In most parts of the United States, an autism diagnosis comes from a medical doctor, a psychologist, a neurologist or some other member of the medical professional. In several state, however, it is also possible to receive an "educational diagnosis" (officially called an assessment) of autism. An educational diagnosis may or may not agree with a medical diagnosis; its purpose is simply to determine that a child is or is not eligible for specific educational accommodations and supports.
For purposes of an "educational diagnosis," states may not restrict the definition of autism - but they may expand it. Two states, Oregon and Minnesota, have been particularly generous in the limitations they place on "autism." A child with an "educational diagnosis" may or may not also be diagnosed with an autism spectrum disorder by a medical professional. In fact, his or her symptoms may not even rise to the level required by the medical diagnostic manual.
Nevertheless, the rates of "educational diagnosis" are reported to the state in precisely the same way as rates of "medical" diagnosis. As a result, the number of children identified as "on the autism spectrum" in Oregon and Minnesota (among others) are unusually high. This, not surprisingly, can be very confusing.
In an attempt to learn more about educational diagnosis of autism, I conducted a web search. The most recent information I could find dates from 2004, and includes an article and links to specific criteria in the AutismWatch site (a website created to debunk autism-related myths). The site explains the issue in this way:
So, what is happening in Oregon and Minnesota? The theories of pollution, lead poisoning or mercury poisoning cannot explain why they have a higher prevalence of autism than Louisiana, New Jersey, Texas or Mississippi. Oregon and Minnesota do not have higher vaccination rates than the rest of the country, and their parents are not any worse or any better than the rest of the US. The difference occurs because the Individuals with Disabilities Education Act lets the individual states decide the details of eligibility. They cannot be more restrictive, but they can be more permissive. As a result, most states either use a slight modification of the DSM IV criteria or have the diagnosis of autism made by a qualified medical professional. Washington does this, for example, but Oregon and Minnesota use much broader criteria.
You can see how this works by comparing their sections dealing with social and behavioral abnormalities that are characteristic of autism:
- The DSM IV lists four specific types of abnormal social behavior (e.g. "lack of social or emotional reciprocity") and requires that at least two of them to meet the social impairment section of the diagnostic criteria.
- The Minnesota statute lists broader social abnormalities (e.g. "may appear to prefer isolated or solitary activities") and requires two of them to meet the criteria.
- The Oregon statute is even more vague: Its social impairment criteria simply states, "Impairments in social interaction" and leaves the interpretation up to the evaluator.
- In contrast, Washington defines autism much more rigorously by requiring "a specific diagnosis, by a board-eligible psychiatrist or licensed clinical psychologist, of autistic disorder."
There is a definite connection between a state's autism prevalence as reported by the USDE and the criteria that state laws have established for autism eligibility under IDEA. However, because the IDEA criteria have no demonstrated relationship to the medical diagnosis, the USDE numbers are not valid for comparing one state to another or even one year to another within a particular state.
If your child has an "educational" diagnosis of autism, please share your info. Does your child ALSO have a medical diagnosis of autism, or does he/she have a different diagnosis - or no diagnosis at all? Do you like this approach to qualifying children for services? And - do you know of more up-to-date information sources regarding educational diagnosis, particularly in Oregon and Minnesota?