How do you help a student who becomes nauseous and has panic attacks whenever they set foot near their school? I once worked with a young person for whom this was the case. She was unable to leave her house to go anywhere, even to visit her grandparents.

I’ve been an educational psychologist for over 30 years, specialising in autism. In the past decade, I’ve seen a steep rise in casework around supporting students with emotionally based school avoidance (EBSA). This shift is reflected in the latest Department for Education figures showing an increase in severe absence among students with education, health and care plans (EHCPs).

Some of these students, like the girl mentioned above, might struggle to attend school at all. Others have a history of periods of sporadic attendance. They may spend the last days or weeks of a school holiday highly anxious about the beginning of a new term, and then not manage to transition back.

What is true for all of them is that, as educational psychologist Meg Fairclough puts it, it’s a matter of “can’t, not won’t”. So what do teachers need to understand about EBSA? And what support can they offer to help get students back into school?

What causes EBSA?

EBSA is an umbrella term used to describe children and young people who have severe difficulty in attending school, due to emotional or mental health needs. It is often a particular problem for autistic students.

Triggers for EBSA range from sensory overload and anxiety about tasks to social relationships with peers becoming more complex as students get older, and difficulty transitioning to a new class.

However, for many autistic students, school isn’t a place where they can be themselves, and this makes it challenging for teachers to get to the bottom of what might be causing their problems with attendance.

It may be tempting to sit down with the individual and ask open-ended questions, such as “what’s difficult about coming into school?”, but these can be very challenging for autistic students to answer. Similarly, questions that ask students to predict solutions, such as “how would you feel if we arranged X for you?” are also tricky because autistic children and young people often cannot imagine something they have no experience of.

Instead, asking something like “what hasn’t worked?” can be an easier way to start the conversation. It can also be useful to observe changes in behaviour that may be early warning signs of EBSA, and explore these patterns as a way of identifying where the difficulties lie.

For example, are there certain lessons where time-out cards are always used? Are there always difficulties around transitions or at certain times of day? Have teachers noticed reduced communication, less engagement in learning or changes in friendship patterns?

An educational psychologist can help schools to make sense of possible causes, using different tools and techniques to elicit pupil voice and explore belonging, as well as assessing children for additional needs that may not have been identified, such as processing challenges.

Some schools have also found EBSA risk profiles helpful to ensure preventative rather than reactive approaches.

What to do when EBSA is entrenched

In cases where EBSA becomes more entrenched, rather than just trying to eliminate obstacles, it is useful to consider what might draw pupils back in. When children are so anxious that they cannot attend school for weeks and months, building resilience can only happen once they are in a more positive mental space.

For example, if you know that students enjoy particular lessons or activities, could they start by coming in just for these sessions?

Some creative thought might be needed here. I once worked with a student who struggled to attend school or leave the resource hub, and we ended up setting up a pseudo mini-enterprise for him. He liked the office staff and began researching and ordering the stationery supplies for the school. He enjoyed it, learned from it and actually ended up saving the school money. He had a purpose and reason to be in school. For others, it’s been guitar lessons, working out with a fitness coach or showcasing their animation skills in assembly.

Schools must find ways to help all autistic pupils feel like they are listened to and valued. Embedding personal interests into the day and making sure there is someone in school who “gets” them can trigger a strong sense of security.

On top of this, teachers need to recognise that overcoming EBSA is an ongoing process.

Psychologists have recently adapted James Prochaska and Carlo DiClemente’s “cycle of change” model to support EBSA. This model acknowledges that young people need to be aware of their readiness to change and understand that relapses can occur.

Each positive step should be celebrated. A student who comes into school at 4pm for half an hour to chat to a teacher or see a friend has achieved something. A student who attends a school trip is making progress.

It doesn’t follow that they are then ready to join lessons or, conversely, that failure to repeat the achievement the next day is an indicator that progress isn’t going to stick.

Whole-school approaches

Alongside individual interventions, we need to think about systemic change.

Making school a place where autistic pupils feel like they belong might involve introducing a more flexible curriculum that feels relevant to pupils; carrying out sensory audits and making sure you’re offering autism-friendly environments; providing more certainty and structure in daily routines; making autism training accessible to all staff; and adapting lessons for students who need more processing time.

Schools may also need to look at whether their resourced provision offers sufficient opportunities for contact with friends in mainstream classes, and evaluate how inclusive their enrichment and extracurricular offer is for students with special educational needs and disabilities.

There are various toolkits, as well as postgraduate-level training courses in autism, that can help schools to refine their whole-school approach.

The value of small gestures

Getting children back into school is a team effort.

Schools can help by ensuring that there is a consistent team around the child; planning “meet and greets”; getting plans in place should a key person be absent or unavailable; and providing “scripts” to help students answer questions from peers about where they have been or why they have to leave early.

Most importantly, however, students need to feel part of the solution - not that it’s something being done to them. To return to the girl I mentioned at the beginning of this article, we realised we could tap into her love of roller skating, which she couldn’t really do that well on the uneven ground in her back garden.

We tried roller skating in the street, every week getting a little closer to school - luckily, only a few streets away.

Once this was established, we put a plan in place to restart attendance. We encouraged her to skate around the school grounds at a quiet time, meet the headteacher and then transition into the building. She had the support of a nominated friend at breaktimes, an alternative place to eat lunch and zero judgement if she was late or had a setback.

I’m now pleased to say she attends full-time.

She had the support of all her teachers, but one of the best things the school did was to create a dedicated space for her to put her pink rollerskates when she transitioned into the building. It was a simple but incredibly meaningful action that signified there was a place in school for her.

Often it’s the repetition of small gestures like this one that convince children that we know them, we care about them and that they belong.

Dr Sue Sheppard is an educational psychologist and module leader on Real Training’s autism courses