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One of the most frequent topics that I 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!  

Medical Versus Educational

A Medical Diagnosis is based on the DSM-V, and/or the ICD-10 codes.

Educational Eligibility for special education is based on the Individuals with Disabilities Education Act (IDEA).

Let’s try to break this down

What is a Medical Diagnosis?

A medical diagnosis is, in fact,  only given by a medical professional.  This can be a pediatrician, or a child psychologist; however, it could also be a neuropsychologist. It could also be a developmental pediatrician or 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 also find a few places on the internet with the full DSM-V definition available. 

These are also great resources. In addition, 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 therefore comprised of three main criteria.

DSM-5 Autism Spectrum Disorders

What is Educational Eligibility?

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

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 movementsresistance 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.

Medical v. 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.

These two outcomes are QUITE different because one wants your child to be like other kids in the world, and the other only cares if your child is doing well in class.

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.

In Addition…

With medical therapy, talk to 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. Plus, you have to 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, therefore, has various uses. I often advise parents to get as much therapy services from the school as possible. This is especially true when the child is at the elementary school level. Elementary school is when therapy seems to be most effective. And then the child get medical therapy too, if possible.

Finally, Here is the FREE resource I promised you. This list has every state’s educational eligibility.


In conclusion, 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 because they have the reference material used to write this post.

Finally, 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.

PASEN also runs a special needs homeschool group, Homeschooling Special (Needs) Kids.

In addition, we also have a group for all parents and caregivers of special needs children called Special Needs Parenting Advice and Support. In this group, we discuss ALL things related to special needs in addition to care.  I hope to see you there!

We also have a Parent Advocacy Training Program available at a discount for a limited time. If you also want to be the most effective advocate you can for your child, we can help.


This comprehensive training is for parents who are stuck in the IEP process. The information you learn in this course will help you effectively advocate for your child, and give you a leg up in the IEP meeting.

First, you will learn basic research. Then you will be taught special education jargon. Finally, you’ll important information about general topics concerning IEPs and Special Education law

Parent Alliance for Students with Exceptional Students (PASEN) is meant purely for educational or medical discussion. It contains information about legal or medical matters; however, it is not professional legal or medical advice and should not be treated as such.

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Professional assistance: You must not rely on the information on this website as an alternative to legal or medical advice from your attorney or medical provider. If you have any specific questions about any legal or medical matter, you should consult your attorney or medical service provider.