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One of the most frequent topics that discuss with parents is to clarify the difference between a medical diagnosis and an educational eligibility under IDEA.  The distinction can be quite small; however, that does not mean it may not be relevant!  A medical diagnosis is based on the DSM-V, and/or the ICD-10 codes, while educational eligibility for special education is based on the Individuals with Disabilities Education Act (IDEA). Let’s try and break this down.

Medical Diagnosis

A medical diagnosis is only determined by a medical professional.  This can be a pediatrician, child psychologist, neuropsychologist, developmental pediatrician, and others.  When they make a medical diagnosis concerning developmental issues like Autism the professionals turn to the Diagnostic and Statistic Manual, Fifth Edition (DSM-V).  You can find a few places on the internet with the full DSM-V definition available.  This is great in my opinion because I do think parents should be aware of the diagnostic criteria that are used to make the medical determination of autism or any other condition. The medical diagnosis is comprised of three main criteria.

DSM-5 Autism Spectrum Disorders

Educational Eligibility

Educational eligibility is quite different.  This is related to IDEA. IDEA lists 13 eligibility categories for special education. These categories are:


Autism Emotional disturbance Multiple disabilities Specific learning disability
Visual impairment including blindness



Hearing impairment Orthopedic impairment Speech or language impairment
Deafness Intellectual disability Other health impairment Traumatic brain injury


Each of these conditions comes with a unique educational definition and many have a medical diagnosis too.  This is likely part of the issue with the confusion between medial and education eligibility. Then to further confuse things some states have further refined the definition of educational eligibility.  Know that states cannot make their refinement of the educational eligibility more strict than the federal definition due to the Supremacy Clause of the US constitution.


The educational eligibility of Autism under IDEA is as follows:

(i)Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

(ii) Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in paragraph (c)(4) of this section.

(iii) A child who manifests the characteristics of autism after age three could be identified as having autism if the criteria in paragraph (c)(1)(i) of this section are satisfied.


You can see the difference between the two definitions.  The educational eligibility has many of the same elements as the medical diagnosis; however, they are quite different!  This is one of the reasons parents get confused when they have a child with the medical diagnosis of autism and then the school says their child does not qualify for the educational eligibility of autism!


This also can hold true for other medical diagnoses like intellectual delay, orthopedic impairment, emotional disturbance, and etc. The medical diagnosis can differ from the educational eligibility.  As I stated earlier, each state can have slightly different eligibility criteria.  We have created a list of all 50 states that contain the special education eligibility of each state by clicking here. This list will help you find, and read, how your state defines educational eligibility for each category recognized in your state.


Medical versus Educational Therapy

Another difference commonly misunderstood is that between medical and educational therapy. Medical therapy looks to make a child “whole” across all areas of life while Educational therapy looks to have a child be “functional” within the educational setting.  These two outcomes are QUITE different. Medical therapy wants to try and bring your child to a point where they are “typical” to other peers at home, school, and in the community.  Educational therapy looks to make a child “functional” in the school environment so the child can operate with reasonable ability in the classroom, on school property in general, and access school services. 

The threshold to qualify for therapy is also very different!  Often the school has a higher threshold to qualify for educational therapy meaning the child has to have MORE impairment than they would often need to qualify for medical therapy. Also with medical therapy you would approach your child’s pediatrician and ask for a referral for an evaluation while in educational therapy you have to ask the IEP team and convene a meeting and get the team (at least 6 other people) to agree your child needs therapy in the educational setting.  Often medical therapy will involve your child working one-to-one with the therapist while educational therapy can sometimes be given in a group setting, be delivered by a therapy assistant, and/or given via teletherapy.  Each form of therapy has various uses.  I often advise parents to get as much therapy services from the school as possible (especially when the child is at the elementary school level as that tends to be when therapy is most effective) and then get medical therapy too, if possible.


I hope you found this post helpful in explaining why there is a difference between medical and educational diagnoses along with medical and educational therapy.  Please take the time to click on the links in the post as it contains the reference material used to write this post. As always, you are welcome to join us for more discussion on visual impairments in the educational setting at our FB group, IEP/504 Assistance for parents of public school students from all over the United States.

AESA also runs a special needs homeschool group, Homeschooling Special (Needs) Kids, and we also have a group for all parents and caregivers of special needs children called Special Needs Parenting Advice and Support where we discuss ALL things related to special needs care.  I hope to see you there!

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