Possible ME/CFS K-12 Educational Accommodations

Some Key Differences Between Possible Adult and Pediatric ME/CFS Presentations

• Symptom Fluctuation: Children often experience more variability in symptom severity, which can change significantly even within a single day. This variability can impact their daily activities and school performance.

• Cognitive Challenges: Children with ME/CFS may have more pronounced cognitive difficulties, such as trouble concentrating, remembering, and processing information. These issues can affect their ability to participate in classroom activities and complete assignments.

• Orthostatic Intolerance: A higher incidence of orthostatic intolerance symptoms, such as dizziness and fainting upon standing, is noted in pediatric cases. These symptoms can limit physical activity and affect school attendance.

• Sensory Sensitivities: Increased sensitivity to sensory stimuli like light, sound, and temperature changes is more noticeable in children with ME/CFS. These sensitivities can contribute to discomfort and fatigue.

• Emotional and Behavioral Changes: Emotional and behavioral symptoms, sometimes mistaken for anxiety or depression, are often linked to the physical burden of the illness. These changes can impact social interactions and school performance.

• Communication Challenges: Children may have difficulty articulating or recognizing symptoms due to their developmental stage and limited vocabulary. This can make diagnosis and management more challenging.

• Physical Symptoms: Physical symptoms such as muscle pain, headaches, or sore throat might be more prominent or fluctuate more than in adults. These symptoms can vary in intensity and impact daily functioning.

The following is a non-exhaustive list of possible educational accommodations for individuals with ME/CFS. Because ME/CFS is a dynamic condition that varies in severity and presentation, different students may require different supports. It's often better to have an accommodation in place and not need it than to be without one when it's essential. While not all schools may offer these specific accommodations, they may provide alternative options to meet similar needs. 

Possible K–12 Accommodations for Students with ME/CFS

• Instructional Strategies

• Use multi-sensory, individualized instruction based on learning style
• Teach tasks sequentially to reduce multitasking demands
• Use visual aids and non-linguistic representations
• Provide internal memory strategies (repetition, rehearsal, mnemonics)
• Provide clear, simple directions with time to clarify
• Break tasks into smaller steps using checklists and graphic organizers
• Offer frequent feedback and monitor task completion
• Support organizational skills with teacher-led check-ins
• Emphasize mastery of core skills over assignment completion or enrichment busywork

• Access to Learning Materials

• Provide written instructions and assignment checklists
• Use digital planners or calendars with teacher guidance
• Provide two textbook sets (home and school) or digital versions
• Offer access to teacher notes, outlines, and slide decks before class
• Allow electronic assignment submission
• Permit audio recording of lessons with signed agreement
• Provide alternate media formats (e.g., accessible PDFs, screen-readable files)

• Technology and Assistive Tools

• Allow use of laptops or tablets for writing and note-taking
• Permit typing of in-class assignments
• Support use of spell checkers, dictionaries, and calculators
• Allow use of noise-canceling headphones or sunglasses when needed
• Provide word processing tools and speech-to-text support if required

• Physical and Environmental Supports

• Preferential seating (e.g., front, near exits, low-distraction zones)
• Allow students to stand, recline, or shift position during class
• Permit eating, drinking, or taking medication during class
• Provide frequent rest breaks during long periods
• Ensure classrooms are well-ventilated, temperature-controlled, and accessible
• Minimize stairs and long walking distances; ensure elevator access
• Reduce exposure to bright lights, noise, or temperature extremes
• Request fragrance-free classroom environments
• Provide quiet recovery space (e.g., health office) during symptom flares

• Scheduling and Attendance Flexibility

• Allow part-time or flexible scheduling based on daily energy levels
• Permit attendance in alternate course sections as needed
• Provide access to remote or hybrid learning options
• Excuse disability-related absences without penalty
• Plan for extended absences with homebound or tutorial instruction
• Reduce or modify homework expectations
• Permit temporary pause or reduction of workload during flare-ups
• Allow course substitutions when appropriate (e.g., for PE or performance-based classes)

• Assessment Modifications

• Provide extended time on quizzes, tests, and projects
• Allow assessments over multiple days or sessions
• Reduce number of items per test while preserving learning objectives
• Permit alternative formats (oral, project-based, take-home)
• Allow students to answer directly on test (no Scantron)
• Provide written instructions for tests
• Allow clarification of directions or questions
• Offer distraction- and sensory-reduced test environments
• Allow assistive tools (laptop, spell checker, calculator)
• Permit breaks, hydration, and snacks during testing

• Health and Medical Supports

• Limit physically demanding activities (e.g., PE, prolonged writing)
• Provide access to rest or health office as needed
• Ensure constant access to hydration and snacks
• Allow extra time for transitions between classes
• Train staff to identify signs of cognitive overload or physical fatigue

• Social and Emotional Supports

• Support social engagement with adaptations as needed
• Teach energy conservation and pacing strategies
• Provide opportunities for self-advocacy skill-building
• Reduce unnecessary academic or social stressors
• Assign a trusted adult contact for ongoing support

• Transportation (If Applicable - including for field trips)

• Minimize time spent on transportation
• Provide access to climate-controlled vehicles
• Allow flexible transportation schedules when needed

• Staff Training and School Awareness

• Train staff on ME/CFS, including symptom variability and invisibility
• Reinforce that symptoms may fluctuate and aren’t always visible
• Educate on differences in child vs. adult presentation
• Understand that students may struggle to articulate symptoms and rely on teacher observation
• Ensure school-wide understanding of ME/CFS as a dynamic disability