Autism Assessment: Medical vs Educational

A common conversation we have with parents is the difference between a medical autism assessment and an educational assessment. If you are a parent going through the process of getting your child an autism diagnosis, it’s important to do your research and make sure that the specific assessment being performed will grant you the type of diagnosis that you will need for the services that you want. A medical diagnosis will not guarantee educational eligibility, just like a school-based assessment will not be covered by insurance when used for private therapy services. As a parent, it’s extremely important to know these differences so that you can properly advocate for your child.

The Differences in Assessment

A medical assessment for autism is typically conducted by psychologist or a developmental pediatrician. They will perform an assessment of symptoms and diagnostic tests and then give a diagnosis based off of the Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5). Based on the DSM-5, an individual needs to have “persistent deficits” in 3/3 areas of social communication and social interaction and at least 2/4 restricted or repetitive patterns of behavior, interests, or activities. To meet the diagnostic criteria, these symptoms need to cause a clinically significant impairment in social, occupational, or other important areas of functions. Developmental history is also taken into account when giving a diagnosis. A medical diagnosis of autism is required for private based ABA therapy, such as at PediaPlex, as well as for insurance purposes. 

A school-based assessment is typically completed by a multidisciplinary team of professionals at the school and is used to determine educational eligibility for services. The educational eligibility is based on the state requirements, which can vary in every state. Generally speaking, a child has to have differences in verbal communication, nonverbal communication, and social interaction, with other repetitive or sensory based characteristics. For a child to qualify for educational eligibility they must meet the specific state requirements and demonstrate an educational need for services. Just because a child might meet all of the characteristics, they must still demonstrate a need for services to meet eligibility. This assessment is just used within the school district to determine if the child is eligible for special education services.

 “Autism evaluations conducted by school districts are often thorough and comprehensive. However, the purpose of these evaluations is to determine eligibility for special education services available to support a child’s needs within the educational environment. Even when the multi-disciplinary evaluation team includes a licensed psychologist, the purpose remains to determine eligibility. Private evaluations conducted by a psychologist are initiated to determine if a diagnosis exists and to direct treatment planning based on the findings of the assessment. While recommendations for the educational setting are almost always a part of the treatment plan, other private services (i.e., ABA, speech/occupational/physical/feeding therapies, social skills, etc.) may also be suggested to address the child’s needs outside of the school setting. Obtaining a formal diagnosis of autism is necessary in order to obtain coverage for these interventions through your insurance provider. ” -Daisy Blagg, Psy.D., Neuropsychology Consultants

Benefits of Each

It’s normal to feel skeptical about getting a medical diagnosis of autism for your child but there are multiple benefits to having one. When a child has a proper autism diagnosis they are able to access therapy services that they would not be able to access otherwise. Insurance requires a formal autism diagnosis from a licensed psychologist when they are covering ABA therapy. Without this diagnosis, insurance will not cover it. It’s important to always verify coverage of your individual policy as certain polices have other restrictions in place for therapy services. Early intervention is extremely beneficial for children so the sooner they are able to get a medical diagnosis the sooner they are able to start therapy services.

Having educational eligibility for your child is beneficial for your child as well. When a child is given this eligibility it is because the child will benefit from having special services to help with their academic progress. An IEP (individualized education program) team will determine what specific services your child will need throughout the school day and develop a plan this way. It could be anything from an aid that assists them in class, speech services by a school therapist, or a classroom with small class sizes to give your child more attention. Educational eligibility will help your child throughout their time in school. Often, private therapists and school therapists, counselors, or teachers will collaborate on a child’s plan of care to make sure they are all focusing on the same goals for that child.

ABA Therapy at PediaPlex

If you are looking to start ABA therapy services at PediaPlex your child will need to have a current autism diagnosis from a licensed psychologist. If this is something you are needing to obtain, please give our office a call! We have a list of referrals for the Dallas/Fort Worth area so that we can help you to get the diagnosis that your child needs.

At PediaPlex, we offer ABA therapy as well as speech, feeding, and occupational therapy services. Our collaborative approach to therapy helps children receive all of their services in one location giving them a full therapeutic day. We have locations in Southlake, Fort Worth, and Frisco, Texas. If you are interested in starting services at PediaPlex, please visit our website today to fill out an intake form!

-The PediaPlex Family