Is it Autism or Is It Not?

Many times parents visit a pediatrician's office and address the fact that their child doesn't speak yet. Or that they're not quite making the same leaps and bounds the other children in the family made at their age. Or that they don't seem to want to do what they're told. "He's not even looking at me when I talk to him!" "I just don't think she can hear me!"

There are so many different things that can happen during the developmental period, and all these things can overlap and look the same to the untrained eye. Unfortunately for many parents, pediatricians are not necessarily trained in how to determine whether Autism affects an individual or not. They do have the DSM criteria they can follow, BUT that still doesn't mean they know what they're doing. Many, many times, pediatricians diagnose AU without even seeing the child (they do it based on rating scales the parent filled out in 20 minutes at their office). As a result, there are many parents who take this medical diagnosis (incorrectly done!) and bring it to school, expecting that the school will automatically take it and provide support for the child.

IT DOES NOT WORK THAT WAY! (The caps are only for attention)

First, there’s EDUCATIONAL CRITERIA that has to be met. Since criteria has to be met, this means that some assessments must be done. These assessments have to address the presenting problem, so if we suspect Autism then the assessments have to be those for Autism (Similarly, if we suspect a Speech Impairment, the assessments have to address speech and not something else).

Why is there Educational Criteria that has to be met? Because the federal government says so (No Child Left Behind, etc.). Unfortunately, school districts receive federal funds so they have no choice but go by the criteria put forth in the legislation.

So we do assessments and the criteria is met, and then what?

That’s where the Second comes in. Second, there has to be a need for specialized instruction. Children can have disabilities all day long but if they’re not impacted at school, then they don’t qualify for special education. They may qualify for support through a 504 plan, but that’s about it. Again, assessments must be done to see exactly where the impact of the disability lies.

Specialized instruction, you say? What is THAT?

THAT is the way we support our students with disabilities. If our assessments show they have a disability that affects their educational performance, then we must provide them with lessons that are specifically designed to circumvent the disability’s effects in the classroom.

AND THIS IS WHERE I LOSE most everyone. Because the specialized instruction lacks. Most educators don’t even really understand that impact shows in more than just classroom grades. You can have a perfect A’s student who is severely suicidal and no one knows it because they got so good at hiding it. You can have a great athlete who wins all the competitions, is sought after by teams and girls, and yet they can’t read properly. But their grades are good because everyone passes the athletes along.

Bringing it back to the difference between a medical diagnosis of AU and an educational one:

A medical diagnosis can be done in as little as 20 minutes at a doctor’s office.

WHEREAS

An educational disability takes various assessments (and professionals involved) and 45 school days to determine, after which there’s another 30 days when we develop an education plan (of course, most schools do both at the same time because, if I assess and know I will be recommending that the student is eligible, I will also develop the initial plan to propose at the same meeting so we can all save time and resources).

A medical diagnosis is for life (unless there’s remission, etc. - which does not really apply to AU anyway).

WHEREAS

An educational disability of AU can eventually go away because that criteria I was talking about earlier might not be met at some point - we would not say the student doesn’t have AU anymore, we would just say that the criteria is no longer met (in addition, an educational label of AU only applies to K12 - colleges operate differently altogether when it comes to student disabilities).

In schools, the criteria for Autism requires deficits with:

Verbal communication

AND

Non-verbal communication

AND

Social interactions

This means that the team must see deficits in ALL THREE, not just one of them. In other words, if a student doesn't talk but they can smile and smirk and play like everyone else, it's likely not Autism.

Verbal Communication refers to how individuals use language to communicate needs and wants, to answer and ask questions, to elaborate on details or add relevant information to a conversation, to ask for help and directions, to ask for feedback, to convey emotions, etc.

Non-Verbal Communication refers to how individuals use non-verbal language to communicate needs and wants, etc. Non-Verbal Communication means: use of face (eyes, expressions), use of voice (because intonation modulates with our emotions, so we can have an individual who just hums, but hums according to their emotion so you can tell if it is a happy hum or a sad one so you can infer emotional states which is extremely useful when the individual cannot tell you much with words), use of gestures and body language (some kiddos take me by the hand to show me the juice box they want is on a shelf that's out of reach for them), and use of the environment.

Social Interactions are generally hindered by lack of communication; when my team assesses a student with poor communication skills, social interactions can be immediately difficult as you have to rely on something else to convey messages, and that may take a few minutes to figure out.

When we assess social interaction skills:

- we look at how interested the child is in those around him/her (if I ignore them, will they come take my hand and take me to the spot where the game is? Or will they continue playing the game with no clue that they are alone now)

- we look at how they reciprocate and negotiate play (Do they play creatively or functionally? Do they seem to just imitate something they’ve seen before, or are they coming up with something new?)

- we look at how they respond to our emotions (Will they go “Awww” if I tell them something sad about my dog, or ignore it completely?)

THERE IS A LOT MORE… I am beginning to think I need an article just for social interaction skills (smile)

THE POINT:

Please do not believe just any doctor, especially if they give you a diagnosis without seeing the child. THAT is probably the most unethical thing they can do, but they do it. Because they get away with it, honestly. It’s in human nature to keep doing something you get away with.

Please seek a second opinion if you have doubts. You never know what you might find. Maybe peace of mind.