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School Counselor Referral Process Guide (2015)
https://dese.mo.gov/sites/default/files/guid-respon-serv-referral-process-guide.pdf

IEP vs. 504 Plan (2019)

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Online Counseling Programs (2019)
https://onlinecounselingprograms.com/resources/school-counselor-toolkit/student-development/elementary/

Evidence-based School Counseling Curricula for Elementary School Counselors  (2016)

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American School Counselor Association (2019)
https://www.schoolcounselor.org/

The Essential Role of Elementary School Counselors (2017)

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Your Kids OT (2017)
https://www.yourkidsot.com/blog/quick-ways-to-calm-down-sea-life-sensory-solutions

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School-Based Anxiety Treatments for Children and Adolescents (2012)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399129/

Alleviate Anxiety through School Counseling Interventions (2017)

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Disruptive Behavior Disorders (2019)
https://www.nationwidechildrens.org/conditions/disruptive-behavior-disorders

Interventions for Disruptive Behavior Disorders (2011)

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https://gozen.com/8-ways-a-childs-anxiety-shows-up-as-something- else/ (2018)

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Identification and Management of Eating Disorders in Children and Adolescents (2019)
https://pediatrics.aappublications.org/content/pediatrics/126/6/1240.full.pdf

Eating Disorders in Children and Adolescents (2014)
https://pediatrics.aappublications.org/content/134/3/582.full

National Eating Disorder Association (2018)
https://www.nationaleatingdisorders.org/

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Psychotic Disorders in Children and Adolescents (2014)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116281/

Psychotic Symptoms in Children and Adolescents (2015)

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Some of the more disturbing behavioral symptoms to present are psychotic symptoms such as auditory or visual hallucination, delusions such as paranoia, or grossly disorganized thought content. Similar to the worry many families will have that a headache is the result of a brain tumor, concern that the psychotic symptoms represent the onset of schizophrenia often creates considerable alarm for families and primary care clinicians alike. In most cases, however, further evaluation suggests causes of psychotic or psychotic-like symptoms other than primary thought disorders.
Case Summary
Ella is an 8-year-old girl who has lived with her adoptive parents for 5 years. She was removed from the care of her birth parents by child protective services because of a history of abuse and neglect. Ella has struggled for many years with a variety of emotional-behavioral problems including inattention, frequent and intense angry outbursts, anxiety, and mood instability. She currently takes a long-acting methylphenidate preparation. Her parents present to her pediatrician because Ella is now reporting that she is seeing "shadows" in her room at night that frighten her. She also has lately stated that she hears a "mean voice" in her head that tells her that she is a bad person. The parents are not aware of specific psychiatric diagnoses in the birth parents, but state that they did have a history of "mental health problems" and were homeless at times. The parents are worried that these symptoms might be early signs of schizophrenia.
Discussion
Accumulating data demonstrates that while psychotic symptoms are relatively common in children and adolescents, childhood-onset schizophrenia actually is quite rare. Estimates of psychotic symptoms in otherwise healthy children have been as high as 5%, with a recent study of adolescents reporting that 15% of the sample reported hearing a voice that commented on what the person was thinking or feeling ( Schizophr. Bull. 2014;40:868-77). At the same time, the incidence of childhood-onset schizophrenia is thought to be less than 0.04% based on data from a group at the National Institute of Mental Health ( Child Adolesc. Psychiatr. Clin. N. Am. 2013;22:539-55). This group has been actively evaluating and recruiting children with early onset psychosis and finds that more than 90% of their referrals end up with a diagnosis other than schizophrenia.

The differential diagnosis for psychosis is extensive. In terms of nonpsychiatric diagnoses (what in the past were referred to as "organic" causes), possible etiologies include CNS tumors, encephalitis, metabolic disorders, and various genetic conditions, among others. Some medications, such as corticosteroids, stimulants, and anticholinergic medications, also can result in psychotic symptoms, especially at higher doses. While the acute presence of psychotic symptoms in an otherwise healthy child should certainly prompt suspicion of a possible delirium or other nonpsychiatric condition, it is important to note that some of the above etiologies can be associated with other types of behavioral disturbances; thus, the presence of earlier behavioral problems does not rule out the possibility that one of these nonpsychiatric causes is present.

Clinical tip: From our experience at a busy outpatient child psychiatry clinic, it is often not clear whose job it is to rule out nonpsychiatric causes of behavior problems. There is a risk that the psychiatrist assumes that the pediatrician has done this work-up while the pediatrician assumes that this component is part of a psychiatric evaluation. Communication about this role is important. If a third specialist is needed, such as a pediatric neurologist or geneticist, then it is important to clarify who will initiate that consultation as well.

The differential for psychotic symptoms also includes a number of psychiatric conditions other than schizophrenia, such as bipolar or unipolar depression, obsessive-compulsive disorder, posttraumatic stress disorder, autism, or an eating disorder. Substance use, particularly cannabis, also needs to be strongly considered. A child psychiatrist or other mental health professional can be very helpful here to help decipher what are sometimes subtle differences in the nature and content of the psychotic symptoms between various diagnoses. Receptive and expressive language disorders also can be present in many youth who experience psychotic symptoms.

The decision of if and when to begin treatment with an antipsychotic medication can be a difficult one and should be made very thoughtfully and with the help of consultation. The concern that a longer duration of untreated psychosis may be related to a more protracted course needs to be weighed against other data suggesting that using as little medication as possible may predict higher levels of future functioning ( JAMA Psychiatry 2013;70:913-20). It is important to note that there are many nonpharmacological interventions that also can be helpful, including individual and family psychotherapy, family education, school modifications, and other social supports.

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Psychotic symptoms in children and adolescents

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Some of the more disturbing behavioral symptoms to present are psychotic symptoms such as auditory or visual hallucination, delusions such as paranoia, or grossly disorganized thought content. Similar to the worry many families will have that a headache is the result of a brain tumor, concern that the psychotic symptoms represent the onset of schizophrenia often creates considerable alarm for families and primary care clinicians alike.

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International Bipolar Foundation (n.d.)
http://ibpf.org/article/accommodations-students-bipolar-disorder-and-related-disabilities

Educating the Child With Bipolar Disorder (2007)

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A Teachers Guide to OCD (2016)
https://www.schoolcounselor.org/asca/media/asca/ASCAU/Anxiety-Stress-Management-Specialist/Teachers-Guide-to-OCD-v1.pdf

How Pediatric OCD Impacts the Whole Family (2017)

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Obsessive-compulsive disorder ( OCD), which is marked by repetitive behaviors, like turning a light on and off multiple times before entering a room, or compulsively washing, takes a significant toll not only on children who suffer from it, but also on parents who try their best to respond to the situation, according to new research.

The findings, first appearing online in December 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry, reveal how OCD impacts the entire family, with disrupted routines, stressful social interactions for the child, and poor job performance for parents. The research suggests these effects might be impacted by the way some parents respond to their children's problems.

The research was led by S. Evelyn Stewart, M.D., of the University of British Columbia, and David L. Pauls, Ph.D., of Harvard University, a 2003 NARSAD Distinguished Investigator Grantee. The study was notable for the large number of families that it involved at multiple locations. The team gathered information from patients and their parents using the OCD Family Functioning (OFF) Scale, a newly developed method to assess the impact of OCD. The researchers found that everyone in affected families had elevated stress and anxiety. Children with OCD reported more feelings of anger and frustration, while their parents described more feelings of sadness.

Daily life was affected even in mundane ways. Families reported frequent disruptions to morning and evening routines. Children also experienced significant social and academic difficulties - challenges, importantly, that their parents often did not recognize. These effects were not limited to the child: almost half of all mothers and one third of fathers reported substantial impacts on their work performance.

While in individual instances, the severity and type of compulsive behaviors were fairly good indicators of the extent of family disruption, the researchers found that the single best predictor was how the families reacted to their child's disorder. Some parents allowed the child to persist in their behaviors or to avoid triggering stressors instead of trying to help stymie these or encourage the child to face their fears. Such accommodations were associated with more negative outcomes for both the child and the family as a whole.

The researchers suggest that clinicians should focus on teaching parents effective strategies to deal with pediatric OCD. The work also underscores the importance of treating the entire family to ensure emotional, social, and professional well-being.

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How Pediatric OCD Impacts the Whole Family

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Obsessive-compulsive disorder ( OCD), which is marked by repetitive behaviors, like turning a light on and off multiple times before entering a room, or compulsively washing, takes a significant toll not only on children who suffer from it, but also on parents who try their best to respond to the situation, according to new research.