Date

From:
XXX, therapist with all relevant academic titles
Address and contact

To:
XXX school
Address

To whom it may concern,

XXX, born XXX, has been my client in psychotherapy since XXX. I am currently seeing him XXX times a month. His current DSM-IV diagnosis is:

• 313.89    Reactive Attachment Disorder
• 309.81    Posttraumatic Stress Disorder
• 314.00    Attention-Deficit/Hyperactivity Disorder
• etc. (depending on your kid, of course)

Individuals with this type of diagnosis, and in particular XXX, exhibit symptoms such as:

• difficulties sustaining attention, and being easily distracted by extraneous stimuli
• making careless mistakes in schoolwork and other assignments
• failing to follow through on instructions and failing to finish assignments
• difficulties organizing tasks and activities
• losing things necessary for tasks or activities (e.g. school assignments, pencils, books, or tools)
• difficulties concentrating due to intrusive, recurrent and distressing recollections of traumatic events
• acting and feeling as if the traumatic event were recurring in the present.

Some of the ways in which this condition may affect him in a school context include the following:

• failing to remember, complete or turn in assignments
• losing or failing to bring things necessary for tasks or activities
• being inattentive or not focused on lectures or tasks
• failing to remember major parts of the school day, including content of lectures, assignments given or completed, “as if they had never happened”
• being unable to self-assess proficiency or readiness for tests
• inability to successfully complete tasks or take tests in the time allotted
• failure to process the information presented to him correctly: this may include misunderstanding assignments, rules, or not noticing the existence of the presented information at all
• on some days, he may not be able to pay attention to class or complete any work at all.

Due to the levels of cortisol and adrenaline spiking on some days and at more normal levels on others, XXX may be viewed as unmotivated and not trying hist best, when in fact, he may be trying his hardest to overcome the effects of chemicals at elevated levels in the prefrontal cortex area of his brain. He may be seen as bored or not giving his best effort, but may well be experiencing higher anxiety.

When faced with intrusive, traumatic memories, he may be seen as loud, talkative, overly social, off-subject or disruptive, although he may be trying his very best to contain and regulate himself. At these times, school staff should not place additional stress on him in an attempt to motivate him and should avoid calling attention to the fact that he has done better or can do better – this serves to increase stress, anxiety, depression, and low self-esteem during difficult days, and will cause him to function less instead of more. Instead, school staff should flexibly adjust his assignments and schedule of deliverables to good days so he has a chance at being as academically successful as he is capable of. Expecting him to be successful self-organizing, self-advocating and taking responsibility for school success as would be expected of somebody of his age without the disability is unrealistic at this time.

It may not be apparent to the untrained observer whether he has a good day or a bad day, and as with all individuals with a similar condition, good days can turn into bad ones within seconds, and without obvious triggers.

To help him be successful in school in spite of this condition, my recommendations are:

(This should be the list of accommodations you’d like the school to provide; discuss and agree with the therapist before going to the IEP meeting)

• preferential assignment to classes with few students in them
• seating at all times in a manner that reduces or eliminates visual, auditory and other extraneous stimuli that may distract him
• proactively giving him copies of all class notes, and video recordings of lectures, so he has a complete set of study materials at his disposal at home to study on good days, even if he failed to take notes or study the subject on a bad day
• extra time to complete all in-class and homework assignments, as well as all tests, without penalty
• verbal review of assignments and questions (particularly in tests) before he starts working on them and when off-subject, to make sure he processes all parts of the assignment
• allow the use of calming music or environmental sounds with headphones for use in self-calming; if needed, permit him to leave class to do so
• establishment of a process that enables him to compensate for those periods of time in which he is “blanking out”. This would likely involve daily monitoring of his agenda for completeness and correctness, daily monitoring that he is in possession of all necessary materials (and providing extra copies as soon as needed), asking him for completed assignments (instead of relying on him to turn them in on his own), and re-teaching of topics he missed in any class due to an inability to focus.

Feel free to contact me if you have further questions about diagnosis, education impact or appropriate accommodations.

Best regards,

(signed, therapist)