Public schools are notorious for using acronyms rivaling alphabet soup. In fairness, they have a lot of federal, state, and local mandates to adhere to and reporting to complete, and it would probably add days onto the school year if they had to pronounce every test, procedure, or committee by its full name. Today I want to touch on two of the most common acronyms that parents have questions about: 504s and IEPs.

A 504 and IEP are two legally binding documents that outline what services or accommodations a school will provide to a child, based on a specific need they have. The documents are similar in that they:

• are federally mandated
• invite parent feedback and suggestions regarding the list of accommodations
• do not require schools to agree to everything the parent/child request
• require that once accommodations are agreed upon, written, and signed by members of the team, school is legally required to provide those accommodations
• are free to student and parent
• are reviewed annually
• share the goal of helping to set students up for success by offsetting the effects of a disability where possible
• require a formal diagnosis, in most cases

There are some differences in the two as well, though most of the time the school system has the responsibility of understanding which a child may qualify for. An IEP has stricter requirements for eligibility, and the diagnosis must be one of the 13 categories covered by the Individuals with Disabilities Education Act (IDEA). It also provides more coverage for different types of accommodations, including changes to the environment (preferential seating near the teacher, for example) and/or to the curriculum (modified assignments or shorter reading passages). A 504 plan covers many more diagnoses, but can only cover changes to the environment not to the curriculum. A student with a diagnosis of ADHD can receive accommodations under a 504 plan but not an IEP.  A student who has autism spectrum disorder (ASD) can qualify for accommodations under an IEP. 

Both a 504 plan and an IEP have a similar process for students and families. If your child is in need of educational accommodations, you approach the school and ask for a meeting. I'd suggest to ask for this via email so you have documentation. To qualify for either plan, a student must have a disability AND that disability must interfere with their ability to learn in the regular classroom. Once the school receives your request they should follow up to schedule a time to assemble a team to meet. The team will likely consist of your child's general ed teacher, the school administrator in charge of 504/IEPs, the student's parent(s), and the school counselor. The team will meet to discuss the child's needs and how they are functioning in the regular ed classroom. If the team decides the child may qualify for services, they will ask parents to sign a document giving them consent to evaluate the child. This is supposed to happen in a reasonable timeframe, but we know that school psychologists are overworked and often their wait list is months long. For this reason, parents may choose to bring a report from a third-party psychological evaluation. See my post about seeking outside testing here. 

​Next the team meets again to discuss recommendations and what accommodations would be helpful and realistic to include in the plan. You can ask for anything, but the school does not have to approve everything (If you ask for a pony it will likely get denied even though your child could benefit from having a pony at school because most schools do not have the capacity to accommodate livestock). Once all of the accommodations are agreed upon, the team all signs the 504/IEP document and the child should begin receiving services. After the child is receiving services, the team will meet once annually to review the plan. Additional team members may be added, like special education teachers, support teachers, speech therapists, occupational therapists, or early intervention program (EIP) teachers. You can also request that outside professionals attend an 504/IEP meeting to provide feedback about their progress or make suggestions to be included in the plan. 

Please remember that I am not a professional educator, just a child therapist, parent, and parent coach who has learned enough about this to know where to point parents for more information. So consult with an attorney or other professional if you have needs beyond the basic process listed here. Additional general resources are listed below. 

The Georgia Department of Education Section 504 Guidance booklet:
​https://www.gadoe.org/Curriculum-Instruction-and-Assessment/Student-Support-Teams/Documents/GaDOESection504Guidance.pdf

Understood.org The Difference between IEPs and 504 plans:
https://www.understood.org/en/articles/the-difference-between-ieps-and-504-plans

Who provides evaluations?
Typically psychologists provide psychological evaluations/ testing, though they may have graduate students who help to administer some of the tests. 

What's the process like? 
Most of the providers I've worked with have a similar process. They do an intake appointment with parent(s) to get more information about what's going on, then they schedule another day for their initial meeting with the child. After they introduce themselves to the child and help the child get comfortable, they'll start with some assessment games and activities. It could be anything from a counting game to putting together a 3D puzzle to listening to a story and answering questions about their comprehension. Providers who are good with kids schedule movement activities in between sedentary activities for variety, and allow kids to stop or take breaks when they need to. For kids who need frequent breaks they may schedule another day of testing so that the child isn't getting burnt out or overtired. Usually parents do not stay with the child during the testing process because we might accidentally say or do things that cause our kids to respond in a different way than they would on their own and skew the results. 

What exactly are they testing? 
It can depend on what your concerns are. If you suspect your child has autism, they are going to do tests that specifically look at symptoms common in autism spectrum disorder. If you think your child may have a learning difference they will be looking a lot at how your child's brain processes written and spoken information. Sometimes we don't know exactly what we're looking for, but we just want to make sure we aren't missing anything, and they can do general tests that look at common areas of development to rule out the need for additional testing. Areas of testing might include intelligence, listening comprehension, visual-motor coordination, impulsivity, language skills, processing speed, nonverbal reasoning skills, memory, attention, executive functioning, flexibility, and motor speed. All the tests are standardized and have been shown to be reliable, valid, objective, normative, and predictable. Some tests are normed for certain age groups (16 and up, or 2 and up) or certain populations (those who might be struggling with social skills) so the evaluator chooses what battery of tests to use with each client. 

Is it expensive? 
It can be. Expect to pay anywhere from a few hundred dollars to a few thousand dollars for a complete evaluation. This price differs based on who you are working with, whether it's at a teaching clinic or private practice, the experience of the evaluator, and the time it takes them to complete the testing. Testing fees cover the evaluator's time and expenses during the testing with your child, but also their extensive time analyzing data and writing the report. It takes a lot of training to have a child do a jumping activity and then translate that into statistical information about their capacity to understand verbal directions. 

Will insurance cover it? 
I won't subject you to my soapbox about the increasing costs and decreasing value of health insurance (oops, maybe I just did). The answer, as with all things insurance, is complicated and may require investigation. Some plans will cover testing, depending on what tests are completed, some will not. Some will cover testing based on what the diagnosis is at the conclusion of testing. Meaning if you get your child tested and the test results indicate that your child has autism, it would be covered; if the results indicate your child has ADHD it would not be covered. So you'd need the testing results to know if the testing would be covered. Imagine insurance companies not covering the cost of a blood draw because the results showed you aren't diabetic. 

Is there a waiting list? 
Likely, yes. In my area those wait times may be anywhere from 3 to 12 months. I tell parents to get on a waiting list while you're deciding if you want to do testing. There is no obligation to move forward if you decide you don't need it, but I'd hate for parents to take 6 months thinking about it only to get on a waiting list for another 6 months. 

What should I do to prepare my child? 
You can let your child know that you met with (professional's name) and their job is to help you and your child understand more about how their brain works. They'll do that by playing some games and activities that measure all the cool things about their brain, and there is no right or wrong answer and no grade. Let your child know that any way they answer questions is good, and it's okay if they don't know some of the answers. They can also ask questions if they don't understand the directions or if they need something repeated. 

When do we get the results? 
The psychologist will schedule another separate appointment (usually with just parent(s)) to go over the results. They will explain their findings including any relevant diagnoses, areas that may require more attention or follow up, strengths, areas for growth, percentiles showing how your child performed in various areas compared to peers of the same age, and recommendations of things to do at home or school to best support them. 

How much emphasis should we put on the testing process or results? 
It's important to remember that you know your child better than anyone, and likely know them better than any test can. If the results are concerning to you in any way, talk to the evaluator about your concerns. Yes, the tests are standardized and shown to be reliable, but we also know that standardized testing at school does not always show a child's full capabilities. There are a hundred factors that can influence test scores, including how well your child slept, if they've eaten, and if they woke up on the wrong side of the bed for no reason at all. Though testing can be helpful for lots of reasons, a single evaluation will never define a whole child. ​

 I get this question a lot: Does my child need a formal psychological evaluation? The answer depends a lot on why you're asking, so I want to share some of the common goals of testing. If a teacher, therapist, or other professional has suggested you might want to look into testing, do you know what goal they had in mind? There are a few things that testing can accomplish: 

Getting a diagnosis so that I can better understand my child. 
           This is a great reason for seeking testing. Sometimes we need someone to help us tease out a child's areas of strengths and opportunities for growth, help us to understand how debilitating their anxiety is, or point out that their impulsivity is not something they have the capacity to control. If I'm not sure exactly what is going on with my child, testing can be helpful to gain clarity. However, if I really already understand that my child is anxious or has difficulty with friends, it may not be worth the time and money to have a formal record of it if there's nothing further I plan to do with the information. 

Getting a diagnosis so that I can advocate for my child to get accommodations for support at school
           When kids are struggling at school, the school will often need some formal documentation to create a 504 plan or Individualized Education Plan (IEP). 504s and IEPs deserve a whole post to themselves, but they are basically legally binding documents where the school outlines what services or modifications they plan to provide the child. That can be anything from sitting closer to the teacher to stay on task, to having extra time on tests, to being pulled out with a small group to get additional help with reading. If this is why you're seeking an evaluation, I will almost always say yes, that's a great place to start. 

Getting a diagnosis so I can prove to family members or other people that I was right 
          If you've always known that your child was sensitive or needed extra support and family members minimized your concerns or flat out refused to believe them, it can be really validating to have a formal record of any diagnosis, recommendations, or data. I don't think it's petty or shallow to get confirmation that your parenting instincts are right on target.  Whether that is worth the expense and time invested in the process is going to differ for each person.

Getting a diagnosis so that we can potentially qualify for specific programs or services
​            There are services that require formal testing for a diagnosis (ex: Katie Beckett Medicaid, organizations that provide respite care to parents, or camps for kids with certain diagnoses). If this is the only reason you're seeking services, I'd suggest looking closely at the documentation requirements as well as doing a cost/benefit analysis. If paying $2000 for testing now means that my child has all relevant services covered for the next 5 years and I currently spend $2000 a year on services, that's an easy yes. If my child would benefit greatly from a camp that catered to his needs, that may also be a yes. If testing is $2000 but it's a long shot that we would qualify for any services as a result of the testing, I may wait. 

Getting recommendations of what can best support my child moving forward
           This is another one that can be complicated. If you don't need a diagnosis, but are looking for specific recommendations to help your child, it may be helpful to search the internet for basic recommendations for supporting a child with the issue or diagnosis that you think your child has. If those basic recommendations are all things that you are already doing, it may be a better use of time and money to do a deep dive into reading books and articles specific to the issue so you can get a better understanding of the concern and strategies to use for support. Then if you still don't feel prepared with ways to support your child, testing may be worth it. 

Getting a diagnosis because I think I'm supposed to
               If you're doing it because you think you should, but don't necessarily have any of the goals listed above, proceed with caution. There's no one right way to support a child with any specific diagnosis, so don't feel pressured to get formal testing if you don't need it. There are plenty of parents who say "my child fits the diagnostic criteria for autism spectrum disorder, but we've never needed formal testing" and they've supported their kids in everything they've needed and the kids are thriving. 

                 Overall, the best way to determine if you want to move forward with testing is to assess how many of the above goals would be helpful for you or your child. If it's more than one, it may be a good idea to investigate testing options. Don't forget that it's okay if one of the reasons for testing is that it may provide additional support to you as well, and supporting you almost always results in you better supporting your child. Stay tuned for more posts about testing, including FAQ and accommodations. 

If you've made the decision that your child could benefit from working with a therapist, how do you go about finding one? It can be harder than you'd think. 
First of all, there is a national shortage of child therapists, unfortunately. The pandemic has exacerbated that, as some therapists who previously worked with children moved to seeing clients virtually and weren't comfortable doing so with kids. Second, the pandemic created a bigger demand in the need for child providers, as referrals increased in both quantity and intensity.  Here is a step-by-step guide to finding someone: 

1. Have an idea of what you're looking for. Do you want someone who specializes in working with kids, or is someone who works with kids in addition to every other age okay? Do you want someone well versed in treatments for trauma, anxiety, or divorce, or are you looking for someone who knows a little bit about everything? Is it important that the therapist has toys available in their office for sessions, or would strictly talk-therapy work for your child? Knowing the answers to these things can help you narrow down what you want in a therapist, and even better, what you don't. 
2. Do you need to use health insurance? If so, start there. Go to the website that's listed on the back of your insurance card to find out which providers in your area are paneled with your insurance. You can investigate some of those therapists and cross reference them with the things you were interested in from step one. 
3. Now the next step should be that you call a few of the providers that matched in steps one and two and make an appointment. Unfortunately that's not usually the case. Step three will really be that you find a therapist you think could be a good fit, call to make an appointment, and they are not accepting new clients. In that case, step three becomes get on as many waiting lists as you can. There's no obligation to book something with them if you've found another therapist first, but if you've spent three months looking for a therapist to no avail, you could have possibly been next up on someone else's waiting list in that time. 
4. Note if you have flexibility. Do you have a flexible schedule? Let the office know on your first call that you could bring your child during the day. After- school appointments fill up fastest, then early morning slots. Sometimes the 11am appointments may be difficult to fill, so you could be more likely to get one of those if you can come in the middle of the day. The same goes for other areas: flexibility in in-person vs. virtual sessions, insurance vs. paying out of pocket, and in specific therapist is going to make the pool of possible therapists exponentially larger.
5. If you have to leave a message or fill out a form online, concisely mention a little about what's going on and how you can be flexible, if possible. "Hi, this is Jane Smith calling on behalf of my 5 year old, John. We're looking for someone who works with kids with anxiety, we have ABC Healthcare, and we can come at any time." I can easily answer that request in one quick email- I know immediately if we can accommodate that need. If the message says "Hi this is Jane calling on behalf on my son, please call me back" that may require 2-3 emails back and forth before I know what is needed and whether or not we can help. 
6. Finally, try again. Most therapists in private practice are one-person shows: they don't have a receptionist or administrative help and they're juggling providing the services as well as managing the business. Multiply this by hundreds of requests and the fact that we are humans, and you've got mistakes. Sometimes we drop the ball on things: we miss an email, we respond to a voicemail but the parent's mailbox is full, we forget to follow up again later, we didn't have a chance to respond yet, etc. If you haven't heard back anything in a week or two, send a friendly follow-up email to ask again if there is any availability for a new client. 

Most therapists genuinely want to take on more clients, but recognize that there is a point at which we are no longer effective for anyone if we are trying to be effective for everyone. In general, we hate having to turn folks away. If you can't get your child in with a therapist for ongoing appointments, you might also consider asking for a one-time consultation or parent coaching session to brainstorm ways to support your child at home in the meantime. 

Do you ever wonder if your child needs to talk to a therapist? Some parents want their child to have an existing relationship with a therapist so that if something difficult comes up they're already comfortable with talking with someone. Others want to seek someone out for a specific issue that they hope to get resolved. How do you determine when to seek out additional support? These three questions can help you decide. 

•  Think about your primary concern. Is it an isolated incident, or is it a pattern you've seen repeatedly? Sometimes our own parental anxiety interferes with our ability to assess the situation. When we see something concerning it is difficult to see how big the concern is when we're in the middle of it. If the issue (example: social anxiety) is one you've witnessed once, it's far less likely to need intervention than if you've been noticing it for three months. 
• Do you notice concern across different environments and contexts? If my child is only nervous when attempting a new activity, that is very different than a child who is anxious at school, at home, in comfortable situations, with friends, and trying new things. This doesn't mean that the anxiety your child experiences in new situations isn't valid or concerning, just that it may not indicate needing a professional's help at this time. 
• Does your child indicate an interest in talking with someone? When a child is adamant that they won't speak to a therapist, I encourage parents not to force them to attend past the first session if they aren't a danger to themselves or others. Having permission to walk away can make kids and teens more likely to engage and less likely to feel the need for a power struggle. Forcing a child to attend therapy when they're refusing to talk is a waste of parental time and money, and can turn them off to therapy in the future. If a child does indicate a desire to talk with someone, that's a great sign that the timing is likely right and you've got an opportunity to support your child in obtaining a healthy resource and an open line of communication. 

I sometimes get questions from parents who are concerned that their elementary school child has a boyfriend or girlfriend. They rightfully don't want their child to grow up too fast or be too focused on romantic relationships while they are young. They may want their child to wait until he or she is older and can better understand the dynamics of these relationships and can enter into healthy relationships. Some parents feel "dating" is not age appropriate for young kids. I understand those concerns. I also know that many, many children whose parents forbid them from having a boyfriend or girlfriend have said to me as their therapist "I have a boyfriend. Don't tell my parents!"

Forbidding dating relationships for young kids doesn't guarantee they won't happen, but it nearly guarantees they won't talk with you about them. This can be a missed opportunity to talk about lots of important relationship dynamics, from consent to kindness to communication. It's sort of like how we help guide our kids when they're first learning to ride a bike. We stay close beside them, giving them pointers and helping them balance before we send them out to navigate on their own. Perhaps the most important benefit; starting these conversations young helps kids feel more confident and prepared for teen relationships, and more comfortable talking with parents about them. 

Some questions I ask parents when deciding if they want to forbid dating relationships for their kids:

• Can you identify your specific concern about your child having a boyfriend or girlfriend? 
• How will you enforce this rule? What is the consequence if they have a boyfriend or girlfriend at school?
• What does having a boyfriend or girlfriend mean to your child? For some, it means just having a friend who is special to them. For others, it may mean saying they will get married one day. Having a boyfriend or girlfriend rarely means going on actual dates or engaging in sexual behavior for kids. 
• How would it serve your child to have a boyfriend or a girlfriend? How would it serve them to wait? 
• What healthy boundaries would you want to put in place for your child's relationships at this age? Examples could be no "dates" until a certain age, no hanging out outside of school with groups or alone, or no sleepovers. 
• What are your family's values about romantic relationships in general? Though these questions may not come up yet, you can begin using language that supports your values. That could be your views on same-sex relationships, treating others with respect, or having kids before marriage. 

Some questions parents might want to ask their kids before deciding if they will allow boyfriends or girlfriends: 

• What's the difference in a girlfriend and a friend who is a girl? 
• What makes someone a good boyfriend or girlfriend? 
• What do you like about this person that made you want to have them as your boyfriend or girlfriend? 
• Does the other person agree to being boyfriend/girlfriend?

Of course I am not suggesting that we push our children into romantic relationships if they aren't interested in them. If kids feel pressured by parents to be in a relationship, it can send confusing messages about why we enter into relationships and who can provide consent for them. On the other hand, I'm not suggesting we give up on rules and boundaries and allow kids to do whatever they want. However, if kids are naturally interested in a romantic relationship with a peer, it can be an age-appropriate opportunity to help them practice the relational skills they're developing with your support and supervision. 

We've all been there at one time or another- we've raised our voice, we've lost our patience, or we've responded to our kids in a way we wish we hadn't. Some people are regular yellers and for some it only happens occasionally, but none of us are immune to the pressures of parenting. Of course there are no perfect parents, but there's a fine line in pressuring ourselves to be perfect versus working to improve our relationships. 

On April 24th I'll formally launch my new e-course Positive Parenting for Behavior Change. To celebrate this launch, I'm doing a free One Week To Less Yelling group that will have FREE resources in it every morning, with a free live Q&A every evening! This will all happen in a  facebook group called One Week To Less Yelling With The Inherent Parent. Just join the group and hang tight until April 19-23rd, when we will do the official challenge!

PLUS, I'll be giving away a 60 minute consultation to one lucky group member. Invite a friend to join and you'll both be entered to win! 

Sometimes my kids get so hangry that I am desperate for them to eat something. One of my kids is particularly picky, so I try to get some protein in him when I can, not knowing when or what he will eat next since his diet is 75% cheez-its. Here are some things we've found with some sneaky protein. His flavor recommendation is in parenthesis. 

LaLa Smoothies, 5g (mango)
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