504 T1D, ADHD, OCD, Anxiety, food allergies.

[ajessrn, BSN, RN]

I wanted to ask for input here on what you have seen help your elementary students with T1D, ADHD, OCD, and anxiety as far as 504 plans. edited to add food allergies. not sure how I could forget about them. peanut treenut and egg. he does not self carry any of his supplies they all live in the nurses office. 

My son is 8 years old has had t1d since age 5. recently was diagnosed with adhd, ocd and anxiety (we knew it was likely but just finally buckled down and paid for testing because this year has been tough at home and at school with behavior). 

we didn't push for a 504 because his school has been very accommodating thus far but I know that as he goes into 3rd grade next year he will need the 504 for standardized testing accommodations. 

I go next week to meet with his counselor to go over accommodations we would like and what his teacher suggests would be helpful. 

He has an insulin pump, cgm (using a cell phone as his receiver so I can follow him), we are working on figuring out adhd medication with his pediatrician. 

I know it really boils down to him personally and his needs but I appreciate any advice or input. 

the things he struggles with at school is getting started on tasks, finishing them. he is very smart and usually knows how to do the work. easily distracted, can be impulsive, blurts out answers, gets stuck when things aren't the way he thinks they should be. 

he also was diagnosed with a mild motor delay however it is very mild. his anxiety does increase with writing assignments. I think that is partly due to his ocd, and wanting words to be spelled perfect and getting upset if he does something wrong. we try really hard to take the emphasis off getting something right vs trying it or completion. 

also we are getting back into therapy. we did some in pre k before his t1d dx but then took a break because schedules and he was doing better. we got by OK in kindergarten and first grade but this year has been harder. 

I work at a high school in the district and I don't do much in the way of 504's so I just want to make sure we get started on the right foot with ours. 

[NutmeggeRN, BSN]

Wow, kiddo has a lot on his plate, as does Mama! He has a LOT going on. Sounds like his T1D is OK?

The other stuff may nb take a bit to nail down. Does his school have paras in the room that can help? I know in my HS one of the CM for 504 plans works a lot with kids that have a variety of dx. He may need some help w executive function skills. Definitely get him on a 504 to give him the classroom accommodations. As they get older, the stakes get higher. (standardized testing especially)

Therapy may be a safe place for him address how this impacts him emotionally.

Good Luck!

[ajessrn, BSN, RN]

thank you. it has been a year for sure. hopefully we are at the beginning of a path to helping him be the sweet smart little dude that he is. 

T1d is doing OK. always a battle with pump sites not absorbing the same from one to the next but thanks to all his tech we keep his a1c in the 6's. I don't know about para's. I know they have rotating TA's. His 1st grade and kindergarten year they had the same TA each day which was nice. For whatever reason in 2nd they don't' have a designated TA. 

[NutmeggeRN, BSN]

22 minutes ago, ajessrn said:

thank you. it has been a year for sure. hopefully we are at the beginning of a path to helping him be the sweet smart little dude that he is. 

T1d is doing OK. always a battle with pump sites not absorbing the same from one to the next but thanks to all his tech we keep his a1c in the 6's. I don't know about para's. I know they have rotating TA's. His 1st grade and kindergarten year they had the same TA each day which was nice. For whatever reason in 2nd they don't' have a designated TA. 

Keep plugging, he may need to have and IEP as other health impaired if his academics are impacted to the point where he needs academic modifications. That opens up a whole new world.

[JenTheSchoolRN, BSN, RN]

As @NutmeggeRN said, sounds like you both have a lot on your plates!

I actually wonder if he qualifies for an IEP here. The T1D alone would qualify him for a 504 plan, but the other things lead me toward an IEP eval. Has he been evaluated by a school psychologist? I ask this because at my school, we'd go this route as this evaluation also lays the groundwork for suggested accommodations. Executive function likely in play here as well and that can come with its own accommodation recommendations (graphic organizers, frequent check-ins, etc). 

Either would provide him with the standardized testing accommodations. Real difference here is accommodation vs modification. IEP allows for modification if he needs things like shortened length of test, read aloud instructions, simplified directions. 504 will allow for extra time on tests, but the test itself cannot be modified in any way. 

Oh, and even though the T1D may not be the primary concern here, for standardized testing, the 504 plan for me is key so I can provide the student with "stop-the-clock" testing if glucose is high or low. (Means, a test can be paused or stopped if glucose level to high or low without penalty.) This will come a lot more into play likely during puberty, which can be hell on blood glucose levels for a T1D. 

 

[ajessrn, BSN, RN]

16 hours ago, NutmeggeRN said:

Keep plugging, he may need to have and IEP as other health impaired if his academics are impacted to the point where he needs academic modifications. That opens up a whole new world.

Thank you. He meets or exceeds almost everything at the moment so he doesn't qualify for an IEP. I can see that changing later when graded work and completed work will start impacting his grades...and if we don't get him the help that he needs now. So far it all doesn't seem to be impacting his ability to learn and keep up but I know that could change quickly. 

@JenTheSchoolRNI requested an iep not really knowing exactly what qualifies someone for one and thinking that he would certainly benefit from having additional help where he struggles but since he is testing well and meeting/exceeding expectations his principal told me he didn't qualify for one at this point but we can reevaluate that anytime. I asked her to take a closer look at his handwriting and written work as that is where he does struggle the most academically right now and she discussed it with the school psychologist and they both came to the conclusion that he doesn't qualify right now. 

Thanks for all your help! And support! I spoke with the counselor and a special education teacher at my school to ask their advice on what accommodations I should ask for and they gave me a few suggestions and also told me to look at LD online and understood.org so I will be looking at those. 

I don't want to put together a ridiculous list of requests but also want to make sure he is getting what he needs to succeed. 

 

[NutmeggeRN, BSN]

WIth all due respect, it is not the principal's decision. YOU can ask for a team meeting and go from there.There are a whole lot of steps in the IEP process, with federal safeguards in place. I would talk to someone in SpED.

[JenTheSchoolRN, BSN, RN]

Just now, NutmeggeRN said:

WIth all due respect, it is not the principal's decision. YOU can ask for a team meeting and go from there.There are a whole lot of steps in the IEP process, with federal safeguards in place. I would talk to someone in SpED.

Same. This is why I suggested an evaluation through SPED. If you were a parent at my school, this is where I'd guide you and involve my SPED director.

(If it were T1D alone, that 504 I would handle, but this has so many other moving parts.)

[NutmeggeRN, BSN]

Just now, JenTheSchoolRN said:

Same. This is why I suggested an evaluation through SPED. If you were a parent at my school, this is where I'd guide you and involve my SPED director.

(If it were T1D alone, that 504 I would handle, but this has so many other moving parts.)

Yes  there is a lot going on there. And other health impaired may be the route.

[ajessrn, BSN, RN]

1 minute ago, NutmeggeRN said:

WIth all due respect, it is not the principal's decision. YOU can ask for a team meeting and go from there.There are a whole lot of steps in the IEP process, with federal safeguards in place. I would talk to someone in SpED.

It may come to that. I am trying to be extremely diplomatic since I work in the district and they really have been accommodating thus far when it comes to helping him. My biggest hope is that therapy and meds will help get him to a place where we are doing better. His teacher is very helpful and overall they are all great so far. I worry about any future teachers who aren't so great which is why I know I need to get everything needs in writing officially for him. 

[NutmeggeRN, BSN]

It is a delicate balance for sure...but sometimes we need to step back from our role as a district employee and be the mom. 

[ajessrn, BSN, RN]

17 minutes ago, NutmeggeRN said:

It is a delicate balance for sure...but sometimes we need to step back from our role as a district employee and be the mom. 

It is so hard. I try not to be pushy but it is my job as his mom to advocate for him. I do think that even if SPEd reviewed it that he would still not qualify. he is extremely bright and I think until it starts to affect his ability to test/do his work he probably won't qualify. 

Everything I read about IEP's says that it has to adversely affect their educational performance and since it isn't at this time I will wait and see. At least I can get the 504 going, work on meds and therapy, and maybe next school year things will be different. I will be on the ball getting him an eval by sped if he starts to fall behind at all.