Why a Diagnosis Doesn't Always Result in Special Education Eligibility

Many parents are understandably surprised if their child has been diagnosed by a private practice psychologist or medical doctor with a condition such as dyslexia or autism but does not qualify for special education services when assessed by the school district. This is because there are different criteria for a clinical or medical diagnosis than for special education eligibility.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) is what private practice psychologists and medical doctors often use to diagnose mental health disabilities. Such disabilities include ADHD, autism, specific learning disorder, major depressive disorder, generalized anxiety disorder, and a variety of other conditions that are commonly diagnosed in children. Each disorder has its own unique pattern of symptoms that must be present in order to receive the diagnosis.

Importantly, symptoms leading to a diagnosis are viewed broadly in regard to the severity with which they impact various aspects of the patient's daily life, whereas schools are only responsible for addressing the educationally-related aspects of the student's life.

Special Education Eligibility Criteria

Special education eligibility criteria are defined in the Individuals With Disabilities Education Act (IDEA), which is federal special education law.

Unlike the DSM-5, which provides diagnostic criteria for 157 different mental health conditions, the IDEA only recognizes 13 disability categories. Like the DSM-5, each of these disability categories has its own unique pattern of symptoms that must be present in order to establish eligibility for special education and related services. However, unlike the DSM-5, these symptoms must be severe enough to aversely affect the student's educational performance. This is because the school's responsibility is solely limited to education whereas the DSM-5 identifies conditions that impact other aspects of the student's life.

As a result, the required symptoms for each disability category under the IDEA are different from the symptoms required by the DSM-5 for similar diagnoses. Therefore, some students with a diagnosis may not be eligible for special education if their symptoms do not significantly impact their educational performance. Conversely, some students who are performing or socially interacting inappropriately may qualify for special education even if they do not meet the criteria for a DSM-5 diagnosis because the required symptoms are different.

What Is The Benefit of Having a DSM-5 Diagnosis?

A DSM-5 (often referred to as a "clinical") diagnosis is not required for special education eligibility or a referral for a special education assessment but must be reviewed by the school district if shared by parents. This is additional data that the IEP team can consider when making eligibility determinations during an IEP meeting. Additionally, within the private school environment, a clinical diagnosis may assist private schools in understanding the challenges that a student is experiencing and this can help in the development of interventions.

A diagnosis may also support eligibility for a Section 504 Plan under the Rehabilitation Act of 1973, which requires evidence of a physical or mental impairment that substantially limits a major life activity (e.g., learning, paying attention). This can lead to accommodations and supports for the student.

Additionally, a diagnosis may provide access to community resources and services, depending on its nature, severity, and state regulations.

At FAPE Consulting, we specialize in conducting psychoeducational assessments that can evaluate both special education eligibility criteria for consideration by IEP teams and, if desired, make determinations regarding DSM-5 diagnoses. Contact us to schedule an assessment or to learn more about our services.

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