Diagnosis and Eligibility

Insurance
  ● TriCare UPDATE
  ● Retired TriCare -ABA
  ● Insurance Policy PDF
● Is ABA Experimental?
● Resources in seeking
     Insurance support for
     ABA services

Open Ga Autism List

Public Service

Referral Information

Staff Hiring

Support Groups
Open Ga Autism List

Testimonials

Articles
As a Parent - ABA
Aspergers & Depression
ABA, Retirees, and TriCare
Briefing the Teacher
Does RU Certify
Therapists?
BCBA-D What is it?
BCABA - Independent?
How to answer when
insurance says ABA
is experimental.
EIBI and Cost
"Certified" Therapist?
"The Autism Puzzle"
What is BCBA anyway?
What is the ABLLS-R?
ASD Evaluations
SLP & ABA
Sign vs. PECS
Diagnosis-Eligibility
Release Records
NAS on Autism
Sleep Tips
Hire an ABA?
ADHD or Sleep?
Aggression
Communication
FBA
NASP & FBAs
Rx data sharing
More than Rx needed
Social Maladjustment
A good Psych Report?

Links
Aspergers
Autism
Support Groups
Behavioral
Consumer Resources
Education
Learning Disorders
Medical
Psychology
Specific Disorders

Diagnosis vs. Eligibility:
What is the difference?

This article was recently published in the
Autism Interest Group of ABA's Newsletter

The issue of Diagnosis vs. Eligibility comes up from time to time. It is very frustrating for parents because, in my experience, neither the schools nor the physicians do a particularly good job of explaining either and none do a good job of explaining both. I must say that as a clinical psychologist starting out years ago consulting on school issues the question of Eligibility and all the issues relating to it was very confusing for me. After having participated in hundreds of IEPs over the past 10+ years and having done many ASD evaluations I can say that most often confusion on this issue arises from miscommunication.

To diagnose ASDs in Georgia one needs to be either a Licensed Psychologist or a Physician. Since nearly none of the school systems in Georgia employ either it is nearly impossible for them to have diagnosed a child with an ASD (or to offer an alternative diagnosis). What schools do is determine Eligibility via the IEP Committee process. Just as the schools can not diagnose legally - physicians and psychologists can not "order" or dictate eligibility to the schools. The two are distinct and have completely different meanings and purposes. A child can hold a legitimate diagnosis of Autism and not have the Autism Eligibility. Usually the alternative is SDD. While I know many have expressed concern with that eligibility it remains a legitimate Federally defined eligibility category that quite often a child with a diagnosis of Autism qualifies under according to the regulations. The debate over the use of SDD as an option is a political issue that is outside the scope of this article. The functional question is whether or not the child is receiving appropriate services to meet all their identified needs.

The schools charge is to determine a child's needs and place them into an eligibility based on the identification of needs and services appropriate to meet those needs. Remember, a diagnosis is a label that covers thousands of people none of whom is the same as your child. A diagnosis of Autism (or any ASD) alone is never sufficient to determine what combination of services a specific child actually needs. This means that often when given a diagnosis by a pediatrician or other physician they have insufficient information in the report (often just a letter) to meet the school's obligation to identify all the child's needs. The schools answer when confronted by insufficient information is often to provide an evaluation by their staff. One issue that arises when this offer is made is that many school staff do a poor job of telling the parent that this does NOT mean they are 'rejecting' the diagnosis offered - which leads to misunderstandings and mistrust. It can mean that they need a great deal more specific information to provide appropriate services on an ongoing basis than they were provided with by the physician. It has been my experience that psychologists can also provide reports with insufficient information but this seems to have occurred less often in my experience - principally because we conduct testing and usually offer more than our diagnosis based on an interview with parents and a single limited observation. The bottom line is that very specific and clear information on the nature of the child's needs, skills, deficits, and strengths is absolutely essential to developing the best IEP possible. By doing so the chances that the child will benefit from the services offered by the school increase dramatically.

If the school conducts their evaluation(s) and makes recommendations this is the point at which clear and penetrating assessment of the nature of the reports is essential. If the parent reviews the reports (which must be provided to them AND the person that wrote the report and conducted the evaluation must offer to explain the contents) and finds it does not adequately reflect the issues that they see in their child they have the absolute right to contest the information and request an Independent Educational Evaluation (IEE). This means that you and the schools must agree on an independent professional who has the appropriate training and the legal right to independently conduct the evaluation that you are asking for on your child. The essential idea is that the person doing the IEE is paid for by the schools (like how your insurance company pays your physicians) but that they are working for your child (not for the parents). Again, the idea here is to provide clear and comprehensive information on the needs of the child so that the adults can agree on what the child needs and how to proceed with providing the indicated services.

I hope that this helps. I hope that this note may help some who are as confused about the differences (very real ones) between diagnoses and eligibility as I was years ago. If I can answer any questions on this topic please contact me.

Robert W. Montgomery, Ph.D.
Director, Autism Spectrum Assessment Program
Licensed Psychologist & Board Certified Behavior Analyst
P. O. Box 1572
335 Parkway 575 - Suite 220
Woodstock, GA 30188
http://www.behavior-consultant.com
(770) 591-9552 - (800) 218-8249 Fax

Our publications (online, email, or print) do not provide medical advice or a professional service. We are not engaged in providing any medical or professional advice or services through the publication or distribution of articles or comments on this site. Individuals with suspected or diagnosed disorders or syndromes, or any condition discussed on this site, should consult with a qualified professional for advice concerning treatment. Please be advised that due to issus of confidentiality Reinforcement Unlimited, and its staff, will not correspond about specific children or their services via email or other electronic communication method. If your inquiry is about a specific child's services please call the office at one of the numbers above.