Brain Tumors, Part 3 — Implications for School

The presence of a brain tumor likely will result in significant implications for a child in school, and the management of a brain tumor at school has several facets. Educators must consider the physical, psychosocial and cognitive issues of this diagnosis in order to ensure that the young person with a brain tumor receives the appropriate education and is successful at school.

The physical aspects of a brain tumor must be addressed at school. The following accommodations and adaptations might be warranted for a child with a brain tumor:

  • Fatigue is a common problem, and the child might need to rest during the school day. It is usually best to do this in the nurse's office or another location away from the other students to avoid increasing peers' feelings that the child is different or unfairly favored.
  • Restroom privileges should be flexible.
  • Exercise may benefit the child with a brain tumor by increasing muscle strength. The child should be encouraged to participate in all physical activities at school. Occasionally, the child might be limited by the effects of the tumor or of the therapy, but should still participate to the extent that the healthcare provider allows. With input from the child and parents, the doctor can establish reasonable limits for strenuous activity, or set guidelines for ways to handle difficult days.
  • Balance and mobility should be evaluated by a physical therapist. Any modifications or accommodations that are indicated should be incorporated into the student's IEP.

Psychosocial concerns for the student might be significant. Due to frequent absences, frequent infections, limitations on physical activity and possible changes in cognitive functioning, a young person with a brain tumor likely will feel left out of the normal social interactions. This is especially true for a student in high school. Students might feel abandoned or lost. To encourage healthy psychological, emotional and social adjustment, the school should consider:

  • With the consent of the child and the parents, the school could educate the child's peers about what it means to have a brain tumor. The hospital school teacher is a good resource for offering a presentation, suggesting materials or assisting with the education of school personnel or other interested community members.
  • Encourage peers to stay in contact with their friend during the inevitable absences. Cards, letters and phone calls can bridge the gap between friends when they are apart.
  • This is a wonderful opportunity to teach peers about supporting a friend, showing compassion and other essential life lessons.
  • Study time together.

  • Identify strong peers to mentor the student with a brain tumor upon the return to school. Many students say that having someone fill you in on what you missed while you were gone can make all the difference in providing a smooth re-entry to school.
  • Help the student find areas of expertise and ways to excel in the school environment. Mentoring support could be included even in the IEP to help the student develop confidence.
  • Include social work or counseling services as part of the IEP. Having someone at school in whom the student can confide, or who can act as an advocate for the student can be a significant asset. This would afford the student the opportunity to discuss worries about homework, fears about the future, social difficulties and problems with family members, all in a non-threatening setting.

Finally, cognitive status and academic progress must be monitored on an ongoing basis. The student is likely to experience some degree of cognitive or learning problems as a result of the tumor or the treatment. Usually, students with a brain tumor qualify for special education support as students who are other health impaired (OHI), learning disabled (LD), or developmentally delayed (DD) under the Individuals with Disabilities Education Act (IDEA). A comprehensive evaluation should be conducted to determine whether the student would qualify under one of these special education areas of need.

Medical appointments, hospitalizations, radiation treatments and other therapeutic requirements can result in excessive absences for the student. This might cause the child to feel concerned about keeping up academically. A student with a brain tumor is likely to miss a lot of school, and will need assistance and flexibility to complete assignments before returning to school. As much as possible, the student should be encouraged to attend school. Homebound education is an option, but it should be used as a last resort — ONLY if the child cannot possibly come to school.

In order to ensure that the student continues to progress, educators should:

  • evaluate for potential classification as other health impaired, learning disabled, developmentally delayed or other special education category
  • create an IEP that allows for the possibility of ongoing change and fluctuation in ability and physical stamina
  • identify areas of strength and help the student focus on the skills and functions that are largely unaffected, rather than those that have been negatively impacted by the diagnosis, surgery or treatment
  • provide for a great deal of flexibility dealing with absences. Give plenty of time to complete missed assignments
  • provide tutorial assistance if the student has been absent or is experiencing difficulty with specific learning material
  • provide careful monitoring to determine if the student's performance declines
  • notify the child's parents or health care provider if the school staff observe a change in behavior, personality or school performance

For more information

Part 1 — Introduction, Incidence and Symptoms

Part 2 — Treatment, Side Effects and Restrictions

National Brain Tumor Foundation

22 Battery Street
Suite 612
San Francisco, CA 94111-5520
nbtf@braintumor.org
Patient Information Line:
1.800.934.2873 9am-5pm PST

BRAIN

P.O. Box 5801
Bethesda, MD 20824
www.ninds.nih.gov
(800) 352-9424

Office of Cancer Communications

National Cancer Institute
Building 31, Room 10A-03
Bethesda, MD 20892-2580
www.cancernet.nci.nih.gov
800-4-CANCER (800-422-6237)

American Brain Tumor Association (ABTA)

2720 River Road
Suite 146
Des Plaines, IL 60018-4110
info@abta.org
http://www.abta.org
Tel: 847-827-9910 800-886-2282
Fax: 847-827-9918

American Cancer Society

National Home Office
1599 Clifton Road, NE
Atlanta, GA 30329-4251
http://www.cancer.org
Tel: 800-ACS-2345 (227-2345)

Brain Tumor Society

124 Watertown Street
Suite 3H
Watertown, MA 02472-2500
info@tbts.org
http://www.tbts.org
Tel: 617-924-9997 800-770-TBTS (8287)
Fax: 617-924-9998

Children's Brain Tumor Foundation

274 Madison Avenue
Suite 1301
New York, NY 10016
info@cbtf.org
http://www.cbtf.org
Tel: 212-448-9494 866-CBT-HOPE (228-4673)
Fax: 212-448-1022

Contributed by:

Robert Trueworthy, MD
Professor
Section Chief of Pediatric Hematology and Oncology
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center