Emotional-based school avoidance is on the increase. The latest Government statistics show that the percentage of ‘persistent absentees’ (missing 50% of schooling) has increased every year from 2015/2016 to 2020/2021. In primary schools, there was a 0.4% increase to 28,314 absentees. In secondary schools, a 0.6% increase to 46,717. This is a total of 75,031 persistent absentees during 2020/211. Furthermore, persistent absence increases from year 5 and 6 (4.8%) at primary school and peaks in year 11 (14.3%) at secondary school2. SEND pupils account for 12% of all pupils in England and 20% of all persistent absences.  In Autumn 2020, unclassified SEND provision, Social emotional mental health (SEMH), Autism (ASD) and moderate learning difficulties were the largest SEND-related reasons for absences.

Children that can’t manage to go to school, due to anxiety-driven reasons, are often called ‘school refusers’. This term is problematic though. It suggests that school pupils make a choice about not attending school. Often, many children feel unable to tolerate school, resulting in persistent absence from school. The phrase, ‘Emotional-Based School Avoidance,’ or anxiety-based absence has been adopted by some educationalists and clinicians as a more specific term. Campaign groups such as Square Peg prefer “barriers to school attendance.” 

Why some children cannot tolerate school

There are a myriad of reasons why children cannot tolerate school. Thambirajah et al (2008)3 separated the reasons into three categories:

  • School factors: bullying, transition to secondary school/starting a new school, difficulty managing certain subjects- PE/reading in class, struggling to understand core subjects, learning difficulties (including undiagnosed) and poor SEND provision.
  • Child factors: separation anxiety, fear of failure, poor self-confidence, peer anxiety, fear of parental desertion, fear of parental well being and co-dependency on parents.
  • Family factors: family bereavement, family transitions, parental over-involvement, mental/physical health of parents and under-involvement/absence of parents. 

School avoidance can become a coping strategy to avoid perceived negative stresses associated with school.  Pupils can feel that they can’t cope with school, further alienating them, leading to avoidance and ultimately partial or complete withdrawal. 

Thambirajah et al, (2008)3 suggests that there is a tipping-point when pupils begin withdrawing from school:

“School refusal occurs when stress exceeds support, when risks are greater than resilience and when ‘pull’ factors that promote school non-attendance overcome the ‘push’ factors that encourage attendance”

For some children, internal school issues can cause anxiety, for other children external factors such as family difficulties can compound anxiety. 

Anxiety and school avoidance

Anxiety is the main characteristic associated with emotional-based school avoidance. Adolescence in particular is associated with a certain degree of anxiety, linked to forming identities, navigating friendships, family life and school pressures. However heightened anxiety can adversely affect daily living within the school day. Pupils might be worried about many issues including:

  • finding school work difficult and comparing themselves to peers (feeling ‘stupid’)
  • friendship difficulties and feeling like they don’t ‘fit in’
  • experiencing or witnessing bullying 
  • family issues: child carer responsibilities
  • other family life dynamics 

Once a pupil starts to associate anxiety around school, they might feel overwhelmed, experiencing accompanying physiological symptoms. Physiological symptoms can include: headaches, sweating,nausea, vomiting, shaking and stomach aches. To escape anxiety and physiological symptoms, pupils may experience an overwhelming desire to stay at home. Home becomes the deferred ‘safe place.’ 

Campaign group, Square Peg asked some school avoiders to describe how they felt as ‘persistent absentees’ from school, these were some responses4:

  • School is a lonely place, full of self-doubt, guilt & shame
  • Raw fear 
  • Anxiety is an uncontrollable, wild, savage beast that prowls beside me, taking me hostage
  • Anxiety inflicts terror and prevents a normal existence

SEND and school avoidance

SEND is an umbrella term for special educational needs and disabilities and can include the following:

  • dyslexia, dyscalculia and dyspraxia.
  • attention Deficit Hyperactivity Disorder (ADHD) and Autistic spectrum conditions (ASD)
  • social, emotional and mental health needs (SEMH)
  • complex developmental trauma 

A recent survey by Not Fine In School asked 1,666 parents why their children avoided going to school, these were the results5:

  • 90% children had diagnosed/suspected SEND 
  • 73% parents cited inadequate school SEND support
  • 70% children had social anxiety/friendship issues

For children with sensory needs, schools can be an overwhelming sensory experience, with daily ‘triggers’ around tests, loud classrooms, corridors, toileting, cafeterias and social time. 

Studies have shown that pupils with autism, alongside sensory needs may struggle with the following in classrooms, making school work challenging6:

  • context blindness and impaired executive functioning
  • limited theory of mind
  • challenges processing verbal instructions
  • hyper-fixation on detail and literal interpretation

The role of schools and families 

Some SEND pupils have an ‘education and health care plan’ (EHCP), a legally-binding document detailing a child’s needs. All EHCP’s are subject to annual reviews and parents, children and school SEND teams are in regular contact with each other. SEND pupils without EHCP can still receive support from SEND and pastoral support teams. SEND pupils and pupils with anxiety may have access to the following support:

  • emotional Literacy Support Assistant (ELSA)  interventions classes (1:1 and group based)
  • pastoral support or designated key-worker
  • meet n’ greet before the school day, flexible start-time or reduced timetable 
  • supervised, safe place to go at break and lunchtimes 
  • peer buddy/mentor (possibly an older, trained pupil)
  • access to ‘time-out’ card if feeling overwhelmed
  • forest school or art/drama/LEGO therapy

Families can support with the following:

  • contact your child’s school as early as possible
  • reassure and acknowledge your child’s experiences
  • talk to your child and try to ‘pin-down’ stresses
  • design a daily routine and encourage coping strategies
  • recognise and praise small achievements

The role of professional therapeutic support 

Accessing professional therapeutic support at any stage of school avoidance can help children and teenagers. In some cases, it may be prudent to carry out cognitive and neurological assessments to diagnose learning difficulties such as dyslexia or neurological conditions such as autism (ASD.) 

For some children, the following therapies may help:

  • Cognitive behavioural therapy (CBT)– identifying and modulating anxious thoughts and behaviour
  • Behavioural therapy– for school phobia- gradual exposure therapy (to school)
  • Eye movement desensitisation and reprocessing (EMDR) – to help process any underlying traumatic events which may be relating to the school refusal
  • Consolidated psychoeducation sessions can help the child understand the nature and reaction of their fear of school.

Some children with the added collective support of families, school and clinical expertise will manage a phased return to school. Others will struggle to return to school indefinitely. 

Alternatives to mainstream schools

On occasion, even with targeted, collaborative support, some children can’t return to mainstream school. Parents may decide to look at alternative school or home schooling options such as:

  • Montessori Schools (child-directed learning)-Maria Montessori
  • Steiner Schools (holistic learning)- Rudolf Steiner
  • Summerhill school (free range pedagogy)- Alexander Sutherland Neill
  • State special schools (usually EHCP pupils only)
  • Elective home education (which can be facilitated by parents, online or in-person tutors, and home school groups) 

If children are home-schooled, there is no obligation to follow The National Curriculum. Local Councils may make an informal enquiry to check children are gaining a suitable education at home. They have the power to serve a school attendance order though, if they deem it necessary that a child needs to be taught at school. Primary school and Secondary school children can access home online learning if desired, for free or for a fee. 

Older teenagers can follow online national curriculum Key stage 4 GCSE’s or iGCSE’s. These are run by private online schools and pupils sit exams as external candidates.  

The Purple House Clinic

At Purple House Clinic, we can offer expert, psychological support to parents and children at the early or later stages of emotional-based school avoidance. Our services include specialist developmental assessments (e.g. for autism or adhd), assessments for specific learning difficulties (e.g. dyslexia) and psychological therapy (including CBT and EMDR).



1 https://explore-education-statistics.service.gov.uk/find-statistics/pupil-absence-in-schools-in-england

2 https://www.centreforsocialjustice.org.uk/wp-content/uploads/2022/01/CSJ-Lost_but_not_forgotten-2.pdf

3 Thambirajah, M., Grandison, K., De-Hayes, L. (2008) Understanding school refusal: a handbook for professionals in education, health and social care, Jessica Kingley Publishers: London (p33)


5Not Fine In School surveyed 1,666 parents in 2018. https://notfineinschool.co.uk/

6 Ozsivadjian, A. & Knott, F. (2016) Anxiety problems in young people with autism spectrum disorder: a case series Clin Child Psychol Psychiatry. 2011 Apr;16(2):203-14


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