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    #234182 10/05/16 11:09 AM
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    I'm all ears.

    We are trying to figure out what sorts of accommodations are useful. Extra time doesn't seem to help exam performance much when ptsd is triggered by stress, for example.

    I especially appreciate credentialed/peer reviewed/ otherwise official-ish kinds of sources, since the university will be most attentive to such information.

    Thus far, we seem to be in a situation where people without the proper credentials are the only ones offering advice-- mostly to DD or myself. The people who could potentially be considered credentialed in some way don't seem to have many suggestions-- they ask HER what would be helpful. It's sort of as if they aren't sure what to do, but won't listen to just HER ideas of what might be helpful either.

    One professor mentioned the idea of a safety net of sorts-- a means of credit recovery for exams where her performance is seriously adversely impacted. (This impact, btw, can be somewhere between 10-30%, depending upon the day and circumstances, and we've got about a year's worth of data now to support that, and about five professors can support that claim, at least somewhat).

    They seem to want to accommodate this as though it were ADD or a LD. It isn't. It's episodic, and it has nothing to do with how well she knows the material. She always knows it well enough to earn B's and A's on assessments. It's just that sometimes her encoding is bad (if she's dissociating/panicky in classes), and sometimes her working memory and retrieval is profoundly impaired in testing situations. Scantrons, multiple choice formatting, and computer-based evaluations all make it worse, and quantitative/calculation-based test items are also problematic.



    TIA.

    The short version of this story, btw, is that my child was the victim of a felony crime, which has been resolved via the legal system, but her uni has turned out to be surprisingly oblivious, even though Title IX arguably obligates them to do more than they have. I'm not actually at liberty to discuss much about that, for obvious reasons.



    Schrödinger's cat walks into a bar. And doesn't.
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    I'm sorry I don't have any resources for you. I just wanted to express my sympathy for your daughter. (I tried to PM you but you are over your PM topic limit, so I can't.)

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    I wish I had a suggestion, but unfortunately I don't - so I just wanted to say I'm sorry about what happened to your daughter and I truly hope you find some useful way to help her...

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    Howler, I am so sorry to hear what your DD has gone through.

    I like the safety net idea.

    I have seen the following accommodations for college students:
    --reduced or eliminated class attendance requirement
    --testing in separate room/ small group
    --testing in smaller chunks (e.g. exam in three short bursts instead of a one hour sitting)
    --flexible deadlines (though of course it all has to be done by term's end)

    You could also consider whether any of these would help:
    --testing in a particular environment (removed from places that are triggering)
    --no-penalty resubmit/retake option on some or all assignments or tests

    So much of PTSD appears to be environmental/situational: would she be better off finishing her degree at another school? (I know, that is not a trivial matter. Just asking.)

    I am betting you are getting no advice because no one there knows what to do. I hope my guesses are useful.

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    I'm very sorry to hear of your child's trauma. I too have a child who was diagnosed with PTSD. I assume this was a diagnosis made by some type of professional? I will note that the person who made my child's diagnosis was not the person who was capable of properly treating the trauma. Finding a therapist or psychologist who specializes in trauma is key. They should be able to not only treat your child's episodes of PTSD, but also point you to the research and suggest the accommodations you are looking for.

    I will echo Portia's comment and add that EMDR, MNRI and Tapping have shown some benefit to people I know who have suffered trauma, myself included. Anecdotal, I know, but perhaps worth mentioning.

    I know our circumstances are probably very different, but please feel free to PM if you think it may be helpful. Best of luck to you and your child.


    Last edited by llg12j; 10/05/16 07:41 PM.
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    Thanks everyone. This is helpful.

    She's definitely been in therapy-- and while her therapist was a trauma specialist, DD is... well, she's apparently still not exactly neurotypical, and the therapist was not really someone who established a good therapeutic relationship with DD. She eventually refused to go any more-- she has seen a non-specialist psychiatrist who has established a good working relationship with her, however, and that she continues to do. She also sees a trauma-specialist psychologist occasionally. They all think that she's doing pretty well, considering-- but that her ptsd is stabilizing, and that it is probably going to be chronic for another decade or so, and will always be a vulnerability to stress/trauma now that she's developed it. For this reason, we remain unconvinced that having her take a year off is a good idea. We have no idea what she'd do with herself, and she would lose the social support network that she has with her friends.

    She is far better than a year ago-- let me say that up front. Her trauma was nearly two years ago at this point, incidentally. Suffice it to say that it was severe.

    Our natural next step would be anxiolytics at this point, but that's a no-go for other (medical) reasons. So here we are.

    She has panic attacks, and the more (general) stress she's under, the more prone to them she becomes. It's sort of like stress fills up a cup-- she can sometimes tolerate the volume of stress promoted by an exam... if she's not otherwise stressed, if she's well-rested, knows the material well, etc. etc.

    Under ideal conditions, she still doesn't test well, by any means-- because she does have ptsd. She has major problems with hypervigilance, and therefore almost any environment can be a distracting one, by definition. Her working memory is not great, retrieval and encoding are definitely impaired relative to what she used to be capable of, and she "drops" things when relying upon her working memory. Her executive skills are also not as good as they once were.

    In her experience, ptsd means that stress and her function (including cognitively) are roughly inversely linearly related, at least up to some critical point-- at which time her response to stressors becomes non-linear, as she basically enters fight-or-flight mode.

    At that point, she is basically incapable of anything but survival based thinking. She isn't even laying down memories, if it happens in class. She has a recording device for lecture settings, though that was not especially helpful in math and physics.

    This is an improvement from where she was a year ago. Then, she had trouble even reading at a college level, her processing was so impaired. She cried and cried at having to read and re-read the same paragraph four times, read it out loud, underline it... just to gain basic comprehension that used to be effortless-- automatic. It was horrifying. I spent a lot of time helping her re-learn things like study skills and organizational strategies that went missing from her brain as a result of the trauma. She took a couple of community college classes over that summer to help her with studying for and taking exams. We were hoping that relearning the skills would defuse some of her anxiety.

    It's as though she has a brain injury. Truly. frown



    Leaving the institution isn't a decision to make lightly-- she does have two years remaining of her full merit scholarship, which means that she graduates debt-free. That's also a not-insignificant resume item. On the other hand, it also means a lot of stress on her in terms of maintaining a 3.25+ GPA. Her assailant and his family also live in the town she attends university, so that is also a consideration.... but she also has friends at the institution, has invested 2y there already, has excellent (and complex) medical care already in place, and we are close. We have certainly considered it, however.

    In a college course, a grade may depend upon only a midterm and a final exam-- if she doesn't do well on the midterm... that greatly increases her stress.

    Just knowing that it could happen often becomes a self-fulfilling prophecy.

    She spent a term avoiding coursework that was heavily exam based, and earned straight A's. (Of course). The trouble is that she has to take some classes that are exam-heavy to earn her degree.

    She also has to earn all A's and B's in those courses.


    Sorry about the full message box-- I've cleared some space now. smile



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    We are going to meet (her and me both) with her university psychologist who is a specialist in the specific type of trauma she sustained, so hopefully we can get some traction with that meeting before going back to the disability office.

    It has been extremely frustrating to know that she needs-- something-- but for her mental health professionals to shrug and say "well, I'm not really the person to say what classroom practices need to look like...avoid courses with exams, then... talk to the disability office-- what do they suggest?"

    and what they have to offer is apparently blank expressions and "we don't really recommend particular accommodations, you understand-- you need to have a mental health professional recommend something specific and we'll evaluate it for approval in a few weeks..."

    Professors have been generally pretty positive-- but she already has exams outside of the classroom setting, and extended deadlines, approved class absences, etc. as a result of her extant/preexisting disability, and they often aren't sure what else they can do. Some have ignored even those, or refused to return phone calls, meet to discreetly discuss disability matters, etc. You can imagine the additional stress that kind of nonsense causes.

    You get the idea. I've spent hundreds of hours in meetings this past two years just on DD's mental health and how to help her get better. I've learned a very great deal in the past two years about PTSD and what is-- and is not-- known about it, and how to treat it or not.

    What I suspect, based on knowing how faculty tend to think, is that she probably needs a menu of things that she and a faculty member can choose from in a particular class. That way faculty maintain a sense that they have autonomy over assessment-- which is a huge thing for most faculty, by the way.

    She'd like to take her exams orally with a trusted proctor-- sometimes it could be the professor, but sometimes the professor would add to her stress level if she doesn't get along with him/her well. She would also like the chance to recover credit if she experienced a flare during testing, and to perhaps be able to take assessments open-notes due to her memory/retrieval problems when under stress. She says that during exams, it's often as though she's trying to read a heavily 'redacted' document when recalling things in her notes or from a text, or auditory recollections. It's like-- she knows everything around it, but not the thing she's trying so hard to remember. It's stubbornly fuzzy/blanked out. Often, she can recall the information almost immediately upon leaving the exam.

    Sometimes, though, she dissociates during testing-- and that is the worst exam performance by far, and it also results in her not even really have any recall of testing, or what she does recall is spotty and inaccurate. So she can walk out of a test and think "Hm. Well, I guess that was okay" only to recover more fragments over the following 24 hours or so, and realize that she may well have failed the assessment. Not by looking things up-- just by the memory coming back slowly as the dissociative state dissipates.





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    HK, I have no expertise in this area. The only idea I can offer you is to ask if the mental health professionals can come to the disability office with you, so you can short-circuit the whole "what do you suggest," "well, what do you suggest" cycle (which sounds immensely frustrating). This sounds like it would be well worth paying for, even if it is not covered by insurance (which it might not be, since the time involved is not therapy time).

    Credit recovery does sound like an accommodation worth pursuing, especially since it could probably be tweaked by different professors to overcome their individual prejudices. If she can write down a description of the memory issue (which you have done vividly), it might help professors understand what she is laboring under. I think that everyone has had the experience of not being able to bring up information that is near the tip of their tongue, but stubbornly not emerging, and then remembering it a few hours later. The idea that that is happening during an exam consistently should be horrifying to an educator.

    Best of luck to you. It sounds like a horrifying situation.

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    Originally Posted by Portia
    I have no idea how long it takes for medication to work, but I wonder if she can take anti-anxiety medication when she feels the attack coming on - or on test days. Maybe on a short term basis until treatments for the trauma itself can become effective. You mentioned the trauma was relatively recent and the timing lines up with increased incidents.


    Originally Posted by HowlerKarma
    Our natural next step would be anxiolytics at this point, but that's a no-go for other (medical) reasons. So here we are.


    I agree that PTSD is a form of anxiety, and that anxiolytics are generally a fine choice for such things, but I don't know what the medical issues are that cause you to rule them out.

    I assume that you have already investigated the possibility of taking a year off with the authorities who granted the scholarship? Under the circumstances, they might be willing to put it on hold for a year instead of withholding it entirely.

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