Articles and Updates from Phoenix Children's
This question can be confusing for parents and clinical providers alike. The answer stems from both worlds having their own criteria for identifying a child with autism. Let’s first start with what happens in the educational world.
In the special education arena, when a child is suspected of having a disability, school districts are required to provide comprehensive evaluations in all areas of disability. Autism is one of many categories of disability where the school is required to provide individualized supports and services designed to assist the child with making adequate educational progress in the least restrictive environment as possible. The evaluation data must support meeting the characteristics of autism as defined by both the Individual’s with Disabilities Education Act (IDEA) and the Arizona Revised Statutes.
The definition of autism in the Arizona Revised Statutes is based upon the federal definition and guides school district decisions.
“Autism” means a developmental disability that significantly affects verbal and nonverbal communication and social interaction and that adversely affects educational performance. Characteristics include irregularities and impairments in communication, engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines and unusual responses to sensory experiences. Autism does not include children with characteristics of emotional disability as defined in this section.
It needs to be stressed that the disability must have a significant impact upon educational performance. This is different from educational achievement. “Achievement” reflects a child performance on academic tests assessing the child’s levels of academic competence while “performance” reflects the child’s day-to-day success with academic tasks and expectations, which will often be reflected in the child’s grades. This distinction is frequently misunderstood by school personnel when they mistakenly deny special education eligibility because of adequate achievement test scores while at the same time the child is failing miserably at school as a direct result of their disability. Therefore, a child with a clinical/medical diagnosis of autism spectrum disorder (ASD) may not qualify for an educational classification of autism as a higher functioning child may still function adequately at school.
A key word here is “adequate.” Schools are not required to provide services that result in maximum levels of performance. In addition, the child may have other conditions such as attention deficit hyperactivity disorder (ADHD) and the school’s evaluation team may attribute the child’s poor educational performance as primarily due to the characteristics of ADHD, thus the school’s evaluation team will determine Other Health Impairment (OHI), and not autism, as the child’s primary disability. It can be easily seen then how a child who may have been clinically diagnosed with ASD is not considered a child with autism at school.
The reverse is also true where an educational classification of autism does not necessarily translate to a clinical diagnosis of ASD. The clinical criteria for ASD are contained in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and is much more specific and detailed than broader educational definition. Briefly, the child must present with all three of the following:
- Significant deficits with social-emotional reciprocity
- Nonverbal communicative behaviors used for social interaction
- Deficits in developing, maintaining and understanding relationships
In addition, the child must display significant difficulties in two of the following four areas:
- Stereotyped or repetitive motor movements, use of objects or speech
- Insistence on sameness
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
These difficulties must first be seen during the early developmental period and the deficits in the area of social communication cannot be better explained by cognitive delays or an intellectual disability. Thus, there are cases where a child may meet the educational definition of autism at school but not all DSM-5 criteria for ASD.
Finally, it needs to be understood by parents and clinicians alike, that schools are not required to accept clinical diagnoses of ASD, but they must consider them when making eligibility decisions. Schools cannot require parents to obtain a clinical diagnosis of ASD to be considered for an educational classification of autism. As noted above, schools must conduct their own evaluations in all areas of suspected disability. If a public school district or charter school does not have qualified personnel to diagnose autism, the educational agency is required to obtain the needed resources privately at their expense.
Here are some resources for additional information: