Anxiety Based School Avoidance
An introduction to Anxiety Based School Avoidance (ABSA)
There are various reasons why students do not attend school or find it hard to attend school. Some students will have low attendance because of illness or truancy, but others can find attending school difficult due to finding this very anxiety provoking.
Although there have been several terms used to describe this group of students, the term used here is Anxiety Based School Avoidance (ABSA). This is different from truancy and other forms of non-attendance because a key aspect of the avoidance stems from significant levels of anxiety.
Students struggling with ABSA can find it very challenging to attend school and some do not attend at all. Others demonstrate sporadic patterns of attendance and some are able to attend successfully with modified timetables and high levels of support. To friends, family and others, the reasons for the anxiety and avoidance can be confusing and baffling and it is not always easy to know how to help or respond. For the young people experiencing anxiety, the feelings can be overwhelming and the young person may feel trapped in a cycle of avoidance and feeling like they cannot cope with school life.
This website has been developed in response to a recognition that many students, parents and professionals would benefit from a greater understanding of Anxiety Based School Avoidance (ABSA) and how it can be managed. Students struggling with ABSA can be supported to make positive progress and with appropriate help, children and young people can learn ways of managing their anxieties.
We hope that this site will help you better understand the nature of ABSA and that it will provide some practical ideas and resources that lead to positive change.
What is Anxiety?
Anxiety is the word we use to describe feelings of worry, panic, fear or uneasiness. These are very natural feelings and all people feel anxiety to some extent. Some situations that may lead to people feeling extra anxious could be:
- Going to the hospital
- Going on a rollercoaster
- Exam time at school
- Bereavement, loss or another emotionally traumatic event
- Going somewhere you would rather not go or doing something that makes you feel uncomfortable
When faced with these situations, it is perfectly normal to experience anxiety and this will affect different people in lots of different ways. For some, they may find it harder to sleep, eat or concentrate. For others, they may find that they just can’t stop themselves thinking and worrying about the situation they fear, this can then get in the way of their day to day life.
When we get anxious, we also experience the physical symptoms of anxiety in our body. We might experience sweating, increased heart rate or butterflies in the stomach. A normal amount of anxiety can be a good thing and even help us to work harder, make changes to our lives and cope with real threats when they are present.
Although anxiety is a normal everyday emotion, all children and young people experience different levels of anxiety. Some cope with situations in more effective ways than others, and for some, anxiety can become a problem and prevent someone from enjoying normal day to day life experiences.
Some children and young people who experience anxiety feel out of control and feel that they are unable to manage their fears. It is important to realise that with support, everyone can learn to better understand and manage their anxiety.
The Fight or Flight Response
Like other animals, humans have evolved ways of ensuring that they stay alive when confronted with dangerous situations such as being attacked. When a person senses a threat, the body releases adrenaline (and some other hormones as well) that activate the body to cope with the threat. This stress response has been really useful for humans, for example if you think about a caveman being attacked by a hungry tiger, the body would prepare him to either run away really quickly (flight) or to stay and fight. In readiness to deal with the threat, these things would happen to the caveman's body:
- There would be an increase in heart rate to pump more blood to the muscles to support the fight or the flight
- His lungs would take in air more quickly to increase oxygen supply in readiness to fight or run
- The pupils in his eyes would get bigger so that he can see better
- The caveman’s digestive systems would be slowed down
All of these bodily changes are automatic. When faced with a real threat, they are really useful in dealing with that threat by running away or standing your ground and fighting. Although this happens when we experience a real threat, your body sometimes finds it hard to tell how real a threat is. Thus, when we are anxious about something, our body can mistakenly automatically go into fight or flight mode (similar to seeing the tiger), when actually there may be no life threatening danger to deal with. This means often when we are anxious, we are usually overestimating the level of threat and without realising it our bodies responds physically to this perceived (and exaggerated) threat or fear.
Everyone experiences Anxiety. Anxiety is completely normal
Everyone experiences anxiety differently, although below is a list of some of the common things that people struggling with anxiety may experience:
- Frequent worrying about events and feelings of unease or panic.
- Physical responses in the body, for example, headache, stomach ache, feeling sick, increased heart rate and feeling low on energy.
- Beliefs and feelings of not being able to cope with something, even though in reality the person often can cope much better than they expect.
- Negative thoughts that pop into the person’s head automatically.
- Difficulties with friendships and feeling anxious when in a group or social situation.
- Thinking about worst-case scenarios happening rather than what is more likely to happen.
- Avoidance of situations that cause anxiety, and this avoidance can make the person feel better temporarily but this can reinforce our anxieties. Avoidance does not solve the anxieties it just puts them to one side temporarily.
- The person may find it difficult to concentrate and pay attention. This can make being at school tough.
- The person may feel down, irritable and negative about themselves.
Experiencing Anxiety is totally normal. It is how we manage the thoughts of anxiety that impacts how we feel and behave.
- Anxiety can be better managed.
- Avoidance is not an effective way of managing your fears and anxieties in the long term.
- Avoidance may offer some temporary relief but it can be dangerous as it can lead to the creation of new habits that can be very difficult to break later on. For example, avoiding school might work initially but every day that is spent avoiding school can actually add to the students anxieties. Long term the student may get behind with school work, friendships could fall away, family conflict can arise, isolation and withdrawal can be experienced and these can all then become new anxieties that the student has to deal with on top of the original fears and anxieties.
UNDERSTAND that Anxiety is normal and that it can be managed.
LEARN how to manage the anxieties.
ACTION, take what you have learnt about anxiety and coping with anxiety and put it into action.
What is School Avoidance?
Anxiety Based School Avoidance (ABSA)
Before reading this section on Anxiety Based School Avoidance (ABSA), please take the time to read the information on anxiety first (above).
School Refusal, School Anxiety and Anxiety Based School Avoidance are all terms that essentially boil down to the same thing, young people missing school as a result of anxiety, fear or other emotional difficulties.
For most young people struggling to attend school due to anxiety, they will be experiencing significant feelings of worry and these will usually be linked to physical symptoms such as feeling sick, having a headache or stomach ache. Young people may deal with their fear of attending school in different ways. There is no definitive list of symptoms or behaviours. School avoidance can extend from the minor to quite extreme types of behaviours. Other than vague and general symptoms of an illness, some other common signs or behaviours may include:
- Anxiety about school, e.g. the classroom, doing work, having lunch, doing PE, walking in the corridors
- Difficulties separating from parents/carers or wanting to be close to someone at home
- Avoidance of other students due to unresolved friendship difficulties or due to anxiety caused by social situations (for example, worrying about being expected to talk in class)
- Difficulties settling to sleep on school nights
- Seeming anxious or agitated on the mornings of school or the night preceding (especially sunday nights or following school holidays)
- Once at school, the young person may complain of feeling sick and try to be sent home/collected
- The young person may promise (and in their heart genuinely mean it at the time) to go 'this afternoon' or 'tomorrow' if they are only allowed to stay at home now
- Some may go through the morning routine quite normally, but are then unable to leave the house or maybe they leave for school but turn back home before getting there
- Some young people may ‘always’ appear to have a reason as to why they cannot attend on a particular day, these reasons could be school or peer related or just because they have the wrong shoes, bad hair, wrong make up or similar
- Flat refusal to get out of bed or to go to school, giving absolutely no reason
- Locking themselves in rooms
- Running off until they feel it is safe to return home (and the pressure to attend has gone)
- Some will gladly take punishment or sanctions as the price of not going to school or appear to show little concern over the consequences of their refusal on their parents (legal or impact on work etc.)
- Some display anger, aggression towards those who try to encourage them to go to school
- Some threaten or act violently or damage property
The more extreme the behaviour, the more important it is that professional advice is immediately sought. Allowing the young person to avoid their fears will not make the problem go away, if anything it will reinforce the fears and lead to a habit that can prove difficult to break later.
Case Study Example : Charlotte
Charlotte has been struggling with attendance at school due to anxiety. After falling out with some of her friends, Charlotte felt very anxious about attending school. These anxious feelings start the night before school and in the mornings when Charlotte is getting ready to leave for school. Charlotte had a range of negative thoughts that she would have automatically and she found it difficult to manage these thoughts. This meant that Charlotte felt anxious and often felt unable to control these feelings and anxieties.
Charlotte found it useful to understand how her thoughts, feelings, physiological changes and behaviours were all connected and linked to each other. With some support, Charlotte completed a version of the ‘anxiety map’, shown below. Click here for a blank copy to complete yourself to help you understand what happens for you when you are anxious.
Charlotte was able to see that her behaviour (avoidance of school) was linked to her thoughts, her feelings and physiological responses. By doing this exercise, Charlotte also learnt how each area affects the others, for example, Charlotte identified that the more anxious she felt, the more her thoughts became negative and the more she felt unable to cope. Charlotte also identified that her avoidance of school increased the negative thoughts and further reinforced ideas about her not coping. Although avoiding school can lead to a temporary sense of relief, it did not help Charlotte to manage her anxieties.
When can Anxiety Based School Avoidance strike?
Struggling to cope with going to school everyday can happen at any time. However, there are some common times when attending school can become more difficult for some young people. These times can include:
- Age 4 to 7, this is when the young person starts school and has to adjust to being away from their parents.
- Age 11 to 12, this is when the young person moves from Primary to Secondary School.
- Age 13 and onwards, this may be when the young person begins to struggle with an emotional or mental health issue such as depression or anxiety. Also around this time, some young people begin to struggle with school related issues, such as bullying (physical or cyber), friendship issues, self esteem, confidence or fear of underachieving to name but a few.
Sometimes it may seem that ABSA rears it head totally out of the blue. However, it is often the case that underlying worries and anxieties have already been around for some time but 'managed' by the young person. It may be that a particular event then acts as the tipping point and suddenly the young person feels overwhelmed and struggles to cope with the emotions or anxieties that were previously contained.
It is important to remember that ABSA is best supported when student's, parents/carers, school staff and other professionals work together. Involvement of health services is often appropriate, particularly when anxiety is having a negative impact on the child/young person's day to day life (e.g. school avoidance). In this situation, it would be appropriate to discuss concerns with a GP and consider whether a referral to the Child and Adolescent Mental Health Service (CAMHS) would be appropriate.