Autism Q & A: What happens when it’s time for kindergarten?

By Daniel B. Kessler, M.D.

Most children who have received special education preschool services will continue to need additional supports in the transition to kindergarten. This is usually true for a child on the autistic spectrum. Also, at age 6, children who are receiving services under the Division of Developmental Disabilities (DDD) and/or Arizona Long Term Care Services (ALTCS) will be required to see a specialist to re-certify their diagnosis.

This is where some families run into difficulties if their child has not received a formal diagnosis of autism. Based on existing state law, the diagnosis must be autistic  disorder. A child will not qualify with a diagnosis of PDD-NOS, Asperger syndrome or autism spectrum disorder. (This will become more of a problem after the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in May 2013, as it is widely expected that current disorders related to autism will now fall under the category of autistic spectrum disorders and there will be no “autistic disorder.”) The only way children who do not have not a diagnosis of autistic disorder can qualify for services is if they meet the criteria for one of three other categorical disorders (defined in law) that include seizure disorder, cognitive impairment or cerebral palsy. These conditions are covered by the ALTCS system by law.

It is not uncommon for a child who had been receiving services under the category of “at risk for autism” (a description sometimes used by providers for younger kids) to lose services if further evaluation fails to support a diagnosis. The child may have been receiving services including speech therapy and occupational therapy and making good progress and the family may wish to continue those supports through DDD even though the child also will be attending a kindergarten program. Parents are upset when their child “loses” the services because he or she doesn’t have the right diagnosis.

Parents should request (in writing) a comprehensive re-evaluation to determine the extent of services and supports available through the school district. Evaluations always must be performed in all areas of suspected disability. Schools often will tell parents that because autism is a medical diagnosis they do not test for it, but the courts have ruled that because autism is also an educational eligibility category (at least by the time the child is entering kindergarten), to not test for it the school is denying the child a free and appropriate education (FAPE). The bottom line is that schools must test for autism in their comprehensive assessments if there have been concerns expressed about it or parents suspect it.

Next: What it means to place a child in a “least restrictive environment.”

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

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