Accomodations for School and College Students

As a psychiatrist, I advocate strongly for my patients with schools and colleges to ensure that they receive the support they need to succeed academically. The law is on our side here, and I've fought hard to get hundreds of students a fair shot at thriving. Here are some ways I can help:

1. Communicate with School Personnel

It is important to establish open lines of communication with school personnel, including teachers, counselors, and administrators. This can involve sharing information about a student’s diagnosis, medication regimen, and any other relevant information that can help the school better understand the student’s needs. All of this is with full parental consent of course.

2. Provide Written Documentation

Written documentation of the diagnosis and treatment plan can help schools understand the nature of the student’s condition and the accommodations that may be necessary. This documentation can come in the form of a letter from our clinic, a treatment plan, or a summary of the student’s medical history.

3. Attend Meetings with School Personnel

I can attend meetings with school personnel to discuss a student’s needs and advocate for appropriate accommodations. These meetings may include 504 plan or Individualized Education Program (IEP) meetings, as well as meetings with school counselors or administrators.

4. Recommend Accommodations

I can recommend accommodations that can help students succeed in school, such as extended time on tests and assignments, preferential seating, breaks during class, and visual aids and organizational tools. These recommendations should be based on the student’s individual needs and the nature of their condition.

I'd like to elaborate a little on specific accomodations that are customarily employed to assist students with ADHD, learning disorders, or emotional disorders. Please look through the list below and consider how this may apply to your own son or daughter:

1. Extended time on exams

One of the most common accommodations for students with ADHD or emotional disorders is extended time on exams. This allows students to have more time to read and answer questions on exams, reducing the pressure and anxiety they may feel during timed assessments. This accommodation is often provided to students who have difficulty with time management, processing speed, or distractibility. It works wonders on standardized tests (SAT, ACT) as well as classroom tests and AP exams.

2. Preferential seating

Another common accommodation is preferential seating, especially for younger students. This accommodation ensures that students with ADHD or emotional disorders can sit in a location that reduces distractions and helps them focus better. This may mean sitting near the front of the classroom, away from windows, doors, or other potential sources of distraction.

3. Note-taking assistance

Students with ADHD or emotional disorders may struggle to take comprehensive notes during class, which can make it difficult to retain information. Note-taking assistance can be provided in the form of a note-taker or access to lecture notes. This accommodation can be especially helpful for students who have difficulty with working memory, processing speed, or executive functioning.

4. Breaks during class

This is another one especially suited to younger students, who may need to take frequent breaks during class to manage their symptoms. Providing breaks during class can help students refocus and regulate their emotions. These breaks may be scheduled in advance or provided on an as-needed basis.

5. Reduced workload

Reducing the workload for students with ADHD or emotional disorders can be an effective accommodation. This may mean providing a reduced number of assignments, shorter readings, or fewer exams. This accommodation can help students manage their time and energy more effectively, reducing stress and anxiety. In these situations, teachers pay more attention to the quality of work, rather than quantity.

6. Flexible deadlines

Flexible deadlines can be very helpful.. Students are given more time to complete assignments, reducing the pressure and anxiety they may feel when facing a tight deadline. This is especially helpful for students who struggle with time management or organization.

7. Priority registration

Priority registration allows students to register for classes earlier than other students, ensuring that they can choose classes that are less likely to trigger their symptoms. This accommodation can also help students plan their schedules more effectively, and is especially useful for college students.

In all such cases, I provide follow-up care to monitor the effectiveness of any accommodations and make adjustments as necessary. I can work with the school to ensure that the student’s needs are being met and that they are making progress academically.

Advocating for patients with schools and colleges is an important part of providing comprehensive care for individuals with psychiatric conditions. Watching previously

struggling students blossom is one of the true joys of child and adolescent psychiatry.

Reach out to me with any questions about academic accomodations for your child.

- M. Ali, MD

Integrative Psychiatry - a Holistic Approach to Mental Health

As our understanding of mental health continues to evolve, so do the treatments available for individuals who struggle with psychiatric disorders. One approach gaining increasing popularity is Integrative Psychiatry, which takes a holistic and individualized approach to treatment, combining both traditional and alternative therapies to promote healing.

At its core, Integrative Psychiatry recognizes that each person's experience with mental health is unique and complex, influenced by a wide range of factors, including genetics, environment, lifestyle choices, and personal history. Therefore, treatment plans are tailored to address the specific needs of each individual, rather than taking a one-size-fits-all approach.

Integrative psychiatry combines traditional Western medicine with complementary and alternative therapies to promote optimal mental health. By incorporating multiple treatment modalities, integrative psychiatry aims to address the root cause of mental health issues rather than merely treating the symptoms.

Some of the therapies used in integrative psychiatry include:

• Mind-body therapies, such as yoga, meditation, and tai chi, which can help reduce stress and promote relaxation.

• Nutritional therapies, including dietary changes and supplementation, which can improve brain function and reduce inflammation.

• Herbal and nutritional supplements, such as omega-3 fatty acids and St. John's Wort, which can be used in conjunction with or as an alternative to traditional medications.

• Acupuncture, which has been shown to reduce anxiety and depression and improve sleep.

• Insight-oriented Psychotherapy, which can help individuals better understand their deeper thoughts and feelings.

When practiced by a fully trained and experienced psychiatrist, integrative treatment is not at all "anti-medicine." Rather, it's a recognition that many inputs must be optimized in the quest for excellent health, and smart pharmacotherapy is merely one part of the solution.

- M. Ali, MD

Our Teenage Girls are in Trouble

If you happen to have three teen daughters these days, how might their mental health look? According to recently reported CDC data, bleak.

In 2021, 57% of girls felt “persistently sad or hopeless.” And 30% seriously contemplated suicide. If your family was average, that would mean two of your girls were pretty depressed through the pandemic, and one of them was thinking a lot about killing herself. Please pause to consider these numbers. I started psychiatry training in 1998, and this is some of the most heart-wrenching data I have encountered.

Fom my work and my life experiences I can tell you, it rings true. Mothers bring in their middle school daughters who’ve started cutting their wrists or thighs, and add that “all her friends are doing the same.” And also: “what happened to my kid? She’s never happy any more.” These are awful things to hear, hour after hour, day after day. Parents are distraught.

What’s the picture like for boys by the way? Not great, but clearly less grim. Rates for serious mood symptoms and suicidal thoughts are about half the rates for girls. The American girl is struggling severely and uniquely.

It’s also worth looking at trends over time. A decade ago, our highschool girls answered yes to the same mood (36%) and suicide questions (19%) at markedly less disturbing rates. The crisis is now.

Is the pandemic to blame? Not entirely. It’s worsened the picture, but the trends were solidly in place before covid-19 was a word. Large annual surveys showed teen depression rates doubling in the decade ending 2019.

Some people wonder whether this is simply a case of girls today being more comfortable saying they are hurting. But our girls aren’t just saying that. They’re contemplating suicide, cutting themselves, attempting suicide, and showing up at emergency rooms. That sounds like both shouting for help, and giving up.

I am alarmed and hurt. Our surgeon general is in the same boat:

https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

I’m in the camp pointing fingers at social media. For hours a day, our girls are glued to a screen, comparing, commenting, wishing, drooling, regreting, doubting, envying, trashing, trolling, justifying. Facebook was launched in 2004. YouTube in 2005. The first iphone was launched in 2007, and instagram in 2010. By 2011 we had Snapchat, and by 2016 TikTok. Check this out:

I’m a doctor. I’m not saying two overlapping timelines prove one event caused the other. But how our daughters spend their time, and who they spend it with, mostly certainly affects how they feel. Consider this: on average, teens spend over nine hours per day online, excluding homework. And over five hours on social media. When I ask them them how social media makes them feel, many are refreshingly honest. “Horrible.” But they feel powerless to do anything about it.

I haven’t even touched on abuse and exploitation yet. Look, I’ve been bullied in middle school. Cussed, mocked, tripped, tricked, threatened, sucker-punched, etc. It was lousy. Painful and humiliating. Wouldn’t wish it on my enemies. But with cyberbullying, the scope and intensity are far worse, the audience much wider, the pain more devastating. You don’t go home and escape for a bit. You go home, lock yourself in your room, and watch the shares and the comments explode.

And with all those hours spent online, what don’t our girls have time for any more? They’re not hanging out IRL (in real life) for one. Too many are lonely, isolated, and excluded. They’re not exercising, not getting fresh air and sunshine. Not working part-time jobs nearly as much. I grew up with hours and hours of real conversations with aunts, uncles, grandparents, and cousins, not to mention parents and friends. Many of these I still quote from. Most teens nowadays aren’t getting any of that.

You know what else they don’t have time for? They’re just not sleeping enough. Between electronics, and homework, academic pressures and social demands, they just can’t find the time. Circadian rhythms change at puberty, pushing the natural sleep time closer to midnight. And most schools start when teen brains are wired to sleep in. The result is a drove of zombies yawning through first period.

No actually, the results are far more sinister. Sleep deprivation alone is capable of wreaking havoc on teen’s mental health. It worsens depression and anxiety, attendance and grades, obesity and metabolic ailments. And it’s an awfully vicious cycle – stressed and unhappy teens can’t fall asleep. This combination is quite lethal too. Insomnia is an independent predictor of suicide.

Honestly, just reading over this post is pretty depressing. But let’s not bury our heads in the sand. There’s urgent work to be done, smart and creative solutions to apply. Even in these confusing times, the foundations of them are pretty basic stuff. More common sense and generational wisdom rather than rocket science. More courage and integrity by the adults “in charge.” And wider access to quality mental health care for our youth.

Further reading:

https://www.cdc.gov/nchhstp/newsroom/fact-sheets/healthy-youth/sadness-and-violence-among-teen-girls-and-LGBQ-youth-factsheet.html

M. Ali, MD