Accommodations

PANS students require a variety of accommodations to support the multiple symptoms across the learning domains.

The level of support is contingent upon the severity of symptoms. Below is a list of a wide range of supports based on those commonly utilized for PANS students as well as widely used for students with that specific symptom like students with OCD, ADHD, etc. Every student will not need every accommodation nor is every accommodation for a particular symptom listed. Some supports are contingent on grade level. Supports must be individualized. Plan for the worst symptoms and hope for the best; in preparation for a flare, including all appropriate accommodations so school staff can react and implement quickly.

“Therapy can be instrumental in negotiating exacerbation, but doing so requires a paradigm shift. Children often lose skills during exacerbation, and traditional remedial intervention may be ineffective. Greater benefit may be found with adaptation and compensation for problems during exacerbation, followed by remediation of ongoing problems during remission.”

PANDAS: A New Frontier for Occupational Therapy Intervention Janice Tona & Trudy Posner


Academic/Cognitive Symptoms

Math Regression

  • Math Facts, Formula Sheets, Calculator for simple computation
  • Extended time on tests
  • Shortened Assignments
  • Manipulatives

Dysgraphia

  • Keyboard/Assistive Technology
  • Built-Up pencils
  • Graph paper/raised line paper
  • Grade work on content rather than neatness
  • Use a recorder to give answers verbally

Language Issues

  • Extra Time for expressive & receptive language
  • Less reading out loud
  • Assisted Technology/Augmentative communication
  • Speech Therapy

Organization

  • Assignment Planner: Weekly layout, keep a pen with it, and clip the current week
  • Homework Binder with a log for parents to communicate with the teacher
  • Graphic Organizer & Outlining Programs
  • Long Term School Projects: Break down into segments with separate goal dates (topic selection, research, outline, first draft, final draft)
  • Color Code Subjects
  • Extra Set of Books for home use
  • Buddy to help take notes
  • Schedule time to clean desk/locker
  • Preferential seating & distraction-free study area

Memory Management

  • Reduce stress & distractions
  • Management: Lists, Timers, Calendars
  • Repetition of Information
  • Recording devices
  • Provide lecture notes/outline
  • Earphones to block stimuli
  • Movement breaks
  • Assistive technology
    • Lists: paper, dry erase boards
    • Timers/Calendars: electronic devices

Behavioral Symptoms

OCD

  • Support/Reinforce Therapies: Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP)
  • Group Activities: Allow a separate set of materials
  • Allow early class dismissal to avoid crowds in hallways
  • Obsessions:
    • Allow “interrupter” when stuck (snapping band on the wrist)
    • Identify special words/prompts for the teacher to interrupt obsessions
    • Goal for curbing repetitive questioning
  • Compulsions:
    • Alter Work Sequence/ Alternative Schedule if stuck on section or task
    • Identify & substitute less disruptive behaviors
    • Use a timer to signal transitions.
    • If the student is continually erasing work, allow a computer
    • Safe Space to release compulsion during day
    • Allow spell check/calculator to be used one time at the end in case of anxiety/perfectionism

Anxiety

  • Relaxation Techniques:  yoga, imagery,
  • Safe Space – Safe Person
  • Cool Down Pass
  • Class Participation: fears range from inaccuracy to being looked at by peers, consider starting with close-ended questions or opinion questions.
    Signal child it is almost their turn. Exempt participation as needed.
  • Class Presentations: Reports can be given to the teacher alone or videotaped at home.
  • Testing: Extended time. Alternate testing location if anxiety increases by watching other kids turn in work quickly

Lateness

  • Late slip on file
  • Temporary later start time

ADHD

  • Extended Time
  • Frequent Breaks
  • Exercise Breaks
  • Redirection
  • Written Directions
  • Preferential Seating: close to the teacher, away from window/door
  • Fidget Toys
  • Testing: Extra/Unlimited Time, Separate testing location if needed
  • Lighter homework load
  • Alarm Reminders to keep the student on task

Mood Changes

  • Calming Techniques
  • Safe Space – Safe Person: ID 1 person to check in with for 5-10 minutes to ease mood changes to enable the return to class.
  • Cool Down Pass to allow the child to leave the situation briefly. Use a card to signal teacher, so the student does not become the center of attention
  • Note: Negative discipline escalates the behavior. Their world is falling apart but they need a safe place where they can be and want to be, even fighting fears that they have left home.

Sensory

  • Sensory Supports: pressure, weighted vests, proprioception
  • Sensory Seeking: varying tactile input
  • Sensory Defense: low light, quiet space, decrease stimulation, muted colors

Physical Symptoms

Tics

  • Nurse Breaks
  • Reading/Writing: Assistive Technology and allow oral Responses
  • Weighted blankets
  • Vocal Tics: Less reading aloud.
  • Testing Modifications

Mobility Issues

  • Adaptive PE
  • Physical Therapy
  • Field Trip accommodations/support

Urinary Frequency

  • Low Key Bathroom Access
  • Track frequency

Fatigue & Low Tone

  • Time to rest
  • Healthy snacks
  • Modified physical activities
  • Encourage endurance without overdoing it
  • Strengthening exercises during remission