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Inability to Write for Pandas Teens

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Help! I am a 10th grade English teacher with a brilliant student who is diagnosed with PANDAS. I have witnessed this student have an anxiety attack over a writing assignment. Since I have been made aware of the diagnosis, I have not found any technique that will help the student write a sentence, paragraph, or much less an essay. The student simply will not write anything down for fear of making a mistake. Are there any known exercises or techniques that will give my student freedom to write? The student describes the block as his brain will not allow him to put down the words . . . Any feedback would be greatly appreciated.

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Bless you for being so concerned and resourceful!


Our 14yo, 8th grade son has similar problems with writing when his PANDAS is active. He participates in his school's gifted language arts cirriculum, but in the height of PANDAS, he has trouble sorting and prioritizing his thoughts for papers, and his small motor skills deterioriate so that the physical act of writing itself becomes incredibly tedious, time-consuming and painful. And even after all of that, the resulting penmanship is so bad, the teacher probably couldn't even read it, anyway.


Also complicating some PANDAS kids thought processes are OCD obsessive thoughts that exaggerate perfectionism, clarity, prioritization, etc. And all of these problems combined make time a real problem, since it can take 4 or 5 times longer for a kid like this to write the same amount of information as a kid without the disorder, and that sense of time getting away from them can, in turn, ramp up the anxiety even further, causing more problems getting the writing accomplished. It can become a viscious circle.


Here are some things our son and his teachers have found can help:


- He is allowed to keyboard his papers, either at the in-classroom computer, in the learning/computer center, or even at home, rather than handwrite


- He is allowed extra time, and if the paper is a "big" one with several sets of requirements or expectations, his teacher breaks it into smaller, less intimidating "bites" for him so that he can take it one step at a time


- At the height of his anxiety, if he simply cannot adequately sort his thoughts and get them down on paper himself, he is permitted to dictate them, either to the teacher or to his parents, and we take the dictation down for him, word for word. Sometimes, once having gotten "the bones" down on his behalf, he is then able to review what he's come up with and make his own edits without too much trouble. We have even used voice-recognition software on our home computer for him at times, though it is not especially reliable.


Many of these kids, like our son, are very bright and exceedingly gifted verbally (as you've probably noticed with your student), so permitting dictation when necessary has really helped. It also fosters success during the toughest periods of the illness so that, when he's feeling better and more under control, he has greater confidence that he can finally get back to writing himself because he knows his thoughts and ideas can be good ones.


Thank you again! You must be a terrific teacher! :wub:

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You are a definitely in the correct profession. Having an understanding teacher/school district is nine tenths the solution! So I congratulate you.

Your district should have access to a school psychologist. This person should be invaluable to you, even if the student has no IEP . A panic attack is a perfect characterization of what is happening in these kids' brains. If you have had one (I have ) it is a horrible feeling. You know the feeling. Forcing the issue will not work. At least this is our experience. The other suggestions are great--if he is able to get past this. Is there another assignment he can do in the mean time. If he is having trouble in your class he is probably having problems in others? and I would bet the teachers are not all as understanding. Has an IEP been suggested for him? This could help spell out the need for accommodations and what they may look like--this is usually where the school psych would get involved. We would be up a creek without a paddle without our wonderful teachers here. The IEP we have this year has been invaluable in spelling out the flexibility & accommodations our ds11 needs.




PS Point the mother to this forum, too.

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Other members have given some good ideas for you to try. I would also add that in addition to what you describe as a fear of mistakes (an OCD symptom), some kids also have temporary impairment in their executive functioning and ability to organize their thoughts. This "real" hurdle can compound the "psychological" fear of making a mistake. When you go to grade the paper, any correction or criticism runs the risk of reinforcing these fears. Likewise, any input the parent(s) give can influence the child's perceptions and fears.


I think it's great that you're trying to educate yourself and help this student. But you will need an understanding of ERP (Exposure/Ritual Prevention - also known as Exposure/Response Prevention) and how to break an OCD fear into small steps. I would also encourage you to get the parents on board with this, as it really requires a team, with the messages and tools being practiced all the time, at school and at home. I recommend "Talking Back to OCD" by John March and "What To Do When Your Brain Gets Stuck" which is for a younger crowd but will give you a good overview in a quick read.


It is also important that a Pandas child be supported by proper medical care, such as long term antibiotics. It sounds like a 504 or IEP would be very helpful, but even an unofficial team of teachers, family and doctors could do much of the same things. The key is emotional support along with medical and OCD therapy tools.


In the short term, you may want to focus more on comprehension and oral communication of ideas. During the peak of an exacerbation, there's only so much a Pandas kid can handle. Sometimes, expectations must be very fluid and adjusted day by day. Try to celebrate even the smallest accomplishments (sometimes simply showing up is a huge feat).


The other major contribution you can make is to advocate for this child among his other teachers. You "speak the language" of teachers and may be in a great position to bridge the gap that's so often present between parents and educators (particularly administrators). Your student is very lucky to have you on his team!

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Bless you for caring about your student so much and seeking understanding as well as solutions that work for him!! I add to the voices that an aware and dedicated teacher is a huge asset on the team for the PANDAS/PITAND child. We have experienced both teachers who refuse to acknowledge the condition or help support the child as well as teachers who have been very interesting in understanding her condition and communicating with me regarding assignments, as well as having them ready for me to pick up and turn back in on one of my many trips back and forth to the school. The latter (we have this now) has made a HUGE difference for our child and spills over into the self-confidence issues that go hand in hand with this. I encourage you to advocate for PANDAS students with the administration and faculty where you work - your input can be extremely valuable!


Most of what I was going to post has already been mentioned.... breaking it down into smaller assignments, allowing oral dictation, etc.


During some PANDAS exacerbations, my DD11 (who is also verbally gifted), sometimes is unable to speak and other times, her handwriting is too difficult to read. (She describes it as knowing what she wants to communicate; however, she is unable to "get the words out" sometimes. She has the OCD issue of anxiety over performance as she has very high standards for her schoolwork. Other times, she will repeatedly erase so much that she tears her papers and not much writing can take place. I too, have taken dictation for her and found that once that is on the computer, she is better able to manage completion of the assignment herself.


One thing I did not see mentioned is if there has been communication with the parents about what you are seeing in the classroom. It truly takes everyone working together and your input about what you are seeing there may be indicative of an infection that requires medical intervention in the form of antibiotics, etc.


Please direct the parents to this forum and thank you again for your efforts in supporting your student!! :)

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Wow! How fortunate for this family to have you as their son's teacher! I have a 12 year old who struggles with any creative writing assignment. Here is what helps him:

Extremely specific details for completing assignment. For example- 6 paragraphs, each paragraph must have a minimum of 5 sentences.



Over due the prewriting: we tell my son he needs x amount of details for each paragraph. He generates a list of ideas for each paragraph. Depending on his ability at the time, either he writes down the details or he dictates to me. He also takes breaks after each paragraph. The details should be 1-2 words or phrases....not complete sentences. Sometimes, he can generate the ideas on his own and sometimes he needs a specific series of questions. (do you think it was a good idea that mr jones did....okay that is a detail. Tell me 3 reasons it was a bad idea....great 3 more details. Etc


He then uses the details to write each paragraph. Usually with breaks in between the paragraphs.


I'm not sure if this would help the student you are working with but we have found the more concrete we can make the requirements the better

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Using a keyboard is a good idea and should be written into an IEP... assuming he will write on a keyboard even.


My son made much progress with concept webs/maps. Use a blank unlined sheet. The whole sheet of lined paper was way too much to tackle for him- very intimidating to look at because to him, every line had to be filled up, or it wasn't "finished." Blank sheets took some of the anxiety away. Try using a soft, friendly color as well, rather than stark white.


When my son was dealing with this, he could more easily tackle the task if he was faced given a main concept/theme in a central bubble (maybe write it there for him as he watches), and just two or three smaller bubbles attached to that, it is more "doable." If you can encourage him to write the theme in the central bubble, he will experience success and that will help. It should only be one word- that way he'll more likely be able to do it. After he can write the theme/title word, have him choose the word that represents or "sums up" the first body paragraph, and write it in one of the smaller bubbles, etc. The idea here is that he adds as he goes along depending on how much he can handle. If he can continue, have him add his own smaller bubble to the first small bubble, and then choose the next word. With a skeleton created, it MAY be easier for him to go back and fill in the spaces with a sentence. The lined paper was terrifying for my son. He would panic if he crossed a line, wrote to big, small, etc. The thicker blank paper will take more erasing, and this boy should feel that erasing is okay.


Hope that helps!

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Welcome! Like others, THANK YOU for caring so much about your student! I don't have time to read other reponses so sorry for any duplication. Can you allow the parent to scribe for your student for the time being, allow assignments to be typed on the computer and printed, or record a narration on a device? Is this student able to verbally tell you what he would like to convey?


Does this student have a 504 or IEP? If not, would you feel comfortable approaching the parents on the possibility of this? Some parents may know this is an option.

Edited by Vickie
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It is so awesome to see a teacher on here!!! I'm a 10th grade P.A.N.D.A.S. kid. As BrownEyesMom mentioned, does their handwriting have anything to do with it? Most of our handwriting is really weird... I know mine is & I can't think of any others I've talked to who have normal handwriting. Most teachers just whine & moan about it so more often than not if I know a teacher isn't going to read it (which obviously isn't the case with you but just saying) I won't even bother to try. That's because writing is a HUGE anxiety/OCD thing for me & lots of other P.A.N.D.A.S. kids. I don't feel comfortable speaking for others, but for me it's not so much about the actual writing as it is the pennmanship. I'll write a letter & have to erase it three times before it's okay. By the time the paper is ready to be turned in, it's a mess. That sounds so petty, but if you've had experienced with us you know that little things can be a big deal & lead to attacks.


I had another OCD problem with writing/reading in elementary school. I would only read phonetically. I KNEW how to say "ship" & "chip" but when I saw it it would be s-hip & c-hip. So I just avoided seeing words for a long time.


These very well might not be your student's specific problems, but I hope they provide some insight into their behavior. Thank you for coming on here. :)

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