What is the difference between a medical diagnosis and an educational identification of an Autism Spectrum Disorder?
Different criteria and outcomes: Educational identification and clinical diagnosis are two very different processes, which, as summarized in Table 1 (below), rely upon different definitions of ASD and provide information for different contexts. The two systems are not directly translatable; although data obtained in one process ought to be disclosed in the other process, as the quality of both processes is largely dependent upon the scope and accuracy of the information obtained. Full disclosure is encouraged and ultimately decided upon by the child’s parents/guardians.
How is the new medical/clinical definition similar to the criteria for an educational identification of an Autism Spectrum Disorder?
The revised definition provided in the DSM-V is actually more similar to the educational definitions than previous versions. Specifically:
- Both now include reference to the impact of ASD on daily functioning
- Both now acknowledge that there is a spectrum of difficulties and neither system attempts to subdivide into categories such as “Autistic Disorder”, “PDDNOS” or “Asperger’s Syndrome”
- Both acknowledge that the impairments usually emerge in early development
- Both include core difficulties in both verbal and nonverbal social communication
- Both include core difficulties in social interaction, although the DSM-V is more specific about the forms of behaviors one might observe
Table 1 Differences between educational identification and clinical diagnosis of ASD
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EDUCATIONAL IDENTIFICATION |
CLINICAL DIAGNOSIS |
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Source for definition of ASD in Colorado |
IDEA/Colorado ECEA Rules |
DSM-IV (APA, 2002) or DSM-V (APA, 2013) |
|
Decider: (i.e., who chooses the ED ID category or clinical diagnosis?) |
The Child Find or Individual Education Team (which includes parents, educational professionals and sometimes the student) |
Psychologist or Physician |
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Time frame that applies |
Evident & impairing right now, will be re-examined at least every 3 years |
Lifelong, persistent condition, assumed to have been present in the past and assumed to be present in the future |
|
Information included in the assessment or evaluation |
communicative behaviors with other children/youth
May include: Standardized assessments of intellectual functioning, language, motor skills, learning style, adaptive behaviors Further investigation into attention, mood or other aspects of mental health, as needed Review of previous evaluation reports, as provided by the family
|
communicative behaviors with adult clinician, parents, possibly siblings
May include: Physical exam, genetic testing, neurological exam or other relevant medical follow-up procedure Further investigation into attention, mood or other aspects of mental health, as needed Teacher report of youth behaviors, learning and adjustment at school Review of existing educational records Review of previous evaluation reports, as provided by the family
|
|
Cost to the family |
Part of a free and appropriate public education |
Estimated cost of $1500-$3500 (sometimes covered by insurance, sometimes not) |
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Access to experienced Professionals |
Child Find and IEP team are always available (i.e., part of a free and appropriate public education); experience with the educational evaluation of ASD varies across administrative units (AU) with some AUs not evaluating for the educational identification of ASD for undiagnosed students |
Geographically dependent: Qualified/trained diagnosticians often practice in metropolitan areas. Rural and frontier communities may not have local access to medical or mental health professionals with experience in clinical diagnosis of ASD |
|
Wait time |
Up to 60 days to complete the evaluation |
Up to 6 months in local clinics; less if seeing individual practitioners |
|
Functional impairment |
The condition must affect educational performance (such as; academics, ability to communicate effectively, work in groups and acquire the necessary social competence to be successful after high school). |
The condition may or may not be impairing to be clinically diagnosed. |
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Results are intended for: |
Developing the student’s individualized education program, (including identifying appropriate educational goals and objectives, accommodations, modifications, and determination of the least restrictive environment) in order to provide the student with a free and appropriate education. |
Guiding parents to appropriate next steps in intervention (both in and outside of school) in order to promote overall wellness and optimal outcomes for youth with ASD and their families. |
Who makes the educational eligibility determination? Who actually decides what category is the best fit for a particular student?
The Eligibility/IEP Committee makes the decision together and is expected to continue interacting until they can reach consensus on an appropriate educational identification decision for the student. Once they have agreed on an eligibility determination, the committee writes a written summary of the process they undertook, the decisions they made, and why. This statement is shared with all committee members and revised until all committee members feel comfortable to sign off on it.
Please note: This is very different than the way medical or clinical evaluations re conducted – wherein the professionals are regarded as “experts” and independently formulate their impression and present it to others, as a completed piece of work – ending in a diagnosis. In an educational identification process, the professionals who conduct and interpret the assessments share their findings with the committee and share their professional opinions, but do not unilaterally dictate the eligibility decisions.