Is suicide unforgiveable? Somewhere I heard that suicide is an “unforgivable sin.” That people who kill themselves won’t get into heaven. Is that true? My nephew — an honor student, accomplished athlete, and respected leader of his church youth group — recently took his own life. The entire family is struggling with overwhelming grief, pain, guilt, confusion — and agonizing questions about the fate of his soul. ANSWER: We’re so sorry for your loss. Before getting into doctrinal questions, we want to encourage you and the rest of your family to do everything possible to bind up your wounds.

Get help through your school system

After age 3, children with developmental delays can continue with early intervention services. These services through the local schools are called individual educational plans (IEPs) or 504 accommodations. This latter term is based on section 504 of the Americans with Disabilities Act, a federal law that ensures every individual’s right of equal access to educational and occupational opportunities.

The Center for Parent Information & Resources provides excellent material on how to obtain help for your child in the school setting. At CPIR’s website click on the Resources tab to find information about IEP’s, 504 accommodations and more.

As a Developmental-Behavioral Pediatrician, I’m often asked to write letters of support so that a child can receive accommodations in school. The accommodations I will ask for depend on the child’s developmental concerns and medical diagnosis.

Medical diagnoses that may call for 504 accommodations include:

• physical issues like cerebral palsy and vision or hearing deficits
• neuro-behavioral disorders such as ADHD, autism, emotional trauma, sensory processing disorder, and anxiety.

School staff generally creates an IEP after an extensive eligibility review to assess for significant learning disabilities, intellectual disability (lower IQ), or other educational problems that might require changes in curriculum or teaching methods for the student.

A medical provider or a parent can request an IEP eligibility evaluation. The school must respond to the request within a specified time period. In some areas, schools may provide additional support or modifications in the teaching plan through extra tutoring, smaller groups within a class without a formal IEP process, or a “response to intervention” (an approach that looks at educational interventions or teaching procedures to determine if they are effective; if they’re not, the school can try something different).

Treat each child as an individual

Each child has a complex story, including particular life events, genetic factors, and strengths and weaknesses. Keeping that in mind, when working with a child with a possible developmental delay, I do a careful physical exam to look for traits that may be part of a genetic syndrome or disorder. I spend time with the child in the office doing back and forth play, imitation games, making requests, drawing, and building things. All the while, I am looking for that direct eye contact that says we are making a connection. I gain information from parents and teachers through questionnaires and surveys that can reveal additional symptoms of ADHD, autism, anxiety, or past trauma.

If a child can get an evaluation like this from a pediatrician, family physician or nurse practitioner, neurologist, psychologist, or developmental specialist, then a diagnosis and appropriate plans can be created.

What educational accommodations might look like

Let’s say that a 5-year-old boy has delayed speech, is shy around other children, has a weak pencil grip, and gets overwhelmed in noisy environments. A medical evaluation shows that he has developmental coordination disorder, developmental speech delay, social anxiety, and over-sensitivity to noise. He would benefit from 504 accommodations that include:

• occupational therapy
• speech therapy
• social skills coaching
• access to noise-reduction headphones during noisy school assemblies
• extra help with tying shoelaces and putting on his jacket
• a plan for letting the staff know if he is starting to feel upset before he has to withdraw, hide, or cry

As he continues in school, if he has a lot of difficulties learning the alphabet, sight-word lists, or sounding out new words, he may need specialized reading help in the form of an IEP rather than just the 504 accommodations.

Help for the child with ADHD

Attention deficit hyperactivity disorder has three main forms – predominantly inattentive, predominantly hyperactive/impulsive, and combined.

Some students with ADHD are easily distracted and seem to be off in their own world. Others are generally quiet; signs aren’t noticed until later in school when their workloads increase and their grades go down. The more common student with ADHD is distractible but also restless and fidgety. They tend to move about the room, talk out of turn, and zoom from one activity to another. About half of the students with ADHD also have difficult-to-read handwriting.

Most students with ADHD benefit from occupational therapy and 504 accommodations in school. Medications may be helpful but are not always necessary as a student matures. Elements of a 504 plan for a child with ADHD might include:

If a child with ADHD is not treated with understanding and appropriate accommodations in school it can lead to academic struggles, feelings of hopelessness, and even depression. This is one reason why getting a diagnosis can be vital for your child. More information and excellent resources for families dealing with ADHD are available through CHADD and ADDitude.

Facing autism spectrum disorder

In recent years the widely encompassing term autism spectrum disorder (ASD) replaced the condition autism. ASD includes less-severe conditions such as Asperger’s syndrome through more severe forms of autism. Still, you will probably hear autism and ASD used interchangeably.

The core symptom of ASD is difficulty with social communication, which can be divided into three areas:

• Use of appropriate facial expression, direct eye contact, and body language that shows that a person wants to know and interact with another person
• Forming relationships at the appropriate developmental level with same-age peers
• Making small talk, carrying on a back-and-forth conversation, sharing interests, and listening to another person

Additional features of a person with autism are repetitive and restrictive behaviors, including:

• Repeating behaviors and movements, echoing speech, “scripting” (quoting lines from movies), performing rituals or patterned behaviors
• Inappropriate intense interest in certain topics, toys, ideas, items
• Difficulty with changes in routine, schedule, or plans, often becoming upset over transitions
• Sensory-seeking such as touching, smelling, tasting, or sensory-overload from clothing, touch, noises, tastes, and visual appearance of items.

There are additional factors that go into a diagnosis of autism spectrum disorder, but these are the main themes.

If a person does not have difficulty with social communication, they don’t meet the criteria for autism. This means that if a child demonstrates delightful back and forth communication they don’t have autism based on current guidelines, even if they refuse to eat certain foods or can’t stand wearing scratchy clothes.

A 504 accommodation for a child with autism might include:

• extended time for taking tests
• extended time for turning in homework
• giving directions in straightforward simple steps
• sticking to established routines
• providing instruction in written or electronic format rather than just spoken or auditory.

Take care of yourself as you nurture your child

On a final note: When you’re raising a child with a developmental delay, it’s easy to focus so much of your attention and energy on your child that you ignore your own needs.

For your own sake as well as your family’s, you need to care for yourself.

• Take care of your own physical needs, including getting proper nutrition, exercise, and 7-8 hours of sleep each night.
• Seek support through relatives, friends, school counselors, your medical team, and your local church. Having people in your corner who can offer you a boost—whether that’s emotional or through practical assistance—is valuable.
• If you are married, tend to your relationship with your spouse. It’s important that you be intentional about your marriage if it is to do more than limp along. A healthy marriage will help you handle stress better, too.
• Do not neglect your faith and spiritual health. Spend time in God’s word and in prayer. For you to thrive, not just survive, your spirit must be fed.