What is autism and what are the characteristics associated with it?

Page 3: Diagnosis and Eligibility

The characteristics of autism—differences in social communication and social interaction and restricted or repetitive patterns of behavior, interests, or activities—are the basis for diagnosis and eligibility. An individual might:

• Receive a medical diagnosis of autism spectrum disorder (ASD)
• Be found eligible for early intervention or special education services under the category of autism

These two types of identification are based on different criteria and provide access to different services and supports—either medical or educational. For this reason, children and students might benefit from both a medical diagnosis and special education eligibility. The primary differences between these two types of identification are highlighted in the table below, followed by more information on each.

Medical Diagnosis

With improved access to medical diagnostic services, it is increasingly common for children and students to receive a diagnosis of autism from a doctor before the special education eligibility process even begins. The American Academy of Pediatrics recommends that all children be screened for autism at 18 and 24 months of age during their well-child visits. Additional screening can be completed at any age if parents or professionals have concerns or if a child has an increased likelihood of autism (e.g., has an autistic sibling or parent). Screening usually involves completing questionnaires or checklists that compare a person’s development and behavior to others of the same age.

If a screening indicates that a child might have autism, a medical provider needs to conduct a more thorough evaluation. There is no medical test, like a blood test or imaging scan, to diagnose autism. Instead, identification is based on information gathered from:

• Interviews or questionnaires completed by parents, family members, or other caregivers present in the child’s life (e.g., childcare providers, teachers)
• Behavioral observations across environments (e.g., home, community, day care)
• Systematic assessment of areas, such as:
  • Overall development
  • Communication skills
  • Social interaction skills
  • Adaptive behavior
  • Motor skills
  • Sensory processing

After this information has been gathered, the doctor can determine whether the child meets the DSM-5 criteria for a medical diagnosis of ASD.

Educational Eligibility

Although a medical diagnosis can open important doors to health and human services, it does not automatically qualify a child or student for educational support. Special education eligibility requires a disability to have an adverse impact on a student’s learning to such a degree that they require specially designed instruction. In fact, although about 3% of children have been identified as having autism, only about 1.8% of all school-age students are eligible for special education services under the category of autism. When a student’s autism does not impact their education to a degree that requires special education, they might instead qualify for accommodations and modifications, which can be provided through a 504 plan. Some autistic students might not need any adaptations at all to access their education.

To determine whether a child or student qualifies for early intervention or special education services, a multidisciplinary team of school professionals must conduct an evaluation. As soon as a parent, caregiver, or professional (e.g., childcare provider, teacher) believes that a child is demonstrating signs of autism, they can request an evaluation from the school in accordance with the Child Find provision of IDEA. Similar to a medical evaluation, this process usually involves:

• Review of relevant medical records (e.g., vision or hearing screenings)
• Review of ASD medical diagnosis, if available (but not required)
• Interviews or questionnaires completed by parents, family members, or educators
• Behavioral observations across environments (e.g., home, school)
• Systematic assessment of areas, such as: 
  • Intellectual ability
  • Academic achievement
  • Communication skills
  • Social interaction skills
  • Adaptive behavior
  • Motor skills
  • Sensory processing

After this information has been gathered, the team must determine if the child or student meets the IDEA definition of autism according to the criteria established by their state.

In this interview, Kara Hume discusses how the information gained from a medical diagnosis and the special education eligibility process can provide educators with a more comprehensive picture of their autistic students.

Later Identification

Although a growing number of autistic children are diagnosed in early childhood, many are not identified until they are enrolled in school. The reasons for later identification are complex and varied but often relate to the increase in social demands as children grow older. For example, toddlers and young children with average intellectual ability and language skills might not appear noticeably different from their peers early on. However, autistic traits can become more apparent as they grow older and must navigate more dynamic social situations (e.g., academic group work, unstructured socializing, peer conflict). In other cases, the characteristics of autism might be initially overlooked in children who have co-occurring disabilities such as ADHD, anxiety, or depression. There is also evidence to suggest that later diagnoses are more common among children who are female, from racial and ethnic minority groups, of low socioeconomic status, or from families not fluent in English.

In this video, Evelyn’s mom, Elizabeth, discusses Evelyn’s diagnosis. Then Evelyn and her mom explain how autism, anxiety, and ADHD impact her (time: 2:44).