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Home >> Accommodations for the Classroom

Accommodations for the Classroom

Each person is unique, but here are some typical accommodations that have been used to help students with dysautonomia:

1. Prioritize core academics. If a child does not have the energy for a full day, consider scheduling required classes later in the day. Elective classes may have to be added once the student can tolerate a longer school day.

2. Consider half days beginning in the early afternoon. Many children with dysautonomia do not function well in the morning because that is when blood pressure is the lowest and symptoms are the worst, although everyone is unique. If you child feels better in the morning, and worse in the afternoon, then seek to arrange their schedule accordingly.

3. Concentration may suffer due to lack of proper blood flow to the brain. This phenomenon is known as cerebral hypoperfusion, or informally as "brain fog." It is a common occurrence among people with dysautonomia. Comprehension, deduction, memory storage and retrieval are often impacted. Curriculum should be adjusted accordingly. Students who have severe brain fog may not be able to remember their locker combination. If possible allow the student to have a name combination lock instead of a number combination. Choosing a word like their pet's name or their parent's initials will be far easier for them to remember than a number combination.

4. In some cases, a calculator should be allowed for math computation. Math that involves sequencing or steps in a process is often problematic for the child with dysautonomia. Consider allowing the student to use a sample math problem as a reference.

5. Frequent absences are to be expected with this condition, as symptoms can improve or worsen from day to day. The student should not be penalized for this.

6. If the student is homebound or partially homebound, teachers should coordinate how much homework is given. Avoid overloading the student.

7. A student who is homebound should still be allowed to participate in all school activities, if their health allows it on any given day. These children should be apprised of all school functions and after school activities. A liaison should be appointed to collect all handouts and keep the child and parent informed. These children are already feeling isolated and this will help them to stay connected, making the transition back to school easier. It is also critical to their emotional and social development.

8. Some people with dysautonomia are hypersensitive to smells. They should be allowed to leave the classroom if their symptoms are exacerbated by odors. This can be particularly problematic in science labs and art classrooms. Note that an odor that is barely noticeable to the teacher may smell very strong and offensive to a child with dysautonomia. Some patients experience headaches and vomitting after exposure to strong smells, so it is important that they be allowed to move to a well ventilated area without the odor. If this is a recurring problem with the student, consider keeping the windows open in the classroom if weather allows for this, or increasing ventilation in the room when strong smells are likely to be present (during science lab or art class). If possible the teachers and classroom aides should avoid wearing strong perfumes and lotions, and ideally other students in the class can be asked to do the same - without pointing out the child who has the smell sensitivity.

9. Noise and light sensitivity may also cause an issue for kids with dysautonomia. At times, wearing sunglasses or having earplugs, on hand, may be appropriate. If the bright light coming from a window is bothering the student, place the student in a seat out of the glare of the sunlight, and consider closing the blinds in the classroom, or dimming the lights for a short time.

10. Fire drills and evacuations may be very problematic. An emergency plan should be worked out for children with dysautonomia. Keep in mind that the noise of the alarm may cause their symptoms to get worse if they have a noise sensitivity. A plan that keeps the child safe must be put into place. Assigning a buddy to assist the child during evacuation or other emergencies may be necessary, preferrably an adult.

11. Allow the student to have fluids throughout the day. Kids with dysautonomia do much better when they are well hydrated, and symptoms can be drastically worsened by even the slightest dehydration. Allow them to have a water bottle with them at all times. If they forget to bring their water bottle, allow them trips to the drinking fountain as often as needed.

12. Allow the child to have salty snacks throughout the day. Salt helps to retain fluids and helps keep up blood volume, helping to increase blood pressure. High intake of salt and fluids throughout the day are an essential for almost all dysautonomia patients.

13. Frequent urination and stomach issues often come with dysautonomia. Allow the child to have a permanent bathroom pass to prevent embarrassment. Allow the child to sit near the door, so that there is less disturbance in the classroom if they have to rush to the bathroom.

14. An extra set of books should be provided, so that the child can have a set at home. Lugging heavy books back and forth can be physically taxing on a child with dysautonomia, since one of the most common symptoms is severe fatigue.

15. Taking the stairs may not always be safe due to dizziness and fatigue. Issue the student an elevator pass. Assign a buddy or adult to accompany them in case of an emergency.

16. If possible, organize the day so that classrooms are close together and the child's locker is in close proximity to all classes.

17. If the classrooms are not close together, allow extra time in between classes to get from one room to the other. The child should be allowed to leave a few minutes before the class is over to get to the next class, without being penalized for tardiness. If the school is too large and the student must travel from one building to another, a segway or wheelchair should be allowed.

18. Preferential seating should be allowed. The child should be placed as close to the teacher and an exit, as possible.

19. Temperatures in the school may impact the child considerably, as children with dysautonomia may have problems controlling their body temperature. Heat will exacerbate their symptoms. Consider allowing them to carry a portable fan from class to class or scheduling their classes in rooms that have air conditioning. If your school requires a uniform, the child should be allowed to dress in layers and remove outer layers if they are too warm (blazer, sweater, tie, etc.). Similarly, the child may have a hard time staying warm in the cold, so allow extra layers and instead of a water bottle, the child should be allowed a sealed container of warm tea or hot chocolate.

20. Allow the student to carry a cell phone for emergencies. If there is concern that the child will use the phone during class, then the student can give the cell phone to the teacher at the start of class, and can retrieve it upon departure from the classroom.

21. Remaining upright is a problem for kids with dysautonomia due to blood pooling in the lower extremities taking away blood flow and oxygen from the heart and brain. This results in worsening of dizziness, fatigue, nausea, chest pain and other symptoms. Accommodations may be needed for the lunch line, fire drills, outside recess, etc. Assign the child a buddy to assist as needed, and allow the child to sit down or recline when he or she needs to do so.

22. Allow the student to position themselves as needed to prevent pooling. This includes elevating feet, sitting on knees, placing knees to chest, or sitting cross-legged. These are compensatory positions to help regulate better blood flow to the heart as well as prevent pooling in the legs. This should not be viewed as disrespectful and should be permitted.

23. Exercise intolerance may require elimination or modification of P.E. Classes. Exercises that are more easily tolerated by most Dysautonomia patients include gentle stretching while in the laying down or seated position, rowing machines, recumbent biking and swimming, as these exercises are less likely to trigger problems with cerebral blood flow and orthostatic intolerance.

24. Students must avoid germs when possible. When a child with dysautonomia gets a cold, flu or infection, it can turn into a more serious illness than if they did not have dysautonomia. Thus, it sets them back academically, socially and physically. A separate room, other than the nurse's office, should be set-aside for the child to rest, when the student is symptomatic. This can be the library, a teacher's office or an empty classroom.

25. Note taking may be difficult or impossible for a child withdDysautonomia. Possible accommodations are assigning a buddy to take notes and make copies for your child, bringing a tape recorder to class, or having the notes given to the child by the teacher. Allowing the student to use a laptop to take notes may benefit some children.

26. Test taking may need to be modified. Children with dysautonomia may need extended time. It may be necessary to have frequent breaks, the directions read and explained, and a scribe. Longer tests may need to be shortened, or broken into segments and taken over several periods of time. Tests should be administered in a quiet room where the student can better concentrate.

27. Frequent breaks should be allowed to improve circulation and prevent blood pooling. The child should be allowed to flex and stretch his legs, to walk around briefly, or to elevate his legs if needed.

These are just a sampling of possible accommodations that may help school-aged children with dysautonomia. There is no cookie-cutter recipe for success when deciding which accommodations are appropriate for an individual student. Accommodations should always be individualized to the child's specific issues. Educators and parents must work together for the good of the student, to come up with creative ways to help ensure the student's success.

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