The big issue: Anxious and absent
Therapy Today, June 2025

When Alice’s* 13-year-old daughter Hannah* first started displaying signs of anxiety about going to school, it came out of the blue. ‘Hannah seemed happy and settled until then – there had been no previous issues – until she mentioned she wasn’t comfortable in assembly or in large groups,’ Alice explains. ‘Then she said she was worried about fire drills, and mentioned that students were not allowed to leave class to go to the toilet.’

Alice emailed the school, which issued a toilet pass and organised some counselling for her daughter. Things settled and Hannah returned to school for the start of Year 10 in September, but by Christmas the issues had resurfaced. Alice attended several meetings with the school to try and find solutions, but by January Hannah was unable to attend school at all due to extreme anxiety and panic attacks. ‘She was shaking at the school gate and very tearful, which had a huge emotional impact on the whole family but especially me as I was dropping her off each morning,’ Alice says. ‘It was very stressful, with tears all round, and I had trouble sleeping from the anxiety of it all.’ 

Eventually, due to concerns about how much education Hannah was missing, Alice made the decision to remove her daughter from school and enrol her in online learning. ‘The school was helpful to a point, although I felt we had nowhere else to go unless Hannah had an Education, Health and Care Plan (EHCP), but we didn’t feel an assessment was right for her, and they basically admitted there was no funding.’ Hannah is now receiving support from The Youth Fairy, a team of therapists who specialise in solutionfocused hypnotherapy for children, teens and young adults. 

Therapy Today, June 2025

Definitions 

Alice is one of many parents in the UK whose children are going through experiences like this. Often mis-labelled as school refusal, emotionally based school avoidance (EBSA) is the term used to refer to a young person’s inability to attend school due to underlying emotional factors such as anxiety, trauma and social difficulties. EBSA can adversely affect a child’s health, social skills, education and life prospects, according to a recent report in The BMJ.¹ While EBSA statistics are difficult to ascertain, the fact that persistent absence rates across state secondary schools in England rose to 21.2% in 2022-23 from 10.9% in 2018-19 suggests that EBSA is part of a growing problem.² The Education Secretary, Bridget Phillipson, recently described school absenteeism as ‘endemic’.³

There are also signs of a move towards adapting the traditional model of school to better support young people struggling in mainstream education. These include hybrid schools, where students split their time between online and in-person learning, and part-time schools such as one in London where children attend once a week.⁴ 

Despite this EBSA isn’t well understood. Myths prevail around both what causes it and how best to support young people and their families affected by it. Sir Martyn Oliver, Chief Inspector of education watchdog Ofsted, recently described the wider issue of school absenteeism as ‘a huge concern for the country’ and reportedly suggested that parents who work from home may give children the perception that school attendance is ‘optional’. 

For parents like Alice, such perspectives only create more barriers to accessing support for their family. Yet experts agree that early intervention, which addresses the emotional root of the problem, is key to achieving positive outcomes for children, preventing long-term absenteeism and enabling them to continue in education. Evidently it’s vital that therapists develop an understanding of the complexities of school absenteeism and EBSA in particular, starting with an informed awareness of why it seems to be on the rise. 

Alice, parent

Causes 

Saskia Joss is a child and adolescent therapist specialising in helping children and teenagers with anxiety and trauma, and the author of Help! My Child’s Anxiety is Giving Me Anxiety (Headline). She believes the COVID-19 pandemic highlighted the emotional vulnerabilities of children, particularly those who were already struggling, resulting in more young people now experiencing EBSA. 

Children who experienced more time at home during the pandemic became more aware of family life and safety, and may now feel that the outside world (including school) is unsafe,’ Joss explains. ‘There has, therefore, been an increase in children often experiencing chronic anxiety or phobia about school. It’s not that they don’t want to go to school – it’s the opposite – they would like to go but they can’t due to anxiety. Setting foot inside the school gates or entering the classroom would be like meeting a big lion and not being able to escape.’ 

However, the pandemic is only one piece of the EBSA puzzle. Other voices in the field say a change in approaches to parenting may have contributed to the rise of EBSA. Lauren O’Carroll, a neurodivergent parenting expert (For more information please visit the Positively Parenting website) whose own daughter experienced EBSA, agrees that parents listening to their children may be a factor but stresses that this is not a bad thing. 

‘More parents are creating safe spaces for their children to express emotions, and when school environments feel increasingly unsafe or overwhelming, which is particularly the case for neurodivergent children, it’s no surprise that their nervous systems go into fight, flight or freeze, making school avoidance a natural response,’ she says.

‘Larger class sizes increase sensory overwhelm. SEN plans are often misunderstood or not followed, leading to frustration. Rigid schedules, constant transitions, and social pressures make school exhausting and anxiety-inducing.’ 

So how can the therapy profession and individual practitioners better support this client group? Greater support for parents is key. ‘Therapists can help parents by acknowledging the chaos they feel when their child avoids school,’ explains Joss. She recommends that therapists focus on helping parents to rebuild a feeling of safety for their children, starting with small experiences to counter fear, because staying out of education can heighten the fear. 

Saskia Joss

Therapeutic interventions 

Therapists who work with adults have a different remit to those working with children and families. ‘As well as an ethical responsibility to support children’s feelings, school counsellors also have to follow legal obligations, such as ensuring the child attends school,’ adds Joss. ‘Parents can’t be prosecuted by the local authority if they can prove that they’re making an effort to get their child to attend school, so school counsellors should also support parents in navigating the system – they can speak with schools and work out what is appropriate for each individual child. Therapy should focus on gradual, manageable changes and avoid pushing for drastic measures too soon. Small steps should be taken to rebuild a child’s sense of safety and confidence in returning to school.’ 

For non-school therapists working in private practice with parents, it’s less about problem-solving and more about focusing on the parents’ experience. Nonetheless, it can still be helpful to read up on how the school system works so that therapists are familiar with the terminology the parents may use, and can signpost further practical support where appropriate. 

Jo Holmes is BACP’s Children, Young People and Families Lead, and has 30 years’ experience working with young people and families, including as a youth worker and counsellor. She stresses the importance of using the appropriate terminology when working with families impacted by EBSA. ‘It’s important to avoid the term “school refusal” because that puts the onus on the child, implying that somebody is asking them to go to school and they are saying no,’ she explains. ‘In fact, there may be many very complex reasons why the child feels unable to attend school, from socio-economic factors such as poverty to discrimination, bullying and high anxiety.’ 

Lauren O’Carroll

Physical impact 

Natasha* sought therapy when her son, who was nine at the time, began experiencing difficulties with school attendance. ‘He had always been willing to go to school prior to this, although due to his ASD diagnosis attending school wasn’t straightforward,’ she explains. ‘For many years we experienced what we called the cola bottle effect, where he held it together, often masking so that he could fit in, or not reacting to the many demands placed on him during the school day, and then was very different in the home environment.’ 

Natasha isn’t sure what triggered the issue. ‘Perhaps it was increased expectations as he started a new school year, or it might have been a particular teacher or friendship issue, or as he got older he felt he didn’t have to conform,’ she says. ‘Initially it was just Mondays and the odd day that he would say he wasn’t going to school and refused to get dressed, staying in bed and getting angry verbally and physically if you tried to encourage him.’ 

After lengthy discussions and trying different ways to engage with him, Natasha’s son would eventually agree to go. ‘Sometimes we’d get to the front door and he’d retreat back to his room, or we’d get to school and he’d refuse to get out of the car. Sometimes a teacher would try and coax him out of the car, or he’d get to the steps and then run off down the street away from the school,’ she recalls. ‘We did always eventually manage to get him in but it was very stressful and at times distressing. My work meetings had to be rescheduled at late notice and my other son was often late to school as a result. During this period his behaviour at home became very challenging, but on reflection he must have been experiencing serious anxiety, stress and overwhelm from the whole experience.’ 

Natasha sought therapy after noticing the physical impact of the experience on her body. ‘I had tightness in my chest and my appetite vanished,’ she explains. ‘My sleep was impacted and I felt truly awful. I was normally a fairly sociable individual but I was purposefully avoiding people and crying most days. I didn’t feel like I could cope on my own, and wanted some help to improve my resilience, which was at an all-time low, so I could support my son and be in a better frame of mind for his older siblings.’ 

Jo Holmes

Supporting parents 

Natasha chose a therapist who had experience of neurodiversity and understood the realities of parenting a child with ASD. However, they recommended discontinuing therapy after just four sessions. ‘The therapist told me at the beginning of the session that she felt my money would be better spent on trying to help my son directly, and on better understanding his behaviour,’ she says. ‘I didn’t really know what to say. She had come to this conclusion after chatting with her supervisor. I wanted to stop the session immediately as I felt rejected and a little stupid – was it my fault? What did I do wrong? I understand that she was trying to help me focus our attention and financial resources on what would most support my son – but who was supporting me?’ 

Joss agrees that it’s important for therapists to take an approach that involves supporting the client so they have confidence in their instincts as a parent. ‘Therapists should also help parents to navigate the educational system and explore options that may make the transition back to school easier, such as working with the school on a tailored plan or easing the child into school gradually,’ she says. 

‘Perhaps, on reflection, I wasn’t clear on what therapy could achieve when I was so close to burnout myself. I may also have talked about the issues we were experiencing with my child, but perhaps the therapist should have steered me towards talking about myself and how I was feeling instead,’ adds Natasha. ‘I was often very distraught on the calls, which probably made it hard for the therapist to support me properly, and perhaps in person rather than online would have been better.’ 

O’Carroll affirms Natasha’s sense that her therapist missed the opportunity to offer listening support. ‘Listening is everything, especially for SEN parents who are so often bombarded with unwarranted advice, when what they need is to be heard and believed,’ says O’Carroll. ‘So many SEN parents have already been harmed by professionals who misunderstood their situation and blamed the way their child is presenting as the result of bad parenting. Accepting help can be hard when you’ve been made to feel like the problem. Every parent of a child with EBSA should have access to therapy, but it must be offered as genuine support and not as a way to “fix” the parent, or as a tickbox to get support to “fix” the child. Therapy should never be framed as a condition for support, or an ultimatum. It must be a safe space.’ 

Seeking support from a therapist is a big step, and it can be difficult to find someone with the skills to help parents coping with EBSA, which is often ‘the tip of the iceberg’, according to O’Carroll. ‘In families with EBSA, parents are often managing very complex family dynamics, their own anxiety about their children’s future, relationship breakdowns, burnout and their own mental health issues, all while fighting for their children’s needs to be met in every domain of their lives.’

Natasha, parent

Allowing emotions 

O’Carroll’s own child developed such extreme anxiety before and during school that this prompted O’Carroll to seek therapy herself. Initially she tried talk therapy and CBT but felt she needed a more embodied approach. ‘I needed therapy to help me regulate my own emotions, to understand why it was so hard for me and to accept that it wasn’t my fault. I needed someone to validate how exhausted, broken, resentful and snappy I had become because of the daily battles,’ she says. 

What most helped O’Carroll was body/somatic psychotherapy. ‘It helped me focus on tracking and allowing my emotions in my body, rewiring past trauma and helping process my emotions rather than suppressing them,’ she explains. ‘This has made me a much calmer, more empathetic parent who is better equipped to handle the intense emotions that come with EBSA and SEN parenting.’ 

One of the most helpful elements of therapy for O’Carroll was practising how to sit with and allow emotions over and over again in the presence of a safe person. ‘This helped me learn how to do it on my own, and to teach my children too – everything I learned in therapy I can model for my child,’ she says. ‘We talk about emotions, how they feel in the body and how they show up. When she becomes anxious I use the strategies I’ve learned to stay calm, which works especially well because people pick up on our emotional state through mirror neurons. When we can remain regulated, our children can borrow our calm. Because I am more regulated my daughter is too, which has led to better school attendance.’ 

Therapists don’t necessarily have to be children and young people specialists or experts in EBSA to provide impactful support for families affected by it, but O’Carroll emphasises the importance of neurodiversity-affirming support from therapists dealing with EBSA. ‘Recognising that neurodivergent brains process the world differently and that school may not be the right fit for every child, and that the parents may need support here too is key,’ she says. ‘Neurodiversity is heritable so the chances are one of the parents will also be neurodivergent.’ 

Holmes agrees that supporting children or their families dealing with EBSA doesn’t necessarily require specialist training but rather a commitment to the essence of therapy. ‘Any reading you do around school attendance is just part of keeping up to speed with the world around you, but I think any focus on specialist training can mean you start taking on other people’s agendas, and that can be dangerous,’ she says. ‘The most important thing is to stick to what counselling is about, which is trying to reduce psychological distress – that is where the evidence base is – through process and goals, and thinking about what the person wants. It’s that bespoke intervention that keeps the individual absolutely central.’ 

Shaping the future 

No one can predict the future of education – the pandemic underlined that – but it’s evident that schools must adapt to respond to the rise of EBSA and persistent absenteeism. Joss is optimistic about the future but unequivocal about the fact that funding is required to tackle the issue effectively. ‘Schools are evolving to support children’s mental health, with more focus on creating safe, regulated environments such as sensory rooms and quiet spaces,’ she says. ‘However, the issue is funding – anxiety often stems from underlying issues, such as social, academic or family-related stress, and needs to be addressed holistically. Schools need much more financial support and training for staff to better manage anxiety and neurodivergence.’ 

The pressure on schools to focus on attendance must also be addressed, adds Holmes. ‘Schools can be a little too quick to get a child off the roll and get parents to home educate. Personally I think there should be more robust safeguards to get a child off the roll,’ she says. ‘I have been in schools where the senior leadership team have practically put a piece of paper into the hands of a parent whose child is not attending school, whether that’s because of SEND needs that can’t be met or because the resources aren’t there – and if they can get them off the roll then that non-attendance data will disappear. That’s not down to schools having bad management but the sheer pressure upon them from Ofsted in terms of attendance.’ 

Above all, families dealing with EBSA need a response from schools, therapists and wider society based on compassion, not blame. ‘Parents don’t cause EBSA,’ adds O’Carroll. ‘Our children’s nervous systems are responding to an environment that doesn’t meet their needs, and ultimately it is that environment that needs to change. Not the parents, and certainly not our children.’ 

* Names and identifiable details have been changed. 

Saskia Joss