When children and young people experience challenges with attending school, it’s often described in a variety of terms that can be confusing to families and professionals alike. Two of the most common terms used are ABSA (Anxiety-Based School Avoidance) and EBSA (Emotionally-Based School Avoidance). While they might sound similar, there are important differences between the two that impact how we approach supporting a child, especially from an Occupational Therapy (OT) perspective.

ABSA (Anxiety-Based School Avoidance)

Anxiety-Based School Avoidance (ABSA) refers to situations where a child or young person avoids school due to underlying anxiety. This anxiety can be triggered by a range of factors, including academic pressure, social fears, bullying, or even sensory overload. For some, school becomes an environment associated with overwhelming stress, leading them to avoid attending altogether. In ABSA cases, the root cause is clearly linked to anxiety, and the child may express symptoms such as:

• Panic attacks
• Difficulty sleeping
• Physical complaints like headaches or stomach aches
• Refusing to leave home due to overwhelming fears about school

ABSA tends to be focused on school-specific triggers and is often easier to pinpoint. The child may be anxious about performance, social interactions, or specific events within the school day that trigger their anxiety.

EBSA (Emotionally-Based School Avoidance)

Emotionally-Based School Avoidance (EBSA), on the other hand, is broader in scope. While anxiety is a common factor, EBSA encompasses a wider range of emotional difficulties. The child’s emotional distress may not be solely about school, and can often stem from complex factors both inside and outside of the school environment. These may include:

• Emotional regulation difficulties
• Mental health concerns, such as depression or trauma
• Relationship difficulties at home or in school
• Fear of failure or rejection
• Low self-esteem and confidence

EBSA is not just about avoiding the school environment due to anxiety, it involves a more complex interplay of emotions that may affect other areas of the child’s life. As a result, addressing EBSA often requires a more holistic approach that considers the emotional wellbeing of the child, their family, and their social relationships.

Key Differences Between ABSA and EBSA

While both ABSA and EBSA involve avoiding school, the key differences lie in the nature and scope of the issues behind the avoidance:

1. Focus of the distress: In ABSA, anxiety is the primary driver, whereas in EBSA, the emotional distress can be more complex and multifaceted.
2. Trigger points: ABSA is usually triggered by school-specific issues, such as academic pressure or social interactions, whereas EBSA can be triggered by a broader range of emotional factors, both inside and outside of school.
3. Scope: ABSA tends to be more focused on the school environment, while EBSA might indicate wider emotional and mental health challenges that affect multiple areas of the child’s life.

The Occupational Therapy Perspective

From an Occupational Therapy standpoint, whether the child is experiencing ABSA or EBSA, the focus is on supporting their participation in meaningful daily activities, including school. Occupational Therapists work to address the environmental, emotional, and sensory factors that may be contributing to a child’s school avoidance. Here’s how OT can help in both cases:

Sensory Processing and Regulation

For children with ABSA, sensory processing challenges may often be at the root of their anxiety. Many children with anxiety-based avoidance struggle with sensory overload in the school environment, loud noises, bright lights, crowded spaces, and fast-paced transitions can trigger anxiety. An OT can assess the child’s sensory profile and create a tailored sensory diet to help them manage their reactions to these stressors. This might involve:

• Adjusting the sensory environment (e.g., providing a quieter space, reducing visual stimuli)
• Introducing sensory regulation strategies (e.g., deep pressure activities, calming movement breaks)
• Teaching the child self-regulation techniques to manage their sensory needs in real time

In cases of EBSA, OTs can address emotional regulation challenges by incorporating strategies that help the child manage their feelings of distress. This might include mindfulness activities, movement breaks, or therapeutic play to build emotional resilience and confidence in managing overwhelming feelings.

Emotional Wellbeing and Routine Building

For children with EBSA, emotional regulation is often a core challenge. OTs can help these children develop coping mechanisms to manage emotions that interfere with school attendance. This could involve:

• Gradually building routines that are manageable for the child, such as a structured morning routine that reduces anxiety about transitioning to school
• Supporting the development of emotional literacy, helping the child identify and express their emotions in a constructive way
• Creating a ‘toolbox’ of emotional regulation strategies that the child can use throughout the day, both at home and in school

Family-Centred Approaches

Both ABSA and EBSA require a family-centred approach. OTs work closely with parents and caregivers to support the child’s participation in school by addressing challenges at home. This may involve:

• Helping parents create a supportive home environment that reduces stress around school routines
• Encouraging consistency in strategies used both at home and school, such as shared sensory regulation techniques or morning routines
• Empowering parents with tools and strategies to manage their child’s emotional responses to school

Collaboration with Schools

Effective support for both ABSA and EBSA involves close collaboration with schools. OTs can play a key role in advocating for reasonable adjustments within the school environment to support the child’s needs, such as:

• Flexible attendance schedules for gradual reintegration
• Breaks during the day for sensory or emotional regulation
• Quiet, safe spaces where the child can retreat if they are feeling overwhelmed

In cases of EBSA, OTs may also work on skills such as organisation, attention, and self-regulation to help the child manage the demands of the classroom.

Conclusion

While ABSA and EBSA both involve school avoidance, understanding the root causes of the child’s emotional or sensory difficulties is key to providing the right support. Occupational Therapists play a vital role in helping children develop the skills they need to navigate these challenges, ensuring they can participate meaningfully in school and beyond. By addressing both sensory and emotional regulation needs, OTs can help children overcome school avoidance and thrive in their educational journey.