Diabetes and the Testing Environment: School Adaptations
It is May 11 and the college acceptances are in! We have many happy and unhappy students in the Washington, DC, area. As we all know, colleges choose students on the basis of multiple criteria: grades, standardized tests (SAT, ACT, etc.), extracurricular activities and, in some cases, the personal interview. Unfortunately, standardized tests are not going away any time soon. Thus, in children and teens with diabetes, the standardized test is fraught with anxiety--more so because the exam is "high stakes" and there are only a few opportunities to retake the examination.
As every parent knows (with or without a child/teen with diabetes), exams provoke stress resulting in the release of epinephrine (counter-regulatory hormones) that actually increases the release of blood glucose. In people without diabetes, this glucose release is a positive adaptation to cope with the impending threat (whether it be a lion or the SAT) and improve performance (run away from the threat or ace the exam). However, as we have discussed in previous blogs, in people with diabetes, this release of glucose into the blood is not necessarily positive (unless the person is "low"). Instead, blood sugars rise to hyperglycemic levels and the ability to concentrate is impaired. Likewise, if the student becomes low during the exam, concentration also is impaired, possibility resulting in a poor performance.
Obviously, test performance is an issue for children/teens with diabetes throughout the entire school year. However, adaptations for these exams are usually discussed with school officials prior to start of school. Oftentimes, these adaptations are noted on school forms or the diabetes team provides an additional official letter denoting the requirements necessary for all students during a testing situation (or a 504 plan is in place). Unfortunately, parents and students often think that these testing adaptations will automatically be applied during standardized testing situations. This may not necessarily be the case and additional documentation may be required for your student to have appropriate accommodations. The goal is not to have a poor testing experience and to be proactive before the student sits for the examination.
All testing agencies are required to provide special accommodations for children with special needs: whether it is learning disabilities, visual problems, or medical issues. However, most organizations require a special letter from the treating physician/diabetes team to document the necessary requirements to provide the best testing environment for your child. What are these requirements for children/teens with diabetes?
- Extended testing time if necessary. (Why? See below.)
- Access to rapid acting carbohydrate and fluids. (Smarties, juice, etc., as food and drink are not usually allowed by the proctor during standardized examinations.)
- Access to a blood glucose meter to check blood glucose (high or low).
- Allowing the student to treat lows or highs accordingly (with glucose or insulin- this takes time).
- Bathroom privileges (if high, may need to void more frequently).
- Extra time to recover from a low or high blood sugar, i.e., 15 minutes to get blood sugar over 70 mg/dl or time to get blood sugar in an acceptable range.
Our diabetes team has a letter that is in our permanent document collection to provide all test-taking students with the optimal environment and necessary precautions. Most diabetes programs provide the same documentation. Thus, make certain that you discuss future examinations with your diabetes team way in advance to forward the appropriate documentation to the testing agency. Please do not wait until your child/teen "bombs" the examination and then decide to ask for the special adaptations, as the exam will still count. (However, your child/teen will have the opportunity to explain the adverse circumstances that occurred during the testing environment at some point during the application procedure.)
Now is not the time to omit the fact that your child has diabetes. Indeed, it is the time wherein the family and school will need to advocate for the best possible testing environment for your child. As I mentioned above, keep in mind that your child will probably not be the only one asking for extended time or special needs during these examinations. Your job as caregiver is to provide the best possible environment to maximize your child's academic potential and achieve the best possible results. (And, if necessary, a 504 plan may be of assistance if not already in place.)
FYI: Our teens with diabetes perform extremely well during these high stress situations, just like their peers without diabetes with the appropriate accommodations in place.