Accommodations Across All Grade Levels & All Levels of Need

The goal of accommodations is to help the student access the curriculum, be involved and progress in their education regardless of having PANS/PANDAS. Accommodation and supports can help PANS students remain functional in school during a flare. Remedial support between flares can help the student regain skills lost during a flare.

  • Communication & Collaboration. Communication and collaborating as a team to frequently assess the student’s need is essential due to the relapsing and remitting nature of PANS. Communication between parents, nurse, teachers, and staff must be established and encouraged. Sudden changes in behavior and health status should be communicated rapidly in order to adjust the level of supports. An IHCP can ensure supports are in place and communication is enforced. (See below for more on Communication & Collaboration.)
  • PANS significantly impacts attendance for most PANS students. Modification in attendance policy may be necessary. Modifications may range from allowing for multiple late arrivals to considering temporary home-hospital placement. Modifications to the schedule may be warranted. (See below for more on attendance.)
  • Contagious Disease Health Alert. Protocols should be set to alert the family via the School Nurse if strep or other infections are reported. PANS Students may have symptom activation simply by being exposed to a student with an infection. School nurses should send informational notices about the impact of illness, such as strep to the class/school. Notices should include why it is important to receive treatment, when can a child return to school, how to prevent its spread, and why it is important to report if your child has strep or another communicable illness. Requesting parents to report an illness does not violate privacy laws when the notice names no students and opens with a general statement such as, “We are seeing an increase in the reported cases of Strep throat.” (See below for examples of School Nurse letters.)
  • Permanent/Semi-Permanent Hall Pass. Many students experience urinary frequency; allowing low-key access to a bathroom pass reduces class interruption and student stress. A Hall Pass facilitates access to a “safe place” during times of exacerbated symptoms.
  • Minimize Stress & Increase Positive Reinforcement. Stress can increase symptom severity and increase recovery time. Providing positive reinforcement rather than focusing on negative behaviors, reduces stress.
    • Provide reassurance and celebrate successes.
    • Manage antecedents to prevent behavior issues.
    • Attempt to redirect behaviors rather than reprimanding.
    • Create a plan to deescalate anxiety. Train all staff working with the student on the procedures.
    • Allow for breaks in the daily schedule as needed.
  • Allow For Options and Be Flexible. Depending on symptoms, it may be helpful to allow the student to show mastery of a subject in different ways.
    • Allow for late work without a grade reduction.
    • Allow for assignments to be redone.
    • Let students choose how to complete assignments, for example, typing, recording or handwriting assignments.
    • Allow for homework accommodations: Many students work extremely hard to “hold it together” during the school day and then fall apart at home. These students may be physically and mentally unable to complete homework assignments.
    • Provide students with laptops.
    • Give extended time on all testing
    • Provide sensory supports such as fidgets, special seating, and lighting adjustments.
  • Create Specialized Behavior Plans. Differentiate between “choice-based” behaviors and neurological symptoms resulting from an encephalitic process. It is important to not blame students for involuntary actions that are a manifestation of their illness. It may be more beneficial to prevent behaviors than to punish them; creating a supportive classroom with sensory supports, break times, safe places, and assignment options can help. Drawing attention to some behaviors may only exacerbate them. Traditional functional behavior assessments (FBAs) are directed by the principle that all behaviors stem from either wanting to avoid something (a task, attention, sensory input) or to gain something desired (preferred items, attention). Traditional FBAs and behavior intervention plans (BIP) can be written but input from the student’s doctor and/or therapist helps to ensure that neurological symptoms are not misidentified as behaviors and inappropriately intervened. For example, some repetitive noises and movements may actually be tics, some behaviors that look like non-compliance may result from being physically ill or from intrusive thoughts, or rage episodes may be a result from brain inflammation, etc. Assessing whether behaviors are involuntary or voluntary can be difficult but understanding that one must look at behaviors from both angles is a good start.