What is the Difference Between a Medical Diagnosis of Autism and an Educational Diagnosis?


Understanding the distinction between an educational diagnosis and a medical diagnosis is really important for families who have children with autism. A medical diagnosis will allow a child to gain access to medical services such as ABA and will be paid for by Centennial Care or private insurance in the state of NM.  In contrast, an educational diagnosis of autism will allow a child with a child to access special education services in his/her school setting.

There are two criteria that have to be met for a child with autism to receive an educational diagnosis of autism and receive special education services.

  1. He/she has to have a diagnosis of autism to qualify for the exceptionality of autism under IDEA.
  2. The IEP team has to agree that the child needs specialized instruction (special education services) to access her/his educational environment.

Often, how an educational diagnosis is determined in NM's schools is incorrect and is being used to deny children with autism special education services.  In addition, parents are often confused when their children have a medical diagnosis of autism but then are told (by their schools) that their children do not have an educational diagnosis of autism and the difference between the two isn't explained.

The question parents often ask me is, "How can my child have autism everywhere else, but not in school?" This a really good question and the answer is, children do not have autism everywhere else, but not in school. It is just that to receive an educational diagnosis, the child has to have challenges in school that qualify her/him for special education services. A helpful visual can be found at https://www.webpsychology.com/difference-between-education-identification-and-medication-diagnosis-autism-spectrum-disorder. However, it should be noted, there are two places in the link provided that do not apply to NM.

  1.  New Mexico Centennial Care and private insurance must cover evaluations for a medical diagnosis of autism
  2.  IDEA mandates that private evaluations be accepted and considered in the IEP process.

A school evaluation for autism does not trump a medical diagnosis. Both evaluations must be considered by the IEP team (which must include the parents) to determine if the child falls under the exceptionality of autism according to IDEA. If the answer is yes, the child has the exceptionality of autism, then the team must decide if the autism exceptionality is affecting the child's ability to fully access her/his educational environment to the extent that specialized instruction is needed. If the answer is yes, the child required specialized instruction, then the child qualifies for special education services and, therefore, meets the school's definition of an educational diagnosis of autism.