Professionals – Teachers

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 treated (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.

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 vharity 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 is finding the trial which ends in February 2006

Epilepsy Action: www.epilepsy.org.uk 0808 800 5050