Clear up the confusion: Medical vs. school assessments

It is a common scenario with our clients: Parents obtain medical assessments that diagnose their child with a condition such as ADHD, Autism Spectrum Disorder or anxiety. They share the medical assessments with their child’s school to obtain a 504 Plan or Individualized Education Plan (IEP). In some cases, the school either declines to evaluate the child or evaluates and finds the child is not eligible for services.

Bewildered, the family feels blind sided that the school didn’t provide services based on the medical diagnosis and/or doctor’s recommendation alone. Understandably, parents often feel that a doctor is more qualified to assess a child’s condition and its impact at school.

Let’s unpack why this happens and clear up some confusion about medical versus school-based assessments.

Medical vs. school-based assessments

When parents notice their children struggling, their first call is likely to a medical provider. Their pediatrician may order testing or refer them to a specialist to determine the underlying cause of a child’s challenges. This may result in a diagnosis which can help the family implement targeted therapy, parenting strategies and explore other treatment options including medication. Sometimes, families can use the diagnosis to secure additional supports in the school setting, such as an IEP or 504 Plan. However, a medical diagnosis does not guarantee school supports – a source of confusion and frustration for many families.

To clear up the confusion, it is important for families to understand the difference between a medical diagnosis and school-based assessments.

When diagnosing a child, a medical professional will evaluate the child wholistically including how the child functions in the home, school, community, and other settings. When determining whether a child needs school supports, the school team will evaluate how the child functions in the school setting only. The school team must consider information provided by parents, including medical assessments and recommendations, but they are not obligated to act based on the medical information alone.

A medical assessment is broader than a school-based assessment. The school’s assessment is narrowly focused on how that child’s disability affects them at school including academics AND social-emotional impacts.

ADHD and autism as an example

For example, students with ADHD can present in a variety of ways in the school setting. Some students function well and do not need school supports. Other students struggle with the ability to focus, stay still, refrain from talking out of turn, initiate and complete classwork, regulate their emotions and/or interact with peers? ADHD students may experience big emotional and behavioral responses to authority figures, challenging schoolwork or social situations. The student may thrive in creative classes and structured academics such as math but, struggle with reading and composition.

In another example, an autistic student may have some very clear needs in the school setting. A non-verbal autistic child will need speech and language support and may need an augmented communication device. A verbal autistic child may still struggle with social pragmatics that impact their communications with adults and peers. Either student may struggle with behaviors that stem from communication challenges. These students may need help with speech and language strategies, assistive technology, perspective taking, flexible thinking, turn taking, and reading nonverbal communication.

Some students with disabilities are high functioning and/or good at masking in the school setting. While they get good grades, they may not demonstrate their true academic potential due to their disability. They may be people pleasers that work hard to perform well at school despite the challenges of their disability. As a result of the effort required to mask their symptoms all day, they fall apart when they get home. Also, these students may struggle with internalized anxiety. This child may not qualify for a 504 Plan or IEP because they are not demonstrating a need in the school setting.

This is difficult for families to process because they understand their child wholistically. They don’t segment their child’s disability into the silos of school versus home versus other settings. They see their child come home from school in distress. They know the distress is related to the school day but, they struggle to get help at school because the student’s disability is not manifesting in the school setting. Families may feel they have to wait for their student to fail (aka fall apart at school) before they can get help.

Hickman Lowder‘s education team can help families navigate these difficult situations.

School-based assessments

When a family brings a diagnosis to the school, the school team may agree to evaluate the student for a 504 Plan or IEP.

A student qualifies for a 504 Plan if they have a physical or mental impairment that substantially limits one or more major life activity, has a record of an impairment, or is regarded has having an impairment. The 504 Plan process is less formal than the IEP process. The school team may not conduct formal assessments. They may establish a 504 Plan based on the medical assessments and feedback from teachers on how the student functions in the school setting.

When a family requests an IEP, the school team may decide to access the student for an IEP. If the team agrees to evaluate, the school will prepare an Evaluation Team Report (ETR). An ETR is a comprehensive school-based assessment that evaluates how the student is functioning in the school setting. An ETR consists of academic and psychological assessments and may include other assessments such as physical therapy, occupational therapy, and speech and language.

The team must consider information provided by the family including medical assessments and diagnosis. They must consider but are not required to follow medical recommendations. The school psychologist will likely ask parents and teacher to complete rating scales which are a series of questions regarding how the student reacts or presents in different scenarios. These ratings scales often show the similarities and difference in how the student presents at school versus home because parents will provide answers related to the home environment while teachers are focused on the school setting. The IEP team will decide whether the child qualifies for an IEP based on the ETR. A child qualifies for an IEP if they:

1. Meet the meets the state criteria for having a disability.
2. The student’s disability must have an adverse effect on his/her academic performance such that it requires specially designed instruction.
3. The child’s poor performance is not due to a lack of appropriate instruction.

You do not need a medical diagnosis

A common misunderstanding it that you need a medical diagnosis to ask for a 504 Plan or IEP. You do not need a medical assessment or diagnosis to ask for a 504 Plan or IEP. Whether or not a student has medical assessment or diagnosis, the school team must conduct school-based evaluations to determine whether a student qualifies for a 504 Plan or IEP.

A diagnosis is information that can support your request. If you do not have a diagnosis, your can provide other information to support your request such as failing grades, inattention, inability to sustain and/or complete work, difficulty with academic work or navigating social situation at school, extreme worries or anxiety about school, shifting perspective about school, behavior difficulties, developmental delays, communication difficulties etc. This can be particularly helpful with certain conditions that have a long wait list for diagnosis such as autism. While you are waiting for a diagnosis, you can still request school-based assessment to determine whether your student needs support at school. If you suspect your child has autism, ask the school team to include an ADOS in their school-based assessments.

The education team at Hickman Lowder can help families navigate assessment and determine whether the family should pursue a 504 Plan or IEP for their student.

Timeline of the IEP process

1. Within 30 days from the request, the school must hold a “suspicion meeting” and decide whether they will evaluate the student for an IEP. At a suspicion meeting, the IEP team determines whether they suspect the child has a disability that impacts them in the school setting. An IEP team is comprised of the school team and the family. If the team does not suspect a disability, the IEP process ends here, and they may recommend a 504 Plan. If the team does suspect a disability, the next step is school based assessments.
2. Within 60 days from the parent consenting to evaluations, the school team must provide an Evaluation Team Report (ETR). An ETR is a comprehensive school-based assessments that evaluates how the student is functioning in the school setting. An ETR consists of academic and psychological assessments and may include other assessments such as physical therapy, occupational therapy, and speech and language. The school psychologist will likely ask parent and teacher to complete rating scales regarding how the student presents. These ratings scales often show the similarities and difference between how the student presents at school versus home because parents will provide answers related to the home environment while teachers are focused on the school setting.
3. At the ETR review meeting the team will determine whether the student qualifies for an IEP.
4. Within 30 days of the ETR meeting, if the student qualifies, the IEP team must draft and implement an IEP.
5. Thereafter, the IEP team must review the IEP annually and revisits assessments every three years.