December 30, 2022

ASD Clinical Diagnosis vs. ASD Educational Classification: Understanding ASD Educational Classification vs. Clinical Diagnosis

By: Nicole Mathes, Ph.D, Rachel Piper, LMSW, & Dr. Suzi Naguib, Psy.D

Many times parents wonder how their child—who has a clinical diagnosis of Autism Spectrum Disorder (ASD) made by a psychologist, psychiatrist or another mental health professional—does not qualify for an ASD educational classification at school. In order to ensure that your child is receiving the appropriate supports and services, it is important to understand how a child can qualify for educational services through the school system.

In the Michigan school system, children can receive special education services under 13 different special education categories, or classifications. Autism Spectrum Disorder (ASD) is one of those 13 categories. In order to receive a diagnosis of ASD, individuals must meet the diagnostic criteria for ASD as stated in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). To receive an educational classification of ASD, however, students must meet a different set of criteria according to the Michigan Administrative Rules for Special Education (MARSE). The table below describes the differences between an ASD diagnosis according to the DSM-5 and an ASD educational classification according to the MARSE criteria.

ASD Clinical Diagnosis

Based on the DSM-5

ASD Educational Classification

Based on MARSE

Persistent deficits in social communication and social interaction across multiple contexts such as:

Deficits in social-emotional reciprocity;
Deficits in nonverbal communicative behaviors such as eye contact, body language, use of gestures, facial expressions
Deficits in developing, maintaining, and understanding relationships

The ASD must adversely impact a student’s educational performance in 1 or more of the following areas:

Academic
Behavioral
Social

Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:

Stereotyped or repetitive motor movements, use of objects or speech (e.g., lining up toys, need to take the same route)
Insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior
Highly restricted, fixated interests that are abnormal in intensity or focus
Hyper- or hypo-reactivty to sensory input or unusual interest in sensory aspects of the environment

Qualitative impairments in reciprocal social interactions in at least 2 of the following areas:

Marked impairment in the use of multiple nonverbal behaviors (e.g., eye contact, facial expression, body postures, and gestures to regulate social interaction)
Failure to develop peer relationships
Marked impairment in spontaneous seeking to share enjoyment, interests, or achievements with other people
Marked impairment in the areas of social or emotional reciprocity

Symptoms must be present in the early developmental period

Qualitative impairments in communication in at least 1 of the following:

Delay or lack of spoken language
Impairment in pragmatics or the ability to initiate, sustain, or engage in reciprocal conversations
Stereotyped or repetitive use of language or idiosyncratic language
Lack of varied and spontaneous make believe play or social imitative play

Symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning

Restricted, repetitive, and stereotyped behaviors including at least 1 of the following:

Encompassing preoccupation with 1 or more stereotyped and restricted patterns of interest that is abnormal in its intensity or focus
Inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping, twisting, whole body movements)
Persistent preoccupations with parts of objects

These disturbances are not better explained by Intellectual Disability or Global Developmental Delay

No diagnosis of schizophrenia or emotional impairment

Determination of impairment is made by a multidisciplinary school team consisting of a school psychologist or psychiatrist, speech and language therapist, and school social worker

Unfortunately, while a child may show certain behaviors at home, they may not always exhibit those behaviors at school. Additionally, under MARSE, the symptoms a child demonstrates must be negatively affecting the child’s educational performance. This means that if the student is performing at grade level, they will not likely qualify for an ASD classification—or any other special education classification, regardless of having a clinical diagnosis (commonly referred to by the school as an “outside diagnosis”) of ASD.

So can a child who has a diagnosis of ASD still get services and support in school? Yes, absolutely!

Scenario 1: For example, a student with a clinical diagnosis of ASD may show poor educational performance, but may not meet MARSE criteria for ASD because they do not demonstrate restricted, repetitive, or stereotyped behaviors at school. A school team might then determine that the student can receive necessary services under a different special education classification, such as Other Health Impaired (OHI). It should be noted that an educational classification does not determine what supports and services the child receives. For example, if this child requires weekly social work support to work on coping skills or friendship skills, they can receive them regardless of an OHI or ASD classification. If the child needs speech and language services, they can also receive them, regardless of a special education classification. The supports and services that a child receives with a special education classification will be outlined in an Individualized Education Program (IEP).

Scenario 2: On the other hand, if the child does not demonstrate poor educational performance, but would still benefit from supports, such as a weekly small group to work on friendship skills, or accommodations to take frequent breaks when frustrated or upset, a parent can ask that the child receive a 504 Plan. A 504 Plan is a legal document that will outline the supports your child needs. This is an appropriate option for higher functioning individuals who may still benefit from some supports and accommodations, but do not necessarily need special education services. For more information on a 504 Plan and IEPs, please refer to our Navigating the School System blog.

It is important to note that a child should receive an appropriate educational classification and that all necessary supports and services be outlined in a child’s IEP or 504 Plan. School records are attached to a child throughout their educational experiences and an inappropriate classification for a child can have negative consequences. For example, if a child begins at a new school or transfers to a new district, an inappropriate classification and description of the child can misinform the school team about the neurodevelopmental status of the child. As in scenario 1, sometimes children do not receive an ASD classification, but another special education classification. In this case, it is important for you (as the parent) to review all documents closely to ensure that your child is receiving appropriate services to meet his/her needs.

As the parent, YOU are your child’s best advocate! Under educational law, a child should receive all necessary supports and services if they qualify for a 504 Plan or special education services. So ask questions and advocate for all the supports and services you think your child should receive.

Below are some resources that may be helpful in navigating the school system and understanding educational law:

Michigan Rules for Special Education: https://www.michigan.gov/documents/mde/MARSE_Supplemented_with_IDEA_Regs_379598_7.pdf

Wright’s Law: http://www.wrightslaw.com/

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