Frequently asked questions
Sometimes parents sense a child's behavior isn't the same as other children's of the same age, and it's hard to know when to relax and when to worry. Knowing the expected developmental milestones can help, but it's not always clear what it means if a child is delayed or what to do about it.
Sometimes a parent knows a child's behavior is different: not typical, not socially acceptable, etc. This can be caused by a variety of reasons, such as:
• Mental health disorders, such as Depression or Bipolar Disorder. • Neuro-biological disorders (such as Anxiety, Tourette Syndrome, Attention Deficit/Hyperactive Disorder, Obsessive-Compulsive Disorder, etc.) • Confusion about, coming to terms with, or dealing with harassment from one's sexual identity (in Southwest Michigan, 45% of youth who think they might be gay reported that they had attempted suicide) • Environmental Triggers (such as bullying, death or divorce in the family, neglect, child abuse, sexual abuse, or even poverty or racism)
Troubling behaviors include, but are not limited to, the following:
• Lack of energy • Withdrawal from pleasurable activities or friends • Isolation, loneliness, or a lack of friends • Anger • Violence toward oneself, others, or pets • Problems at school • Cutting and other self-injury • Talking about suicide • Repeating words or actions involuntarily • Staying up days at a time • Extreme impulsivity • Getting "stuck" on thoughts, ideas or actions • Binging/anorexia/eating disorders • Perfectionism • Sneaking out of the house • Setting fires • Using drugs and/or alcohol, especially at a very young age • Destroying property • Overly giddy or silly behavior • Sexual promiscuity • Frequent physical complaints with no apparent cause (such as stomachache or headache) • School avoidance
If you think your child is suicidal, please call 9-1-1, the suicide hotline in your town (2-1-1 many towns), or visit the emergency room. If your child does not seem suicidal, but exhibits behaviors that concern you, here are some options:
• Contact your primary care physician for an evaluation or referral • Contact your local Community Mental Health agency for an evaluation • Ask a friend for a referral to a therapist or counselor they like • Attend a parent support group • Ask your school for an evaluation for special education services • Ask your school for referrals to independent evaluators they use and respect • Call your insurance company for referrals and to check on the type of coverage you have • Call a parent advocate agency (such as the National Federation of Families for Children's Mental Health or the Michigan Association for Children's Mental Health)
It is sometimes difficult to get a good mental health diagnosis. Many times a child will be labeled with multiple diagnoses. Sometimes doctors are reluctant to give a child a diagnosis of bipolar disorder, for example, because they don't want to burden a child with a label that carries stigma.
This is actually counterproductive in some cases, if it means the child does not receive appropriate medical care. As a rule, mental health agencies rarely refer to a child as having a mental illness, and instead refer to children as having a serious emotional disorder (SED), though you may hear other labels, such as oppositional defiant disorder.
Your child is most likely not acting the way he or she is acting in order to make your life miserable - though sometimes it can feel that way! They are hurting inside. They don't know the right behavior, or their "wiring" keeps them from always choosing it, even if they want to. Many times, loneliness can drive bad behavior.
Ask Dr. Sears has a website about discipline, which means "to teach". These ideas are time-honored and work well. However, sometimes children with mood, emotional or behavior disorders do not respond to discipline the way other children do! If you find Dr. Sears isn't enough, the Child & Adolescent Bipolar Foundation recommends using "Therapeutic Parenting". The idea is that the parents need to teach and provide healing at the same time as parenting.
Parent Management Training - Oregon Model also teaches a specific way of working with children who have emotional and behavioral disorders. If you live in Michigan, you may qualify for PMTO. Contact your local Community Mental Health agency.
Some families have had very good luck with the Love & Logic parenting classes, or The Explosive Child video and book, which teaches you how to avoid "meltdowns".
• Contact your local Community Mental Health agency • Ask a friend for a referral to a therapist or counselor they like • Attend a parent support group • Call a parent advocate agency (such as the National Federation of Families for Children's Mental Health or the Michigan Association for Children's Mental Health)
Sometimes a child's behavior seems mostly manageable at home, but when faced with the stimulation of noise from other students, multiple people to deal with all day, confusing academic work, the length of time expected to be on task, etc. the child's behavior can deteriorate at school.
The first thing to do is request a meeting with the child's teacher to discuss what is happening. It helps to be strengths-based. Help the teacher see the same child you know and love. Talk about all the good things about the child first. Then describe the areas where you notice your child needs more support. Sometimes a reward system for using the expected behavior is very successful.
Sometimes a child honestly does not know what is expected and needs to be taught. For example, he or she needs to be taught what a good apology looks like. Help the school to see that instead of punishment, the child often needs teaching - the definition of the word "discipline" is to teach.
All schools in Michigan are supposed to start implementing Positive Behavior Supports, which should help children be more successful in schools. If your school isn't implementing PBS yet, ask them when they are going to start.
Be supportive of the teacher in his or her efforts. Many times what you may deem as their "bad" behavior comes because they too do not know what to do. Give them tools. Try not to judge. It is extremely rare that a person chooses the profession of teaching if they do not love children! Be courteous and thank the teacher for their time.
If you think more could be done for your child, or the meeting (or meetings) does not help, consider a more serious plan. This can be a Section 504plan or an Individualized Education Program (IEP).
IEP means Individualized Education Program. It is a term described in a federal education law, known as IDEA - which is the Individuals with Disabilities Education Act. Sometimes you will see a date after "IDEA", such as "IDEA 2004", because that's when the last set of amendments were made to the law by Congress. Section 504 refers to a portion of a federal civil rights law, the Rehabilitation Act of 1973, which was not specifically written to cover education and school.
The purposes of IDEA are, at a minimum, "to ensure that all children with disabilities have available to them a free appropriate public education [FAPE] that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living" and "to ensure that the rights of children with disabilities and parents of such children are protected", and "to assess, and ensure the effectiveness of, efforts to educate children with disabilities".
IDEA requires an IEP to be written for children who qualify, and the IEP must include specifics about what services the child will receive and how often, the goals for the child, the degree to which the child will be educated with children who do not have disabilities, and so on. IDEA requires that children be educated in the Least Restrictive Environment (LRE) possible, which means included in regular programs, classrooms and learning to the extent possible.
The purpose of Section 504 is to protect individuals with disabilities from discrimination for reasons related to their disabilities. The law covers programs and activities receiving or benefiting from federal financial assistance, which includes schools. Schools must provide children who have specific disabilities with reasonable accommodations comparable to those provided to their peers.
Whereas a 504 plan refers to accommodations, special education refers to services. It does not refer to a place. A child who receives special education services can be fully included in his or her home classroom and receive supports and services such as:
• Occupational therapy • Anger management training • A "safe" place in the building where he can go to cool down • Transportation to and from school • Extended school year
These services and supports will be written down into a legally binding document, called an Individualized Education Program (IEP). IEPs can be reviewed and revised any time the parents choose, but at a minimum, every three years.
Children who meet specific criteria can qualify for receiving special education services under one of several categories. The most frequently used categories for children with mood, behavior and emotional disorders are "Otherwise Health Impaired" or OHI "Emotional Impairment" or EI and "Specific Learning Disability" or SLD.
Sometimes children with Asperger's Syndrome or Autism exhibit similar difficult behaviors, and these children would qualify for special education services under "Autism Spectrum Impairment" or ASI. Typically in the mental health world, these are considered developmental disabilities and not serious emotional disabilities.
The best and most official way to start the process of special education rolling is to write a letter to the school principal requesting an evaluation of your child for special education services. See here for a sample letter. Be sure to keep a copy for your records.
The school then has 10 days to let you know if they will provide the evaluation or not. If they do not, they must have evidence why not.
If the school does agree to evaluate the child, they must do so within 30 school days, and a team will then convene to determine the child's eligibility. Sometimes this is called an IEP Committee (IEPC) or Team (IEPT). If the child qualifies, and IEP will be written. If he does not qualify, the team may consider writing a Section 504 plan.
The schools may use a wide variety of tools to evaluate your child, including academic testing such as the "DIBELS" (a reading test), intelligence testing or IQ, psychological, and so on. Some tests must be administered by psychologists or other specialists with specific licenses.
Some tests they may use are: • Child and Adolescent Functioning Assessment Scale (CAFAS) • WISC • Woodcock-Johnson • Dynamic Indicators of Basic Early Learning Skills (DIBELS)
The evaluation may also include observations of the child in the classroom, questions to the parents and teachers, and other means. It is important to remember that the school is looking for anything that impedes learning or academic functioning, since teaching academics are the school's responsibility.
In essence an IEP includes several parts:
• A statement about present performance (sometimes called a PLAPF) • Two or three goals with objectives • Information about where the services will be delivered
At the meeting, the team should work to fill out these sections. This is supposed to be an INDIVIDUALIZED plan, so do not accept a pre-filled document that is written for someone else and then has the name changed to your child's. However, the school psychologist or special education teacher may have filled out the performance statement ahead in order to save time at the meeting.
If you do not understand any of the testing or anything written in the performance statement, ask the school to explain it to you. Don't let them move ahead until you understand, because the results of these tests will be the foundation of the IEP.
The section with the most need for group effort will be the goal statements and objectives. Be sure the goals are something you are interested in. Ask specifically how they will be measured. How will you know he has reached the goal? In the cases of children with emotional impairments, sometimes it is important to make sure the objectives do not all rest on the shoulders of the child, but spell out how the school is going to support him in reaching the goal.
Consider it this way, "The child has a need, and what are we all going to do together to help him get it met?" Make sure all your concerns are addressed, but use your time wisely. Spend the most time and argue the strongest for your highest priorities. Be sure to get everything promised to you written into the IEP.
After discussing other services, the parent will be asked to sign the IEP. You may do so, and the school will want you to do so. You may also take it home and think about it, show it to a friend or advocacy group, etc. You need to return it as soon as possible, however, because the IEP will go into place if you don't sign and return it within 10 days. If you do not agree with the IEP after further review, see if you can reschedule more time, or revisit an issue with the team. If this is not possible, you may want to sign in disagreement, or ask for mediation or due process.
Attorneys Peter and Pam Wright have an excellent website detailing a great variety of specific questions about IEPs, including due process.
Before the IEP meeting, the school should make sure you, the parent, can attend the meeting. If you cannot, they must choose a new date. They should also inquire who you would like to attend the IEP. Certain people from the school will attend, but you may also choose to bring a therapist, a friend, etc., and the school should make sure they are invited. If you would like a specific paraprofessional or teacher to attend, you may request it. Be sure the meeting is held when you and your supports can be there.
Before the meeting, prepare by speaking to others you know whose children receive special education services. Ask them what type of services their child receives. This doesn't mean your child needs these, but it will help you to know what kinds of things are possible. Search online to see what other types of services and accommodations might be helpful for a child with a similar disability to yours. Think about your priorities and what would make a successful meeting.
We use a meeting planning form at Advocacy Services for Kids, to help you identify your goals ahead of time. Contact us here to request the form. Be sure to review a blank IEP to know exactly what you will be working to achieve. In summary: • Set a date when you and your supports can attend • List your top priorities to discuss at the meeting. Be flexible. You may not get to everything, so keep to the topics most important to you and put your energy there. • Think about your child's needs. Bring ideas for accommodations you would like to see. Be flexible. There are lots of ways to get needs met. • At the meeting, start with what is going right. • Assume the best in others. They also want to see your child succeed - they may just think there's a different route to success than you do. • Question anything you don't understand. • Get all promises in writing. Say, "Let's write that in the IEP just to make it official." Or "Would you put that in writing?" • Thank everybody for their time, support and energy. • If you need to think it over, take a copy home and really read it and think about it. Have a friend or advocate read it, if you like. • Make sure to sign it and return it within 10 days, or it goes into place anyway!
Despite everyone's best effort, and a great IEP, sometimes things go awry. Not all teachers seem to read the IEP, or it isn't implemented the way you thought it would be. Sometimes the child still fails to make progress despite the supports offered. You have the right to go back to the table. You do not need to reopen the IEP to meet, however.
Ask the team to meet with you, saying something like, "My son still seems to be having trouble in math. What can we do to support him differently?" For some time, I met monthly with a team at my son's school, identifying trouble areas and potential solutions. Ask if there is a similar team that meets and if you can be on the agenda every month.
If everyone feels like they are on the same team, they are more likely to work together for a common good - your child's welfare. Instead of pitting parent against teacher or child against teacher, try to think in terms of the academic results of the disability - basically, what is the child's need, instead of whose fault it is.
You have the opportunity to go through a mediation process or even due process if you believe the school is in gross violation of the IEP contract.
Sometimes it is helpful to do a Functional Behavior Assessment (FBA) of the child to determine why he or she is acting in a certain way, and then trying to improve the behavior. The rationale is that everyone behaves in order to either get something they want or get away from something they don't want. An example may be that a child does not perform well in reading, so he wants to avoid reading time. His behavior is that he is suddenly "tired" during reading time. If he is allowed to sleep, his behavior is rewarded. He will develop a negative coping skill and eventually fall farther and farther behind. A FBA would identify a few trouble spots and potential reasons for the behavior, potential rewards the child might currently be receiving for doing the behavior, and suggested alternatives.
The need to hospitalize a child can be very upsetting to the child and his family, but it is still necessary in order to keep him or her safe, as well as keep other family members safe. Your child may need to be hospitalized if: • The child is threatening to hurt himself or herself or others • The child is or has actually hurt himself or herself or others • The child is delusional or "out of touch with reality" • The child is manic or extremely depressed
You can start the process of determining whether your child needs to be hospitalized by contacting his or her mental health care provider, such as psychiatrist, therapist, or caseworker.
• Be sure to tell them briefly but specifically what behaviors your child is doing, especially whether he or she is: hurting him- or herself or others, threatening to do so, delusional or manic. • Contact your health insurance provider to determine which hospitals are covered. Get as much information about coverage and fees as possible. Be sure to get the staff person's name, and take notes. • Contact the hospital and tell the intake staff the same behaviors described to your child's mental health care provider. (sometimes the mental health care provider makes this call for you) • Ask the hospital staff if they have any openings, and if so when to arrive • If the hospital is out of town, ask the staff if there is an inexpensive place to stay, such as the Ronald McDonald House. • Ask the staff specifically what to pack and what NOT to pack for the child • Ask about visiting hours and the staff expectations for you to participate in various family therapies, meetings with doctors and social workers, etc. • At the appointed time, arrive at the hospital. Bring records of what medications your child is taking or has taken, and how the medications affected your child.
Insurance companies typically approve payment for about 3 days of hospitalization for a child. Someone from the hospital will probably be in contact with the insurance company on a regular basis to determine if more time is needed. If you do not have insurance you will need to work with the hospital and the local Community Mental Health agency.
Your child's day at the hospital can vary depending on where the inpatient stay takes place. It may include some type of school work, but it may not. It may include group therapy, individual time with the doctor, recreational therapy, individual therapy, art or music therapy, free time, etc. You may be expected to participate in some activities during the day, such as family therapy or meetings with the doctor. Some hospitals have open visiting hours, and some are quite limited, allowing only 1 phone call home per evening. Typically, doctors will use the inpatient time to alter medications. Sometimes they will remove all previous medications and start over. This can lead to a lengthier stay. Be sure to report all worrisome behaviors you see during the hospitalization to the hospital staff, including side effects.
You may feel a variety of emotions when your child is hospitalized. You may feel fear, anxiety, relief, shock, guilt, or a lot of other, sometimes confused feelings. The experience may seem surreal. You may feel very surprised to hear a mental health professional suggest to you that your child should be hospitalized. You may feel ashamed or even resistant. You may want to take the child to the hospital, but feel guilty for "abandoning" him or her.
Try to remember, you are doing this because you love your child. If your child was acting irrationally because of a blood sugar problem, you would certainly hospitalize them. Children occasionally need surgeries or have other reasons to spend the night (or several) in a hospital. You wouldn't dream of denying your child this type of basic medical care. Remind yourself that this is no different. Your child is ill and needs help. He or she isn't bad or defective. The hospital is not a punishment.
It may be difficult to put aside your emotions while you are expected to tend to the "business" transactions such as making appointments or arranging insurance.
When it is time for your child to come home, the hospital may have a partial day or "step-down" program to consider. Work with the social worker to make sure he or she has the prescriptions needed, appointments with local specialists, and a safety plan, if needed. Be sure the school is made aware of when the child will be returning to school.
Despite the hope for improved mood and behavior for your child, a hospitalization can be traumatizing, exhausting, and expensive. Draw on friends, church members, and others. Attend a parent support group for advice and support. Sometimes the stigma around mental health keeps others from knowing what to say or responding appropriately. Try to accept the support from others, even if it is offered awkwardly.