What is the difference between a medical diagnosis of autism and an educational diagnosis of autism?
I get this question a lot, especially from a new family who is perhaps on a waiting list for a medical diagnosis of autism (or something else!) but are starting the process for an educational diagnosis of autism in order to start services at school. It's not even a question, really; many people (parents and educators, alike) may not even know there IS a difference between an educational diagnosis of autism and a medical diagnosis of autism. But, it's important to know and understand, especially if you're getting on this rollercoaster for the first time. Some important information before we go into the differences:
How do you get an autism diagnosis?
In the medical field, all children should be screened specifically for Autism during regular well-child doctor visits at 18 months and 24 months. This is a recommendation from the American Academy of Pediatrics. If your pediatrician has NOT talked to you about this screening and you have ANY concerns about the development of your child, speak up! You may even get an earlier or more frequent screening done if your child is at high risk for ASD (e.g., having a sibling or other family member with ASD or other developmental delays, problems due to pregnancy or birth complications, etc.).
The type of things a pediatrician should be observing even before they do an official screening will be shared enjoyment (giggling in response to an interaction, eye contact in anticipation of something like peek-a-boo, pointing or waving, fear of the doctor, and so forth) and communication (more focused on what they understand than what they speak at this age such as responding to name or other simple commands).
Most offices will then use the Modified Checklist for Autism in Toddlers (M-CHAT)™ . You can use the PDF version. It's 20 quick questions that can be observed or answered in one sitting; not time-consuming. Questions like, “Does your child ever play pretend or make-believe?” and “When you smile at your child, does he or she smile back?”. Remember, this is just a SCREENING. In other words, the doctor is just putting you through the first hoop to see if another hoops need to be set up for you.
Who can give an autism diagnosis?
Your pediatrician should refer you to a specialist. This is typically:
- Developmental Pediatrician (doctors who have special training in child development and children with special needs)
- Child Neurologist (doctors who work on the brain, spine, and nerves)
- Child Psychologists or Psychiatrists (doctors who know about the human mind)
A comprehensive diagnostic evaluation may include: looking at the child’s behavior and development, interviewing the parents, hearing and vision screening, genetic testing, neurological testing, and other medical testing. Yup, it can be that thorough.
The difference between medical and educational diagnosis
It's important to say something here about the educational options afforded to you. As soon as you have concerns about the development of your child, you do NOT need to wait for these full medical evaluations which can take many months to secure before accessing educational services. If you have concerns, contact your local school district and tell them that you have concerns about the development of your <age> child, and who can you talk to about getting a developmental screening. They should be able to direct you to who to talk to to start the process (depending on the age of your child).
So here are the major differences you will experience between a medical evaluation and an educational evaluation:
Who performs the medical and education autism diagnosis?
Performed by medical specialists with specialized experience
Performed by qualified school personnel, typically the school psychologist
May qualify for medical funding; will be referred out by the specialist and/or dependent upon your insurance coverage
May not qualify for medical funding; insurance typically will require a medical diagnosis for clinical services, but always check with your insurance provider
What is "educational impact?"
Impact in educational setting not required for diagnosis; While this information is useful for making a diagnosis, it is not required for your child to demonstrate that their symptoms have an effect on their ability to access learning opportunities at school. Medical professionals are looking at the medical diagnosis and seeing if your child fits under those requirements alone.
Impact in educational setting required to qualify for services; This is where it gets a little tricky. In the educational setting, the team has to determine if your child's symptoms have an adverse impact on their educational learning. This means that if your child doesn't need a lot of support for daily functioning and may be academically at or above grade level AND is able to
“keep it together” or mask their social and behavioral challenges during the day at school, then they MAY NOT qualify for an educational diagnosis and services. That doesn't mean they don't have autism or isn't a handful at home; it just means that they've figured out how to use their tools to get by during the school day.
What tools do they use to diagnose autism?
Use of standardized assessments and observations in the clinic setting; You'll probably be given a lot of forms to fill out asking about the development of your child and challenges, and the doctor should do direct observations and assessments. It's unlikely any medical professional will come to school or home or the park to do any sort of direct observation there. They are looking for symptoms that fit into the diagnostic criteria.
May use standardized assessments but also may simply use observations and interviews. They will talk with your child's teacher and ask for their input as well as do observations of them in the classroom or other settings. They may use the child's medical evaluation report and results of assessments to help their decision-making. They are looking for symptoms that affect their ability to learn at school.
What developmental areas are assessed?
Looks at functioning across all modalities and settings; They want to know about diet and eating habits, sleeping habits, how they do at the dentist office, how they interact at home with siblings, as well as other challenges. And of course all areas of development such as speech and language, motor, social, and behavior.
Generally focuses on functioning in school environment (and need for specially designed instruction); While knowing about their eating and sleeping habits is helpful to know once they qualify for services, this information is not generally required for the initial diagnosis and approval for services. They just want to know “how do they look at school?”
How to qualify for services at school with an educational diagnosis of Autism
That's all folks. A quick run down of the medical and educational diagnosis of autism. This is how a student receives specially designed instruction in the school setting. The student:
- Has documented evidence by the school team that there are impairments in communication, social interaction, patterns of behavior that are repetitive, restricted or stereotypic, and/or unusual responses to sensory experiences
- Has impairments inconsistent with their development in other areas
- Has these impairments documented over time and/or intensity
The school team must also determine and document that:
- The disability adversely affects the student’s ability to learn without specialized support
- The student needs special education services as a result of the disability
Each state and each district have slightly different qualification requirements, so when in doubt, go to the source. Contact your school district and get information for your situation.