Medical vs Educational Services, Student Behavior & Untangling the Confusion at the IEP Table
As a Special Education Advocate and mom of two, I hear this a lot—
“Why doesn’t the therapy we do outside of school line up with what happens in school?”
It’s one of the most misunderstood parts of the IEP process.
And when that disconnect happens, it’s not just frustrating. It creates a ripple effect. School teams, medical teams, and parents all start heading in different directions—even though we’re actually speaking the same language. We just don’t realize it.
So let’s slow this down and walk through it together.
Let’s make sense of what’s really happening at the IEP table—so you can feel grounded in what to ask for, what to expect, and how to move forward when things feel off.
“Behaviors in the classroom don't always mean resistance. Sometimes it means ‘I’m not ready yet.’ Sometimes it means ‘I don’t know how.’ And sometimes it means ‘I’ve tried everything I could… and it still wasn’t helpful.”
If you’re parenting a child whose needs don’t fit neatly into checkboxes—especially when it comes to behavior and regulation—you’ve probably heard more opinions than support.
Maybe someone told you,
“That’s a medical issue, not an educational one.”
Maybe you’ve been told, “We don’t provide therapy.” Maybe you’ve seen phrases like “refusing,” “defiance,” or “behavioral non-participation” written in your child’s records and thought,
That’s not even close to what’s happening!
You’re not wrong to pause.
You’re not overreacting if your gut says something feels off. Because this isn’t just about behavior. It’s about regulation. It’s about access. It’s about what your child needs to show up and stay okay in a school environment.
What parents are hearing—and why it makes sense to ask more questions
You might hear a team say, “We take medical diagnoses under consideration to see if they impact education.” And that’s technically true.
But the way it’s said? It often makes it sound like:
“If it’s medical, it’s not our job.”
And that’s where conflict usually starts—not because anyone is trying to dismiss you, but because nobody’s explained how the pieces are supposed to fit.
Medical teams and educational teams are like two experts with different toolboxes. One is trained to diagnose and treat. The other is trained to support and teach. They’re not meant to compete—but they do need to communicate.
When disagreements happen with the school team, it’s easy to feel stuck—like special education is the only path forward. But that’s not always the case.
A 504 Plan is another option. It can support your child in many of the same ways as an IEP—just with a different structure. Sometimes, a student does not need specially designed instruction; they just need support to access learning.
We do not have to limit support to one model. What matters most is choosing the path that actually works for your child.
And as parents, we’re often the ones stuck in the middle, trying to translate between what medical teams express is needed for the child and what is available for the child in the educational setting, based on eligibility. That’s not a failure on your part. That’s a flaw in the system and a miscommunication between teams.
Here’s how I explain it to families: expecting medical and educational systems to perfectly align—without collaboration—is like expecting a toddler to tie their shoes without ever being shown how.
Everyone’s doing the best they can, but nobody has the full picture until we bring it together.
Medical vs Educational—why both matter, and where your child fits
Medical care is where you go when you’re trying to understand what’s happening. It’s where diagnoses are made, therapy goals are created, and coping tools are introduced.
Educational support is where we apply that understanding—especially if your child’s diagnosis affects their ability to participate, regulate, or learn during the school day.
Schools don’t diagnose. They’re not built to treat anxiety or sensory disorders in a clinical sense. But they are required to support the way a disability affects your child’s education.
So if your child shuts down during transitions… If they panic at noise in the cafeteria… If they avoid writing, explode at the end of the day, or struggle to initiate tasks…
It doesn’t matter whether the diagnosis came from a doctor, a therapist, or a full team outside of school.
If the need is real and it shows up during the school day, the school has a responsibility to support it.
Now—here’s where it gets nuanced.
There are absolutely situations where a medical diagnosis does not affect the school setting.
Take anxiety, for example. Some students experience anxiety intensely in social or unstructured settings—but not in the classroom. If school is predictable, staff are supportive, and routines are consistent, that anxiety may not interfere with learning.
In those cases, it is not that the school is ignoring the diagnosis—it is that, right now, the need does not require educational intervention. And that is okay. There are times when a medical-based therapeutic approach is the better fit to address a specific skill delay.
The goal is collaboration. When schools and medical teams align, the student receives consistent support across environments—and that promotes real growth.
A diagnosis does not automatically create an IEP. It is part of the story—not the whole story.
But when the school team hears that information and says,
“Okay, does this impact access? And if so, how do we support it?”
—That is when things start working.
Medical insight helps clarify what’s going on. Educational support helps respond to it.
And the IEP table is where both sides come together to make decisions as a team.
Parents are not outside that team. Your input is part of what shapes the support plan. You know your child best. And when behavior starts speaking louder than words, your insight matters more than ever.
Behavior is communication—because your child is telling us everything, even if they can’t say it
Let’s be honest—behavior is often the first thing that gets noticed, but it’s the last thing that gets understood.
When a child says no, shuts down, lashes out, or refuses, it’s not just resistance. It’s a signal. It’s a form of communication. And when we treat it like a problem instead of a message, we miss the chance to help.
Behavior tends to reflect something deeper—Fatigue. Overwhelm. Frustration, Shame. Fear. Sensory overload. Confusion—but effective support begins with individualized understanding, not assumptions.
Understanding the antecedent, otherwise known as tiggers—is what happened before the behavior—is critical for meaningful support.
Sometimes it’s a child who’s masking all day and finally runs out of energy. Sometimes it’s a child who’s tried to ask for help—but wasn’t understood—so now they’re pushing back.
You’ve probably heard the phrase, “All behavior is communication.” But no one tells you what it’s actually saying.
Here’s the heart of it: when we say that behavior is communication, we’re talking about more than just yelling or meltdowns. We’re talking about a child using their entire body—consciously or not—to say, “Something’s not right.” Whether it’s a clenched jaw, walking out of the classroom, covering their ears, or refusing to move forward with a task—it’s all sending a message. Especially for kids who struggle with language usage, regulation, or processing information, behavior becomes their clearest form of expression.
They may not have the words to say, “This is too hard,” or “I’m scared,” or “I’m trying, but my body won’t let me.” So their behavior steps in and does the talking.
And if we’re only focused on what it looks like on the outside, we’ll miss the deeper message underneath.
That’s when kids get labeled, plans get written without context, and everyone ends up frustrated. In the worst cases, a pattern of stress, inattention, or shutdown gets mistaken for something it’s not—and a student ends up with a potential diagnosis concern like ADHD that doesn’t fully reflect what they actually need.
Here’s what I’ve learned from the children I work with—and the ones I’m raising:
They’re not refusing to be difficult. They’re not saying no because they don’t care. They’re not disengaged because they’re lazy.
They’re stuck.
And when a child is stuck, we don’t push harder. We step back, get curious, and ask:
“What just happened in their world that made this feel impossible?”
Some days, the same behavior will mean something totally different depending on how the day started, if the routine was interrupted at home before school, what demands were in place, or what supports were used by paraprofessionals, service providers, and staff alike.
That’s why collaboration and strong home-school communication matter. That’s why regulation can’t be treated as an afterthought. That’s why understanding the “why” behind the behavior isn’t a luxury—it’s the first step toward getting the plan right.
At the same time, behavior isn’t always tied to a disability.
Sometimes it’s a student learning how to test boundaries, make decisions, or figure out what’s okay and what’s not—just like any other kid. That doesn’t mean we ignore the behavior or assume it’s always intentional. It just means we pause long enough to ask:
“Is this coming from a skill gap—or is this part of typical development?”
Behavior can happen for a lot of reasons. Sometimes it’s environmental—what’s happening around the child. Sometimes it’s genetic—how their brain is wired. And sometimes, we honestly don’t know. But whether it’s predictable or not, it still deserves to be understood.
That’s why school teams have to hold space for both.
Looking through a disability lens doesn’t mean every behavior is disability-related. It means we’re committed to understanding the whole child—not just reacting to the moment in front of us.
That balance—of curiosity, context, and fairness—is what keeps IEP conversations collaborative instead of combative.
With that being said, let’s be clear. Children with disabilities are still bright children. They do know right from wrong. We can’t assume every tough moment is just disability-related, and we also can’t excuse away all behavior under the idea that “they can’t help it.”
Sometimes, it is boundary-testing. Sometimes, it is a choice. And children receiving special education services and with 504 plans are still expected to follow the student code of conduct. Yes—they can get detention. Yes—they can be suspended or even expelled. That part often gets lost in the conversation. This is another common misconception that happens in the special education community.
What we’re talking about here isn’t about removing accountability.
We’re talking about building understanding—so that the accountability actually makes sense, supports growth, and gives your child a fair chance to succeed.
What schools can do—without needing a diagnosis or a perfect label
One of the hardest parts for parents is feeling like their child’s needs don’t “fit” neatly into the school system. Maybe the behavior isn’t constant. Maybe the diagnosis is recent. Maybe your child shows up differently at home than they do at school. And suddenly you feel like you're left trying to connect all the dots yourself.
But here’s the thing: schools do have ways to support students whose needs show up through behavior, regulation, and emotional overwhelm.
When a child is dysregulated, avoidant, or shuts down, it doesn’t mean they’re being defiant. It usually means they’ve hit a wall. That’s an access issue—and access is something schools can address.
Sometimes it starts with observation. Sometimes it’s conversations around triggers (antecedent), recovery patterns, or environmental stressors. Sometimes it’s not a formal plan yet—but a conversation that opens the door to meaningful support.
Support doesn’t have to look dramatic to be effective. It has to be appropriate for the child’s current needs.
It might be offering extra time when a student gets stuck. It might be building in a quiet moment before transitions. It might be scripting language for how adults respond during stress.
Small things shift access in big ways.
And for kids who are already working so hard to hold it together, that shift can be the difference between meltdown and classroom success. Between shutting down and trying again. Between “I can’t” and “Okay, I’ll try.”
This doesn’t require the student or school district staff to get it perfect. It just requires teams to stay curious about what’s underneath the behavior—and to be willing to respond with flexibility, not just structure.
Let’s find the middle ground—because it doesn’t have to be all or nothing
You don’t have to pick a side between “this is medical” or “this is educational.” You don’t have to come in ready to fight with school staff at the next IEP meeting or school pick-up line. You don’t have to have the perfect language or evidence.
You’re allowed to say:
“This is what I’m seeing. And it’s affecting my child’s ability to learn. Can we talk about what that means for school?”
That one sentence can open the door and will guide the entire IEP team.
Because the truth is—your child’s behavior is telling us something. And the goal isn’t to control it. The goal is to understand it, support it, and respond in a way that helps your child stay safe, seen, and ready to learn.
This isn’t about blaming schools. And it’s not about excusing behavior. It’s about making sure your child isn’t asked to mask, power through, or collapse their way through the school day just because no one knew what to do differently.
If you’re sitting with all of this thinking,
‘This sounds like my child—but I don’t know how to say it,’ that’s where I come in.
I help parents turn what they know about their child into the kind of language that school teams can hear. I bring clarity to the table—so your voice doesn’t get lost in emotion, confusion, or misunderstood intentions.
Together, we build a plan that reflects who your child actually is—not just what the data shows, or how the behavior looks on paper, but the real child behind it all.
You do not have to choose between silence and escalation.
You don’t have to figure out how to navigate this system on your own.
There is another way forward—and it starts with a conversation rooted in facts, framed with care, and delivered with calm authority.
This is what I do. This is who I am.
Let’s turn your voice into action—and your child’s needs into a plan that works.
