you are not on your own. We hope this webpage will provide you with the information you need.

What are the signs of EBSNA?

Spotting the signs of EBSNA and taking action quickly can enable a child or young person to remain in education and achieve their aspirations.

Children and young people can display a range of behaviours, which on their own may not be a sign of EBSNA. However, Parents/ Carers of children and young people with EBSNA have reported the following behaviours:

Frequently feeling unwell

Separation anxiety

Frequent minor absences

Tearfulness and general irritability

Sleep difficulties

Emotional volatility

Lack of appetite

Friendship issues

Changes in personality

Poor academic attainment

Autistic young people are also described as experiencing 'Autistic Burnout'.

What is the impact of EBSNA on children?

The impact of EBSNA on children is far reaching and can include:

poor academic attainment

reduced social opportunities

limited employment opportunities

an association with poor mental health in adulthood

EBSNA absence can often lead to long periods of time away from school. EBSNA is different from absence for physical illness and truancy. Most young people experiencing EBSNA can be highly anxious and show significant distress about attending school. In many instances, they remain engaged with education and want to return to school even though they feel unable to do so. Often, the young person's anxiety will reduce during weekends or school holidays.

EBSNA is complex and the issues are specific to each individual so there is not one way to resolve the situation for all children and young people. It is likely to be a gradual process to support a child to return to school particularly when it may feel that the EBSNA is well established, but there are many avenues of support available. This webpage offers information, advice, and a range of strategies gained from Surrey families' lived experiences.

How can EBSNA impact families?

Supporting your child with EBSNA can impact on families in different ways, we've listed some of these below, along with potential sources of support.

Parent Carer mental health and wellbeing

Caring for a child with EBSNA might impact on your mental health and wellbeing. You may feel lonely or isolated, but please know that you are not to blame, and you are not on your own. Family Voice Surrey have created a School Anxiety group for parents and carers.

It is important to look after yourself. If you find that your mental health and emotional wellbeing is poor, there are services that can offer advice or emotional support:

The Child Mind Institute offer information on why Self-Care is essential to parenting on their website

Mindworks Surrey information for Parents/Carers - Every child or young person is different and may require different services. Mindworks Surrey will guide you through each step you need to take as a parent or carer, from your initial concerns to being introduced to the Mindworks service

Healthy Surrey Wheel of Well-being - The Wheel of Well-being is a handy way to think about things you can do to help improve your mood, reduce the risk of depression, strengthen your relationships, and even add up to seven years to your life

Relate - services include relationship counselling, family counselling, mediation and children's and young people's counselling

Parent and Carers Group - The Hope Service - The Hope Service is a multi-agency service for young people aged 11-18 who are experiencing complex mental health, emotional, social and behavioural needs.

Barnardo's Parent Wellbeing Service - The Parent Wellbeing Service offers support to parents or carers whose children are experiencing poor mental health and wellbeing such as anxiety, depression, stress, self-harm and eating disorders. The service will enable parents and carers to be a protective factor for their child/young person in their wellbeing recovery. Increasing their confidence to support their child/young person

This shortlist of Helplines and online support services for parents has the details of further services who may be helpful to refer to.

Parenting support and advice:

For more general parenting support and advice, the following may be helpful.

Family Lives - provides targeted early intervention and crisis support to families who are struggling. The issues they support families with include family breakdown, challenging relationships and behaviour, debt, and emotional and mental wellbeing

Surrey Family Information Service's parenting courses and advice web page

Surrey Family Learning offer a wide range of free courses which are offered online, from parenting and wellbeing to Maths and English for parents who speak English as an additional language

The Free online parenting guides which are available to all Surrey residents that include top tips from childcare, education and NHS health experts.

Finances:

Supporting a child experiencing EBSNA can also have a financial impact on families if for instance, parents have given up work or reduced their working hours to support their child or have paid privately for education provision, counselling, therapy and assessments. There is a range of financial assistance that may be available to you.

Siblings:

EBSNA may also have an impact on siblings, if for instance they are often late for school or mirror their sibling's behaviour. The Local Offer Support for sibling and young carers web page, provides details of activities that siblings can do together, help for young carers and financial assistance.

Ways you can support your child

Unfortunately, there are many children and young people across the UK struggling with school-based anxiety and other difficulties that can impact on school attendance.

Such difficulties should not be viewed as a behavioural or parenting problem. There are many different things that can trigger anxiety and attendance difficulties including bullying, academic pressure and sensory issues in the school environment.

It is common for children to pretend or hold in their distress until they get home from school - this is called "masking". This can lead to misunderstandings and differences in opinion between home and school. It is important that professionals work in partnership with parents and listen to the voices of children and young people.

What you can do if your child is struggling to go to their education setting?

Believe your child's distress is real, listen to what they say and trust your instincts as a parent

One of the most important ways you can support your child is to calmly listen to them and acknowledge that their fears are real to them. Remind them how important it is to access education and reassure them that you and the education setting will try and make it a happier place for them.

Listen to and talk with your child

Consider when and where you will talk. Think about what communication method might be easiest for your child e.g. text messaging, letters, brainstorming key words and feelings. You may find ' mapping the landscape visuals', to be a useful method of communication for your young person. Your young person can 'drag and drop' their thoughts.

Agree an appropriate time and place with your child, e.g., this could be in the time after school and before dinner if your child is attending school. For children who are not attending, agree with them the best time to talk for instance, in the middle part of the day or after they have had breakfast. Try to avoid first thing in the morning before they are fully awake or just before bed as they may be tired or it might disrupt sleep.

When you speak to your child, try to remove any distractions (such as family members, TV or electronic devices) and also set a limit on how long you speak to them for.

You may like to refer to the NHS Talking to your child about feelings web page for support in approaching this conversation.

Focus on listening

If your child has opened up to you, it is because they trust you and feel a need to share their difficulties. Let them talk and try to ask open questions that encourage a fuller response than 'yes' or 'no'.

Examples of open conversation starters:

What is going well for you at the moment?

What would you be doing differently if it wasn't for these difficulties?

What is going well in school?

If things get better, how would that look?

How are things with friends?

If you woke up tomorrow and knew it was better, what would have changed?

What do you want to change?

When things where better than they are now, what was happening then to make it better?

When did this start?

What ideas do you have about what you need to feel better at the moment?

How does it affect you?

What kind of support would help you?

What is this stopping you doing......?

Are there things or people that help?

Let them know if you do not understand or need clarity

Answers can get muddled as children try to explain feelings they may not understand, asking clarifying questions shows you are listening and trying to understand.

Examples of ways of clarifying might include:

"Did I understand you when you said?"

"Did I hear you correctly when you said?"

"Let me check [...] you feel angry/ frustrated/ sad because [...]"

At the end of your conversation validate their feelings, acknowledge their strength and clarify priorities.

Examples of how to do so:

"I can see that things are difficult at the moment. However, you managed to share/ talk about a lot of things today. So, let us recap/ see where we've got to..."

Empathise and acknowledge how hard it is

It is important to let your child know that overcoming anxiety is hard, and that you are proud of their efforts. Let them know you are trying to understand their experience, are listening to what they have to say and want to help. Try not to validate their fears. The message you want to send is, "I know you're scared, and that's okay, and I'm here, and I'm going to help you get through this."

Make yourself available to talk again if needed

It can be a relief to talk, but ongoing anxiety is not solved with just one conversation. Let them know they can speak to you again. Explain that you will look at how you can help them. Never leave this kind of conversation without agreeing next steps, this will help the child to realise that you are working with them to move things forward.

A support plan can be used to support your child/young person think through how support can be individualised to support their own needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

It is crucial that all adults, at home and in school, work together to understand the reasons for EBSNA and find solutions together. As soon as signs are spotted parent/carers should tell the school there is a problem and request a meeting.

If you have a younger child who is experiencing anxiety with accessing a pre-school environment you may find the NHS Learning to talk resources following resource helpful to support the development of language.

Activities outside of an education setting

You may like to look at encouraging participation in activities outside of an education setting to support social interaction and reduce isolation. Some suggestions of how to do so include:

The Local Offer Directory contains details of both one off and ongoing leisure and social activities.

Club 4 holiday activities run during the longer school holidays and offer healthy food and fun activities for eligible children aged 5 to 16. The Club 4 website also includes a number of holiday ideas for children.

The video below aims to support parents and carers to develop plans to manage the anxiety of getting into school.

Who can you contact for support?

There are a number of services who can offer support if and when you feel you need it.

Support from School or education setting

It is important to communicate any concerns regarding EBSNA with your child's school/setting. They can help to find out what's worrying your child and what you and they can do to help. A support plan can be created that could include:

Home-school meeting to understand the reasons for the non-attendance.

An allocated named key adult who can maintain daily communication, to include a wellbeing check and ensure work is set, if not in class

Meeting with the pupil to gain their views around the non-attendance or participation

Jointly creating a support plan with you, your child and the school/setting.

Making reasonable adjustments according to your child's needs and the reasons for their non-attendance/participation.

Schools in Surrey can take a Surrey Healthy Schools approach to wellbeing and health and can access a range of resources and services to support your child. Support can include mental health support, counselling, and access to a School Nurse, they can also ask Specialist Teachers for Inclusive Practice (STIPs) to assess your child's difficulties.

Children and Young People with Additional Needs

An underlying Additional Need or Disability can contribute to anxiety levels; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia. These can make school feel like a difficult place to be for a child, even if they do want to attend school. It is worth noting that additional needs includes Social, Emotional or Mental Health Difficulties. These can affect a child's ability to make friendships and cope with strong emotion.

You may therefore also wish to discuss with the school if they feel an assessment of your child for any relevant additional needs is required.

If you need a bit more help

There are times when the challenges of family life become more difficult, and families may need some personalised support for a period of time. Targeted help focuses on the specific needs of the family to help them make positive changes. Requests for support (we used to call these referrals) can be made by all health, education and social care practitioners. Parent/carers can also request support via the Children's Single Point of Access (CSPA).

Helpful resources and services

You may also find the information and support offered by these services is helpful to you. The details of further services can be found on our Local Offer Directory.

Define Fine
A small UK parent led organisation that support families affected by EBSNA.

Not Fine In School
A UK based organisation set up to support parents, young people and professionals impacted by EBSNA: They also have a family support group on Facebook.

Young Minds
Have a parent's guide to School Anxiety and Refusal.

Every Mind Matters- Children's Mental Health
This is important for children of all ages, but in particular if the child is transitioning from one school to another, or to another class, which may make them more anxious about school.

SEND Advice Surrey
Offer impartial, confidential, free advice and support to parents/carers of children and young people with special educational needs and/or disabilities.

Family Voice Surrey
Champions the needs and rights of SEND families in Surrey: families with children or young adults up to the age of 25 who have special educational needs, chronic illnesses, including mental health conditions, or disabilities.

The National Autistic Society Surrey Branch
Is a volunteer-run support group founded by parents to support other parents. Volunteers offer a variety of local support group meetings, talks, parent programmes and activities for families that include autistic children or adults.

Are safe spaces for young people to drop into to talk about worries and mental health confidentially. There is also a phone service and virtual workshops operating alongside the face-to-face sessions. The opening times and phone number are listed on their website. They also offer two daytime projects for young people who aren't in school called 'Slow Grow' and 'Forests Skills'.

Children and Family Health Surrey

Have a number of sensory video workshops, on their website.

Your Child's GP can offer support which might include a referral to a Paediatrician or Mindworks who provide advice, help and support to children, young people and their families through a wide range of emotional wellbeing and mental health service,

You can also speak to your child's school nurse. The video below describes what a school nurse does and how they can help.

EBSNA information for young people

Everyone feels anxious or worried about school or college sometimes. This is normal, Anxieties are part of life and learning to deal with them is part of growing up However, sometimes anxiety or constant worrying can become a problem especially when it stops us doing what we want or need to do. If you have high levels of anxiety and worry about attending school, you may be experiencing Emotionally Based School Non-Attendance (EBSNA).

You most definitely are not alone and there is lots of useful information which can help you to find the best ways to help support yourself with this.

Some signs of EBSNA

Getting head or stomach aches

Feeling unsure

Feeling bad tempered

Worrying about relationships

Struggling to sleep

Feeling scared

Feeling depressed

'Autistic Burnout'

Remember you are not alone many children and young people feel this way.

We understand that it can be hard to start a conversation about how you are feeling sometimes as you may be worried about the reaction you will get. You may be surprised to know that your parent/carer or teacher may already have an idea that you are finding things difficult and it may be an easy conversation to have. It's important to tell your family and school how you feel so they can support you. There is no wrong way to do so and you might like to write a letter or send a text to say how you are feeling.

You may wish to complete a support plan which can be used to support you think through how support can be individualised to support your needs. This can be completed independently, with a parent/carer, trusted adult or with friends. This plan can be shared with school/college to help create a package of ongoing support.

You can also let them know about this webpage so they can come and look at the resources for parent/carers and schools.

Some of these services might also be able to help you:
Please remember, in the case of an emergency, call 999 or 112 from a mobile.
How can you support a child with EBSNA you are working with?

EBSNA is a complex issue, staying curious, feeling confident to try a different approach, remembering that no one is to blame for the situation, along with a culture that promotes staff and student well-being, can all support a successful reintegration.

It is important to remember most school-anxiety/ school refusing children do WANT to attend school however their difficulties and anxiety are overwhelming. They care about their education and want to succeed; however, they need understanding and support at home and at school to do so. They may need adjustments to their daily routines, timetables, or their school environment. Pressures to focus on attendance rather than the child's needs can make things even harder to 'fix'. As soon as concerns are raised, a designated member of school staff should reach out and connect with the parents/ carers. Preferably staff with a trusting relationship.

Many of the factors associated with positive outcomes will already be present within your education settings existing good practice and include:

Developing a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement

Early Intervention

Working with parents and staff as well as the child or young person

Working flexibly with a focus on understanding the function of the child or young person's avoidance behaviour

A focus on a rapid return to an education setting alongside intervention, support and adaptations within the school and home environment (be mindful that a focus on rapid return will not be appropriate for all children and young people).

Implementation of the 'Assess, Plan, Do, Review' Four part cycle:

Assess

As part of the 'Assess' phase you can identify EBSNA signs and risk factors, education setting push and pull factors to gather information to build a rich picture of the situation. You can use Surrey's Early Help Assessment form and Early Help Assessment practitioner guidance.

Plan

As part of the 'Plan' you can bring together all the information gathered and use it to inform a co-authored action and support plan.

Do

The 'Do' strand should describe strategies and interventions that have been effective in supporting the reintegration of a child or young person who is experiencing difficulties coming to an education setting. Carry out additional High Quality Teaching strategies and note differences made. Refine delivery of strategies to maximise the effect they have. Ensure that additional provision is delivered as it is meant to be. Think about what you need to adjust considering initial observations and feedback.

Review

Using assessment measures to monitor the progress of an intervention and adjust the plan for next steps will be part of your 'Review.'

Where can I receive advice or support with EBSNA?

Training and Webinars

Surrey Educational Psychologist Service and Mindworks School Based Needs Services are continually delivering training. The training is underpinned by research and provides extensive resources. Training for schools/settings can be booked on the training section of the Surrey Education Services. Third sector and wider partner EBSNA webinars have been uploaded to the Surrey Youth Focus webpage.

There is a progressive programme of training and support for schools to assist in the development and maintenance of a supportive and inclusive school culture. For more information visit Surrey Healthy Schools

Effective Family Resilience incorporating Early Help Assessment training is bookable through the Surrey Children's Services Academy: Training covers how to use the Family Resilience Windscreen and identify the range of services available to support families.

Resources

Individual support for children and young people

A Profile of Risk of EBSNA has been developed that looks at 5 key risk areas for EBSNA. The checklist is for use alongside the usual attendance monitoring systems in education settings, e.g., SIMS and consideration of patterns of attendance, to screen for possible EBSNA in relation to non-attendance. If the resultant profile suggests to you that the pupil is at risk of emotionally based school non-attendance, the next step is to obtain the views of the pupil, parent/carers and other staff within a setting. A support plan should be co-produced with the pupil, parent/carers and education setting using the EBSNA support guide for settings and the EBSNA Support Plan template provided by Surrey County Council and partners.

If the family need resources to be made accessible e.g., no access to technology or are not confident using it, are visually impaired or have English as an additional language you must ensure the resources available to families can be made accessible and families are supported to use them.

As part of any plan to support the child to attend well, education settings should facilitate relevant pastoral support. This should be done with the clear aim of improving attendance as much as possible while supporting the underlying EBSNA issue. The Department for Education have published examples of effective reasonable adjustments.

You may also like to refer to the Department for Education's summary of responsibilities where a mental health issue is affecting attendance.

Additional Support Services

The Inclusion Service provides support to schools, parents and young people in providing services on behalf of the Local Education Authority and deals with non-attendance, child Protection and making enquiries about children missing education.

Surrey's Education Psychology Service offer a weekly helpline for education settings that operates in every quadrant every Wednesday from 1-4pm (including school holidays).

Surrey County Council are developing a new support pathway for EBSNA via our Learners Single Point of Access (L-SPA), this will allow referrals for support to be made direct to our multi-professional team. More information COMING SOON

Whole School best practice

By asking "can we create an environment where EBSNA doesn't exists?" schools are already employing many strategies that support CYP who may experience school related anxiety. We suggest that schools develop a Surrey Healthy Schools approach to wellbeing, health, inclusion and achievement and use the Self-Evaluation Tool and training to assist the leadership and management of these areas. This can help to foster a compassionate, respectful and anxiety friendly environment.

Surrey Healthy Schools presents an opportunity for schools to actively promote physical, emotional and mental health and wellbeing. It is a commitment to encouraging personal, social and health development and supports the links between health, behaviour and achievement. It is not aimed merely at pupils' health or school curriculum development but centres around the whole school environment and all aspects of school life.

By looking at the systems already in place and creating opportunity for open discussion, you will develop a solid foundation that works for your school.

Where can you find support and advice?

This EBSNA Padlet website has an EBSNA resource bank designed for professionals.

Surrey Educational Psychology Service EBSNA Whole School Initial Audit Tool for Schools is a useful tool to gain a whole school understanding of EBSNA awareness and will help to identify areas of development.

Graduated Response Early Years information and documents to help special educational needs coordinators (SENCOs), early years practitioners, home-based childcarers and playworkers support children with Special Educational Needs and Disabilities (SEND) and their families.

Surrey Inclusion & Additional Needs service schools a document designed to schools and settings understand Surrey County Council service offers available to support schools to meet pupils needs as they emerge.

Ordinarily available provision (schools) this guidance aims to support settings, practitioners, families, and carers to work together to ensure that children's additional needs are met at the earliest opportunity.

Surrey Wellbeing Partnership (SWP) is a formal joint venture of local and national charities of various sizes with a common goal: to work with children and young people in the community to improve wellbeing and mental health so that they can live full, fun and confident lives.

Mindworks School Based Needs Team: offers advice and signposting for children, young people, parents and school staff, 1-1 support and group work for children, young people and parents (both within school and out of school settings).

Mindworks - Complex Mental Health Needs Teams (Community Teams)- work across Surrey and are made up of health and social care professionals. These multi-disciplinary teams promote good mental health and provide assessment and treatment to children and young people up to the age of 18 with a mental health condition. The teams assess and treat children and young people who are struggling with difficulties associated with neurodevelopment conditions where these are having a significant impact on the child's development and quality of life and causing them and/or their carers distress.

Mindworks - Mental Health Support Team for Specialist Schools in Surrey - a school-based service, which supports the mental health of children and young people in specialist schools across Surrey. The team offer support and advice to key people (teacher and or parent/ carer) around the child or young person to enable them to identify any concerns, understand what has happened for that child or young person and support any developing mental health needs.

The Mindworks 24/7 mental health crisis line, is available for children and young people who are worried about themself, a friend, or for parents worried about their child or young person. It can be contacted on 0800 915 4644, is open all day and all night, seven days a week.

Transitioning from primary to secondary school or changing schools in-year is a particularly significant change for children. Learning about change and how to cope with it will help them with transition and prepare them for many other changes and challenges they will face in life. Young Minds have a section of resources related to supporting school transitions.

Youth Engagement Scheme (YES) - is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system.YES is an early intervention for young people, between the ages of 13 and 16, who are struggling with one or more of: school attendance, low self-esteem, lack of self-confidence and/or are at risk of becoming involved in anti-social behaviour and the criminal justice system. You can email yes@surreycc.gov.uk for more information.

You may also find the details of further services who offer information and support on our Local Offer Directory.

# data[].attributes.attachment_link.title
Emotionally Based School Non-Attendance (EBSNA)

# data[].attributes.attachment_link.description
Emotionally Based School Non-Attendance (EBSNA) refers to children who are unable to attend school, rather than choosing not to attend because of increased feelings of fear and anxiety that may make school feel unsafe. Support for EBSNA is available.

# data[].attributes.body
When a child is supported in their environment and can develop their sense of mastery, bonding, meaning and skills, their resilience, or ability to cope, can increase. Perhaps have a think with your child what things already supports them in these areas and what things might help them feel more supported.

# data[].attributes.body
Ideas for talking to your child about how to remain calm in uncertain situations and reduce their anxiety.

# data[].attributes.body
It can be helpful to think about your child's motivation and readiness to go back to school and to change their current situation. This image can help to demonstrate the process of change and where your child is currently at, including how you may be able to support your child to feel more ready to change.

# data[].attributes.headline
Supporting your child with Emotionally Based School Avoidance - a guide for parents

# data[].attributes.subject
Supporting your child with Emotionally Based School Avoidance - a guide for parents

# data[].attributes.body
This guide provides information about EBSNA, why children may avoid school, including the cycle of avoidance and anxiety, and guidance on talking to your child about school in useful videos.

# data[].attributes.attachment_link.readable_text
HWB.GOV.WALES uses cookies which are essential for the site to work. Non-essential cookies are also used to tailor and improve services. By continuing to use this site, you agree to our use of cookies.

# data[].attributes.headline
Emotionally Based School Avoidance (EBSA) Information for parents and carers

# data[].attributes.subject
Emotionally Based School Avoidance (EBSA) Information for parents and carers

# data[].attributes.body
This general guidance from West Sussex EPS provides some information about what EBSNA is and the signs of EBSNA, including how you may talk to school about it.

# data[].attributes.headline
A little book supporting children and families to be emotionally ready for school

# data[].attributes.subject
A little book supporting children and families to be emotionally ready for school

# data[].attributes.body
A story to read with your child to support them to normalise their emotions and think about how this impacts on their behaviour.

# data[].attributes.body
There are a wealth of pathways you can follow to get mental health support for your child, so if you feel your child needs more support than they are currently accessing, take a look at the options here.

# data[].attributes.attachment_link.readable_text
If your child is struggling and needs some help, you may be feeling really worried as a parent - and also like you're not sure where to start. Remember that you and your child are not alone. On this page you can find the services, professionals and organisations that can help you, and information about how to access them.

Trying to find the right help for your child and finding your way around different services can be really tiring at times. Remember to look after yourself as you go - and to remind yourself that you're doing your best and it's not always easy.

1. Make a note of your concerns

Before speaking to a professional, make a note of your concerns and the times you have noticed particularly worrying behaviours or feelings. You can do this really simply by making a list on your phone. You can then take this with you to appointments to give the professional a clear sense of your child's situation, and to support any requests for referrals.

2. Explore local services

If you're on a waiting list for help, explore whether there are services available locally that you might be able to access in the meantime. Your child might also be able to get more immediate online support from organisations like The Mix and Kooth. You can find other online services and helplines at the bottom of this page.

3. Try talking to other parents

As you find your way around local services, try talking to other parents who have been through this, or speak to any friends or family who might be able to advise you about where to get started. For example, if you know anyone who works in mental health support, they might have a good idea about what's available locally.

4. Follow up after the appointment

Where possible, follow up by email after appointments - for example with teachers or other staff at your child's school - to confirm what's been agreed. Then check in a week or two later to find out what's happened. This is a good way to keep things moving.

I spoke to other parents and those who worked in mental health. I asked them what help they thought I needed. It's always good to open the conversation up and talk to other parents and mental health professionals.

Speaking to your GP

GP stands for 'general practitioner'. This is the doctor who provides overall care to look after both your child's physical and mental health. You can speak to your registered GP, or another GP at your local surgery, by calling your doctor's surgery to book an appointment.

Your GP can help with things like:

speaking to your child to find out how they're doing and what's going on for them

discussing your concerns with you and providing advice

suggesting different types of support or treatment, such as counselling and therapy or medication (treatment options will depend on your child's age and what they're experiencing)

letting you know what support is available locally and making referrals. This may include CAMHS or other mental health support services

offering your child regular check-ups to see how they're doing

finding local support groups for your child

Before making a referral to a support service, your GP will often want to see your child. If your child does not want to go to an appointment right now, you can still speak to your GP yourself to ask for information and advice.

GP surgeries offer urgent on-the-day appointments for when your child is really struggling. You can access these by calling the surgery first thing, or as soon as it opens.

If you don't feel that your GP is taking your concerns seriously or you would like a second opinion, you can ask the surgery to book you another appointment with a different GP. It could also help to ask the surgery whether there's a GP who has experience or specialises in young people's mental health.

Your child might like to use our guide for young people to help them prepare for an appointment. You and your child can also use Doc Ready to help you think beforehand about what you'd like to say.

CAMHS is a free, NHS-run service that helps children and young people with their mental health. CAMHS provide support and treatment such as counselling and therapy, medication (usually prescribed by a child and adolescent psychiatrist) and staying in hospital (also called 'inpatient care'). You might also hear this service referred to as CYPMHS (Children and Young People's Mental Health Services).

CAMHS teams are usually made up of nurses, therapists, psychologists, child and adolescent psychiatrists (medical doctors specialising in mental health), support workers and social workers, as well as other professionals.

Each CAMHS is a local service run by a local team in your area. This means each CAMHS around the country is slightly different and may offer different types of support, and that waiting times can vary between different areas.

Our parents' guide has more detailed information about CAMHS services and how to access support.

Counselling and therapy

Counselling and therapy (sometimes called 'psychotherapy') are both types of talking therapy that involve talking about - or exploring through art and other creative materials - feelings, thoughts and experiences. This can help your child to make sense of what's going on in their life and find ways of coping when things are difficult.

You can access counselling or therapy for your child through:

your GP, who can refer them to services provided by the NHS (including CAMHS) and/or other local organisations.

your child's school, college or university - some of which offer free or subsidised counselling services.

local free or subsidised counselling services, which you can find by searching online and/or using the Youth Access directory.

a private counsellor or therapist, who you can find using the directories listed in our guide if this is an affordable option for you.

For more information about how counselling works and how to access it, take a look at our guide for parents and carers.

Therapy helped me to gain a better understanding about how I was feeling and it allowed me to learn how to cope with my emotions without getting overwhelmed by them.

School, college and university

If your child is struggling and they are still at school or college, it can help to be open with the school about what's going on and what support your child needs. You can do this by emailing, phoning or arranging a face-to-face meeting with any member of staff - such as their teacher, form tutor or head of year, the SENCO (the coordinator for special educational needs support), a member of the pastoral team or the school nurse if there is one.

Depending on their age, it may be important to make sure your child feels some control over the information that's shared about them - for example by discussing with them who they would feel most comfortable for you to speak to in the first instance.

Depending on what's going on for your child, you might want to ask for some of the following things:

linking your child with a member of staff, for example from the pastoral team, who they can chat to when they're struggling

linking your child with a peer buddy or mentor

finding a way for your child to feel more part of the school or college community, or to manage unstructured lunch and break times, for example by joining a club

offering a flexible start-time or timetable

referring your child for support such as counselling, to CAMHS or to other local mental health services

If your child needs to access mental health support at university, you can find out how to go about this on the Student Minds website.

You can find more tips on working with your child's school in our guide.

Other local support services

You may be able to access other mental health support services in your area, including counselling or therapy organisations, support groups, drop-in sessions, clubs or mentoring schemes and charities supporting young people with specific issues.

You can search for these online, or through the Youth Wellbeing or Youth Access directories. Your local authority's website should also detail the Local Offer and Information Advice and Support (IAS) service, listing local provision for children and young people up to age 25 with special educational needs and disabilities. ( Find your local authority.)

Getting urgent help

If you are worried that your child is at immediate risk of harm, or is not safe, call 999 or take them to A&E.

Some parents tell us that taking their child to A&E in this situation can feel strange. Remember that this is the right thing to do. The NHS is very clear that a mental health emergency should be taken as seriously as a physical one - and that you will not be wasting anyone's time.

You can also contact your local NHS urgent mental health helpline (England only) or 111 for 24-hour advice and support.

YoungMinds Parents Helpline

We offer three different services to parents and carers who are concerned about their child's mental health (up to the age of 25). You can contact us by phone, email or webchat for information, advice and support.

To find out more about these services and how to make use of them, have a look at our Parents Helpline and Webchat page.

Support for you

Supporting a young person who is struggling can be incredibly worrying and exhausting - and it's entirely understandable if you are finding things difficult at the moment.

It's so important to recognise the impact the situation is having on you, and to think about ways you can take care of yourself - including getting support from other people so that you can take some time off. Remember that it's okay to ask for help when you need it, and to share your worries with someone you trust.

Many parents find it helpful to reach out to other parents so they can talk through how they have handled difficult situations with their children and get support. You can connect with other parents by:

You can also find support services such as counselling or therapy through your GP and other local organisations, or privately if this is an affordable option for you.

Sometimes it helps just having someone there who can listen to what you're going through - and if you need someone to talk to, you can call the Samaritans anytime on 116 123.

Useful helplines and websites

# data[].attributes.attachment_link.title
Getting Help For My Child's Mental Health

# data[].attributes.attachment_link.description
If your child is struggling and needs some help, you may be feeling really worried as a parent - and also like you're not sure where to start. Remember that you and your child are not alone. On this page you can find the services, professionals and organisations that can help you, and information about how to access them.

# data[].attributes.body
This webpage provides a collection of advice for parents, including practical guidance around registering your child's absence at school to where to go for a community of support.

# data[].attributes.attachment_link.readable_text
6. LOCATE & READ YOUR SCHOOL'S POLICIES

Focus on policies for ATTENDANCE, SEND, & MAKING COMPLAINTS (as applicable).

Check they are being followed correctly and if they are not, ask why?

The school should respond to attendance problems by making assessments and helping to investigate what the underlying triggers or unmet needs are so that they can be addressed. This might involve the SENDCo, and referrals to an Educational Psychologist, CAMHS, and possibly other services such as Occupational Therapy and Speech and Language Therapy.

The Department for Education told us that when a school identifies an emerging issue, including mental health issues which require additional support, they should not delay putting it in place.

The school should follow the graduated approach process set out in the department's statutory guidance on special educational needs and disability code of practice.

The guidance is clear that support should be provided from an early stage, whether or not the child has a specific diagnosis.

A child in school who has this support would be regarded as receiving special educational needs (SEN) support.

A school should always involve a specialist where a pupil continues to make little or no progress or where they continue to work at levels substantially below those expected of pupils of a similar age despite evidence-based SEN support delivered by appropriately trained staff.

For some children it will be appropriate for a request to be made to the local authority for an Education, Health and Care needs assessment. This request can be made by the school or the parent.

The special educational needs and disabilities code of practice intentionally does not require a diagnosis for a child to access the support they need. The process is based on a child's needs.

7. BE PROACTIVE

Ask for meetings and contact people who might be willing to help (including your GP, CAMHS helpline, School Nurse, Local MP, LA attendance team).

Take independent witnesses with you to meetings to make notes and support you.

Research your child's and your own rights then quote best practise - refer to legislation and statutory guidance for schools.

After meetings request copies of the minutes. If you don't feel they are accurate ask for them to be amended.

If a written record is needed write your own summary of the main points and anything agreed and email it to everyone involved for their approval and records.

8. CONTACT CHARITIES & SUPPORT SERVICES

Start with the following websites (see links below):

Then also look at others you think may be helpful

Check your council's LOCAL OFFER to see if they list anyone who might be able to help.

9. THREATENED WITH PROSECUTION?

Act quickly - hopefully you will have been keeping records and trying to get medical evidence - (don't leave it this late to get medical evidence and referrals) - this is what protects you, as prosecuting parents of a child with a diagnosis of mental health problems: (a) generally doesn't happen and (b) breaches the Equality Act (2010). Sadly, people often get to the point of being in court the following week, don't have representation and then don't point out to judge that the child is absent because of mental illness. So, it is VERY important to see your GP and get a CAMHS referral in place ASAP.

A parent cannot be penalised if a statutory exception applies. These exceptions are: where the school has given permission; where the pupil is prevented from attending by sickness or other unavoidable problems; where their family is marking a day reserved exclusively for religious observance; or where the local authority has failed to fulfil any duty it has to help them get to school.

It is for schools or local authorities to decide if they wish to use a penalty notice as a sanction in individual cases.

Penalty notices are governed by the Education (Penalty Notices) (England) Regulations 2007 as amended. The regulations require every local authority, in consultation with their schools and the police, to draw up a code of conduct for issuing penalty notices.

It is for local authorities to decide whether to prosecute a parent having taken account of all the circumstances of the case and the information submitted by the school. Local authority officers are best placed to assess the family's circumstances and decide upon the most appropriate course of action.

The Department for Education would encourage parents to work with their child's school and their local authority, to discuss the reasons behind their child's absence and agree an action plan so that the right support can be put in place to help their child to return to regular and consistent education, whether at school or otherwise.

10. RESEARCH RELEVANT LEGISLATION & DfE GUIDANCE

Local authorities are responsible for arranging suitable education for children of compulsory school age who, because of health reasons, would otherwise not receive suitable education (section 19, Education Act 1996). This applies whether or not the child is registered at a school and whatever type of school they attend. The education must be full-time or as close to full-time as the child's health allows.

The DfE statutory guidance on ensuring a good education for children who cannot attend school because of health needs sets out that local authorities should provide education as soon as it is clear that the child will be away from school for fifteen days or more, whether consecutive or cumulative.

The DfE make it clear that local authorities should be providing a "safety net" of suitable education for any child of compulsory school age who, by reason of illness, exclusion from school, or otherwise, may not for any period receive education. A local authority must make arrangements for the suitable education of any child of compulsory school age who, by reason of illness, exclusion from school, or otherwise, may not for any period receive education without such arrangements. Education Act 1996, s.19(1). Thus, the local authority can have a duty to provide alternative arrangements in situations not only where children are unable to attend by reason of illness or exclusion. This is because the phrase "or otherwise" "is plainly intended to encompass other causes of non-attendance at school or non-receipt of education". R (DS) v Wolverhampton City Council [2017] EWHC 1660 (per Garnham J) (at para.36).

Local authorities should have a named officer responsible for the education of children with additional health needs. The Department for Education (DfE) say that the current legal framework provides for sufficient "flexibility" to avoid issues such as prosecution for non-attendance, even where absences have not been authorised.

The DfE say that there are statutory exceptions which ensure that a parent should not be penalised or prosecuted where a pupil is prevented from attending school by sickness, or where the local authority has failed to fulfil any duty it has to help them get to school.

The DfE also make it clear that it is not necessary for children to be marked as absent due to illness in order to receive adequate education outside of school.

Relevant Judgements & Case Law

# data[].attributes.attachment_link.description
Advice and information for families trying to navigate systems in the search for support when a child or young person is finding attending school difficult

# data[].attributes.headline
Not Fine in School- Parent Support Facebook Page

# data[].attributes.subject
Not Fine in School- Parent Support Facebook Page

# data[].attributes.body
Not Fine in School offer a parent support group of families who are going through similar situations. It can be helpful to hear from other parents in similar situations to you.

# data[].attributes.attachment_link.title
Not Fine in School: Family Support for School Attendance Difficulties | Facebook

# data[].attributes.attachment_link.description
✰ WELCOME TO OUR FACEBOOK GROUP FOR PARENTS/CARERS/FAMILY This group is EXCLUSIVELY for parents/carers (& other adult (over 18) family members) of children who experience difficulties attending…

# data[].attributes.body
Independent Provider of Special Education Advice

# data[].attributes.attachment_link.provider_name
(IPSEA) Independent Provider of Special Education Advice

# data[].attributes.attachment_link.title
(IPSEA) Independent Provider of Special Education Advice

# data[].attributes.attachment_link.description
IPSEA (Independent Provider of Special Education Advice) - helping children and young people with special educational needs and/or disabilities (SEND) get the education they are entitled to by law

# data[].attributes.headline
A guide for parents and carers: School anxiety

# data[].attributes.subject
A guide for parents and carers: School anxiety

# data[].attributes.body
This guidance from YoungMinds offers information about how to have a conversation with you child's school about support and supporting your child at home, including what to do whilst your child is at home.

# data[].attributes.attachment_link.readable_text
It's normal for children and young people to feel worried about something that's happening at school - for example, when starting a new school or during exams. Sometimes, however, school can become challenging, stressful or distressing over a much longer period of time.

If your child is feeling anxious about school, or not able to go, it can be exhausting for both of you. Mornings in particular can become really stressful for the whole family, as you try to juggle your child's feelings alongside the need to get them to school and get on with your other responsibilities such as work. Even if you manage to get your child to the school gate, you might know how difficult they're going to find the day - or know that you'll be facing the same problem tomorrow morning.

If you're in this situation, we've got advice to help you explore what's going on with your child, make changes at school that can help, and find the support you need if your child can't go to school.

Young people can feel anxious about school for lots of different reasons. They might be worried about making friends or fitting in, find schoolwork or lessons confusing, feel pressured to learn in a certain way or find their relationships with teachers difficult.

Sometimes, going through difficult experiences outside of school - such as bereavement, an illness in the family or being a young carer - can also make it harder for a child to feel settled at school.

For some young people, the school environment isn't right for them, and trying to fit into it can create a huge amount of stress. This might be the case if they are struggling with their mental health, or have a neurodiverse condition or Special Educational Need (SEN) such as autism, ADHD, dyslexia or dyspraxia. This can make the school environment anxiety-provoking and exhausting, especially if their condition or need is undiagnosed or not being well supported.

Young people might show they're feeling anxious about school by:

not wanting to get up and get ready

saying they can't go

worrying a lot about small issues, such as having the right equipment for a lesson

feeling sick, or having stomach aches or headaches

not sleeping well

not doing schoolwork, or their grades dropping

being angry or upset, or acting out - at school or at home

withdrawing - seeming low, quiet or depressed

It's often difficult for your child to articulate the problem. They may be in a heightened state of stress and not know why or feel able to explain. Your child probably wants to feel able to be in school, just as much as you want them to be there. In many cases it just doesn't feel possible.

Sometimes it can be difficult to work out what's making your child feel anxious, and the first step is often helping them to identify exactly what's worrying them. Once you understand the problem, you'll be in a much better position to make changes that can help.

Young people can find it hard to explain what's causing their feelings, and might not be able to answer direct questions like 'what's going on?' Using an anxiety iceberg can help to open up the conversation - giving you a more relaxed way of exploring together what's causing their anxiety.

Watch our video to find out how to make an anxiety iceberg with your child.

If you're making an anxiety iceberg with younger children, you might want to draw images on the iceberg, or encourage them to write simple words. With older children and teenagers, you can ask them to write key words and phrases on the iceberg, or do this as a mind map, with 'school' in the middle and all the things they're finding difficult around the outside.

Through this exercise, you might identify worries such as arriving at school, finding the environment noisy or overwhelming, finding lessons confusing, feeling lonely through the day, or feeling uncomfortable during specific subjects.

Once you understand what's going on for your child, you can use their anxiety iceberg or mind map to communicate with the school and ask for specific changes.

Follow these steps to start a conversation with the school:

Here are some examples of things you can ask the school for:

Remember that even though this situation can be really tough for you and your child, it's a good idea to maintain a positive relationship with the school. Recognise the support they're offering and any changes they're making. This will help you work together to make things better for your child.

Building a relationship with the attendance team at my son's school was hugely helpful, we were talking with them each day.

If your child isn't going to school at the moment, it might feel incredibly stressful and tiring. You might be worried about when they will be able to get back to school or the impact on their education. Or you might feel overwhelmed because you're juggling this alongside work and other family commitments. Things are probably feeling tough for your child too.

During this time, it's important to keep working with teachers and other staff to try strategies that can help your child get back to school. Keep encouraging them to take achievable steps towards attending too. When the right support is in place, it's often easier for a young person to get back into their usual routine if they can return to school as quickly as possible.

If your child's anxiety about school has built up to the point where they can't go, it's a good idea to get them some professional mental health or SEN support. Find out how to do this further down the page.

Alongside requesting professional help, try to:

The school's SEN and attendance policies should be on their website. Knowing what these are can support you during meetings with the school.

This can help if your child is unable to go to school for a longer period of time and you need to ask for more support, including provision of alternative full-time education.

Encourage your child to get up, do some studying and stop for lunch at the same times they would if they were in school. This will make adapting back to school easier. Explain to your child that if they cannot go to school, they will need to study at home - at least until alternative arrangements are put in place. Ask the school to help you facilitate tasks and activities your child can do and use online resources such as BBC Bitesize.

Not going to school could leave your child feeling really isolated. Make sure they stay connected to the outside world by seeing friends and family, doing activities they enjoy and getting outside for walks and exercise.

Speaking to friends online can be really important if your child is feeling isolated at home. Sometimes, however, you might notice that your child is spending lots of time gaming or on their phone, and that this is getting in the way of important daily activities like spending quality time with family, learning, or sleeping and eating well. If this is becoming a problem, have a look at our guide to gaming or guide to social media for more information and advice.

Local authorities must provide alternative education if a child of compulsory school age is unable to attend school over a longer period of time. If your child cannot attend school because of a mental or physical health issue, the local authority should provide an alternative as soon as it is clear that they will be away from school for more than 15 days (either consecutively or over time). Find out how to request alternative education.

Getting back to school after weeks or months may feel extremely difficult for your child, but you and the school can help make it more manageable. Here are some things you can do to help:

Set small, achievable targets, such as visiting the building outside school hours or attending one lesson.

Request a home visit from a school staff member so your child can check in while feeling safe, see that the school cares and discuss any strategies that might help them.

Ask for a reduced timetable, with regular reviews to discuss building back up at a manageable rate.

Discuss changing classes or sets if your child thinks this would help.

Focus on qualifications needed for what your child wants to do next, perhaps dropping a less relevant GCSE to reduce stress.

My son wasn't questioned about his absence when he did feel able to pop in for favourite lessons, helping to ease him back into full days of education.

If your child is struggling with anxiety and it's affecting their day-to-day life, learning or relationships, it's a good idea to find some professional support. Speaking to the GP and finding them a counsellor or therapist are two good places to start. You can find more information about GPs, counsellors and other mental health services in our guide to getting support from mental health services.

If there is no other obvious reason for your child's inability to attend school, they may have an undiagnosed Special Educational Need (SEN) such as dyslexia, autism or ADHD.

If you think this is the case:

Speak to the school's SENCO or your GP to ask for a referral for an assessment.

While you are waiting for an assessment, you can also ask the SENCO to refer your child for support from other professionals, such as an Educational Psychologist or Speech and Language Therapist. These professionals can identify specific needs and make recommendations for additional support the school can put in place - even if your child hasn't had a formal diagnosis yet.

SEN support at school
If your child is diagnosed with SEN, extra support and adjustments should be put in place at school to help them attend and learn. This is called SEN support, and should be available within the school's existing resources. Speak to the school's SENCO in the first instance about how the school will support your child.
Education, Health and Care (EHC) plans
If you do not think your child's needs can be met by the school's existing resources, you can ask the local authority to carry out an Education, Health and Care needs assessment (EHC needs assessment). If the local authority decides your child needs additional support, they will then make an Education, Health and Care plan (EHC plan). This outlines how the extra support they need will be provided. Find out more about EHC plans.
Your Local Offer
Your Local Offer is the information, support and services available for young people with SEN, and for their parents and families. You can find out what support is available in your area by going to your local authority's website and searching for their Local Offer.

While we take care to ensure that the organisations we signpost to provide high quality information and advice, we cannot take responsibility for any specific pieces of advice they may offer. We encourage parents and carers to always explore the website of a linked service or organisation to understand who they are and what support they offer before engaging with them.

We have more tips and advice on supporting your child with school, and information about how you can get in touch with our Parents Helpline.
This page was reviewed in December 2022. It was created with parents and carers with lived experience of supporting their child or young person with school anxiety. We will next review the page in 2025. YoungMinds is a proud member of PIF TICK - the UK's quality mark for trusted health information.
Whether you love the page or think something is missing, we appreciate your feedback. It all helps us to support more young people with their mental health.

Please be aware that this form isn't a mental health support service. If your child is in crisis right now and you want to talk to someone urgently, find out who to contact on our urgent help page.

At YoungMinds we take your privacy seriously. If you'd like to read more about how we keep the information we collect safe, take a look at our privacy policy.

# data[].attributes.attachment_link.title
School Anxiety and Refusal | Parent Guide to Support

# data[].attributes.attachment_link.description
If your child is anxious about school, or refusing to go to school at all, read our tips and advice on how you can support their mental health.

# data[].attributes.body
This worksheet could be completed with your child or they could complete it alone to express their thoughts and feelings about school.

# data[].attributes.body
Define Fine offer a range of resources and a parent support network to discuss any challenges you face with other parents struggling with living with EBSNA too.

# data[].attributes.attachment_link.readable_text
Define Fine: is a parent/carer-led organisation set up in response to the growing number of children and young people who experience school attendance difficulties. This is sometimes referred to as 'school refusal', or emotionally based school avoidance however these phrases may not explain the full picture of the barriers to attendance which may be due to any number of complex reasons such unmet Special Educational Needs & Disabilities including physical or mental illness, either suspected or diagnosed, bullying or issues relating to academic pressure, or even the school environment*.

We are also keen raise awareness of attendance difficulties and work with professionals and decision-makers, locally and nationally, to reduce the numbers of children experiencing attendance difficulties, and ensure they are able to access a suitable education.

School attendance difficulties are complex but all too often these children are described as being "fine" when they are in school. Define Fine has produced resources based on relevant government policies and guidance, to help parents and their families to work with professionals to assess and then plan appropriate and timely support.

# data[].attributes.attachment_link.description
Define Fine: Parent Peer Support for School Attendance Difficulties Define Fine: is a parent/carer-led organisation set up in response to the growing number of children and young people who experience school attendance difficulties.

# data[].attributes.body
This article explains why it is important to take care of your own wellbeing when supporting your child's emotional needs too.

# data[].attributes.attachment_link.readable_text
Parenting can be stressful under the best of circumstances, but moms and dads of children with developmental and mental health challenges often have to deal with strain of a different magnitude. Caring for a child with special needs can become a full-time job - and an overwhelming one at that, if you don't have adequate support. Without enough help, parents may be headed toward caregiver burnout, which negatively affects everyone.

The consequences of chronic stress related to raising kids who have intense needs are real. Studies show that parents of children with developmental, psychiatric or learning disorders are far more likely than others to experience:

According to one British study, chronic stress puts these parents at risk for medical issues as well. This study found that parents of children with either autism or ADHD had significantly higher levels of both cortisol, the stress hormone, and CRP, a biomarker linked to everything from colorectal cancer to diabetes to heart disease.

The risks, both emotional and physical, to caregivers of challenging children are important to address, for the children's sake as well as the parents'. Below, we look at common contributors to caregiver stress and offer some suggestions to help parents stay healthy, balanced and committed to their kids.

Accepting limits to what you can do

Experts agree that part of avoiding or lessening burnout is to challenge the idea that you are the only one who can help and there is no limit to what you need to do.

Dr. Wendy Blumenthal, an Atlanta-based psychologist, says she sees mothers who reach a breaking point because they are driven to shoulder all the responsibility for their high-needs child. "These supermoms - they're not sleeping, they're constantly anxious, calling every doctor they can think of."

"These parents feel like they should be able to do it all and the first thing to go is basic self-care," says Elaine Taylor Klaus, the cofounder of Impact ADHD, which offers training for parents of kids with ADHD and other disorders. "There are long-term risks of caring for these kids," she says. "And one of them is that parents burn out." Taylor Klaus urges parents to take seriously their own basic self-care including:

Getting enough sleep every night

Staying hydrated

Getting regular exercise

Spending time away from children

Isolation and exhaustion

When you have a child whose behavior is difficult or whose needs are challenging, feeling cut off from support and empathy can contribute to the stress. Colleagues, neighbors, friends, family - even your spouse can seem to be on another planet. "People cannot understand what you're going through," says Patricia Kandel, who has raised two children with serious mental illness. "There's so much alienation."

By the time her family decided their youngest daughter needed to go into a group home, Kandel says, "I was barely functioning." She, her husband and her 20-year-old daughter were all diagnosed with PTSD "from all the years of living the way we did," and her marriage had become unrecognizable. "It's not a typical marriage. It's survival."

Outside assistance was nowhere to be found. "You can't get a babysitter," Kandel continues. "Our own family wouldn't even help us. We never had any money. I had to be here 24 hours a day."

High-stress and time-intensive situations like this one are also where respite care could play a role, says Jill Kagan, director of Access to Respite Care and Help (ARCH). "Respite care is temporary relief for the parent or the primary caregiver of the child so they can take a break from the responsibilities of their continuous caregiving," she explains.

Many parents aren't aware of the existence of respite care, she says. "They're so focused on getting services for their child that they may not even stop to think that there are services out there for them as well. It seems out of the realm of possibility." But it isn't. ARCH's website includes an introduction to respite care and ways for parents to locate respite care by state as well as a list of funding sources. (ABCs of Respite: A Consumer's Guide for Family Caregivers)

It takes a village, but you need to ask

Another obstacle to getting help is that you may be afraid to ask. But in truth, people who genuinely want to help may not know how.

Parents need to be fairly direct. "Could you watch the kids on Wednesday so that I can get a haircut?" "If I give you a list, could you pick up the groceries?" These specific requests make it easier for family and friends to pitch in while not feeling out of their depth.

"People are often willing to help you in small ways," says Dr. Blumenthal. "Like watching your non-challenged child so you can take your special-needs child to therapy." Proposing babysitting exchanges with another parent (or even network of parents) of another special needs child is another way to get some time away, and some needed perspective.

Getting out and about

Many parents of kids with psychiatric and developmental challenges find that they lose touch with friends and activities outside the home. "Fifty percent of my sessions are just parent sessions" to help navigate that reality, says Dr. Matthew Rouse, a clinical psychologist at the Child Mind Institute.

Taking care of your emotional and social health is just as important as practicing more routine self-care. Several experts, including Dr. Rouse, emphasized the importance of reclaiming an adult-only social life. Dr. Rouse asks questions like:

What are you doing for yourselves?

What are you as a couple doing to support each other?

When's the last time you had a date night?

When did you last spend time with friends?

To mitigate feelings of isolation, Dr. Rouse recommends:

Finding a support network outside the immediate family. There are online and in-person support groups for just about every diagnosis out there.

Spending time with friends who have no connection to your child. "Support groups are great," Rouse says "but that's still doing something for your child."

Planning social activities that put you among people who care about you.

Time for activities that are purely pleasurable - reading, running, painting.

"The way I've framed it with parents who are resistant to this," Dr. Rouse says, "is to tell them, 'It's like you're depositing money into a bank and building up cash reserves. To have more to give your child, you have to build up those reserves.'"

Related: How Parent Support Groups Can Help

Nurturing the marriage

Throughout, parents need to pay close attention to perhaps the most vulnerable relationship of all - the one between spouses. Experts suggest that parents make it a point of maintaining their relationship with small steps they can continue, and that they make it a point of letting the marriage exist outside of roles as caregivers.

"I encourage parents to take little breaks such as when their child is in a therapy session or in school," says Dr. Cindy Ariel, a Philadelphia-based psychologist who specializes in working with families of special-needs children. Other small steps you can take might include an in-home break or "date." Even if you don't have help, there are still ways of finding time to devote to your relationship so that you and your partner don't end up feeling like you're merely tag teaming as caregivers.

Maintaining a healthy marriage and effective caregiving team is made much harder when parents disagree about treatment strategies and approaches. Andrea Weissman's son Ethan, now 12, has learning, attention and social challenges. She and her husband often disagree on what is considered "normal" behavior.

"He thinks a lot of stuff is more normative than I do and tells me I'm 'catastrophizing,' " she says. "We certainly don't parent in a consistent manner - which is not good for Ethan." Or for her-she feels she drinks too much as a result.

This is a common situation, according to Dr. Blumenthal. "There are information seekers and information deniers," she says, "people who want to dismiss the diagnosis or write off their child's symptoms as normal." When one parent is a "seeker" and the other a "denier"- which she says is often, especially when a child is first being diagnosed - the conflict can put an enormous strain on the relationship.

"If you have differences around the child's treatment, try to see things from the other person's perspective," Dr. Rouse suggests. "That will help you to reconnect." And that's easier if you've laid the groundwork with even something as simple as a "nightly check-in" that can help you and your partner stay close.

"Just making time before bed to tell each other about the highlight and lowlight of the day" is beneficial, he says. "So it's focused more on the person's emotional experience during these events, and less like a planning or logistics meeting. It can build intimacy and empathy just through sharing and listening."

# data[].attributes.attachment_link.description
Parenting can be stressful under the best of circumstances, but moms and dads of children with developmental and mental health challenges often have to deal with strain of a different magnitude. Caring for a child with special needs can become a full-time job - and an overwhelming one at that, if you don't have adequate support.

# data[].attributes.body
A questionnaire for you to complete to help your own understanding of your child's non-attendance. It may be helpful to share this with school staff too.

# data[].attributes.body
This video talks about a Sunday evening-Monday morning plan to support your child to be ready for school and how you can create one together using the resources below.

# data[].attributes.body
This provides some ideas of things you might find helpful to do to make that Monday morning calm and relaxed.

# data[].attributes.body
This provides a visual reminder of some things that you could do on Sunday evening to support your child to be ready for school.

# data[].attributes.body
We often advise professionals to use an Emotion Coaching approach with children, focusing on empathy and guidance when approaching difficult conversations. You may want to think how you could use this approach when talking to your young person about their feelings about school.

# data[].attributes.body
This anxiety thermometer worksheet could be used to rate levels of anxiety about certain activities.

# data[].attributes.headline
Surrey Discovery Conversations and Support Plan Template

# data[].attributes.subject
Surrey Discovery Conversations and Support Plan Template

# data[].attributes.body
This templates can be used in collaboration with your child and their school to find out more about your child's views and come up with a plan to support them return to school.