This fact sheet will:

Inform educators regarding some of the needs of children and adolescents with NPDs.
Suggest strategies to establish a modified programme that may aid students in coping and functioning within the school setting.

Educators:

Remember when dealing with parents, that they are often depleted emotionally and physically.

They feel helpless and out of control.
They feel like failures.
They are struggling with frustration, anger, fear, embarrassment and grief.
They often find schools intimidating.
Your compassion and caring will come across if you ask, ‘How can we help?’

General Guidelines:

You can expect that once treatment commences, it will take 4 – 12 weeks to notice significant change in the child’s condition.
Change happens in steps with frequent setbacks.
You need to work closely with the parents and the treatment team. We strongly recommend a case conference to coordinate the management plan.
If support and modifications can be implemented, the best place for the child who is able to adapt, is at school.
Remember to involve the principal (who can offer resources and support the teacher).
In high school, a guidance counsellor and a teacher that the child has identified with will provide support at school.
Interventions and strategies implemented at school need to be applied in a flexible manner based on the unpredictable, changing needs of the child. Whatever the needs that day are will dictate the strategies that are required.
While a child’s use of these school-based strategies may appear as unnecessary accomodation, in fact, this will be the exception when the child is dealing with an NPD. These are coping strategies for the 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 on the child. This strategy may not be helpful as the child will need to go through major adjustment as a result. Such an action needs careful consideration.
A learning disabled child can look depressed and vice versa. The frustration of a learning disabled child could precipitate an NPD. On the other hand, an NPD child may come across as a learning disabled child. Consequently, the psychoeducational assessment may be affected.

Key Strategies

1. Extra School Support and Modification of Expectations
2. Primary Contact Person Responsible for Coordination of the Student’s Management Plan
3. Guilt Free, Homework Free, Take a Break Days
4. Compassion and Understanding
5. Social Rehabilitation
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 in the given time frame) would 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.
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 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: A ‘Do whatever you can’ approach leaves the child with the feeling that they have never completed their homework. If the child is told to do one question, they can complete their homework and feel successful.
Expectations should be gradually increased once the child is better. Wait for clearance from the treatment 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 the most vulnerable phase for all ages. This is the time when the child is most susceptible to suicide. The child has more energy and can follow through on suicide plans.
Unstructured, unsupervised activities for the child can be stressful at this time. The child may be either a bully or a victim. If vulnerability is focused inward the child will become a victim. If the vulnerability is focused outwardly, the child becomes a bully and may become involved in socially inappropriate behaviour. As an alternative, assign the child to other activities at recess. A staff member is needed who has the responsibility to supervise these special needs kids
A small number of children may need home instruction (provided by the school board) on the recommendation of their physician.
Negotiate with a high school student an alternative evaluation system. Ask the student what mark that they think they are worth. Teachers can work this out with the student. Then guarantee the student that this will be their mark on the report card if they meet the following expectations:
- - The student will complete all of their modified homework load.
  - Hand in all their assignments by the negotiated deadlines.
  - The student may write the exam even if it is negotiated that the mark will not be part of the final mark. This can be renegotiated each term.
  - The teacher must be satisfied that the student has achieved a level of success. Accomodate but don’t grant.

Time Out Mechanism For Stress Relief

There may be time throughout the day that the child will need to leave the classroom (i.e. overwhelmed, tearful, anxious, hyper etc.).

Elementary

A pre arranged signal with the teacher would facilitate this in an unobtrusive manner.
The child could: visit a friendly face (teacher, principal, or other school personnel).

Secondary

- help the librarian
visit the guidance counsellor
help in the office
go to the cafeteria

Children who are unable to read or write at their desk (due to overwhelming symptoms) could be:

Elementary

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

Secondary

go and work in the library or study hall

“Take a Break” Tokens (child initiated)

This plan is negotiated with the child (elementary).
The number of tokens needed per day is negotiated with the child (no more than 3 per school day).
They are left in the desk to be used at his discrimination.
When feeling overwhelmed (angry, unable to cope, anxious, tearful, panic) the child takes the token and leaves it on the teacher’s desk.
The student goes to a negotiated place (principal’s office, library, guidance office, resource room, computer lab).
The length of time 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 the child to take the envelope to a negotiated destination.

2. The Primary Contact Person is Responsible for Coordination of the Student’s Management Plan (Often the case coordinator of the clinical team).

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

How The Teacher Can Get the Most Help from a Case Conference

Sometimes a case conference between the clinician, educators and parents will facilitate a clear and focused plan.
In high school, parents could arrange a meeting with all of the classroom teachers. Parents can use this opportunity to share their knowledge with the teachers as to what the child is going through.
Make sure that proper release of information forms are signed to communicated both ways with the clinical team.
Share your observations without hesitation.
Make sure that the classroom teacher attends the case conference.
Work on any misunderstandings between the teacher and parents at the beginning of the case conference.
Make sure you show interest in attending a discharge planning meeting with the clinical team. You will learn about long term follow-up and tips on managing the student.
After the initial sharing of information, the student needs to be part of the negotiation of the modified academic plan.

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

These days are usually taken with the parent and are a positive coping strategy.
These children blame themselves for everything and don’t have the self esteem and self worth to regulate their feelings. They are conscientious and doubt themselves and feel worse if they can’t do the work. Consequently, guilt free time off is necessary.
If they can’t handle the social expectations then time off helps them to cope.
Take a Break Days can be from a half to a full day in length, involve little to no expense, and be simple and interactive (not the movies). The activity should be selected with the child’s involvement and could include any on the following: lunch in a favourite park, walk, car ride, visit with a relative, craft or creative activity, swim, ball game, bowling, play, crossword, puzzles, visit to the humane society, or volunteering. Turn off blackberry/cellphone if possible.

4. Compassion and Understanding

Imagine that each of these children is walking around with a huge, gaping wound that no one can see.

5. Rehabilitation: Social and Academic

Social

These children often drop out of the social scene (clubs, drama, sports, music). As the child improves, they need assistance to help them reconnect with their social group. This may involve:

Being included in a club.
Being given a new responsibility (invited to help in the kindergarten).
Performing a task with a friend (i.e. helping with pizza day).
Art and Drama are excellent vehicles for rehabilitation.

Academic

A student’s progress at school may be seriously affected for a period of time.

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 some relief for parents.
Help to pair the student with a peer tutor.

6. Confidentiality

Due to the stigma that still exists in society at this time:

It’s better if fewer people know the details. Only those directly involved need to know.
Staff should be informed on a ‘needs to know basis’.
Maintain the privacy of the child, to which he is entitled.
Adhere to the Board of Education Privacy and Confidentiality Policy.
Reports between teachers should not be duplicated and put in the OSR so that confidentiality can be maintained.
Modifications should be kept confidential.
Note: Loss of confidentiality can seriously interfere with the progress of a child’s adjustment.

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