4 ASD and School Age

Whether students transition to school-based services from early intervention with an ASD diagnosis or receive an ASD eligibility or diagnosis while within school (i.e., preschool through high school, 3-22 years of age), considerations related to the impact of ASD upon their educational needs, engagement, progression, and attainment are import to consider for families, caregivers and providers alike.

Difference between medical diagnosis and education classification

We often hear about confusions regarding a medical diagnosis versus an educational classification or special education eligibility of ASD.

Medical diagnosis is formal and traditionally made by a psychiatrist, clinical psychologist, or physician (e.g., pediatrician, developmental pediatrician, pediatric neurologist) based on criteria contained within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013). General developmental screening followed by hearing assessments and additional medical testing specific to parent and/or physician concerns as needed often precedes screening, evaluation, and/or medical diagnosis. If concerns regarding the presence of ASD remain following the hearing assessment and medical testing, administration of specific ASD diagnostic screening tools (e.g., M-CHAT (Robins et al., 2014), Autism Screening Questionnaire (Berument et al., 1999) and possible referral to other specialists are warranted. The medical diagnosis is made to reflect the functioning of the whole individual, across situations and settings and will typically include, but may not be limited to, a review of the following (Ozonoff et al., 2008):

Parent/primary caregiver interview:

• Family history (e.g., medical and psychiatric diagnoses)
• Social history (e.g., family context, family/environmental stressors)
• Developmental history (e.g., sensory, motor, language, social, adaptive, and cognitive skills).

Other diagnostic tools:

• Previous evaluations (e.g., diagnostic, speech/OT, medical)
• Interviews and/or reports from other caregivers (e.g., teachers, therapists)
• Observations and/or reports of the individual interacting with caregivers in a variety of settings (e.g., clinic, home, school, community)
• Standardized diagnostic tools (e.g., Autism Diagnostic Interview – Revised ADI-R; Rutter, LeCouteur, & Lord, 2003), Autism Diagnostic Observation Schedule-Generic) (ADOS-G; Lord et al., 2000)

Educational classification is established by school personnel and typically involves a multidisciplinary team evaluation and case conference committee decision. Educational eligibility is based upon both the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and special education eligibility criteria as outlined within the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA) and the Indiana Department of Education Article 7 (IDOE-Title 511-Article 7, 2010).

Eligibility for special education under ASD eligibility criteria requires that the symptoms related to ASD result in a consistent and significant negative impact on academic achievement and/or functional performance as identified through a comprehensive multidisciplinary evaluation for ASD. This typically includes, but may not be limited to, evaluations completed by the school psychologist, speech-language pathologist, occupational therapist, and special education teacher. The multidisciplinary evaluation will include the following assessments:

• Current academic achievement in relationship to the academic standards currently adopted through the Indiana Department of Education and foundations to academic standards using norm-referenced, criterion-referenced, and/or other achievement measures
• Functional skills or adaptive behavior across various environments from multiple sources
• Receptive, expressive, pragmatic, and social communication skills using norm-referenced and/or criterion-referenced measures
• Motor skills and sensory responses
• Social and developmental history reviewing, but not limited to, the following areas: communication skills, social interaction skills, motor skills, responses to sensory experiences, relevant family and environmental information, patterns of emotional adjustment, and unusual or atypical behaviors
• Systematic observation(s) of the student across various environments
• Additional assessments and information as needed to:
  • Exclude the presence of an emotional disability, blindness or low vision, deaf-blindness, or a cognitive disability, unless the ASD characteristics are exhibited to a greater degree than typically seen with these respective areas of disability
  • Determine eligibility for both special education and related services as applied to transportation and/or developmental, corrective, or other supportive services required to assist the student in benefiting from special education (e.g., occupational therapy, physical therapy, etc.)
  • Inform the case conference committee of the student’s individual and related service needs.