My Child Won’t Go to School… What’s Really Going On? (EBSNA Explained)

Dr Marianne Trent (: 00:00

I've been thinking a lot about the phrase school refusal, because if I'm honest, it's one of those terms that never quite sits right with me. Because when we say a child is refusing school, it sounds like willful defiance, like something intentional. But in my experience as a clinical psychologist, that's very rarely the case. In this episode, I'm delighted to be rejoined by Dr. Adam McCartney, a qualified educational and child psychologist. And together we're thinking about what's often called emotional based school avoidance, EBSA or EBSNA. It's a fascinating insight into children, schools, and parents. And stay tuned to learn what the most common age is for school refusal. The answer might just surprise you. Hi, welcome along to Psychology Actually. I am Dr. Marianne Trent. I'm delighted to reintroduce you to the wonderful Dr. Adam McCartney, who is a qualified education and child and community psychologist.

(: 01:03

Hello again, Adam.

Dr Adam McCartney (: 01:05

Hello. It's great to be back with you, Marianne.

Dr Marianne Trent (: 01:08

So nice to have you be back. And we've been speaking about, actually, it'd be really helpful to think about an episode for what's called emotional-based school avoidance, sometimes called EBSA. This seems to be something that really is a very emerging and pressing issue for so many schools and children and young people right now. Can you tell us what is EBSA?

Dr Adam McCartney (: 01:36

It's essentially where children feel they are unable to attend schools simply due to the level of stress, anxiety, or emotional demand they feel from entering the education environment. I should stress as well. There's also another term, it's very similar, but slightly nuanced different EBSNA and the NA stands for non-attendance. And the reason that exists is the complexity of this topic is often met with judgement in one direction or the other. And NA is trying to say that we're not looking at the child as being judged. So I think your viewers will appreciate that there's professionals out there who are always trying to remove the judgement factor on young people.

Dr Marianne Trent (: 02:26

Yeah. And thank you for introducing me to the term EBSNA, because I wasn't aware of that, and I will start to refer to it as that in future, because I think language matters, but also this child and young person, they're already having a really hard time, right? And so how we're talking about this issue, both internally as a school, as a parent, as an education provider, but also to the child, that really matters,

Dr Adam McCartney (: 02:56

Doesn't it? Yeah, it does. Children, especially those in secondary school, are very attuned to feelings of judgement , feelings of shame. Regardless of their developmental journey, it's part of growing up. Our teenage years are so heavily ingrained with forming our identities and how we relate to the education system is a huge part of that identity formation. And in the last 10 to 15 years, it has taken a drastic turn, and we are seeing increasing numbers of EBSNA on EBSA, but we're also seeing generally just students not being fulfilled by education anymore, or not seeing the purpose of it in the same way that you or I might have seen in our days. I remember my own educational journey. The idea of not sitting my GCSEs was like, it just was unthinkable, but now students and young people are much more aware of opportunities, particularly online, about how to make money that isn't necessarily linked to a sound and quality education.

(: 04:09

So we need to rethink this issue about what sort of demands we're placing on the young people today.

Dr Marianne Trent (: 04:16

Yeah. I'm a big fan of Makita Oliver's podcast with Lily Annon. I'm taking a while to actually listen to the old episodes, so I'm still in the Lily era. And it's actually quite rare that neither one of them say that they've got really a GCSE between them and they're in their early 40s. But like you said, that isn't super common for someone who's kind of in their 40s because attendance was so kind of regimented and getting yourself to these exams like come hell or high water, you are going. And it isn't so uncommon these days, I agree.

Dr Adam McCartney (: 04:52

Yeah. And previously the two most important skill sets were literacy and numeracy, but now we've got technologically literate skills and children can learn them passively or they can learn them actively, but they don't always need the education system to do that. How many young people have we seen learn coding on their own? I can't count the number of assessments I've done. It's like, "Oh, you can't string a sentence together, but it can code." These types of skillsets, it's a different world these young people live in. And what's vital for us as not only adults, but professionals working with them is that we've got to appreciate that their value systems and their priorities are going to be different to what we experienced.

Dr Marianne Trent (: 05:41

It's very difficult then as a parent who's potentially getting letters saying your child's attendance is below the levels of expectation. And I think, am I right in saying that parents can be fined for that and can even face prosecution when actually, if you firmly believe that the education system is not a great fit for your child, and yet you don't have the capacity to be able to home educate them yourselves, you really must be feeling caught between a rock and a hard place.

Dr Adam McCartney (: 06:12

You really must be. And I think the threshold for schools to start being worried about a child's attendance is something like 93% if it drops below that. It used to be as low as 82%, but I think the benchmarks have changed. And what has happened with the punitive side, you just mentioned parents being fined, different local authorities and different schools take a different approach to that. Some go very much down that route and parents equally will push back on that through whatever legal channels they have. But what that does is it causes distrust between the families and the schools and the legal frameworks cannot be punitive. They must be relational. They must be community based because one, those parents will just leave that school and move on somewhere else until they can get that relationship. But being that draconian approach to school is not congested to long-term investment in young people.

(: 07:21

They build up negative associations and they just start to resent the system generally and it's avoidable and we've got to work with the children. And of the cases I've worked with in terms of EBSNA, when the child is on the verge of not attending school, let's say they've got still got in the 70% attendance rate, you can actually salvage that. The second they're at home full time, the work that has to go in is exponentially higher. It's not cost effective at all and the gains are marginal. It took me, I remember one case, it took me like two years to get them back into school for one day. And then sadly, they transitioned to secondary school and they were back to where they were. They stopped coming in again. It just shows you the sensitivity of these cases. Yeah,

Dr Marianne Trent (: 08:19

It does. And I remember it well from CAMS actually. At a certain point in days gone by, there would be an automatic referral to CAMS at a certain level of threshold of attendance. I have to confess, I'm not sure if that still happens because maybe attendance is impacted upon more globally currently, but then having to really work with the child, the young person and the teachers to kind of put in place a bespoke system really to optimally support this child or young person's attendance, not easy at all.

Dr Adam McCartney (: 08:52

No, and I feel like I'm the bear of bad news at all times in this conversation because it doesn't look like it's going to get any better in the short term. For those who follow school or education based news, every day there's another academy saying they're going to have to make redundancies due to budget cuts and that's the world over there. The resources available to schools is diminishing. I know that the current government is talking about changing that and I hope to God they can, but it is diminishing, which means that there's the teachers who are expected to do more holding. The TAs or the teaching assistants are expected to do more pastoral reactive work and everybody essentially is expected to do more with less. And when you've got someone who's got a complex or sensitive emotional need that requires patients being, holding for just for long periods of time, and then the adult expected to do that has a high cognitive load, is under pressure from standards and practises, has got their head teacher asking to do six or seven different roles.

(: 10:06

It's not really ideal situation, is it?

Dr Marianne Trent (: 10:09

No, it really isn't. It really isn't. And I was talking to my youngest child over dinner yesterday and he was saying, "Oh, it'd be great if I didn't have to go to school because I could just be here all the time." And I actually said to him, "I kind of like the break when you're at school though. I love being your mom, but I don't like having to constantly think, is he okay?" And he has migraines and so we have to keep him hydrated all the time. And so actually his attendance is not amazing because he gets these migraines. And I was like, "I enjoy not having you there." And actually, as I connect to that idea now, if I'm trying to operate a clinic or do my work from home when they're here, I'm just biologically different. I'm a slightly more like less relaxed state and they're on my mind and it is hard.

(: 11:04

So I think any parent who has a child who's kind of struggling to get to school has got that mental load of having their child there when actually they may not really want them there, but they're allowing them to be there for their own child's wellbeing, but then it impacts on their ability to get their work or their tasks or just a little bit of quiet time where they can support their own wellbeing is so important.

Dr Adam McCartney (: 11:31

Yeah, it is so important. I always say that teachers are the third parent and they are essentially not only the offering that respite care that you're talking about, but they are taking that emotional load that a parent is expected to give and they are meeting that child in a nurturing boundaried way so that they can support the social development into a fully functioning adult who is happy. That's the ideal in a way. And the important thing we got to remember as parents is that in the modern day, I forgive you for believing that you're expected to do everything, but it's not realistic. And it's not how it used to be. Child rearing was always community based. You always had people around you. I remember talking to mothers and they always said the first thing that comes up for a new mother is look after the mother.

(: 12:29

They don't say look after the father. They do now in terms of pop culture, but they used to be look after the mother because the sanity of the parents automatically supports the sanity of the child. But if you've got a high demand environment and low resources, whether it's in your home or at school, everybody suffers, everybody then places it within child because it's the loudest voice, so to speak, but everybody's resilience is low. Child, teachers, parents. Essentially, we got to move back to a community-based way of approaching education, approaching home life, and getting out of the silo and martyrdom type stuff that we've done. I wrote a post about a year ago around education's built on goodwill. It's built on the fact that teachers will take that extra 20 minutes in after school to do some admin, or they will mark their books at home.

(: 13:31

Really, that needs to be built into the school day. We look at the ... In Finland, the Finnish system, the teacher delivers the main core aspects of the curriculum and then spends the afternoon planning every single day. And they have a team around them who are competent in delivering their plans. And some schools might say they do this, but from what I understand, it's a very robust system over there.

Dr Marianne Trent (: 13:58

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(: 14:52

Now back to the show. Can you tell us what the most common age tends to be for children or young people starting to experience more signs of emotional based school non-attendance?

Dr Adam McCartney (: 15:04

We naturally think that it would be GCSEs because that is the test time, a lot of stress for a lot of students, but it's actually in key stage three and that's year seven through the year nine. We usually get a grace period in year seven of students being able to tolerate a new environment, getting a bit used to the transition, and then they make a decision emotionally whether they like that transition or not. And usually by the end of year seven, beginning of year eight, we will start to see these rises. Interestingly, the EBSNA also matches trends and exclusion. So we know a key stage three, exclusions rise rapidly, particularly in the last 14 years. And we think that's got to do with the increase in academic demand, but also the moving from primary school to secondary school where behaviour systems are much more rigid and expectations are much more in line with academic achievement.

Dr Marianne Trent (: 16:09

That makes so much sense. And actually having my own eldest child be in currently in year eight, you see them join year seven and have a lot of energy and enthusiasm and excitement for, "I've got more than one classroom now and I've got all these teachers to kind of work with. " And then I saw it kind of dip off that enthusiasm and then it becomes real life. And I wonder if it's something about not feeling as emotionally held as they did by their previous primary school teachers, which often is just one or two teachers.

Dr Adam McCartney (: 16:42

Yeah, exactly. And we just spoke about the viewing your teacher as the third parent, and it is having that relationship with at least one or two teachers at secondary school. You move between classes, you may have five classes in a day. My own school, I think we had up to eight different teachers in a day, and that can be a blessing and a curse those many transitions. The thing is, if you don't like your teacher, you only have to suck them up for like 30 or 40 minutes. I'm actually developing some training with a friend and colleague, Matt Robson, who went through this in his journey whereby he didn't have a great educational experience, but it was the relationship with his maths teacher that got him through it. And the story he told me was as he was leaving the classroom after a bad day, the math teacher called him back and said, "What are we going to do?

(: 17:38

How are we going to get you through this? " And what that does is one adult seeing the child and saying, "I care about you. I'm going to do something for you. I'm going to get alongside you. " And that's vital. That is absolutely vital. I remember even doing A levels and I was quite naturally good at biology. It was my favourite subject. And my mock exams, I got a high B and I was okay with that. And my teacher just said, "That's not good enough for you. " And what he was saying was, "You're capable of more..." And he's just telling me, "I believe in you. " And it's that belief that spurred me on to go and study and really work hard at it. And it was because I liked him, he liked me that then that dopamine I was telling you about, I was in the optimal level to pursue the learning journey a bit further.

Dr Marianne Trent (: 18:32

I love that. And it's the idea that we spoke about before about emotionally collecting the children and young people that you're working with if you're working in a school and actually that sounds like you were emotionally collected, you were held in mind, which then made you want to work really hard, not just for yourself, but for that relationship that was really important to you. And that is a really important consideration, I think.

Dr Adam McCartney (: 18:59

Absolutely it is.

Dr Marianne Trent (: 19:01

I'm aware that locally there are kind of education attendance buses that come and round the children up and drag them back into school. And sometimes as a parent, you might think that's the only thing you can do is to kind of try and facilitate getting your child on this bus or bundling them yourself into the car and getting them to school. There's a whole lot of distress, I think, for the child and the parent there. Is there anything else that a parent can do if they're struggling with a child or young person who's got signs or symptoms of EBSNA?

Dr Adam McCartney (: 19:33

Yeah. I mean, just hearing you talk about these buses, it's so distressing and upsetting. And what's the most vital thing, again, it's coming back to community-based relationships. When you are that parent, it is vital that you can form some sort of relationship with the school. Quite often there'll be one person of a voice of contact and it's say, usually it's the same or pastoral lead and they are really useful in terms of helping you understand what's going on inside the school. And that's a vital relationship to have. But if I was a parent in that situation, I would be asking questions about which teacher does my child like? And how can my child use that relationship to enjoy coming into school? And when I work with schools, I often talk about what does their pastoral system look like? And in my mind, I'm thinking about secondary schools.

(: 20:32

They tend to have their pastoral systems as there's rooms that they go into and they go and meet the pastoral lead and you'll talk to them. However, I feel like it needs to be more threaded throughout the school environment. I had a long discussion with actually a head teacher the other day, and we both came to the conclusion that the core subject leads need to have pastoral training. That is your English and your math because you spend the most time with your English and your math teacher. So if you can have some sort of pastoral support coming from them every single day, that's strip feeding and we know little and often works better. So again, going back to what parents can do, it's asking, "Does my child like the math teacher? Does my child like their English teacher? If not, how do we nurture that relationship?" And it's those types of conversations that are really vital.

(: 21:27

They don't feel like you won't get a turnaround overnight and it's not some sort of discreet intervention like going in and doing some ELSA work, emotionally literacy work. This is much more, it's more nuanced, but it's much more powerful.

Dr Marianne Trent (: 21:46

Okay. So a really good question for a parent then of a prospective primary school student or a secondary school student, if they're going to an open evening, would be to check out and to ask, what is your pastoral care like?

Dr Adam McCartney (: 22:05

Yeah, that is a really good question and have your follow-up questions. Is it just a single team? Is it just a couple of people or is there a relational policy throughout the entire school? If a school's really open and honest, they might share that relational policy with you.

Dr Marianne Trent (: 22:22

What would a relational policy look like? Because I've never heard of that term before from a school setting.

Dr Adam McCartney (: 22:27

They're not super common. When I was working in the LA, we had a huge project and it was fabulous. I loved it where we would help schools set up their relational policies. And it's essentially to remove the behavioural policy and reframe everything in a positive light rather than causing consequences. So for example, one school that I supported with was when a child was escalating through the challenging behaviour stuff, rather than going down the punitive route, it was which adults then need to get alongside that. So for example, in the first instance, it might be spending five extra minutes with their English teacher at lunchtime or something like that. Then once it got to a certain threshold, each school will have a different set of needs. So I don't want to be too specific, but once it got to a certain threshold, it was including the SENCO.

(: 23:21

And in this particular school, the SENCO, the special needs coordinator, was on the senior leadership team. So that was a huge impact. It meant that they had a better client within the system. And then it was your yearheads and things like that would get alongside the child. So it was about when to introduce heavier means of pastoral support and bring in that expertise.

Dr Marianne Trent (: 23:45

Okay. So it almost sounds like the key aspect then for EBSNA is to think about externalising the problem from the child so that the child is not the problem, but how can we really strive to help support this child to optimally engage in their education and for a parent to not be thinking about it as us versus them with school, that actually we're all part of a team. It sort of reminds me a little bit of if parents separate and then there becomes a stepparent, how can we just support everybody to love and support and care for this for this child without starting any wars, without pitting people against each other? How can we just help this child to thrive and not feel like we're like on opposite sides and not having the child feel like they're at the centre of the problem and maybe being open to their ideas as well.

(: 24:41

And I love the idea of thinking about which staff member do you actually have that rapport with that we could then use as part of the intervention to help you to thrive. Is that right?

Dr Adam McCartney (: 24:55

Have

Dr Marianne Trent (: 24:55

I understood that

Dr Adam McCartney (: 24:56

Right? Absolutely. And I would say it does need to be the same staff member each time because that leads to burnout. You need to move that pastoral support around the team. And you're absolutely right. It is avoiding that sort of us versus them mentality. One, once your child clocks on that you are in that zone, they're going to know that they can get out the door. They need to know that you view education positively and that it is an essential thing to have in one's life. If a child doesn't believe that you have that, then you're on an uphill battle. And the second thing is you got to keep in mind the emotions you're feeling about the frustration. Your child's probably also feeling just as intense, if not more intense. And like you said, moving away from that within child blame, so to speak, and moving towards that relationship mentality of who do I need to speak with?

(: 25:56

Who is in a good place to lighten the load? And that is your role as a parent. It is not about being the warrior for your child. In my experience, it often doesn't lead to good outcomes. You might get an EHCP or you might get an education provision outside of the school, but ultimately if your original goal was to have a mainstream, healthy journey, that doesn't work. It's relationships are always the best key.

Dr Marianne Trent (: 26:27

They are. And as you were talking, I was just thinking, well, how do I do this as a parent? So people might be like, "Well, Marianne's a qualified clinical psychologist. She's a mother of two. She's got one in primary, one in secondary." I bet she's really attached and really attuned, and I bet she's doing some gold standard parenting. And I was like, "Yeah, that's not really the case." But what I do do, so I am able to be in a position where most of the time I will pick my youngest child up from school and take him there. So we've got that time where we can kind of check in about the day before it happens and the day at the end. And I really do try to make that a time where I'm not on my phone or I'm just with him and we can kind of chat that through.

(: 27:11

But also, I know that's a luxury that many working parents don't have at all, so I'm aware of that. But also, I still find it really important to every day get around the dining table and eat together. We do not allow anyone to be eating in their rooms by themselves in our house. It's just not something we do, not for dinner anyway. My husband can occasionally be found in bed eating bowls of chilli on a Saturday lunchtime and I'm like, "That is gross. Stop it. Horrible." But as a rule, certainly the kids don't tend to eat in their rooms because it's really important for us that we sit together and we talk about any issues that have come up. So the school had started something that might seemingly on the surface look like quite a small thing yesterday. They've got a new bell and it sounds very different, it's electronic, but they also picked the same day to do a lockdown process using that same bell.

(: 28:09

So then every time the bell went off for the rest of the day, the kids thought in primary they were going down into lockdown because they haven't heard it enough. But being able to talk with my son about that on the way home and then also talk through it over dinner really helped me to tune in to any distress that he was having, not trying to fix it in the moment, just having that conversation and that to and fro, but also modelling a bit about my day as well. And that hopefully, I hope they're developing that understanding that we can always have conversation. And really in terms of attuned time, I'm not saying that each child gets loads of time one-to-one with me every day. They don't, but I try to ring fence at least five minutes, which I'm aware makes me look kind of terrible, but that's the minimum that I can do.

(: 29:10

Sometimes that's the only thing I do. But in that five minutes.

Dr Adam McCartney (: 29:16

But in that five minutes, you probably ... I know you haven't realised that when you're speaking there, but what you have done is you validated your son's emotions. You haven't solved it, but just by saying, "What you're feeling is valid, but I'm going to let you sit with it. " And then he kind of goes, "Okay, so this is okay to feel like this. " And then, "Okay, it will pass." It's like that great phrase, "This too shall pass." And sitting with emotions, we talk about a lot in our industry, but sitting with emotions are very important, sitting with the uncomfortableness and learning that it's not going to end your world. It's something that you can't manage. And a big chunk of that is sitting with those emotions Just with someone who can continue. I'm not talking about that containing us and I'm going to make you feel better by saying all the right words.

(: 30:08

I'm going to sit here with you because I like you. That's what you did with your son. It worked by the sounds of it.

Dr Marianne Trent (: 30:15

Yeah. I don't like their behaviour all the time, I have to say, but I always love them and I think that's important as well, isn't it? That even if we're cross with them, we still love the child, but I'm not a big fan of that behaviour right now. But yeah, I do do that, I think.

Dr Adam McCartney (: 30:34

I'm sure you do. I'm sure you do.

Dr Marianne Trent (: 30:38

Thank you so much for your time today, Adam. I would love to know from our audience what questions they've got. We could potentially come back together and discuss planning more episodes as well. So if anyone has got any burning questions about what it's like to work as an ed psych, any problems that you're coming up against with your child or working in a school or how we figure this stuff out as parents or my opinion as a ClinPsych, let us know in the comments. We'd love it if you tagged us on social media too. You can tag us in your stories, you can tag us in your posts. I'm Dr. Marianne Trent everywhere on socials. And Dr. Adam McCartney is on YouTube, on LinkedIn, and on Instagram. There's also his brilliant podcast with his colleague and friend, Dr. Mike, which is called Between Two Psychs.

(: 31:26

Adam, thank you again so much for your time. I thought it was really important that we get together to think about putting an episode out before exams, before SATs, before GCSEs and A levels. So thank you so much for making time for us.

Dr Adam McCartney (: 31:42

Thank you for having me again.

Dr Marianne Trent (: 31:44

Thank you so much to my guest for today. And if you are liking the sound of Ed Psych, please do check out Between Two Psychs podcast. We really would love to know what you think to this episode. And if you've enjoyed this one and you haven't already caught the other one I did with Adam, where we looked at vignettes for what an educational psychologist actually does, I think you'll find that one fascinating too. I know I did, and so many aspects of that have stayed with me. It was in fact my reflections after that episode that invited me to contact Adam and discuss chatting about EBSNA. If you've got any ideas for future episodes, whether they're linked to education or another form of psychology in the way that we live our lives, I would love to hear from you. Please do feel free to pitch me your ideas for episodes via my social media, where I am Dr. Marianne Trent everywhere.

(: 32:35

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(: 33:33

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(: 34:28

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