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If Your Child Has an "Educational Diagnosis" of Autism, Please Share Your Thoughts and Insights

By July 13, 2011

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?

July 13, 2011 at 10:14 am
(1) Sandy-2000 says:

If your child had an evaluation via the school to determine eligibility for special eduction and then received an IEP and special ed services, your child in fact has an educational diagnosis, regardless if you have a medical DX or not. Some states wont even classify an IEP autism until the age of 9; prior the IEP is termed DD (developmentally delayed).

There are of course children who have diagnosis and don’t qualify for special ed. I do not believe 504′s are used in that info gathered to obtained the stats per state of autism, or any disability.

July 13, 2011 at 11:03 am
(2) autism says:

Sandy – where is the source of this info (especially the “IEP autism” info and the info about how 504′s are used)? I can’t find anything that lays this out officially!


July 13, 2011 at 12:06 pm
(3) MJ says:

That Autism Watch article you linked to is rather bad. It makes many blanket statements as if they were fact without even bothering to provide the least bit of evidence to back up the assertions.

For example –

“However, many of the children assessed as autistic by the schools do not meet the DSM-IV criteria for autism”


“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.”

None of these statement has has any backing.

Exactly how many children don’t meet the DSM-IV criteria for autism and where the link to the source that actually sampled the population and determined that?

Where is the data on relative pollution levels across the various states? This data is partially available from the EPA (and a few other federal sources).

Where is the link to vaccination levels for the relevant time periods? The CDC has this data.

Where is the socioeconomic data that shows a breakdown between the states? Again, this data is available.

If you want up-to-date information you might want to try the States’ web sites. Some states (for example Wisconsin) provide comprehensive information about their special education services.

July 13, 2011 at 12:13 pm
(4) Sandy-2000 says:

Well, any time you look at a school, it’ll tell you the percentage of ethnic groups, as well as special ed general ed and all sorts of info. You never see anything about 504′s. When you look at individual school records, you only see the percentage of each IEP classification of the IDEA disabilities.
You can find these records on line of any school district. I just looked up NJ for state-wide. Autism was not the highest, either for the recent year I looked up.
Any study that states they used public educational records, that’s what they’re looking at.

July 13, 2011 at 12:56 pm
(5) jodifla says:

Michigan is a state where the school personnel can label your child with “educational autism.” In theory, the criteria in the Michigan schools follows closely along the DSM-IV; however, in practice, the guidelines aren’t strictly followed…or even that well understood by the school psychologists. When I was arguing with the school psychologist about my son’s issues, I asked her to articulate the guidelines and severity levels in the Michigan rules….and she could not. She admitted she hadn’t looked at them in quite a while.

Four other assessments, by four separate teams, including one at a Children’s Diagnostic and Treatment Center run by a hospital and another by a University center, said definitely no autism, but language delays.

The school psychologist, who observed but never worked with my son, thought she knew better. She was overruled by her own boss.

July 13, 2011 at 12:57 pm
(6) autism says:

MJ – One reason I posted this was to ask “the world” whether there are any better, more up to date sites describing state and/or federal laws and practices relative to “educational diagnoses.” This is an area about which I know very little, and you’re right: an “autismwatch” site is hardly expert testimony.

Sandy – I do appreciate that you’ve looked at individual districts, and made what certainly sound like plausible conclusions. I’d just love to see a more official statement on state or federal policy on this issue – please let me know if any pop up for you!


July 13, 2011 at 1:14 pm
(7) jodifla says:

It’s interesting and quite scary that this info isn’t easily available. You have to go state by state, it seems:

Here’s an article from Delaware Today:


The Autism Debate

by Christine Facciolo

Dr. Anne Meduri, a developmental pediatrician at Alfred I. duPont Hospital for Children, says the growing increase in cases of autism has been caused by “a combination of things.” Every day more than 900 Delaware schoolchildren head off to classrooms where they learn the social, verbal and behavioral skills that the rest of us take for granted.

They have autism …,

Is there an epidemic of autism, or has the explosion of cases resulted from new definitions, greater awareness and more services?

“I think it’s a little unclear what’s happening,” says Dr. Anne Meduri, a developmental pediatrician at the Alfred I. duPont Hospital for Children in Wilmington. “It’s probably a combination of things.”

as Meduri notes, the criteria for an educational diagnosis of autism are less specific than for a medical one.

“I’ve seen children for a medical evaluation that I didn’t feel necessarily met the criteria, but they were able to give them an educational diagnosis of autism,” she says.

July 13, 2011 at 1:57 pm
(8) Sandy-2000 says:

Lisa~ I believe the CDC studies used special ed- public education records. I know the 2002 study did. Studies actually state where they obtained their info. 504′s are not part of special ed, they’re part of Americans With Disabilities Act.

July 13, 2011 at 1:19 pm
(9) jodifla says:

Wisconsin is another state with an educational autism label much broader than the DSM.


July 13, 2011 at 2:50 pm
(10) justamom says:

Lisa Jo:

I live in MN. I have been keeping track of the IDEA data for MN since 2003. I have read, cover to cover the studies done on the prevalence rates here.

Laidler’s paper / website you quote is without references or merit. Yes, Minnesota has an educational diagnosis of autism. Several other states do too. The reasoning is two fold.

(1) In the late 1990’s and early 2000’s, there were only 3 places in the Twin Cities to go for an autism diagnosis. Wait times could be 18 months to 2 years to get a diagnosis. The legislature concurred with parents that children should not need to wait to receive services.

(2) The school districts would rather catch those at risk earlier rather than later and get them appropriate services, when the impact on the child can be greater. When an assessment is done, it is done with care and thoughtfulness and consensus of a team from the school, not haphazardly.

Have there been errors? I am sure there have been, some that have received an Autism Educational Diagnosis who did not receive the same from a doctor and some that slipped through the cracks. However, to think that schools would OVER diagnose (as one of the TV stations up here implied that the schools were chasing additional special education funds) is ludicrous. The districts would never “win” because it costs more to educate these children than what is given to them as a subsidy.

July 13, 2011 at 3:36 pm
(11) Sandy-2000 says:

For starters, and educatioanl ‘diagnosis’ serves a different purpose than a medical diagnosis and many schools have been doing this since the 1990′s I suppose for various reasons. Mainly because they just can. A child can have a medical diagnosis but still never qualify for an educational one. I highly doubt it had anything to do with fewer places to go for a diagnosis and in my experience, the special ed team about blocked the door from me getting a medical diagnosis. They tried to convince me why their label was enough. Why? for fear it would come back not being autism. And yes, I can see from my own experience MN schools are chasing funds. Early Intervention requires no diagnosis, and that’s where the bulk of the rates are in MN, more so in one ethnic group than any other. Those funds also come from a different source than elementary aged children. I’m sure there was also no shortage of child psychologists and psychiatrists, Fraser has been around for 70 some odd years alone. The thing is, no one was diagnosing it as autism. It also doesn’t then explain why MN schools are still doing this.
“When an assessment is done, it is done with care and thoughtfulness and consensus of a team from the school, not haphazardly.” I have yet to meet a parent who would agree with this, of a child in grade school. If the parent has a private assessment done and many do, they clearly see the difference.

July 13, 2011 at 3:50 pm
(12) justamom says:


Please name more than 3 centers that had the ability to give a formal diagnosis in children in 1998 in the Twin Cities. Fraser did NOT have doctors on staff at that point.

July 13, 2011 at 6:21 pm
(13) Lisha says:


Thank you for your post. I am from MN as well, and my son was given an Early Childhood Education Exam from our school district and they determind that he: “qualified for services under the Autistic qualifications”. My school district did extensive in-home and school visits. Our team included many teachers, and specialists. So, I totally validate your statements regarding educational diagnosis in MN. On another note, my sons team have been very clear that they can not make a “diagnosis of autism” and that only a MD can, they are qualifying him only for services under the ASD criteria. My son has since been diagnosed as having ASD through an MD.

As a parent in MN I just wanted to comment that I do not feel the Early Childhood Education teams rush to label a child Autistic and in my case did extensive testing before they gave him an educational diagnosis.


July 13, 2011 at 2:51 pm
(14) justamom says:

The old CDC number of 1 in 150 is from a study conducted in 2002, is based on eight year olds born in 1992 to 1994. In 2002, Minnesota’s 8 year olds (born in 1994) had a rate of 1 in 151 based on IDEA numbers.

By 2008, however, the 1994 birth cohort prevalence rate based on IDEA data rose to 1 in 80.8. In 2010, this 1994 birth cohort prevalence rate based on IDEA data remained fairly stable at 1 in 80.3.

Younger birth cohorts, however, have an even higher rate. Currently (2010 IDEA data), those born in 2002 have a 1 in 58.2 chance of having an educational diagnosis of autism, or 1 in 36.3 boys.

For reference, please see the following:

A. Shattuck, PT; The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education; Pediatrics April 2006; 117:1028-1037.

Shattuck found that some states had a diagnostic substitution problem, relabeling what used to be called Mental Retardation (MR) or the current educational label Developmental Cognitive Delay (both Mild to Moderate and Severe to Profound) as Autism. His paper notes that this is NOT the case in Minnesota.

July 13, 2011 at 2:52 pm
(15) justamom says:

B. Gurney JG, Fritz MS, Ness KK, Sievers P, Newschaffer, CJ, Shapiro EG, Analysis of Prevalence Trends of Autism Spectrum Disorder in Minnesota; Arch Pediatr Adolesc Med July 2003; 157:622-627.

The conclusion of the study was that federal and state administrative changes led to better identification (better diagnosis) and Autism Spectrum Disorders were under diagnosed in the past (greater awareness). The comment section of this report states that this data source “cannot be used to answer the important question of why ASD prevalence is rising.” The body of the report (as in many studies) however, mentions that either ASD could be on the rise or the rise could be attributable to better diagnosis and greater awareness. The report mentions several possible theories (“speculations” was the word used in the report) for the rise in prevalence including “the changing exposure profile of one or more environmental factors is causing interactive effects among a small pool of genetically susceptible children, resulting in higher ASD incidence rates,”

Please note this paper was written in 2003 and it mentions environmental factors. For those of you that go to the paper and see that it dismisses vaccination as a possible environmental factor, should note the following:

“…well publicized fears that the measles, mumps, and rubella vaccine is causally related to ASD onset, despite a preponderance of evidence against such a relation, have contributed to an erosion of confidence about the safety of immunizations among some parents in the United States and Great Britain and led to a corresponding drop in immunization coverage among children in both countries.”

July 13, 2011 at 2:53 pm
(16) justamom says:

You may note this article was written in 2003, prior to the 2004 IOM report. It was sponsored in part, by the Minnesota Department of Health. In a March 30, 2007 letter from Dianne Mandernach (former Commissioner of the Minnesota Department of Health) to Representative Shelley Madore, Ms. Mandernach presented this report in response to a meeting held on mercury free vaccination legislation stating, “We are pleased to support research looking at the incidence of autism in Minnesota.” Ms. Mandernach disclosed that the MDH funded the study, in part [$20,000] using federal immunization funds. There was only one sentence in the entire report on immunizations – the quote above. Any possible correlation was dismissed.

C. Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ; The Incidence of Autism in Olmsted County, Minnesota, 1976-1997 Arch Pediatr Adolesc Med Jan 2005; 37-44.

In 2005, Barbaresi et al, published The Incidence of Autism in Olmsted County, Minnesota, 1976-1997. The authors performed a population based incidence study from 1976 to 1997 by re-examining medical and school records of children living in Olmsted County Minnesota. The study re-diagnosed children based on these records and DSM-IV criteria to develop incidence rates of “research identified autism.” The incidence rate for autism from 1980 to 1983 was 5.5 per 10,000 (note: the study actually states per 100,000 but I have to believe that this is a typo, because most prevalence and incidence studies used per 10,000) or 1 in 1,818 children. The study found an incidence rate for children from 1995-1997 of 44.9 per 10,000 or 1 in 222.7. The authors note that “the increase was confined to children younger than age 10 born after 1987.” Any requirement that the age of onset of autism begin prior to age 3 was removed.

July 13, 2011 at 2:55 pm
(17) justamom says:

The study was able to conclude that diagnostic substitution (Shattuck’s theory) was not the case in Olmsted County. Again as in the 2003 study, the authors offer two explanations of the increase in the body of the report, either

(1) the increase is a true increase in the number of children affected, or

(2) the increase is due to “increased awareness” generated by better diagnostic criteria (DSM-III) and “the availability of educational and other services” that led parents to bring their child’s problems to the attention of health care professionals and schools.

Please note, the study is totally devoid of any proof of that “increased awareness” is indeed the cause of the increase other than a temporal association between the increase in diagnosis and the 1987 DSM-III and the 2001 mandate that IDEA recognize autism spectrum disorders.

Most parents of children with autism in the 1990’s would state that the availability of services was not what caused them to bring their child’s problems to the attention of schools and health care professionals. In fact, there was a shortage of services present in the Twin Cities in the 1990’s, with waiting lists for a diagnosis of 18 to 24 months and speech and other services of up to one year. The inability of parents to get in to see health care professionals led to the state allowing the school districts to diagnose autism for special education purposes under specific criteria in order to receive services.

Again, as in the 2003 study, “environmental factors, including immunizations” are mentioned and then discounted. The study discounts the MMR theory of causation because the vaccination has been required for school entry in Minnesota (measles 1967, rubella 1973, and mumps 1978 and the triple vaccine has been available since 1971) and it does not correspond with the timing of the increase the researchers observed.

July 13, 2011 at 2:56 pm
(18) justamom says:

The Thimerosal theory is discounted by the Danish study by Madsen Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data published in Pediatrics in 2003. Although vaccination records were available to the researchers in the Olmsted County Study, this was not reviewed in the study. There was no study of the changing of timing of receipt of the vaccinations from prior to the entry of school (age 5) to prior to entering daycare (all immunizations before eighteen months).

While the authors state, “We cannot exclude the possibility that environmental factors caused this increase, additional studies are needed to address this possibility,” they conclude the increase is due to “improved awareness, changes in the diagnostic criteria and availability of services leading to identification of previously unrecognized young children with autism.”

In other words, the doctors missed them. But a recent article from Dr. Patrick Massey, columnist for the Daily Herald states, “Physicians 40 years ago were as good at diagnosis as we are today – maybe even better. They would not have missed 90 percent of autistic children.”

An Absurd Conclusion

Think about it:

If the Olmsted County study conclusion is real – that it is increased awareness because of the changes in 1987 and 1991, when might the increased awareness lead to a leveling off of newly ascertained cases? Are doctors and school officials still learning how to diagnose autism after 20 years?

The Epidemic is REAL.

July 13, 2011 at 3:48 pm
(19) autism says:

Wow – great info, great insights!

I’m sorry that that AutismWatch article, while it did include info about “educational diagnosis,” also referenced the question of whether or not there is an epidemic. It clearly isn’t a terrific authority on either issue, though it is interesting to see the number relative to “educational” v “medical” diagnosis.

I didn’t realize how many of you are well-versed on this topic; I had heard about it mostly through Sandy because she’s in MN. Living as I have in PA and MA, we just don’t hear about it at all.


July 13, 2011 at 5:54 pm
(20) C. S. Wyatt says:


The Office of Special Ed Programs (OSEP) has all data from the early 1990s onward, including a breakdown of diagnostic source. Yes, MN has “more autism” in schools than medically diagnosed. It is a huge difference.

I used the OSEP tables and charts in my dissertation to illustrate the problem universities have: “autistic” students ineligible for services under the ADA/504 standards. Having experienced years (decades?) of supports, these students start asking for things we simply do not provide without a formal 299.00/.80 diagnosis on file at the disability services office.

Yes, there are individuals also suddenly eligible for some accommodations, though that has been rare in my experiences.

I am leaving MN this week to work at a university in PA. I will be working, at least part of the time, with those students receiving supports for ASDs and ADD/ADHD. Having come from Calif., I’m learning how wildly states differ in diagnostics and classifications at the K12 level — and the effects on university expectations expressed by parents and students.

July 13, 2011 at 11:59 pm
(21) justamom says:

Just curious:

Would the OSEP necessarily record or even know if a child had an education Dx and subsequently got diagnosed by a medical professional? Unless the parents signed waivers for the sharing of information between the school and the doctor, how would the school or OSEP even know?

Please see other parent post above.

July 13, 2011 at 9:23 pm
(22) jodifla says:

re: Diagnostic Substitution in Schools:


By Paul Shattuck

Results…Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern.

July 13, 2011 at 10:16 pm
(23) justamom says:

Also from this article:

“Examination of Minnesota special education data from 1991 to 2001 revealed an increase in autism prevalence but no corresponding declines in prevalence among other special
education disability categories. A similar analysis of nationwide special education cohort data from 1992 to
2001 likewise found no decreases in prevalence for the
mental retardation or speech/language impairment categories”


“Although special education trends cannot substantiate
or refute the presence of an actual epidemic of autism,
they do represent very real challenges for schools.”

July 14, 2011 at 12:21 am
(24) C. S. Wyatt says:

I provided a graph of the data to Lisa directly. I cannot post the tables here, but there is a clear correlation between declines in some categories and rises in others. I have the data analyzed 1991 through 2006 and am working on new data through 2010.

No idea how anyone could miss the correlations. It’s very obvious in graphed data.

July 13, 2011 at 9:27 pm
(25) jodifla says:

About how schools are skewing the autims rate:


Special Education Data Provide Misleading Trends Of Changing Autism Prevalence — AutismMedNews

Paul Shattuck, a researcher at the University of Wisconsin-Madison’s Waisman Center, writing in Pediatrics, says special education data cannot be used to claim there is an autism epidemic because the figures are “hopelessly confounded” by changing and uneven identification and reporting practices among schools and states.

Schools nationwide don’t adhere to any common diagnostic guidelines when they’re sorting kids into these categories,” Shattuck explains. “States and individual schools are left to devise criteria. Everyone is using a different yardstick to measure the same thing.”

Shattuck notes that the diagnostic methods employed by schools in special education settings are distinct from medical and psychological diagnoses of autism, which entail a more precise definition of the condition and uniform diagnostic methodologies

July 13, 2011 at 10:37 pm
(26) justamom says:

This is just an interview and rehash of Shattuck’s 2006 article. Minnesota was one of 5 states where he deemed Diagnostic Substitution did NOT exist.

July 13, 2011 at 11:27 pm
(27) jodifla says:

Well, how about something newer:


California’s Specific Learning Disabilities Counter Epidemic

THe Left Brain Right Brain blog details that while autism rates have tripled in California, overall special education rates have remained CONSTANT. THe difference is that fewer kids get a label of Specific Learning Impairment….so THAT”s the diagnostic substitution in California, instead of mental retardation.

It is not hard to imagine all the states have something similar going on that explains their higher rates.

July 13, 2011 at 9:46 pm
(28) Malia says:

All this arguing… just to cut the rates.

July 13, 2011 at 9:51 pm
(29) Sandy-2000 says:

That comment was totally uncalled for.

July 14, 2011 at 7:38 am
(30) Malia says:

It’s a valid comment. The center of all these discussions lately have been focused on the validity (or invalidity) of the autism epidemic. You yourself have made several comments on the topic. This one is just short and sweet.

On one hand, we have the assertions being given to parents that all needed services for their children will be provided, even if their child is diagnosed on the spectrum (for example, when PDD-NOS and Aspergers are removed from the DSM). On the other hand, the same people are saying that diagnoses are being made just for the sake of getting access to services within the education system (which is the thrust of the comments on this thread). The vaccine threads argue over “the numbers” in two ways that suggests that (a) a number of people were diagnosed with other disorders in the past (therefore, the old numbers should be higher and (b) that too many diagnoses are being made today of people who don’t “really have autism.” The effect of this is to try to equalize the numbers between past and present so vaccines or environmental factors aren’t blamed for any “increase” because, in the opinion of those defending vaccines, there can be no increase.

We go round and round and round this same barn discussion after discussion after discussion. The reality is that autism is being diagnosed more frequently today than in the past. You may ascribe whatever combination of “reasons” for it you want, but that IS the truth. The other truth is that we all want the “numbers” to come down. Manipulating the “definition” is one way to accomplish this, pushing HF ones “off the spectrum” into “other disorders” is another way. Declaring “cures” is another.

… So, declaring that all this arguing is occurring just to cut the rates IS a perfectly valid comment.

July 13, 2011 at 9:48 pm
(31) autism says:

Thanks Jodifla and everyone else for the links and info. Much appreciated!


July 14, 2011 at 11:10 am
(32) autism says:

Looks like this series of comments is starting to go downhill, so I am going to end it now. Many thanks to everyone who shared links and information!


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