School Placement Outcomes and Services at Preschool, Kindergarten, and School-Age for Children Diagnosed with ASD before Age Three Years

Background: Longitudinal studies of children with autism spectrum disorder (ASD) tend to focus on stability of diagnostic outcomes. Given the broad spectrum of functioning with ASD, there is a need to know more about functional outcomes such as school placements as well as distribution of different disability levels.  

Objectives: To examine the school placement of children diagnosed early at three points in time: preschool, kindergarten, and school age. In addition, educational placements were compared among those with moderate to severe disability, milder disability, and who no longer met criteria for ASD at school age. 

Methods: Participants were 56 children identified through an early intervention chart review as being diagnosed with ASD under age 3 years (Time 1 M=25.15, range 13 – 35 mos). 82% were male. Parents were recruited to fill out a set of questionnaires when their children were 7 – 16 years old (Time 2  M=10 yrs 7 mos). Measurements included (1) an extensive parent questionnaire including items about school placement history, current learning problems and school services received; (2) GARS-3; (3) Autism Spectrum Rating Scales (4) Vineland Adaptive Behavior Scales-II. A subset of children also were evaluated directly using the ADOS-2 and brief forms of the WISC-IV or the Leiter-2. Each participant was placed in a school-aged severity outcome category based on all available information. Agreement between judgments based on questionnaire material was kappa (w)=.83. A reliability substudy was conducted to validate the judgment-based ratings with in-person Best Estimate Diagnosis. Agreement between judgments and Best Estimate Diagnosis was 91%.

Results: Time 2 diagnostic distribution was 48% falling in the ASD with Moderate/Severe Disability category, 32% in the ASD with Mild Disability category, and 20% in the No ASD/Social Communication/Learning Disability category. For preschool settings, all children in the two ASD groups were in special education settings with many services. For the eventual No ASD group, all but one were also receiving services, but a smaller proportion were in self-contained classes. In kindergarten, the majority of the two ASD groups received from some to extensive services, but fewer were exclusively in self-contained settings. However, members of the eventual No ASD group were in less restrictive settings than the two ASD groups in kindergarten, and over half had no to only some services. About one-third still received a significant amount of services, however. By school age, all of the Moderate/Severe group were in special education settings, with 75% in highly restricted settings. For the Mild group, half were in regular public school settings with services, whereas the other half were in more restricted settings. The No ASD group had half the children in regular classes, and the rest in a variety of low-restriction settings. 

Conclusions: This is the first study to describe school placements at three points in time, according to different severity levels of outcome, for a community sample of children diagnosed early with ASD. It gives insight into the time it takes for the children with the most favorable disability outcome to function with fewer educational supports.