Practical advice for Teachers working with Children and Adolescents who have been
affected by Encephalitis.
This page has been prepared by the Encephalitis Society in conjunction with Beth
Wicks, Educational Consultant.
Introduction
A child who has suffered from encephalitis is likely to show subsequent developmental
problems; these may be physical, cognitive, behavioural or emotional, or a mix of
these. This guide offers teachers and education support staff advice on the best
approach for ensuring a smooth re-integration back into school for the child, parents,
pupils and teaching staff. It also offers advice regarding longer-term provision
to meet the educational needs of these pupils.
Return to school
Before returning to school these children sometimes spend some time at home and
receive home tuition. It is important to liaise with the home tutor to give him
or her information regarding the child’s previous strengths and weaknesses
and to receive information regarding current levels of functioning. For many of
these children the initial return to school is most successful on a part-time basis.
They are likely to suffer from fatigue and to have significantly reduced stamina
and ability to concentrate. The speed of re-integration should be assessed with
a gradual move to full-time attendance. It is important to remember that, as this
illness affects the brain, recovery cannot be seen in the same way as recovering
from other temporarily debilitating illnesses, such as flu. It must be acknowledged
that there may well be ongoing ramifications affecting learning and, after the initial
period of physical recovery, these other factors must be remembered and monitored.
With some children it will be immediately obvious that they have very significant
acquired special educational needs from the outset and referral to the LEA for a
statutory assessment is, therefore, urgently indicated. This, of course, can be
implemented for a child with sudden onset of problems without going through the
normal process of provision under School Action and School Action Plus. It is not
appropriate to wait to see if there is any further recovery of function before statutory
assessment is instigated – a subsequent statement does not have to be maintained
and it is further disadvantageous to the child if vital time is lost.
How schools can help
The first critical step is to ensure that there is good communication between the
school and the parents and this should involve regular meetings and progress reports;
the frequency of which should be linked to the child’s specific problems,
their nature and extent.
The type of practical steps the school can take include:
- liaising with the home tutor or hospital teacher (if one is involved) to arrange
the programme of integration (e.g. provide work for the home tutor or arrange part-time
attendance)
- establishing regular contact with parents at an appropriate level
- placing the child’s name on the school’s SEN register
- nominating the school nurse or a named person to gain information about the medical
aspects of the condition
- ensuring that the SENCO has adequate information regarding the possible
- cognitive effects of the condition, as well as the physical and emotional ones.
- seeking information from relevant professionals at the hospital where the child
was treat ed (particularly from a clinical psychologist if one was involved), for
instance through your school doctor or nurse, or through the parents.
- seeking advice from the local community paediatrician
- referring the child to your educational psychologist
- If appropriate, referring to the LEA for statutory assessment
- ensuring that this advice leaflet (along with the general information regarding
the effects of encephalitis included in the pack) is distributed to all school staff
and outside agencies working with the child (e.g. LEA support teacher, educational
psychologist etc) Make sure that new teachers receive this information at the start
of each academic year.
- heightening peer awareness before the child’s return to school to minimise
the damaging effects of teasing and bullying and to promote understanding of the
child’s changing needs
- remaining aware of the possible long term implications of an illness affecting the
brain on future learning ability and the fact that cognitive impairments may not
be apparent until years after the initial illness.
- remaining aware of the fact that these children often show an unusual pattern of
difficulties and it can be easy to misinterpret these, for instance to assume that
they are not trying hard enough or that their parents are making too much fuss or
being over-protective.
- ensuring that the pupil’s progress is actively monitored for the remainder
of his or her time in the school
- ensuring that all relevant information about the child’s illness and the possible
future effects of this on learning (including this leaflet) is passed on to the
receiving school or college when the child transfers.
- Being aware of possible difficulties with peer relationships and considering specific
PHSE programmes, buddy systems or use of Circle of Friends (talk to your educational
psychologist)
Your school is well able to meet the, often complex, special educational needs of
a child who has suffered from encephalitis, but don’t assume he or she will
be like other children with learning difficulties or assume that he doesn’t
have SEN because other children appear to have more severe difficulties. This child
can only be compared with what he or she was like before the illness, or would have
been like now, not with other children. Do ask for help and advice from those mentioned
above when planning to meet the child’s needs – you need support and
possibly additional resources.
How Teachers can help
In addition to ensuring there are good communication links between the parents and
school, teachers can help the pupil by:
- carefully considering the child’s (possibly unusual) pattern of strengths
and weaknesses
- realising that information and skills that he or she learnt prior to the illness
are often retained or re-established, but it is the acquisition of new learning
that is frequently impaired.
- taking account of possible difficulties with language comprehension and information
processing and therefore: making instructions specific and uncomplicated giving
only one instruction at a time allowing extra time for the completion of tasks asking
the child to repeat instructions to make sure that he or she has understood
- taking account of possible difficulties with recent memory and therefore: giving
prompts and reminders providing calendars, diaries and other aide memoires allow
for a high level of repetition and rehearsal giving written (or pictorial) reminders
of verbal instructions for the child to refer back to link new information to past
learning
- use multiple choice format for tests whenever possible to enable demonstration of
knowledge with less dependency on free memory
- taking into account problems with concentration or attention and therefore: being
aware that the child cannot improve this at will recognising that he or she may
be easily distracted and may need a quieter environment for some important tasks
realising that he or she may not be able to do more than one thing at once or may
not easily be able to swap from one task to another realising that he or she may
be able to concentrate more at certain times of the day/week or in certain situations
than at others.
- being aware of possible problems with interpretation of visual information and therefore:
ensuring that this is clear, uncluttered and that not too much is presented at once
- recognising that the child may become tired very rapidly and therefore allowing
breaks as necessary
- thinking about his or her strengths and weaknesses and encouraging focus on areas
of competence to enhance self esteem and to maximize learning
- assisting the child who may have difficulties with organisation, planning and problem
solving. He or she will not be able to develop strategies to assist with this without
help and direct teaching.
- realising that injury to the brain can affect the child’s ability to monitor
his or her behaviour and he or she will need help with this. Therefore: establish
structure and routine
- set clear rules BUT ensure that these are understood and that the child can follow
them
- do not let behaviour become problematic before intervening – antecedent management
is effective
- realise that frustration relating to acquired cognitive problems can provoke inappropriate
behaviour
- encourage appropriate interaction with the peer group
Teachers can also provide valuable information to educational psychologists and
health professionals with regard to the child’s development, their strengths
and weaknesses and any other observations, for example behaviour and social interaction.
Reports to doctors on a child’s progress in school, even if unsolicited, are
always welcome and may be vital in focusing medical attention on a problem requiring
in depth assessment or treatment.
Further Reading
“Head Injury- some consequences for injured school pupils , their teachers
and schools”
Available from CBIT, The Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE.
Epilepsy Action to start pilot courses
Epilespsy Action will start trials of a training course in the North East this September
to improve teachers’ understanding of the condition.
A survey by the charity found that one in 10 teachers stigmatise children with epilepsy.
The survey asked the parents of 225 children with epilepsy about how their offspring
were treated: 12 per cent said teachers treated them differently.
Simon Collister, educaton officer at Epilepsy Action, said: “Teachers are
not to blame for this situation, the problem is that there is no statutory training
for teachers that explores not only the health implications but also learing implications
of epilepsy”.
Epilepsy Action:
www.epilepsy.org.uk 0808 800 5050
Last modified: March 2006