Should a Child Whose School or LA Suggests “EBSA” Be Assessed for CPTSD?

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Should a Child Whose School or LA Suggests “EBSA” Be Assessed for CPTSD?

1. Overview

When a school or local authority labels a child with “Emotionally Based School Avoidance” (EBSA), it is often presented as a benign, neutral explanation for non-attendance. However, EBSA is not a clinical diagnosis, has no formal criteria, and does not identify the underlying cause of the child’s distress.

A significant proportion of autistic and ADHD children experience school-based trauma arising from:

• repeated punishment for disability-related behaviour,
• sensory overwhelm,
• humiliation or shaming practices,
• bullying that was not stopped,
• inconsistent or unpredictable adults,
• isolation rooms or exclusion,
• chronic fear of school settings.

For these children, the presentation labelled as “EBSA” may instead be more consistent with PTSD or Complex PTSD (CPTSD).

Because trauma requires specific treatments and triggers legal/safeguarding duties, children labelled with EBSA should be screened for CPTSD.

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2. Why EBSA Cannot Rule Out CPTSD

EBSA:

• is not a medical or psychiatric diagnosis,
• does not explain cause,
• is used by non-clinical staff (teachers, EPs, attendance officers),
• lumps trauma, anxiety, burnout, bullying, ASD distress, and fear into one category,
• does not require trauma screening.

Therefore, EBSA cannot be used to state or imply:

• that the child is not traumatised,
• that trauma is unlikely,
• that a PTSD/CPTSD assessment is unnecessary,
• that the child’s behaviour is simply avoidance.

Using EBSA as a blanket explanation prevents proper diagnosis and is incompatible with safeguarding.

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3. Clinical Reasoning: Why CPTSD Must Be Considered

CPTSD (ICD-11) requires:

• prolonged or repeated exposure to threat,
• environments where escape was not possible,
• avoidance of trauma-linked places or situations,
• emotional dysregulation,
• negative self-beliefs,
• relational or trust difficulties.

Autistic and ADHD children are especially vulnerable because they:

• cannot remove themselves from sensory or social threat,
• are punished for distress behaviours,
• become hypervigilant under inconsistent discipline,
• experience humiliation more intensely,
• rely on adults for safety,
• have limited ability to predict or escape danger.

If a child is avoiding school, and school itself was a source of prolonged distress, then avoidance is consistent with CPTSD.

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4. The EMDR Logic: Why Cause Must Be Identified

EMDR (Eye Movement Desensitisation and Reprocessing) is apparently effective for trauma-based avoidance.

EMDR does not peer to work for avoidance caused by:

• sensory overload,
• autistic burnout,
• general anxiety,
• executive dysfunction,
• perfectionism,
• depression.

Therefore:

• If EMDR helps → trauma was the underlying cause.
• If EMDR does not help → trauma is not the main driver.

This proves that identifying the cause of school avoidance is clinically essential.

EMDR is little understood in the sense of what exactly doing and how it works but that there is a difference or appears to me indicates until proven otherwise but a difference exists.

Therefore continuing to use EBSA as a catch-all label without clarifying cause is a clinical failure.

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5. Why Failing to Screen for Trauma Is potentially Negligent

Under child mental health standards, when a child presents with:

• avoidance of a location linked to distress,
• hypervigilance,
• panic at school entry,
• shutdown/freeze responses,
• sudden fear of school staff,
• regression or withdrawal,
• emotional dysregulation triggered by school cues,

a trauma assessment is required.

Failing to screen for trauma breaches:

• NICE guidance on anxiety/PTSD assessment,
• safeguarding duties (investigate potential harm),
• ICD-11 trauma criteria (avoidance must be evaluated),
• clinical duty of care,
• reasonable professional practice.

By diagnosing “EBSA” without clinical trauma assessment, schools and LAs risk causing ongoing untreated trauma.

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6. Why Educational Psychologists Cannot Diagnose CPTSD

Educational psychologists (EPs):

• are not trained to diagnose mental health disorders,
• operate outside the medical/psychiatric diagnostic framework,
• cannot diagnose PTSD, CPTSD, or trauma disorders,
• cannot eliminate trauma from consideration.

EPs may identify risk factors but cannot provide a definitive clinical explanation.

Therefore, relying solely on EP involvement after an EBSA label is insufficient and inappropriate.

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7. Who Should Diagnose Trauma

Trauma should be assessed by:

• a clinical psychologist trained in trauma,
• a child and adolescent psychiatrist,
• a trauma specialist clinician.

These professionals can:

• conduct structured trauma interviews,
• differentiate sensory/ASD distress from trauma,
• diagnose PTSD or CPTSD under ICD-11,
• recommend appropriate treatment.

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8. Legal and Safeguarding Implications

If a child avoids school because school caused trauma:

• this is a safeguarding issue (harm in a regulated setting),
• the school and LA may have breached statutory duties,
• the child may be entitled to disability discrimination damages,
• failing to investigate trauma is potentially negligent,
• later psychological injury may support a personal injury claim at age 18–21.

EBSA is often used to:

• deflect from school responsibility,
• avoid acknowledging harm,
• prevent escalation to children’s services,
• sidestep clinical pathways,
• avoid potential liability.

Recognising possible CPTSD reverses this deflection and centres the child’s safety.

9. URGENT: Emerging Evidence Suggests Trauma in Autistic/ADHD School Avoidance Is Being Missed

Why EBSA May Mask Trauma – Emerging Evidence and Clinical Implications

A growing body of research suggests that a significant proportion of what is currently labelled as EBSA may in fact reflect unrecognised trauma responses, particularly in autistic and ADHD children. This does not imply blame, but instead highlights how current systems may overlook the way neurodivergent children experience and process threat, shame, sensory overload, unpredictability, or repeated distress within the school environment.

9.1. EMDR Evidence Suggests Hidden Trauma

EMDR is a therapy designed specifically for traumatic memory processing, not for ordinary anxiety, sensory overload, or executive-function difficulties. Yet several studies now report improvements in “stress” or “anxiety” among autistic adolescents following EMDR. The most clinically plausible explanation is that these young people were experiencing trauma-based distress that had not been recognised as trauma.

This strongly suggests that:

• autistic and ADHD young people may accumulate traumatic experiences in school settings,
• these experiences may be misinterpreted as “school refusal”, “EBSA”, “behaviour”, or “rigidity”,
• and the true traumatic component remains unidentified and untreated.

9.2. Trauma Can Present Differently in Neurodivergent Children

Autistic and ADHD children often have:

• heightened sensory sensitivity,
• increased vulnerability to shame and humiliation,
• difficulty predicting adult reactions,
• reduced ability to escape or verbally report distress,
• increased physiological reactivity to perceived threat.

These factors mean that experiences which might be mildly stressful for neurotypical peers can become overwhelming or traumatic for neurodivergent children — even when adults did not perceive the situation as severe.

3. Why This Matters Clinically

If EBSA is masking trauma, then the child is not only struggling with attendance — they may be carrying untreated traumatic stress that affects:

• concentration,
• emotional regulation,
• trust in adults,
• ability to learn,
• long-term mental health.

Recognising trauma changes the entire clinical pathway.

Instead of attendance plans alone, the child may require:

• trauma-informed stabilisation,
• EMDR or TF-CBT,
• sensory environment adjustments,
• relational safety work,
• reductions in triggers at school,
• a safeguarding review if harm occurred in the setting.

9.4. The Overlooked Implication: Some Distress Attributed to “Autism” May Actually Be Treatable Trauma

One of the most important consequences of this emerging evidence is that some symptoms currently assumed to be features of autism or ADHD may actually be trauma-driven and therefore treatable.

For example:

• shutdowns or freezes in school,
• avoidance of certain classrooms or staff,
• hypervigilance,
• sudden distress on school arrival,
• disproportionate fear of discipline,
• emotional explosions after school (“after-school restraint collapse”).

These behaviours may not simply reflect autism;

they may reflect trauma layered on top of neurodivergence, arising from repeated experiences of threat or overwhelm in school.

If trauma is never assessed, these behaviours become incorrectly categorised as “part of autism”, meaning the child:

• does not receive trauma-appropriate intervention,
• is misunderstood behaviourally,
• has unmet mental health needs,
• and remains vulnerable to continued harm.

9.5. Why Clarifying Trauma vs. Non-Trauma Distress Is a Safeguarding Issue

If an autistic or ADHD child is experiencing trauma in school, this affects:

• their emotional safety,
• their right to a safe learning environment,
• their mental health trajectory,
• and their entitlement under the Equality Act 2010 to adjustments that prevent psychological harm.

Failing to identify trauma means failing to protect the child.

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10. Conclusion: Should Every EBSA Case Be Screened for CPTSD?

Yes.

EBSA is a behavioural description, not a diagnosis.

CPTSD is a trauma disorder with profound implications.

Given:

• the vulnerability of autistic/ADHD children,
• the documented harms caused by school practices,
• the high prevalence of trauma in school-based avoidance,
• and the need for correct clinical treatment,

every child labelled with EBSA should be assessed for trauma, including possible CPTSD.

This is not optional. It is a clinical, ethical, and safeguarding requirement.

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11. Next Steps

This page can be expanded with:

• a trauma screening checklist,
• a template letter requesting CPTSD assessment,
• guidance for GPs and CAMHS,
• legal arguments for failing to investigate trauma,
• evidence summaries of trauma in autistic/ADHD children.

Disclaimer: These pages are for general information only and does not constitute legal advice. For individual guidance, contact for children SENDIASS, IPSEA, otherwise Advisory, Conciliation and Arbitration Service(ACAS) or the Equality Advisory and Support Service (EASS). See the full Legal and Support Disclaimer for details.