There is no one thing that causes EBSNA. Instead, it’s a complex issue caused by several things happening together – this is sometimes called multi-factorial. Anxiety is a key feature though. A certain level of anxiety is a natural part of growing up so children and young people can learn how to cope with it in everyday life. But sometimes the level of stress for a child or young person gets so big that it cannot be managed by the support that’s available to them. The anxiety builds up to the point where they cannot go to school, or be in lessons. There are many reasons why a child or young person might develop EBSNA, but these are some of the things that might play a part. Issues for your child Issues at home Issues at school Mental health difficulties, such as existing anxiety and depression. Not wanting to be separated from parent carers or other family members (separation anxiety). Difficult relationships with staff or peers/other children. Low self-esteem and confidence. A stressful home life. Bullying. Finding it hard to manage and control their emotions. Major changes at home, such as parents divorcing or separating. Finding school work hard or particular subjects difficult. Sensory difficulties. The death of someone close. Feeling socially isolated. Difficulties with relationships, trusting others and attachment to parents and carers. Being a young carer. Finding the school environment hard to manage, such as sensory difficulties. Finding it hard to manage change. Other family members who have had EBSNA. Exams and tests, the academic demands and pressure to perform well. Having a special educational need or disability. Worry about a parent carer who has a physical or mental health difficulty or conditions. Moving on (transition) –including small moves from lesson to lesson and bigger things, such as starting a new school year. Difficulties accessing learning or making progress at the same rate as other children in their year group. Seeing or experiencing domestic violence or abuse. Not feeling known, understood or listened to. Overuse of gaming, difficulties with social media.   Unable to manage and stick to the school’s behaviour policy. Community issues, such as gang membership and racism.