Improving academic success for students with myalgic encephalomyelitis/chronic fatigue syndrome

[Dolphin]

http://www.tandfonline.com/doi/abs/10.1080/21641846.2015.1004831?journalCode=rftg20#.VQiT2Y6sWH8

Improving academic success for students with myalgic encephalomyelitis/chronic fatigue syndrome

Faith Newtona*

Received: 20 Nov 2014
Accepted: 27 Jan 2015
Published online: 06 Feb 2015

Abstract

Students with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) often struggle to achieve academic success not only due to symptom interference, but also because educators may lack an understanding of the cognitive and learning deficits that accompany the illness.

Traditional education research may lead teachers to employ less-than-effective strategies and accommodations to support students with this illness.

Recent findings from neurocognitive research provide greater insight into the cognitive deficits that accompany ME/CFS and also suggest more effective classroom strategies.

The purpose of this paper is to outline the cognitive and classroom challenges faced by students with ME/CFS, and to provide examples of sensible accommodations for those problems.

These accommodations are intended to improve the academic success of students with this debilitating illness.

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Keywords

myalgic encephalomyelitis,
chronic fatigue syndrome,
fatigue,
Brain Fog,
instructional strategies

 

[Dolphin]

Here are some extracts

Many students with ME/CFS also suffer from Postural Orthostatic Tachycardia Syndrome (POTS). This condition causes the blood to rush to the student’s feet when moving from a horizontal to a vertical position, and may result in the student passing out. This POTS response can interfere with the student’s learning. Recent research by Ocon et al. [2] and Stewart et al. [3] found that accuracy and reaction time worsen as the student’s orthostatic stress increases. Even prolonged sitting in the classroom may be a stressor. Both these studies recommended a variety of physical accommodations including shorter classes, modified seating, access tofluids, and the ability to move around the room periodically.

By providing additional time, students with ME/CFS usually perform with similar accuracy to their peers, suggesting that processing speed is the critical variable. Consistent with these observations, Deluca et al. [6] found, in adult ME/CFS, that there were no deficits in performing tasks that required working memory if time constraints were minimal.

 

[Dolphin]

Distraction also appears to have a disproportionate impact in ME/CFS. Lange and Vernon [7] focused on deficits in working memory and discovered that patients with ME/CFS are particularly vulnerable to lapses in concentration with even a minimal distractor interposed between presentation and recall.

 

[Dolphin]

I can relate to this. (Though some of it may be a problem for any people who are not fluent in a language. But any extra problems make it worse)

Despite all of these difficulties, children with ME/CFS, with effective supports in place to minimize illness-related deficits, are capable of mastering complex subjects at high achievement levels. Lange and Vernon [7] explained this apparent paradox with the example of someone speaking French as a second language dining in a restaurant with several native speakers. The nonnative speaker would require more concentration and additional time than the other diners to comprehend the menu. By the time she is ready to order, the general conversation might have moved on to a different subject, leaving the nonfluent woman at a loss to know what was being discussed. She might have expert knowledge of the subject, and might–if everyone slowed down to accommodate her translation speed – make a significant contribution. Unless the other diners recognized the problem and slowed the pace of conversation to her processing speed, they might leave the table believing that she had little knowledge and little or nothing to contribute.

 

[Dolphin]

Complete copies of preformatted notes, or having a scribe take notes for the student, reduces demands on processing speed and allows the student to concentrate on what the teacher is saying without having to perform any secondary processing.

Furthermore, devices such as tablets allow students to record lectures to be replayed in short segments to reinforce the initial presentation. For students prone to auditory distractions, having the teacher use a microphone that broadcasts directly into earphones may enable better concentration. In higher level math courses, using a calculator to perform basic operations (addition, subtraction, multiplication, and division) allows students to devote available processing capacity to learning concepts rather than struggling to retrieve basic “math facts”.

 

[Dolphin]

Deficits in executive functioning

These difficulties can be overcome by reducing the number of simultaneous tasks the student must undertake. If distraction is the issue, allowing the student to complete assignments or tests in a more private setting reduces the need to screen out distractions.

 

[Dolphin]

Overcoming executive function deficits may also require additional time. To be successful, students need extended time to complete assignments or master new content. To facilitate task completion, teachers can assign priorities to their material, a key point that may be challenging for teachers to accept and implement. Pinker’s observation is relevant here:“No matter how valuable a subject may be, there are only twenty-four hours in a day, and a decision to teach one subject is also a decision not to teach another one.”[13]

 

[Dolphin]

To accommodate ME/CFS students, teachers can make a determination regarding what information and/or skills are essential for subject mastery as contrasted with those that are merely good to know.

 

[Dolphin]

None of these strategies will succeed with students who are too physically or cognitively impaired to work. Students with ME/CFS cannot“push through”their fatigue without significant physical and mental consequences. One reason why fatigue may become insurmountable is the student’s inability to self-monitor declining energy while attempting to continue their work–which may result in the student struggling to stay awake. In this circumstance, teachers can learn to recognize early signs of depleted energy such as a student’s increasingly vague responses (“I don’t know”), or a noticeable change in skin color which indicates an approaching limit to the day’s physical and/or cognitive activities. When this occurs, such students should be reassured that the teacher understands that they are in the grip of an illness (rather than lacking motivation), and facilitate their withdrawal for a prolonged period of rest. For some students, such rest might require several days to even weeks, but for others only a few hours.

 

[Dolphin]

There is a lot more than this. I just concentrated on what I thought were the most important points and/or those I thought were the most realistic.

 

[Denise]

I was disappointed by several things.
Among them:
this article was published in a journal (Fatigue) few educators would consider looking at and the article is therefore unlikely to help many (any?) students,
the article did not information about the illness or at least provide a reference for a definition since few educators (in the US) are knowledgeable about it,
the strategies mentioned were not also provided in a table or box format (so educators could easily reference them),
there was no information about unpredictability and duration of PEM (it is referred to simply as "prolonged symptom flare-ups),
and there was nothing in the article to help students who are so sick they cannot attend school at all.


Edited to add - I don't see any original research in this article, but rather a compilation of some tips for educators. For the record - I am not implying that compiling tips isn't useful.

 

[Denise]

@Dolphin I edited my post (in case you want to unlike).


"Edited to add - I don't see any original research in this article, but rather a compilation of some tips for educators. For the record - I am not implying that compiling tips isn't useful."

 

[Dolphin]

@Dolphin I edited my post (in case you want to unlike).


"Edited to add - I don't see any original research in this article, but rather a compilation of some tips for educators. For the record - I am not implying that compiling tips isn't useful."

That's very considerate of you. I'm happy to leave my like.

 

[Denise]

Thank you @Dolphin.

 

[Battery Muncher]

I found this very interesting! Is there any way to get hold of the full article?

 

[SOC]

Thanks, @Dolphin for pointing out this article. If I can get access to the full article, I will definitely be using some of my limited cognitive energy to read it in detail.

The parts Dolphin has quoted are entirely consistent with my experience tutoring students with ME. My students have not lost their ability to handle advanced subjects, but physical and mental fatiguability, and executive functioning deficits get in the way of education in any traditional mode. A major problem is one that seems to have been covered only briefly:

None of these strategies will succeed with students who are too physically or cognitively impaired to work. Students with ME/CFS cannot“push through”their fatigue without significant physical and mental consequences.

So while the accommodations mentioned can certainly help students with mild or possibly mild/moderate ME succeed in school, they are not going to solve the problems of students with moderate-to-severe ME who cannot walk around a school building or maintain effective cognitive function for several hours at a time even at slowed-processing levels.

Kudos to Faith Newton for addressing this important issue. I hope she, or someone else, addresses the needs of students with moderate/severe ME who are being schooled in alternative ways -- homeschool, school-supported home education, and so on.