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Parents are usually the first to recognize that their child is struggling in school – maybe they’re falling behind academically, having difficulty paying attention, or avoiding school altogether. Sometimes there’s already a diagnosis, such as ADHD or autism, but other times, no one’s quite sure what’s going on. You don’t need to wait until your child is failing, or until they have a diagnosis, before raising concerns and asking the school for help. When Should You Ask for Additional Support? Every child has a subject they struggle with or an occasional off day; the concern is when a pattern develops. Some signs that your child may need additional support include: Persistent difficulty with reading, writing, math, attention, organization, communication, or memory; Frequent emotional distress, behavioral challenges, or school avoidance; Trouble making progress despite classroom interventions or targeted support; A significant difference between your child’s apparent abilities and their school performance; A disability or medical condition that affects attendance, stamina, concentration, mobility, communication, or access to learning. What Are the Options? Schools can provide several levels of support. Some students benefit from general education interventions, called Tier 1 or 2 supports, such as small-group instruction, targeted academic support, or regular check-ins with a teacher. Other students might need more formalized supports, such as an Individualized Education Program (IEP) or a 504 Plan. An IEP is available to any student who: meets the criteria for one or more disability categories (such as “health,” which includes ADHD) under special education law; isn’t making effective educational progress because of the disability; and requires “specially designed instruction.” Specially designed instruction is defined as teaching that’s individually adapted in its content, method, and/or delivery to address a student’s disability-related needs. An IEP includes measurable goals, identifies the services the student will receive, and explains where and how those services will be provided. Services might include specialized instruction, speech-language therapy, occupational therapy, counseling, or behavioral support. A 504 Plan is appropriate when a student has a disability or health condition that substantially limits one or more “major life activities,” such as learning, but doesn’t require specially designed instruction. A 504 Plan focuses primarily on accommodations and access. Examples might include extended time, movement breaks, preferential seating, access to the nurse, modified attendance procedures, or support managing a medical condition. A 504 Plan isn’t simply a less intensive IEP, and neither plan is necessarily “better.” They have different eligibility standards and serve different purposes. The right option depends on what the student needs. Requesting an Evaluation If you suspect that your child might require additional support, you should submit a written request to the principal or special education department asking the school to conduct an initial evaluation to determine whether your child is eligible for an IEP. The request doesn’t need to be lengthy or written in legal language; it should explain your concerns and clearly state that you’re requesting an evaluation. If your primary concern is that your child needs accommodations rather than specialized instruction, you can request an evaluation for a 504 Plan through the school’s 504 coordinator. If you’re unsure which plan may be appropriate, you can ask the school to consider your child’s eligibility under both laws. A medical diagnosis can be helpful but is not required before you request an evaluation. Likewise, a diagnosis by itself doesn’t automatically make a child eligible for an IEP or 504 Plan. What Does the IEP Timeline Look Like in Massachusetts? After receiving a referral for an evaluation, the school district must send the parent an evaluation proposal and consent form within 5 school days. Once the parent provides written consent, the evaluations must be completed within 30 school days. The Team must then meet to review the results and determine eligibility within 45 school days of receiving consent. Because these deadlines are based on school working days rather than ordinary calendar days, vacations and school closures affect the timeline. Parents should return consent forms promptly, keep copies of everything they submit, and note when documents were sent and received. What Happens at the Eligibility Meeting? At the meeting, the Team, including the parent(s), reviews the evaluations and discusses the child’s strengths, challenges, and educational needs and then determines whether the child meets requirements for an IEP. If the child isn’t eligible, that doesn’t necessarily mean they don’t need support; the school should then consider whether the child qualifies for a 504 or would benefit from other interventions. A student doesn’t automatically receive a 504 Plan after being found ineligible for an IEP; 504 eligibility requires a separate determination. Parents are important members of the Team, you can, and should, ask questions, provide outside reports where applicable, and request clarification when needed. Most importantly, trust that you know your child best. And remember that it’s your right to request these evaluations and determinations, and that it’s your job to advocate for your child! Claire S. Smith, Educational Consultant Pediatric Associates of Greater Salem 

Suicide is a serious concern affecting children and adolescents, and pediatric healthcare providers have an important role in prevention. Although conversations about suicide can feel uncomfortable or frightening for parents and caregivers, recognizing warning signs, encouraging open communication, and seeking help early can make a meaningful difference in a young person's life. Children and adolescents may experience significant emotional challenges related to school, friendships, family relationships, bullying, social media, mental health conditions, or other stressful life events. Sometimes, however, a child who is struggling may not openly communicate what they are experiencing. Understanding changes in behavior and knowing when to seek help can help families respond before a situation becomes a crisis. Recognizing Warning Signs There is no single behavior that can predict suicide risk. However, parents and caregivers should pay attention to significant or persistent changes in a child's mood, behavior, or daily functioning. Potential warning signs may include withdrawing from family or friends, losing interest in activities they once enjoyed, changes in sleep or appetite, declining school performance, increased irritability or agitation, frequent expressions of hopelessness, or feelings of worthlessness or being a burden to others. Parents should take any statements about suicide, death, self-harm, or not wanting to live seriously. Even if a comment is made during an argument or appears impulsive, it should not simply be dismissed. A child's emotional distress deserves attention, understanding, and appropriate evaluation. Talking With Your Child Parents do not need to have the perfect words to begin a conversation. A calm, compassionate, and nonjudgmental approach can help a child feel safe enough to share what they are experiencing. If you notice changes in your child's behavior, start by sharing what you have observed. For example, you might say, “I've noticed that you've seemed different lately, and I'm concerned about how you're doing.” Give your child time to respond and listen without immediately criticizing, minimizing, or trying to solve the problem. If you are concerned about suicide, it is appropriate to ask your child directly whether they are thinking about suicide or hurting themselves. Asking directly does not cause suicidal thoughts or increase suicide risk. Instead, it can create an opportunity for a young person to talk about feelings they may have been afraid or unable to share. When Therapy Can Help Therapy can provide children and adolescents with a safe, supportive space to talk about difficult emotions and develop healthier ways to cope with stress. Depending on the child's age, needs, and circumstances, therapy may focus on emotional regulation, coping skills, communication, self-esteem, problem-solving, relationships, or processing difficult experiences. A therapist can also help parents and caregivers better understand their child's behavior and learn strategies for providing support at home. Therapy does not mean that something is “wrong” with a child. Seeking mental health support can be a proactive step toward improving emotional well-being and building skills that can help a young person throughout their life. When to Contact Your Pediatrician Parents should contact their child's pediatrician when they notice concerning emotional or behavioral changes, particularly when symptoms persist, interfere with school or daily activities, or involve self-harm or thoughts of suicide. Your pediatric healthcare team can help evaluate your child's emotional and behavioral health, discuss concerns with your family, identify potential risk factors, and determine whether additional mental health services are appropriate. Depending on the situation, a pediatrician may recommend counseling, behavioral health services, psychiatric evaluation, or other community-based resources. Seeking help early is important. You do not need to wait until your child is in crisis before talking with their healthcare provider. Creating a Safe and Supportive Home Environment Suicide prevention also includes creating an environment where children feel comfortable asking for help. Regular conversations about emotions and mental health can help reduce stigma and make it easier for children to speak up when they are struggling. Parents and caregivers should also consider reducing access to potentially dangerous items in the home. Medications, firearms, and other potentially harmful objects should be stored securely and appropriately. If your child is experiencing suicidal thoughts or significant emotional distress, speak with your pediatrician about additional steps you can take to help maintain a safe environment. Encouraging healthy routines, adequate sleep, physical activity, positive relationships, and time away from excessive screen or social media use can also support overall emotional well-being. These strategies are not substitutes for professional treatment when a child is experiencing a mental health crisis, but they can contribute to a supportive home environment. You Don't Have to Face It Alone Suicide prevention is a shared responsibility. Parents, caregivers, pediatricians, mental health professionals, schools, and communities can work together to identify concerns and connect young people with appropriate support. If you are worried about your child, trust your instincts and reach out to their pediatric healthcare provider. Asking for help is not a sign that you have failed as a parent, it is an important step in protecting your child's health and well-being. If your child is in immediate danger, has attempted suicide, has seriously injured themselves, or cannot be kept safe, call 911 or go to the nearest emergency department. In the United States, you can also call or text 988 to reach the Suicide & Crisis Lifeline. Every child deserves to feel heard, supported, and valued. Early recognition, compassionate support, and access to appropriate care can help children and adolescents move through difficult moments and toward hope and recovery. Shannon Richardt, LCSW Pediatric Associates of Greater Salem

As September approaches, the fall sports season is about to begin. Sports injuries—especially sports-related brain injuries—have long been a major medical interest of mine. While many sports can cause brain injuries in pediatric patients, most of these injuries occur from tackle football. Concussions are the best-known sports-related brain injury, but an increasing concern in tackle football is the repeated sub concussive head impacts that occur throughout a season. The effects of subconcussive brain trauma were brought to the forefront this spring when the second physician to join Pediatric Associates of Greater Salem, James Higgins, MD, was identified as having Grade IV CTE on his postmortem brain examination. Many families with children age seven or older likely knew Dr. Higgins well. For families newer to PAGS, I would like to briefly introduce him and describe the profound influence he had on the founding and growth of the exceptional practice we are all part of today. Dr. Higgins graduated from Harvard College in 1970 and Harvard Medical School in 1974. After completing his pediatric training at Boston Children’s Hospital and Massachusetts General Hospital in 1978, he joined Ayres D’Souza, MD, at Pediatric Associates of Greater Salem, the practice Dr. D’Souza had founded the year before. During his remarkable 42- year career, he provided care for patients during approximately 250,000 outpatient visits and attended roughly 10,000 deliveries at Salem Hospital. Beyond his work at PAGS, he was instrumental in creating a Level II Special Care Nursery at Salem Hospital, expanding care for sick newborns throughout the North Shore area. The impact he had on countless patients and families during more than four decades of practice is immeasurable. In 2020, he started to notice problems with his speech and was diagnosed with aphasia leading him to retire from the practice of medicine. His aphasia evolved into Dementia, which lead to his death on May 11, 2025, at the age of 76. In addition to his exceptional work as a pediatrician, Dr. Higgins was an accomplished football player. He began playing tackle football in sixth grade, became an All-State cornerback at Livingston High School in New Jersey, and later played for the Harvard football team. After he was diagnosed with aphasia, he and I discussed the possible connection between contact sports, including football, and neurodegenerative disease. In a final effort to advance medical knowledge, Dr. Higgins chose to donate his brain and spinal column to the Boston University Chronic Traumatic Encephalopathy (CTE) Center. BU neuropathologists completed their evaluation this spring; they determined that he had Grade IV CTE at the time of his death. CTE is graded from I to IV, with I being the mildest form and IV the most advanced. 

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