Special education services for children with migraine

Migraines can seriously impact a child’s social and emotional development. They can also present a significant barrier to educational success. If your child has migraines, you know how difficult it can be for them to even make it to class each day. All the challenges adults face are magnified for children. They don’t have the social skills to cope with stigma. Having migraine in childhood increases the risk of depression and anxiety. Young migraineurs are also easy targets for bullies.

Loneliness and isolation with migraine

The stakes are high for children with migraine. According to Erikson², the primary psychological job of elementary-aged children is to develop a sense of competence. If a child does poorly in school or fails to develop healthy peer relationships, he or she may struggle with feeling inferior. This can lead to a lifelong struggle with poor self-esteem. Likewise, middle and high school students need to develop a sense of personal identity². We all know how it feels to be viewed as “the sick one”. The loneliness and isolation of migraine can prevent a teenager from ever really knowing who he or she could become. As these children transition into adulthood, migraine can derail careers, destroy intimate relationships, and set them up for a lifetime of failure and isolation. Depression, anxiety, and increasing pain could easily become their future.

Parents naturally want to do everything possible to ensure their children have the greatest chance for success. Many might not realize that in addition to early medical intervention, there are educational services available to support young migraineurs through most special education programs.

Laws that protect disabled students

All U.S. public schools are required to provide every qualified student “a free and appropriate education in the least restrictive environment”³. This right is protected by two federal laws : Individuals with Disabilities Act (IDEA)³ and Americans with Disabilities Act (ADA).¹ IDEA addresses the responsibilities of schools to children with physical, emotional, and developmental disabilities. ADA addresses disability discrimination in general. Under both laws, disabled students are entitled to “a free and appropriate education in the least restrictive environment” free of discrimination. 

Individualized Eduction Plan (IEP) or 504 Plan

This is accomplished through the implementation of either an Individualized Education Plan (IEP)³ or a 504 Plan¹. IEPs are regulated by IDEA and 504 Plans are regulated by Section 504 of the ADA. There are specific criteria your child must meet to qualify for either program. It isn’t enough to have a disability.  A disabled student must also require special services and/or accommodations in order to make progress in school or benefit from the general education program. Individual school districts are responsible for implementation, so the process varies in each community.

How do students qualify for IEPs?

In general, students who qualify for an IEP are at risk of academic failure due to the symptoms of migraine. Examples are failing grades, excessive absences, disciplinary problems, or social problems that disrupt the learning environment for the child or others. If it can be demonstrated that your child needs special accommodations in order to prevent him or her from failing or being expelled, then an IEP is likely. Most students with an IEP spend at least part of the school day working with special education teachers for remedial or specialized instruction.

How do students qualify for a 504 Plan?

Even if your child doesn’t qualify for an IEP, he or she may qualify for a 504 Plan. This plan is written and carries the same enforcement power as an IEP. These children are not part of the school’s special education program though. A child with a 504 Plan spends his or her entire day in the mainstream classroom. His or her assigned teachers are responsible for ensuring the necessary accommodations are made.

Accommodations for students with migraine

• No penalty for absences or tardies due to migraine symptoms
• Flexible due dates and no grade penalty for late work
• Permission to wear sunglasses or hat in the classroom to protect from florescent lighting
• Permission to  wear earplugs or headphones when experiencing phonophobia
• Ability to rest in a quiet, comfortable room away from others in the event of an attack during the school day
• Ability to leave the classroom without waiting for permission due to nausea or vomiting
• Older teens may be allowed to keep acute medication with them during the school day
• Permission to have a full water bottle and/or light snack to prevent dehydration or low blood sugar
• Note taking service during absences or visual disturbances
• Tutoring services or home-based instruction in the event of extended absence or hospitalization
• Alternate testing (quiet room, verbal instead of written, etc.)
• Being excused from pep rallies or assemblies that may trigger attacks

Starting the process

A parent or educator submits a written request for evaluation. By law, a child is entitled to one evaluation per school year. The school is required to obtain a parent’s consent and begin the evaluation or explain in writing why they decline. You have the right to appeal the decision.  That process must be explained in writing and may vary with each school district. This process can be lengthy and may include multiple appeals. There is a lot of paperwork and meetings. Once you start the process, it is important that you follow through to get services as quickly as possible. The sooner your child can start receiving support, the better his or her chances of success.

The school psychologist or social worker will contact the parent for written permission to begin the evaluation process. Typically this contact is made within 30 days of initial request.

The evaluation process

The school has 60 days to begin its evaluation after receiving signed parental consent.  A variety of methods may be used to evaluate your child, including academic & disciplinary records, standardized testing results, psychological testing, medical records, and mental health records from private providers. You may submit medical and psychological records from non-academic sources for consideration. You are also entitled to a copy of all records used in the evaluation process.³

The final evaluation

When the evaluation is complete, you and your child will be invited to an IEP meeting where the results of the evaluation will be discussed and eligibility determined. Each school district has its own time limit criteria, so ask the evaluators when to expect completion. You and your spouse may invite anyone you desire to participate in the final evaluation, including outside professionals such as doctors, counselors, or ministers. Non-educators may provide input, but do not have the final say.³  Final determination is the responsibility of the evaluators (usually the school social worker or psychologist in collaboration with the child’s teachers).

Implementing an IEP

If it is determined that your child is eligible, then you will be asked to consent to the implementation of an IEP. When your child turns 16, a Transition Plan is required to establish what services will be utilized to help prepare him or her for life after high school.

What happens if my child is not eligible?

If your child is determined to be not eligible, he or she is then considered for a 504 Plan or other special services outside of the Special Education program.

If you disagree with evaluation, you may request an independent education evaluation at no cost to you. For this independent evaluation, the examiner must not be employed by the school district. The school must provide you with information on how to obtain this evaluation and either pay for the evaluation or arrange for you to receive it at no cost. You are not required to explain why you disagree and you are entitled to one independent evaluation each school year.³

Private schools and homeschooling

• Private schools may or may not have special education services and are not required to adhere to IDEA. They are, however, subject to ADA and must not discriminate against students with disabilities.¹
• Home school students may be evaluated by the public school in the district in which they reside. However, evaluation and participation are at the discretion of the local district.

Benefits of an IEP or 504 Plan

These programs were designed to give students with disabilities a fair chance to fully benefit from public education.^1,3 Additionally, these accommodations can make the difference between developing confidence and self-esteem or academic and social failure that results in a lifetime of suffering. As your child gets close to graduation, these services will include transition support to work or higher education. Many colleges, universities, community colleges, and trade schools also provide services to students with disabilities. Having an IEP or 504 Plan in high school can make gaining access to these services much smoother because the paper trail documents your child’s disability.

Teach your child to advocate for themselves

Ultimately the best lesson from this process is teaching your child to advocate for themselves in any situation.  Students can learn at an early age to accept migraine as a disability that doesn’t have to keep them from succeeding. By validating their legitimate and unique needs, teachers and faculty send the message that your child is believed. Imagine the difference it would make to grow up with migraine if you had been believed, validated, and accommodated from the first day of kindergarten. You can give that to your child.

Personal experience

We fought for many years to get our son the services he needed. It started in 3^rd grade when he was identified for remedial services after a Traumatic Brain Injury left him with retrograde amnesia and triggered the onset of migraine attacks. He was finally evaluated in 5^th grade when it was determined he did not qualify for either an IEP or 504 Plan. He had been receiving a lot of supportive services. When those services were removed, he began to struggle once again. We had the right to appeal the decision, but chose not to because we were moving that summer.

Trying to get accommodations after moving

In middle school we tried again with a new school district, but were rebuffed because he did not have a record of academic failure, discipline, or attendance problems. We knew how much he struggled and did everything we could to help him. Apparently that worked against us.

Getting another evaluation

By high school things were quickly falling apart as migraines caused him to miss school at least one full day every week. He started falling behind and his grades were slipping. This sudden downturn also contributed to the development of depression. We almost had the school administration convinced to do another evaluation when he asked to transfer to an online school where he could have flexible due dates. We agreed to try it just for one year., but he did just as poorly in online school.

Approved for an IEP and Transition Plan

Another move and another school transfer finally made all the difference. By this time he was starting 11^th grade. The school psychologist immediately recognized that his history of TBI qualified him for services and arranged for an evaluative placement in the Special Education program. Later that year his formal evaluation was complete and he was approved for an IEP with a Transition Plan for post graduation. He is now a happy, confident senior, getting all the support an accommodation he needs to succeed in high school and beyond.  It was a long, hard-fought battle that was well worth the fight.