This guideline will help parents advocate for their child by providing strategies that are a starting point for discussions with the school to establish (in a cooperative atmosphere) a modified program (or management plan) for the child.

Parents:

When discussing a management plan for your child, with the school staff, keep in mind that teamwork is important. AVOID AT ALL COST AN ADVERSARIAL APPROACH.
Remember that you and the staff both want what is best for your child.
Work towards building trust. This is a no blame, no fault scenario.
Discuss your plan and approach with the clinical team before you approach the school.Positive outcomes are the usual case when parents, school personnel and the clinical team attend a case conference.
Remember that the staff has to work within the limitations of time and resources.

Guidelines:

All concerned need to realize that once treatment of the child commences, it will take 4 – 12 weeks to notice significant change in your child’s condition.
If support and modifications can be implemented, the best place for your child is at school.
Remember to involve the principal (who can offer resources and support the teacher).
In high school, a guidance counsellor or a teacher that the child has identified with will provide support at school.
Implementation of interventions and strategies by the school should be flexible, based on the unpredictable, changing needs of your child. Whatever the needs are will dictate the strategies that are required.
While your child’s use of these school-based strategies may appear as manipulation, in fact, this is the exception. These interventions provide coping strategies to help your child and are used out of necessity. Most children will prefer the consistency of staying in class.
Homework and classroom modifications must be kept private and confidential. The rest of the class does not need to know what is going on.
Changing schools is an extra burden for your child. This strategy may not be helpful as your child will need to go through major adjustment as a result. Such an action needs careful consideration and consultation with the clinical team.
If your child needs to be out of the school setting due to the stresses, or a situation that is considered counter productive to their emotional well-being, then they should not be penalized but given ‘home instruction’. When a student will be absent for a prolonged period of time for medical reasons (in hospital, recuperating at home from surgery or injuries, mental health i.e. depression) a letter from the attending physician is provided, indicating the necessity to be home and a possible length of time. The school board usually arranges (providing you advocate for it) for a qualified teacher to come to the home or an alternative setting (i.e. public library) and provide tutoring. You may need to inform and share information with educators and administrators i.e. the principal, the superintendent and/or the trustee. Home instruction (paid teacher takes the role) is quite different than home schooling (parent takes on the role).

Key Strategies

1. Extra School Support and Modification of Expectations
2. A Primary Contact Person Responsible for Coordination of the Student’s Management Plan
3. Guilt Free, Homework Free, Take a Break Days
4. Empathy and Understanding
5. Think Rehabilitation: Social and Academic – Identify and fill in the gaps
6. Confidentiality

1. Extra School Support and Modification of Expectations

A child under pressure (experiencing stress or not being able to cope or function at the expected level) will benefit from the following:

Eliminated, reduced or modified homework load.
Extra help at home and school, i.e. a tutor (senior student or experienced teacher), teaching assistant (floating), parent volunteer, senior students (community service), a co-op student (work component of a tutoring course).
High school students may benefit from a reduced workload by dropping courses. Some students and/or parents may need significant councelling and support to make such a decision.
Different programmes may be available through Boards of Education and should be investigated through the school administration. Different Boards have different programmes for prolonged absences.
Daily notation by teachers and parents through a journal or planner will facilitate communication between home and school.
Modified homework can be notated in a planner i.e. Do every second question. Note: Avoid a “Do whatever you can” approach which leaves the child with the discouraging feeling that they have never finished their homework. If the child is told to do one question, they can experience the satisfaction of completing their homework and feel accomplished.
Expectations should be gradually increased once the child is better. Wait for clearance from the clinical team before increasing expectations (i.e. the child may appear OK at school but this may not actually be the case). REMEMBER: this early stage of improvement is often the most vulnerable phase for all ages particularly adolescents.

Time out Mechanism for Stress Relief

There may be time throughout the day that your child may need to leave the classroom (i.e. overwhelmed, teary, anxious, hyperactive etc). A pre-arranged signal with the teacher would facilitate this in an unobtrusive manner.

An elementary school student could:

visit a friendly face (teacher, principal, friend or sibling
help the librarian
visit the guidance counsellor

A secondary school student could:

help in the officego to the cafeteria

Elementary school children who are unable to read or write at their desk (due to decreased concentration) could:

be given a job to do in the library (i.e. put books on shelves)
be given a simple but meaningful task in the library (research something)
choose an activity that they could handle

A secondary school student could work in the library or study hall

Coloured Tokens or Buttons (child initiated)

This plan is negotiated with younger children

The number of tokens needed per day is negotiated with the child.
They are left in the desk to be used at his/her discrimination.
When feeling overwhelmed (angry, unable to cope, anxious, tearful, panic) the child takes the token and leaves it on the teacher’s desk.He/she goes to a negotiated place (principal’s office, library, guidance office, resource room or computer lab).
The length of time (often 10-15 minutes) is negotiated and works best if the child returns to class when he/she is ready.

Envelope to take to the office (teacher initiated)

The envelope is left on the teacher’s desk and when the teacher notices that the child is not coping he asks him/her to take the envelope to a negotiated destination.

2. A Primary Contact Person (i.e. guidance, teacher, principal, TA) Responsible for Coordination of the Student’s Management Plan

A primary contact person at the school facilitates seamless and consistent communication (with home, school and the clinical team) regarding how your child is doing, implementation of the management plan, evaluation and changes to the plan, as your child’s needs change.

Case Conferences/Teleconferences

Sometimes a case conference between the clinician, educators and parents will facilitate a clear and focused plan.
It is often a good idea if the parent approaches the teacher first before he/she goes to the principal.
In high school, parents could arrange meetings with all of the classroom teachers. Parents can use this opportunity to share their knowledge with the teacher as to what their child is going through.
The child needs to be informed regarding the outcome of case conferences by the teachers and/or parents. The final plan should incorporate the input of the student.
Plan for a follow-up meeting in four weeks to review the progress.

There will be individuals who are supportive and others who are resistant. Try to get the resistant individual on side. Tenacity is important.

3. Guilt Free, Homework Free, Take a Break Days

These are usually taken with the parent and are a positive coping strategy.
Children often blame themselves for everything and don’t have the self esteem and self worth to regulate their feelings. They are sensitive, tend to doubt themselves and feel worse if they can’t do their work. Consequently, guilt free time off is necessary.
When they can’t handle the social expectations then time off helps them to generally cope.

4. Empathy and Understanding

Remember that your child is walking around with a huge, gaping wound (vulnerability) that no one can see.

5. Rehabilitation: Social and Academic

Social

Children with NPD often drop out of the social sub culture. As your child improves, he/she may need a boost to help them reconnect with their social group. This may involve:

Being included in a club.
Being given a new responsibility (helping in the kindergarten).
Performing a task with a friend (i.e. helping with pizza day).
Art and Drama are excellent vehicles for rehabilitation
Coaching the child on how to explain their extendend abscence through the physical symptoms they have experienced, such as stomach trouble, and their doctor’s recommendation (“My doctor said I couldn’t come to school because of my stomach trouble.”)

Academic

The child may require specialized tutoring to “catch up” academically.

It is often helpful for someone outside of the family to assist with homework. Tutors can help the child complete their homework successfully and provide you with some relief.
Negotiate with the school for a temporary individual education plan which outlines modifications required by the child. This often includes one on one time with a tutor.

6. Confidentiality

Due to the stigma that still exists in society at this time:
It’s better if fewer people know. Only those directly involved need to know.
Staff should be informed on a ‘needs to know basis’.
Parents and teachers need to maintain the privacy of the child, to which he is entitled.
Boards of Education have a Privacy and Confidentiality Policy, ask to see it and inquire how it is implemented.
The OSR (Ontario Student Record) can be negotiated. Parents can request that some information be removed and shredded.
Ask for classroom modifications to be kept confidential.

How do you cope with other children’s questions?

“How come you leave the class?” “Why don’t you have homework?”
Modifications need to be kept confidential.
The teacher’s creativity and leadership will help with this.

Reviewed by M. Kodsi, M.D., Child and Family Psychiatrist.