School-based Services and Interventions

View detailed information on Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) in ND-PAE Age-Dependent Symptom Diagnosis Guidelines and review differential diagnoses in Differential Diagnosis for ND-PAE. Refer to the Assessment page of the FASD Toolkit: https://www.aap.org/en/patient-care/fetal-alcohol-spectrum-disorders/assessment-for-fetal-alcohol-spectrum-disorder/.

Early care and education special services and accommodations

Young children, ages 3-5 years who have a range of impairments impacting learning and school performance can benefit from special education services. To obtain these services, children need to meet the criteria established by federal and state school district regulations. Special Education is a continuum of services based upon a child’s need. 

504 Plan

 A child who is identified as having physical or mental challenges that interfere with major life activities, regardless of a specific clinical diagnosis, can receive accommodation through a 504 Accommodation Plan. The name derives from the enabling section of the Civil Rights Rehabilitation Act. Check with the local department of education or school system for available support services. School districts may require specific medical forms to support 504 plans. 

Individualized Educational Program (IEP)

Determining if a child is eligible for special education services is a multi-step process. When a child is identified as possibly needing special education and related services, an evaluation can be requested by parents or teachers (with parent or caregiver consent). The evaluation will help assess a child in all areas related to a child’s suspected disability. Qualified professionals, together with parents, determine if a child is a “child with a disability,” as defined by the Individuals with Disabilities Education Act (IDEA). Any child who is found eligible for special education services will have an Individualized Education Program (IEP). IEPs are authorized through the IDEA. An IEP focuses on identifying the specific strengths and weaknesses of a child and how they impact a child’s education. An IEP includes specific specialized instructional goals and the related services to achieve those goals in the least restrictive environment (LRE) with typically developing peers. 

Schools follow a strict timeline for evaluations for an IEP. Once a parent signs consent, school systems have 60 school calendar days to complete an initial evaluation with a child. If found eligible, the school must construct an IEP within 30 school calendar days from receipt of the letter of determination. After the IEP is written, it must be implemented as soon as possible but no later than 10 school calendar days after creating the IEP.

An IEP can help provide a continuum of care from an Individualized Family Service Plan (IFSP). An ISFP is an analogous plan used for Early Intervention (EI) services as a child prepares to enter a preschool setting. If a child is found eligible, services are available on a continuum and may range from attending developmental pre-school (full or part-time) to receiving educationally related services only. The pediatrician can assist in guiding the family to contact their EI case manager to begin the transition process, or to contact their local school system.

Role of the pediatrician in obtaining early care and education programs 

Pediatricians can help ascertain medical causes for academic and behavioral challenges and work with parents, schoolteachers, and counselors to initiate school-based services. Early identification of FASD, including ND-PAE, and inclusion in specific school-based services can mitigate mischaracterizations of behavior and academic potential, and prevent or reduce lifetime stigma as well as academic failure. 

During routine health maintenance visits, pediatricians solicit reports about a child’s adjustment to early care and education programs. If developmental concerns arise, pediatricians can administer developmental screening tests and/or refer to developmental specialists or Child Find programs. Child Find is specific to each state and county, but all programs are mandated by the IDEA to identify children with disabilities and assist in formulating IEPs. Child Find is typically accessed through a school’s website or staff and is often the point of entry to services for preschool-aged children who are identified with learning difficulties or a disability.

Pediatricians can help parents obtain initial services for children three years of age entering early care and education programs, and support families transitioning from an IFSP to services through the local school system. They can help a child qualify for an IEP by completing the school’s medical report forms and writing a Letter of Medical Necessity. When writing a letter of medical necessity, it is important to note the last visit, diagnoses, the concerns related to learning that are impacted by the diagnoses, and next steps. 

It can often be difficult or impossible to document maternal use of alcohol during a child’s pregnancy, making a definitive diagnosis of ND-PAE impossible. In these cases, the medical diagnosis should be as descriptive and specific as possible to accurately reflect the perceived disability and aid interventions. The observed impairments can be described clearly (e.g., neurodevelopmental disorder, static encephalopathy) and are valid diagnoses in communicating with educators. View a Sample Letter of Medical Necessity.

Role of the Pediatrician and Obtaining Early Learning Services for Young Children with ND-PAE