Table 9 Scholastic cluster recommendations

S1. Scholastic difficulties are common in TSC and should receive early and ongoing screening, followed by appropriate action. The rates of difficulties in scholastic skills (e.g., reading, writing, spelling, mathematics) are very high in TSC (~ 60%) and can persist into adulthood. For this reason, all children with TSC should have early and ongoing screening to identify difficulties, gaps, and concerns about scholastic skills, followed by formal assessments as needed

S2. Delays in language development, counting, social/communication skills, and other developmental milestones may be markers for later scholastic difficulties. Caregivers, healthcare providers, and educational teams should monitor for signs of difficulties in language development, counting and math skills, social and communication skills, and other milestones that may indicate a potential for later school difficulties

S3. All children with TSC should be considered for an individual educational plan (IEP/IEDP) to support their learning. Given the high rates of scholastic difficulties, all children with TSC should be considered for an appropriate individual education plan (referred to as an “IEP” or “IEDP” in many countries) or its equivalent. An IEP/IEDP is a legal document drawn up by an educational authority with the family and outlines requirements to support students who need accommodations, curriculum modifications, or alternative educational programs

S4. School-aged children with TSC should be supported in the most appropriate educational environment to meet their needs. Caregivers and educators should advocate for the most appropriate educational environment that would be beneficial for the child with TSC. Given the wide range of TAND profiles in TSC, an appropriate educational environment could range from a mainstream school, to a fully inclusive environment, or a “special” school or classroom. The options and programs vary significantly in different countries, and families should seek the most appropriate environment to meet their child’s needs in partnership with the relevant educational authorities

S5. In all educational environments, educators should use high-quality teaching strategies, Response to Intervention (RTI), individualized teaching, and appropriate accommodations to ensure student success in scholastic skills (e.g., reading, writing, spelling, and math) and in all other aspects of education. The educational needs of children with TSC are highly heterogeneous and children with TSC often present with a range of educational strengths and weaknesses that require high-quality educational support. For this reason, educators should implement a highly personalized program of teaching, accommodations, modifications, and alternatives using high-quality teaching strategies and response to intervention (RTI) approaches

S6. Educators should monitor the overall TAND profile of each child with TSC and consider how it may affect the child’s ability to access education. Educators should be aware of each student’s TAND profile and how it may affect their education. This may include difficulties in many TAND clusters and may be associated with specific psychiatric diagnoses (e.g., ADHD, autism, mood, and anxiety disorders). Educators should, in particular, monitor for neuropsychological deficits (particularly in executive and attentional skills) and provide appropriate supports, such as schedules, outlines, organizers, and assistance in planning and breaking down assignments into parts. Social support may also be needed, for example, support in terms of making and maintaining healthy relationships. Teachers, special education teachers, or others within the school should monitor for social difficulties and provide support and teaching, to support the development of the social skills of students. This broad view of a child’s TAND profile should lead to the incorporation of appropriate educational strategies, accommodations, and goals to support each child with TSC

S7. Plan for educational transitions. For all educational paths, transitions through each stage of schooling and beyond secondary education must be considered and planned for early. Educators and clinicians should suggest resources and provide information to support these important transitions