While most kids with multiple sclerosis (MS) have mild and manageable symptoms, a small percentage experience symptoms that have a significant impact on their daily lives, including school. It's critical to recognize and address these symptoms before they impact your child's academic progress; this means knowing the signs of emerging difficulties.

Symptoms can change from week to week, so watch your child carefully. Here's what to look for:

• Vision — Blurry or double vision may impact reading, writing or attention.
  
  
• Learning and memory — Because MS can affect brain function, a child's attention span and thinking abilities — such as the ability to reason and process and remember information — may be impacted. This is particularly true for younger children who develop active MS before they master educational building blocks, such as mathematics and grammar. These children may be at risk for performing poorly compared with kids who master these subjects before they develop active MS.
  
  
• Writing — Acute attacks or lingering symptoms can cause numbness, weakness, fatigue, poor posture or coordination difficulties, all of which can affect handwriting.
  
  
• Socialization — Learning social skills is a critical part of development, and school is where most of this development happens. MS can make socializing at school more difficult: Children with MS may withdraw from peers because they feel different from their schoolmates, depressed or embarrassed, or because of physical symptoms such as fatigue. In general, children with more obvious physical symptoms are more likely to have trouble with socialization.

When a child's symptoms are making certain tasks difficult, try to come up with strategies to get the task done — for instance, can your child try counting on her fingers? When you teach your child a new way to accomplish a task, see if it makes the task easier. Can your child perform the task alone, or can he or she do it with assistance? Does that mean your child will need additional help in the classroom?

Types of School Accommodations

There are several levels of intervention to help a child who's having difficulty in school, ranging from informal agreements with the teacher to more formal arrangements. They are:

Informal Accommodation

This is an informal arrangement that you discuss and negotiate with your child's teacher. Formal testing isn't required and your child doesn't have to meet specific criteria or be deemed eligible.

For example, the arrangement could include:

• Multiple-choice tests if your child has trouble recalling information
• Bathroom pass if your child has bladder control problems
• Frequent breaks if your child has fatigue or difficulty concentrating
• Preferential class seating arrangement if your child has vision problems or attention deficit
• Reduction in homework if your child has extreme fatigue or problems with writing

Formal 504 Plan

This is the next level of intervention after an informal accommodation. School administrators such as the principal are involved. To qualify, you need a letter from a medical provider verifying that your child has MS. Discuss this plan with school personnel, such as guidance counselors, at the beginning of each school year.

A formal 504 plan could include:

• Aid for students with vision impairments (for instance, a reader)
• Computer for taking notes and tests
• Equipment modifications
• Extended test-taking time
• Physical and occupational therapy
• Psychological services
• Relocation of classrooms for children with fatigue or physical disabilities that affect gross motor skills
• School health services
• Speech and language therapy

Special Education

Individuals with Disabilities Education Act (IDEA) and Individual Education Plan (IEP)

For this type of intervention and services, children must undergo formal psychoeducational testing and be deemed eligible by meeting one of the criteria under IDEA, clearly demonstrating that either medical, psychological or physical conditions are significantly impacting the student's learning. IEPs are tailored to individual students to aid in their learning.

For example, the plan could include:

• Medical services for diagnostic or evaluation purposes only
• Mobility services
• Occupational therapy for students with fine motor or vision problems
• Parent counseling and training
• Physical therapy
• Psychological services
• School health services by a school nurse or other qualified personnel
• Social work services
• Speech/language therapy and audiology services
• Therapeutic recreation or adaptive physical education

Working with the School

Each school system has a procedure for developing plans to help students whose school performance is suffering and who are in danger of missing educational milestones.

Usually, the process begins by contacting the school principal, principal's designee or the teachers. The case is then referred to a team that develops and implements an accommodation plan for the student. Parents get a copy of this plan and there's a follow-up meeting to determine whether the accommodation is working. At the follow-up meeting, the plan may be redesigned or the team may decide that a formal 504 plan, an assessment to determine eligibility for an Individual Education Plan, or both is needed.

Be prepared to provide your child's educational history to the school psychologist and neuropsychologist. Before you meet, think about the following questions and have specific examples ready:

• Did your child receive psychoeducational testing before being diagnosed with MS?
• Have you or your child's teachers had concerns about your child's learning?
• Does your child currently receive, or has she or he received, any formal or informal educational services at school?
• What are your child's current complaints about learning difficulties at school?
• What symptoms get in the way of your child's schoolwork and life at school?

When you work with your child's school to help them understand and respond to your child's needs, it's helpful to keep in mind that teachers and administrators, like most other people, have an easier time recognizing and responding to symptoms they can easily see and understand — such as walking difficulties, balance problems or tremor — than to less obvious ones, like fatigue and cognitive changes. The more you understand your child's symptoms, the better prepared you'll be to help others understand them and to communicate what your child needs. Don't hesitate to ask your child's health care team for suggestions on interacting with the school.

Interpreting School Reports

The following is a list of cognitive abilities as they relate to schoolwork. Becoming familiar with these terms may help you understand psychoeducational or neuropsychological reports from your child's school.

Fluid reasoning — Learning ability that can influence the speed and amount the child can learn, as well as the child's ability to manipulate and use information in a reasoning process. This is important for reading, solving problems and generating solutions.

Crystallized or learned knowledge — Learned and stored knowledge and experience. For instance, vocabulary, spelling, ability to read and social studies.

Short-term memory — The ability to hold information for a short period of time. For example, remembering a locker combination in the first 20 minutes after it's assigned.

Long-term associative storage and retrieval — The ability to store information for a long period and recall that information when it's needed. This is important in school, where students are constantly asked to remember information they learned days, weeks and months ago.

Visual processing — The child's ability to recognize and remember information that's presented visually. This is necessary for tasks such as copying notes from the chalkboard or processing what's shown on slides or in videos.

Auditory processing — The ability to recognize information that's heard. This is important in understanding classroom instructions and following directions.

Information processing speed — How quickly the child can do mental tasks of any nature. This strongly affects test-taking skills.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated January 20, 2010

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.