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Break the Stigma Around Children's Mental Health

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School-Link: Caring for the mental health needs of children and young people

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Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or sensations (obsessions). It also can give you an urge to do something over and over again (compulsions). Some people have both obsessions and compulsions.

OCD isn't about habits like biting your nails or thinking negative thoughts. An obsessive thought might be that certain numbers or colors are "good" or "bad." A compulsive habit might be to wash your hands seven times after touching something that could be dirty. Although you may not want to think or do these things, you feel like you can't stop.

Everyone has habits or thoughts that repeat sometimes. People with OCD have thoughts or actions that:

Take up at least an hour a day

Are beyond your control

Aren't enjoyable

Interfere with work, your social life, or another part of life

OCD comes in many forms, but most cases fall into at least one of four general categories:

Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical condition like pregnancy or schizophrenia.

Contamination, a fear of things that might be dirty or a having a compulsion to clean (you may hear this called "obsessive cleanliness disorder"). Mental contamination involves feeling like you've been treated like dirt.

Symmetry and ordering, the need to have things lined up in a certain way.

Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these thoughts might be violent or disturbing.

[Self-Test] Do You Have Symptoms of OCD?

Many people who have OCD know that their thoughts and habits don't make sense. They don't do them because they enjoy them, but because they can't quit. And if they stop, they feel so bad that they start again.

Obsessive thoughts can include:

Worries about yourself or other people getting hurt

Constant awareness of blinking, breathing, or other body sensations

Suspicion that a partner is unfaithful with no reason to believe it

Worries about germs and dirt touching your body

Compulsive habits can include:

Doing tasks in a specific order every time or a certain "good" number of times

Needing to count things, like steps or bottles

Fear of touching doorknobs, using public toilets, or shaking hands

Rituals of washing and cleaning

Doctors aren't sure why some people have OCD. Stress can make symptoms worse.

It's a bit more common in women than in men. Symptoms often appear in teens or young adults.

OCD risk factors include:

A parent, sibling, or child with OCD

Physical differences in certain parts of your brain

Depression, anxiety, or tics

Experience with trauma

A history of physical or sexual abuse as a child

Sometimes, a child might have OCD after a streptococcal infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.

What Causes the Compulsion to Wash?

Experts believe OCD is caused by an abnormality in the brain's circuitry. Brain scans show brain activity is different in people with OCD. There's probably a genetic component too, especially when OCD begins in childhood. Of all adults with OCD, 1/3 to 1/2 say their illness started in childhood or adolescence.

Why is someone with the disease compelled to wash, as opposed to check or count or hoard? That's not known. It's true that with all types of OCD, you may act out a compulsion to relieve anxiety produced by an obsessive, intrusive thought.

Your doctor may do a physical exam and blood tests to make sure something else isn't causing your symptoms. They will also talk with you about your feelings, thoughts, and habits.

There's no cure for OCD. But you may be able to manage how your symptoms affect your life through medicine, therapy, or a combination of treatments.

Treatments include:

Psychotherapy. Cognitive behavioral therapy (CBT) can help change your thinking patterns. In a form called exposure and response prevention, your doctor will put you in a situation designed to create anxiety or set off compulsions. You'll learn to lessen and then stop your OCD thoughts or actions.

Relaxation. Simple things like meditation, yoga, and massage can help with stressful OCD symptoms.

Medication. Psychiatric drugs called selective serotonin reuptake inhibitors help many people control obsessions and compulsions. They might take 2 to 4 months to start working. Common ones include citalopram (Celexa), clomipramine (Anafranil), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft). If you still have symptoms, your doctor might give you antipsychotic drugs like aripiprazole (Abilify) or risperidone (Risperdal).

Neuromodulation. In rare cases, when therapy and medication aren't making enough of a difference, your doctor might talk to you about devices that change the electrical activity in a certain area of your brain. One kind, transcranial magnetic stimulation, is FDA-approved for OCD treatment. It uses magnetic fields to stimulate nerve cells. A more complicated procedure, deep brain stimulation, uses electrodes that are implanted in your head.

The Role of Family Members

Families often make the mistake of enabling loved ones with OCD. For instance, a person who sees their partner cleaning the house 3 or 4 hours a day may at first think they've got the world's greatest partner.

But that same person may later see their partner is irritable, exhausted, and their cleaning patterns are bizarre. So they may ask whether they think there's an issue. The partner may agree to get treatment because the person spoke up.

In this way, family members can play an important role in supporting a person with OCD. They may steer a loved one toward a diagnosis or help with treatment. They may participate in therapy. There are also support groups for people who have a loved one with OCD.

Some separate conditions are similar to OCD. They involve obsessions with things like:

Your looks (body dysmorphic disorder)

Collecting, arranging, or ordering things(hoarding disorder)

Pulling out/eating your hair(trichotillomania)

Picking at your skin (excoriation)

Worrying about your physical health (hypochondriasis)

Body odor or how you smell (olfactory reference syndrome)

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Unwanted thoughts or habits that stand in the way of everyday life may be obsessive-compulsive disorder (OCD). Learn about its symptoms and treatment.

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The term dysfunctional is defined as "abnormal or impaired functioning" on the part of an individual person, between people in any sort of relationship, or amongst members of a family. Poor functioning refers to both behavior and relationships that aren't working and have one or more negative, unhealthy aspects to them, such as poor communication or frequent conflict.

This is a term used often by mental health professionals for interactions between people and is often used to describe any relationship in which there are significant problems or struggles. Dysfunctional relationships or situations are often the impetus for getting help in psychotherapy. Many families develop dysfunctional aspects when trying to cope with a troubled teen because family members are forced to adapt to the teen's emotional or behavioral problems that impact them on a daily basis.

A troubled teen who expresses anger by hitting others

A teenage couple that deals with conflict by not speaking to each other

A family in which a parent is drinking daily and family members are afraid to talk about what's happening

A teenager with a dual-diagnosis who uses drugs to deal with their symptoms rather than deal with what is causing them

In dysfunctional families, there are a variety of patterns that can occur. Here are the most common:

Parents or teens abuse alcohol and/or drugs

One or both parents have compulsive behavior, such as gambling or overworking, that leads to difficulties for the rest of the family

One or both parents threaten or actually carry out violence that may or may not involve the children

One or both parents treat the children as possessions and as if the children are only around for the parents' own personal needs or satisfaction

One or both parents are extremely strict to the point of not giving their children autonomy and exerting tight control over their lives

One or both parents are unable to provide or simply stop providing emotional and/or physical and financial support

Many families have times when these patterns occur, but it is when they start to become the norm that dysfunction occurs.

When dysfunctional patterns become the standard in a family, the detrimental effects on the children are great and can be carried on into their adult relationships. Some of these potential and damaging effects for children are:

Having to take sides in a parental conflict

Actions of parents not matching their words, which causes a distorted reality

Being rejected or being favored

Having rigid controls put over everything from who their friends are to how they dress

Having parents that are either way too involved and overly protective or parents who are uninvolved and disinterested

Being ridiculed or ignored when sharing thoughts or feelings

Being physically abused

Feeling like they have to be the adult in the situation

If your family is experiencing dysfunction for any reason, seeking out family therapy may be a good option. Family therapy has been shown to be extremely effective in learning new ways to communicate, solving problems between family members and becoming sources of support and strength to each other.

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How Dysfunctional Behavior Affects Families

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The term dysfunctional is defined as "abnormal or impaired functioning" on the part of an individual person, between people in any sort of relationship, or amongst members of a family. Poor functioning refers to both behavior and relationships that aren't working and have one or more negative, unhealthy aspects to them, such as poor communication or frequent conflict.

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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Violent Threats and Incidents in Schools - The Educator's School Safety Network

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On February 14, 2018, the shooting at Stoneman Douglas High School in Parkland Florida became the spark that once again ignited a national conversation about violence in schools.

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It's not unusual for children -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their parents, teachers, or other adults. When this behavior lasts longer than six months and is excessive compared to what is usual for the child's age, it may mean that the child has a type of behavior disorder called oppositional defiant disorder (ODD).

ODD is a condition in which a child displays an ongoing pattern of an angry or irritable mood, defiant or argumentative behavior, and vindictiveness toward people in authority. The child's behavior often disrupts the child's normal daily activities, including activities within the family and at school.

Many children and teens with ODD also have other behavioral problems, such as attention deficit disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some children with ODD go on to develop a more serious behavior disorder called conduct disorder.

What Are the Symptoms of Oppositional Defiant Disorder?

Symptoms of ODD may include:

Throwing repeated temper tantrums

Excessively arguing with adults, especially those with authority

Actively refusing to comply with requests and rules

Deliberately trying to annoy or upset others, or being easily annoyed by others

Blaming others for your mistakes

Having frequent outbursts of anger and resentment

Being spiteful and seeking revenge

Swearing or using obscene language

Saying mean and hateful things when upset

In addition, many children with ODD are moody, easily frustrated, and have a low self-esteem. They also sometimes may abuse drugs and alcohol.

What Causes Oppositional Defiant Disorder?

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.

Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal functioning of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.

Genetics: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.

Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.

Continued

How Common Is Oppositional Defiant Disorder?

Estimates suggest that 2%-16% of children and teens have ODD. In younger children, ODD is more common in boys. In older children, it occurs about equally in boys and in girls. It typically begins by age 8.

How Is Oppositional Defiant Disorder Diagnosed?

As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular illness like ODD. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose ODD, the doctor may sometimes use tests such as neuroimaging studies or blood tests if they suspect that there may be a medical explanation for the behavior problems that occur. The doctor also will look for signs of other conditions that often occur along with ODD, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. The doctor often must rely on reports from the child's parents, teachers, and other adults because children often have trouble explaining their problems or understanding their symptoms.

How Is Oppositional Defiant Disorder Treated?

Treatment for ODD is determined based on many factors, including the child's age, the severity of symptoms, and the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

Psychotherapy: Psychotherapy (a type of counseling) is aimed at helping the child develop more effective coping and problem-solving skills, and ways to express and control anger. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve behavior. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior. Behavior management plans also often involve developing contracts between parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors.

Medication: While there is no medication that is scientifically established or formally approved to treat ODD, drugs may sometimes be used to treat symptoms (impulsivity, irritability, etc.) or other mental illnesses that may be present, such as ADHD or depression.

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What Is the Outlook for Children With Oppositional Defiant Disorder?

If your child is showing signs of ODD, it is very important that you seek care from a qualified mental health professional immediately. Without treatment, children with ODD may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. In addition, a child with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder. When started early, treatment is usually very effective.

Can Oppositional Defiant Disorder Be Prevented?

Although it may not be possible to prevent ODD, recognizing and acting on symptoms when they first appear can minimize distress to the child and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.

Sources

SOURCES:

Mayo Clinic: "Oppositional defiant disorder (ODD)."

KidsHealth: "What Is ADHD?"

healthychildren.org: "Disruptive Behavior Disorders."

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It's not unusual for children -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their parents, teachers, or other adults.

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What Is OCD?

Obsessive-compulsive disorder (OCD) causes upsetting thoughts called obsessions. It also causes the urge to do behaviors called compulsions (also called rituals). Kids and teens with OCD get stuck in a stressful cycle of these thoughts, anxiety, and rituals.

If you think your child has OCD, start with a visit to your child's doctor or mental health provider. They can check for OCD or for other problems that could be the cause of your child's symptoms.

How Is OCD Treated?

Treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, kids learn coping and calming skills for anxiety. They learn how to safely face fears without doing rituals.

Along with therapy, doctors may give medicines for OCD to some kids. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors). These include Zoloft®, Prozac®, and Luvox®.

Treatment works best when a parent or caregiver goes to therapy with their child. That way, they can learn how to coach their child through OCD symptoms, help their child practice skills they learn in therapy, and offer daily support.

What Signs Might Parents Notice?

Obsessions

These are stressful thoughts that come to mind over and over. A child with OCD doesn't want to think about these things. But they feel they can't stop.

Parents may notice obsessions as intense fears or worries. Kids with OCD may feel unusually upset about:

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

things that are not straight, even, or arranged "just right"

Compulsions (Rituals)

These are behaviors a child will do, trying to feel better. To the child, rituals seem like the way to stop thoughts and relieve fears. They seem like a way to keep bad things from happening.

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

take a long time to do things - like get dressed, shower, eat, do homework

Kids may involve parents in rituals. And at first, parents may not realize that something is a ritual. For example, a child with OCD might ask for reassurance over and over. Or a child may insist a parent say or do something a set number of times, or in a set way.

Kids and teens with OCD can have obsessions, compulsions, or both.

Feelings

OCD symptoms are hard on kids. Rituals may seem to give them some relief at first. But rituals multiply. They start to take more time and energy. Kids have little left for things they enjoy. OCD thoughts, feelings, and rituals become a stressful cycle. This can make it hard to focus in school, have fun with friends, get to sleep, or relax.

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

Some kids may not let parents know about the thoughts, fears, and behaviors OCD causes. They may feel confused or ashamed about their fear and keep it to themselves. They may try to hide rituals they do. Some kids may have OCD symptoms for a while before their parents realize it.

How Can I Help My Child?

If you think your child may have OCD:

Talk with your child about what you've noticed. Talk in a supportive way, listen, and show love. Say something that works for your child's situation like, "I notice you fixing your socks a lot, trying to get them even. Getting them to feel right causes you a lot of stress."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Let your child know that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person. To diagnose OCD, they will spend time talking with you and your child. They will ask questions about your child's symptoms that help point them to signs of OCD. If they diagnose OCD, they can explain the treatment.

Take part in your child's therapy. Part of treatment is coaching parents on how to respond to their child's OCD symptoms. Learn all you can about ways you can help. Learn how to support your child's progress without giving in to rituals.

Be patient. Overcoming OCD is a process. There will be many therapy visits. Be sure to go to them all. Help your child practice the things the therapist shows you. Praise your child's effort. Show how proud you feel. Remind them that OCD is not their fault.

Get support, and give it. There are lots of resources and support for families dealing with OCD. The International OCD Foundation is a good place to start. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

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OCD causes upsetting thoughts (obsessions) and the urge to do "ritual" behaviors (compulsions). Kids and teens get stuck in a stressful cycle of these thoughts, anxiety, and rituals. OCD can get better with the right attention and care.

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Section 504 - just what exactly is it? You've probably heard about it, but every school district addresses Section 504 in a different manner. Some districts have even been heard to say, "We don't do that in this district." But in fact, compliance to Section 504, which is a federal statute, is not optional. This article attempts to answer basic questions pertaining to the implementation of Section 504 in public school systems.

What is Section 504?

Section 504 is a part of the Rehabilitation Act of 1973 that prohibits discrimination based upon disability. Section 504 is an anti-discrimination, civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of the non-disabled are met.

Section 504 states that: "No otherwise qualified individual with a disability in the United States, as defined in section 706(8) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance..." [29 U.S.C. §794(a), 34 C.F.R. §104.4(a)].

Who is covered under Section 504?

To be covered under Section 504, a student must be "qualified " (which roughly equates to being between 3 and 22 years of age, depending on the program, as well as state and federal law, and must have a disability) [34 C.F.R. §104.3(k)(2)].

Who is an "individual with a disability"?

As defined by federal law: "An individual with a disability means any person who: (i) has a mental or physical impairment that substantially limits one or more major life activity; (ii) has a record of such an impairment; or (iii) is regarded as having such an impairment" [34 C.F.R. §104.3(j)(1)].

What is an "impairment" as used under the Section 504 definition?

An impairment as used in Section 504 may include any disability, long-term illness, or various disorder that "substantially" reduces or lessens a student's ability to access learning in the educational setting because of a learning-, behavior- or health-related condition. ["It should be emphasized that a physical or mental impairment does not constitute a disability for purposes of Section 504 unless its severity is such that it results in a substantial limitation of one or more major life activities" (Appendix A to Part 104, #3)].

Many students have conditions or disorders that are not readily apparent to others. They may include conditions such as specific learning disabilities, diabetes, epilepsy and allergies. Hidden disabilities such as low vision, poor hearing, heart disease or chronic illness may not be obvious, but if they substantially limit that child's ability to receive an appropriate education as defined by Section 504, they may be considered to have an "impairment" under Section 504 standards. As a result, these students, regardless of their intelligence, will be unable to fully demonstrate their ability or attain educational benefits equal to that of non-disabled students (The Civil Rights of Students with Hidden Disabilities under Section 504 of the Rehabilitation Act of 1973-Pamphlet). The definition does not set forth a list of specific diseases, conditions or disorders that constitute impairments because of the difficulty of ensuring the comprehensiveness of any such list. While the definition of a disabled person also includes specific limitations on what persons are classified as disabled under the regulations, it also specifies that only physical and mental impairments are included, thus "environmental, cultural and economic disadvantage are not in themselves covered" (Appendix A to Part 104, #3).

What are "major life activities"?

Major life activities include, but are not limited to: self-care, manual tasks, walking, seeing, speaking, sitting, thinking, learning, breathing, concentrating, interacting with others and working. As of January 1, 2009 with the reauthorization of the Americans with Disabilities Amendment Act, this list has been expanded to also include the life activities of reading, concentrating, standing, lifting, bending, etc. This may include individuals with AD/HD, dyslexia, cancer, diabetes, severe allergies, chronic asthma, Tourette 's syndrome, digestive disorders, cardiovascular disorders, depression, conduct disorder, oppositional defiant disorder, HIV/AIDS, behavior disorders and temporary disabilities (e.g., broken writing arm, broken leg, etc.). Conditions that are episodic or in remission are also now covered if they create a substantial limitation in one or more major life activity while they are active. Students who are currently using illegal drugs or alcohol are not covered or eligible under Section 504.

What does "substantially limits" mean?

Substantially limits is not defined in the federal regulations. However, in a letter from the Office for Civil Rights (OCR), they state, "this is a determination to be made by each local school district and depends on the nature and severity of the person's disabling condition." New guidance from the Americans with Disabilities Amendment Act states that Section 504 standards must conform with the ADAAA and is "intended to afford a broad scope of protection to eligible persons." In considering substantial limitations, students must be measured against their same age, non-disabled peers in the general population and without benefit of medication or other mitigating measures such as learned behavioral or adaptive neurological modifications, assistive technology or accommodations.

Who can refer a child for consideration for evaluation under Section 504?

Anyone can refer a child for evaluation under Section 504. However, while anyone can make a referral, such as parents or a doctor, OCR has stated in a staff memorandum that "the school district must also have reason to believe that the child is in need of services under Section 504 due to a disability" (OCR Memorandum, April 29, 1993). Therefore, a school district does not have to refer or evaluate a child under Section 504 solely upon parental demand. The key to a referral is whether the school district staff suspects that the child is suffering from a mental or physical impairment that substantially limits a major life activity and is in need of either regular education with supplementary services or special education and related services [letter to Mentink, 19 IDELR 1127 (OCR) 1993]. If a parent requests a referral for evaluation, and the school district refuses, the school district must provide the parent with notice of their procedural rights under Section 504.

Who decides whether a student is qualified and eligible for services under Section 504?

According to the federal regulations: "...placement decisions are to be made by a group of persons who are knowledgeable about the child, the meaning of the evaluation data, placement options, least restrictive environment requirements, and comparable facilities" [34 C.F.R. §104.35(c)(3)].

Unlike Special Education, the federal regulations for Section 504 do not require or even mention that parents are to be a part of the decision-making committee. The decision to include parents in the decision-making committee is a determination that is made by each school district and should be spelled out in the district's procedures for implementing Section 504. Parents should at least be asked and encouraged to contribute any information that they may have (e.g., doctor's reports, outside testing reports, etc.) that would be helpful to the Section 504 committee in making their determination of what the child may need. Schools are expected to make sound educational decisions as to what the child needs in order to receive an appropriate education.

What information is used in doing an evaluation under Section 504?

Under Section 504, no formalized testing is required. The 504 Committee should look at grades over the past several years, teacher's reports, information from parents or other agencies, state assessment scores or other school administered tests, observations, discipline reports, attendance records, health records and adaptive behavior information. Schools must consider a variety of sources. A single source of information (such as a doctor's report) cannot be the only information considered. Schools must be able to assure that all information submitted is documented and considered.

Can my child be placed under Section 504 without my knowledge?

No. Parents must always be given notice before their child is evaluated and/or placed under Section 504 (34 C.F.R. §104.36). Parents must also be given a copy of their child's Section 504 accommodation plan if the committee determines that the child is eligible under Section 504.

What types of accommodations will my child receive if determined eligible under Section 504?

Each child's needs are determined individually. Determination of what is appropriate for each child is based on the nature of the disabling condition and what that child needs in order to have an equal opportunity to compete when compared to the non-disabled. There is no guarantee of A's or B's or even that the student will not fail. Students are still expected to produce. The ultimate goal of education for all students, with or without disabilities, is to give students the knowledge and compensating skills they will need to be able to function in life after graduation.
Accommodations that may be used, but are not limited to, include:

Highlighted textbooks

Extended time on tests or assignments

Peer assistance with note taking

Frequent feedback

Extra set of textbooks for home use

Computer aided instruction

Enlarged print

Positive reinforcements

Behavior intervention plans

Rearranging class schedules

Visual aids

Preferred seating assignments

Taping lectures

Oral tests

Individual contracts

Will my child still be in the regular classroom or will he be in a "special class"?

A Section 504 eligible child will always be in the regular classroom unless (according to federal regulations): "... the student with a disability is so disruptive in a regular classroom that the education of other students is significantly impaired, then the needs of the student with a disability cannot be met in that environment. Therefore, regular placement would not be appropriate to his or her needs and would not be required by §104.34" (34 C.F.R. §104.34, Appendix A, #24).

Can my child still be disciplined under Section 504?

Yes. Children under Section 504 are still expected to follow the district's student code of conduct. However, when disciplining a child under Section 504, schools must consider the relationship between the disability and the misbehavior if the child is going to be removed from the regular setting for longer than 10 days. This does not mean that a student with a disability cannot be sent to a discipline center or that they cannot go to in-school suspension, or be suspended from school for three days. Very strict guidelines exist for schools in discipline issues with students who have a disability under Section 504. Your campus or district 504 coordinator can assist you in this area should you have additional questions concerning the discipline of students with disabilities. Children having disabilities with behavioral components should have individual discipline plans as well as behavior intervention plans.

If I disagree with the school's evaluation, will the school district pay for an outside independent evaluation?

Under Section 504, schools are not required to pay for an outside independent evaluation. If a parent disagrees with the school's evaluation decision, they may request a due process hearing or file a complaint with the Office for Civil Rights. (Ask your district or campus for a copy of Notice of Parent and Student Rights Under Section 504 of the Rehabilitation Act of 1973.)

How often will my child be re-evaluated?

While there are no specific time lines on this issue, students must be re-evaluated at least every three years or whenever there is going to be a "significant change in placement." The campus 504 committee should re-evaluate your child's plan every year to make sure that his or her accommodation plan is appropriate based on their current schedule and individual needs. The accommodation plan may be revised at any time during the school year if needed.

Will my child still be able to participate in nonacademic services?

Yes. Districts must provide equal opportunity in areas such as counseling, physical education and/or athletics, transportation, health services, recreational activities, and special interest groups or clubs. However, the "no pass, no play " standard used for students in most states also applies to students under Section 504 (34 C.F.R. §104.37).

What are my rights as a parent under Section 504?
As a parent or legal guardian, you have the right to:

1. Receive notice regarding the identification, evaluation and/or placement of your child;

2. Examine relevant records pertaining to your child;

3. Request an impartial hearing with respect to the district's actions regarding the identification evaluation, or placement of your child, with an opportunity for the parent/guardian to participate in the hearing, to have representation by an attorney, and have a review procedure;

4. File a complaint with your school District Section 504 Coordinator, who will investigate the allegations regarding Section 504 matters other than your child's identification, evaluation and placement.

5. File a complaint with the appropriate regional Office for Civil Rights. For additional information, contact: U.S. Department of Education, Washington, D.C. 20202-1100
(800) 421-3481
www.ed.gov/ocr
E-mail: ocr@ed.gov

Do I contact the State Education Agency (SEA) if I have a complaint concerning Section 504?

No. The State Education Agency has no direct jurisdiction over Section 504 implementation. Complaints may be addressed to your local District 504 Coordinator or to the Office for Civil Rights.
One note of caution: Please do not substitute this information for independent and individual legal advice. Such advice should be sought from a licensed, qualified attorney in the field of Section 504 disabilities. Every situation is different, and a good assessment of the risks involved in your particular situation can only be determined by consulting with your attorney and providing him or her with all of the relevant factual data. Sometimes just one "minor" detail can make a material difference in the outcome of a case. Understood.org is a comprehensive resource for parents of kids with learning and attention issues. Explore their 504 plan tools, including this Sample 504 Plan for a Child With ADHD.
Updated January 2010

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A parent's guide to Section 504 in public schools

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Section 504 - just what exactly is it? You've probably heard about it, but every school district addresses Section 504 in a different manner. Some districts have even been heard to say, "We don't do that in this district." But in fact, compliance to Section 504, which is a federal statute, is not optional.

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Health Care Toolbox: How and When to Refer

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Health Care Toolbox: How and When to Refer

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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American Counseling Association: Code of Ethics

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American Counseling Association: Code of Ethics

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Amazingly Simple Graphic Design Software - Canva

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Create beautiful designs with your team. Use Canva's drag-and-drop feature and layouts to design, share and print business cards, logos, presentations and more.

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Amazingly Simple Graphic Design Software - Canva

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Create beautiful designs with your team. Use Canva's drag-and-drop feature and layouts to design, share and print business cards, logos, presentations and more.