WHAT’S THE DIFFERENCE BETWEEN EDUCATIONAL ELIGIBILITY AND A MEDICAL DIAGNOSIS

By Lani M. Jones, PsyD, HSPP

As a new school year is upon us, parents are often scrambling to ensure that appropriate school accommodations and IEPs are in place and ready to go in order to ensure their student’s academic success. However, there’s often a flurry of confusion and frustration regarding “diagnoses” made on an IEP and how those determinations differ from medical diagnoses made by professionals outside of the school setting. Navigating through all of the terminology and acronyms, understanding laws, and figuring out how to ask the right questions to get the needed answers can quickly become overwhelming.

Families are often surprised to learn that even though their student has an IEP, that educational documentation does not automatically translate to a medical diagnosis or access to services in medical and community settings. If a student is receiving adequate supports from the school, parents may wonder if a medical diagnosis is even necessary. In addition, a medical diagnosis does not automatically mean that a student will qualify for school accommodations and services. If needed, both a medical and a school evaluation can be pursued simultaneously.

What’s the difference between educational eligibility and a medical diagnosis? Educational eligibility is determined by the Individuals with Disabilities Education Act (IDEA) and is typically only recognized within the school system. The educational system has established criteria for determining if a student is eligible to receive school-based accommodations and/or therapies through an IEP or 504 plan. There are 13 different IDEA eligibility categories to consider in order to determine eligibility for an IEP. A 504 plan, in contrast, is broader and has less stringent requirements than an IEP. The school evaluation determines if the disability or area of difficulty is negatively impacting academic performance in the general education curriculum.

Based on the student’s presenting needs, the school evaluation is often completed by a school psychologist, speech-language pathologist, occupational or physical therapists, and other therapy providers and includes input from teachers, parents, school personnel, and any other significant people in the student’s life. The school may review a medical diagnosis or outside evaluation for additional input in order to better understand the student’s needs.

A Case Conference will be held with the parents, teachers, and professionals to determine what the needs of the student are and to discuss the results of the evaluation. Parents are encouraged to be active participants in these meetings, as they are often the student’s best advocates. The team will also consider what impact the area of difficulty has on the student’s academic performance. Based on those results, the school will determine if the student is eligible for services and what those services will look like (e.g., classroom accommodations, alternative classroom environment, ongoing therapies).

Educational eligibility and a medical diagnosis don’t always align. For example, a student with a medical diagnosis of attention-deficit/ hyperactivity disorder (ADHD) may meet educational eligibility under the category of Other Health Impaired (OHI). Another example is that a student with a medical diagnosis of generalized anxiety disorder may meet educational eligibility under the category of Emotional Disability (ED). A medical diagnosis does not necessarily guarantee a student will meet educational criteria for additional accommodations.

What does a psychology evaluation look like? In Indiana, an evaluation is typically completed by a doctoral-level psychologist. An evaluation is often completed across three office visits: intake, testing, and feedback. The evaluator will meet with the individual and caregivers to complete an initial diagnostic interview to gather history and further information about the presenting concerns. The evaluator will determine if an evaluation, including testing, is needed in order to rule out or differentiate any possible diagnoses. At the testing appointment, the evaluator will administer any needed psychological tests in order to gain a better understanding of the individual’s strengths and weaknesses. The assessments may include paper-and-pencil tasks, play-based activities, and/or parent- or selfreports assessing multiple areas of development, such as cognitive, adaptive, emotional, and/or social communication skills. Possible diagnoses may include autism spectrum disorder, intellectual disability, learning disorders, ADHD, or mood disorders. At the feedback session, the evaluator will discuss all of the testing results, diagnoses, recommendations, and next steps; answer any questions from the family; and will provide a copy of the evaluation report.

How might an outside evaluation benefit my child? Even if your child is being fully supported by an IEP, accommodations, and therapy supports within the educational setting, a medical diagnosis from a qualified healthcare professional (e.g., psychologist, physician, or psychiatrist) outside of the school setting can provide access to a variety of additional services in the medical and community environments, such as additional therapies or ongoing financial supports.

Graduating from or aging out of the school system is often a natural time for an outside evaluation. When an individual transitions to life after high school, be it in a supported living environment, vocational training, or postsecondary institution, further documentation to provide access to resources may be needed. An evaluation can aid in documenting any ongoing disabilities and may provide more information about current needs in a new environment. In addition, most colleges and universities will not recognize any results from an IEP and will require a medical diagnosis and documentation in order to provide accommodations.

If you’re wondering if a psychological evaluation may be right for your child, discuss your concerns with their primary care physician. Then, if needed, the physician can make the appropriate referral to a provider(s) to best meet your child’s needs.

Dr. Lani Jones is a licensed clinical psychologist and First Steps provider. She has extensive expertise in completing psychological evaluations related to neurodevelopmental disabilities. She also provides ongoing treatment and therapy to children, adolescents, and adults.

More information can be found at providencebehavioralgroup.com.