Journal of Autism and Developmental Disorders (2021) 51:4033–4042

https://doi.org/10.1007/s10803-020-04867-9

ORIGINAL PAPER

Educational and Diagnostic Classification of Autism Spectrum Disorder

and Associated Characteristics
Janine Stichter1   · Melissa Stormont1 · Nargiza Buranova1 · Melissa Herzog1 · Rose O’Donnell1

Accepted: 31 December 2020 / Published online: 13 January 2021

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021

Abstract
Research continues to highlight discrepancies between clinical diagnoses of Autism Spectrum Disorder (ASD) and determi-
nation of special education eligibility for services within school settings. However, limited research has been conducted on
the impact of those discrepancies for the identification of appropriate services within schools. The aim of the current study
is to examine students’ characteristics (e.g., language, social emotional) associated with educational eligibility and clinical
diagnoses. More specifically, the study examines characteristics differentially associated with ASD diagnoses to inform
targeted evidence-based interventions. The study accessed data from a four-year cluster-randomized trial of 283 students
with and without reported ASD diagnosis. The results of the study demonstrate that the educational eligibility of Autism
did not differentiate between students with and without autism on any of the measured characteristics including language,
peer and social competence, academics, and aggressive behaviors. However, the Autism Diagnostic Observation Schedule,
second edition (ADOS-2; Lord et al. in Autism diagnostic observation schedule. Western Psychological Services, Torrance,
CA, 2012) classification was a more sensitive diagnostic measure for characteristics associated with autism. Implications
for research, practitioners, and schools are discussed.

Keywords  Autism · Autism spectrum disorder · Special education · Eligibility · Social competence · Assessment · ADOS-2

The reported prevalence of Autism Spectrum Disorder
(ASD) has been consistently and rather drastically increas-
ing over time. According to the most recent statistics, the
prevalence is 1 in 54 individuals is diagnosed with Autism
Spectrum Disorder (ASD) (Maenner et al. 2020). This is
approximately 10% higher than the rate reported in 2014
and approximately 175% higher estimates reported in 2000
(Maenner et al. 2020). Following a similar trend, the number
of children identified for special education under the cate-
gory of Autism has also increased. According to the National
Center of Education Statistics (2020), in the 2018–2019
school year 11% of the special education population, or
781,000 students, were identified in the Autism category.
As a comparison, in 1992, just 2 years after Autism was
included as a federally recognized disability category eligi-
ble for special education, the number of students identified
* Janine Stichter
stichterj@missouri.edu
1 process of matching students with appropriate educational
University of Missouri, Columbia, USA
with Autism was only 15,580 (U.S. Department of Educa-
tion 2001).
This drastic rise in students served under the category of
Autism highlights a growing need to explore the methods
by which students are identified and the implications of eli-
gibility determination within the schools for students with
ASD. More specifically, research has highlighted a notable
discrepancy between educational eligibility of Autism as
compared to clinical diagnoses of ASD (Barnard-Brak 2019;
Doehring and Volkmar 2016). That inconsistency may result
in the absence or lack of services provided to students with
ASD, or access to the services under different eligibility
criteria, which may not be supportive for individuals with
ASD (Doehring and Volkmar 2016). Moreover, evaluation
of social skills deficits, which is a hallmark characteristic
of ASD, is not consistently included across school districts
for Autism eligibility determination (Bateman et al. 2015;
Sansosti and Sansosti 2013). Therefore, the purpose of the
present study is to add to the literature by investigating dif-
ferences in characteristics of students with clinical diagnosis
of ASD and special education eligibility may impact the

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services, specifically in the area of social competence. To
provide a context for the study, the literature on Autism eli-
gibility, social competence of individuals with ASD, and
the implications of accurate autism identification will be
discussed.
Autism Eligibility
A discrepancy persists between the number of children diag-
nosed with ASD and those identified in the Autism eligibil-
ity category within schools. According to analysis conducted
by Barnard-Brak (2019) it was estimated that there were
approximately 54% fewer children with IDEA educational
eligibility of Autism as compared to the estimated CDC rate
of ASD in the U.S. One explanation for the under-identifica-
tion of students with ASD is that the educational and clinical
systems operate under different criteria. Moreover, clinical
diagnosis of ASD is not sufficient to qualify a student for
educational services if the disability is not thought to impair
the student’s academic performance. The federal government
defines Autism within the Individuals with Disabilities in
Education Act (IDEA 2004) as 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”
(see §300.8). However, many states, and even school dis-
tricts within a given state, differ in their interpretation of the
“educational impact” required, given the limited guidance to
define this concept (Stichter et al. 2017a, b).
For example, while some districts may consider social
or emotional impacts when determining educational perfor-
mance, other school districts interpret this criterion as only
academic performance (Stichter et al. 2017a, b). This results
in a number of students who are not receiving special edu-
cation services, despite having a clinical diagnosis of ASD.
Current estimates suggest that only about 74% of students
with an ASD diagnosis receive special education services
(Baller et al. 2015). Therefore, individuals with ASD who
lack a comorbid diagnosis of intellectual disability are at a
greater risk of not being identified for appropriate services
and supports, given their greater likelihood of having aca-
demic success and/or more subtle symptom presentations
(Bateman et al. 2015; Sansosti and Sansosti 2013). Yet,
under-identification and inaccurate identification of stu-
dents with autism may limit their access to recommended
services or lead to the provision of inappropriate supports
and interventions, particularly in the area of social compe-
tence; the absence of appropriate interventions may nega-
tively impact students’ development and academic perfor-
mance (Doehring and Volkmar 2016). School environments
are social environments; therefore, students with social skills
limitations should be offered supports to promote their social
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Journal of Autism and Developmental Disorders (2021) 51:4033–4042
competence, which is essential for their short and long term
success (Ainscow 2005).
Social Competence and Autism
Although social skills impairment remains the hallmark
characteristic of Autism Spectrum Disorder, limited atten-
tion is given to assessing social skills of students with ASD
in school settings (Stichter et al. 2017a, b). Furthermore, not
all districts consider social deficits as meeting the defini-
tion of “educational impact,” especially for students with
strengths in academics (Bateman et al. 2015). Despite having
strong academic skills, students with ASD often experience
poor long-term outcomes, as social competence becomes
increasingly important to a student’s success as they get
older (McPartland et al. 2014). Students with ASD may
experience deficits in both social communication and social-
emotional reciprocity. Social-emotional reciprocity includes
difficulty with initiating social interactions and responding
to social situations, reduced interest in and understanding
of emotions and feelings of other people, abnormal social
approach, poor eye contact, and limited and/or inappropriate
facial expressions for the situation (Stichter et al. 2010). Def-
icits in social communication include perceived low interest
in peers, poor understanding of the nature of friendships and
common social relationships and building and maintaining
social relationships (Shulman et al. 2020).
It is also important to note that the social skills impair-
ments of students with ASD tend to increase during school
years and adolescence. Social interactions become more
complex with maturation and as individuals with ASD
become aware of their disability and differences as com-
pared to others (Shulman et al. 2020). Furthermore, students
with ASD are likely to experience emotional stress or exhibit
other emotional and/or behavioral problems, which often
negatively affect their academic performance leading to
increased risk for dropout, and limiting acceptance by their
peers (Zablotsky et al. 2014). Lastly, poor social competence
of individuals with ASD is linked with post-school outcomes
that are not commensurate with their intellectual abilities
and academic success (McPartland et al. 2014).
Eligibility and Access to Evidence‑Based
Interventions
Of the approximately 74% of students with an ASD diagno-
sis who are identified as needing special education supports,
about one-third of these students receive supports under
non-Autism categories (Christensen et al. 2016). If students
with ASD are not identified or identified as having another
disability, the opportunity to provide needed interventions
Journal of Autism and Developmental Disorders (2021) 51:4033–4042 4035
may be missed. Specifically, qualifying for special education
services under different categories may affect a student’s
access to certain services that may be beneficial given their
needs (Barton et al. 2016). As such, simply qualifying for
special education services under any given category is not
sufficient in meeting the unique and multi-faceted needs of
this population.
The lack of alignment between clinical diagnosis, educa-
tional eligibility, and state and regional variances in Autism
identification impede the ability of school professionals to
appropriately match evidence-based ASD services and inter-
ventions to students who might benefit from them (Doehring
and Volkmar 2016). Evidence-based practices (EBPs) are
instructional strategies that meet specific criteria and have
been proven to be effective based on a significant body of
research (Cook and Cook 2011). What Works Clearing-
house (WWC), the Council for Exceptional Children (CEC),
the National Research Council (NRC), and other research
organizations select effective practices for students with
ASD based on research and accompanying results with this
population (Cook and Cook 2011; West et al. 2013). One of
the challenges researchers face is describing the population
for whom the evidence-based practice (EBD) is effective and
under what circumstances. Students with Autism Spectrum
Disorder (ASD) are a heterogeneous population (Cook and
Cook 2011; Stichter et al. 2017a, b), which makes it highly
problematic to form equivalent groups among research
participants to generalize the findings (West et al. 2013).
However, there are certainly characteristics more commonly
manifested among individuals with autism than those with-
out autism.
Exploring how school districts are evaluating students for
Autism eligibility is also important to better understand the
characteristics of students identified to inform intervention
needs. For example, if a school district uses method A to
identify students and this method does not emphasize a key
component of autism in the process, such as social compe-
tence, then interventions that were researched to be effec-
tive for students with autism, defined as having social com-
petence deficits, may not be effective for similarly labeled
students in that school district. In the absence of policy and
practice changes to improve consistency in school based eli-
gibility criteria, further examination of the characteristics
used in eligibility determinations can inform appropriate
interventions and/or priorities for intervening and with this
population.
Assessing Characteristics for Evaluation
A major component to the under- or misidentification of
students with ASD in the schools is the lack of consistent
standards, methods, and expertise for identification under the
Autism category (Barton et al. 2016). As previously men-
tioned, IDEA provides federal legislation for the broad defi-
nition of Autism criteria, but individual states can include
additional components, interpretations, and procedures or
require varied levels of evaluations (Baller et al. 2015). A
such, most states define Autism using similar criteria in
DSM-5 but may require different documentation to qualify
a student for services under the category of Autism.
However, some features of the DSM-5 do not align
with federal statute on Autism criteria identification (e.g.,
repetitive and stereotyped behaviors, symptoms that cause
clinically significant impairment), which leads to misalign-
ment between educational and medical definitions of ASD
(Doehring and Volkmar 2016; Stichter et al. 2017a, b). In
addition, in some states outside evaluations are necessary,
whereas in other states, outside evaluations can be used
but are not required (Barton et al. 2016). The assessment
requirements also vary by state. In a study by Barton et al.
(2016), twenty-four states did not provide any informa-
tion on the number and types of observations needed for
the Autism eligibility process, while seven states included
specific details on the observations needed. Fourteen states
highlighted that a team of qualified professionals must con-
duct the Autism evaluations at schools, and only four states
required school psychologists within the school to adminis-
ter assessments (Barton et al. 2016). According to Sullivan’s
(2013) analysis of general and special education data from
46 states, students from some states were nine times as likely
to be found eligible for special education under the category
of Autism than in other states.
Furthermore, there is also limited guidance from the
law and national organizations regarding the assessment of
Autism in schools. Barton et al. (2016) further noted seven-
teen states do not include specific information on required
assessment tools to be used by schools to identify Autism,
only two states indicated that the DSM-5 should be used,
and eight states required standardized or norm-referenced
assessments. Even when assessments are used, McKenney
et al. (2015) review of school psychology journals noted a
lack of information regarding the practical utility of various
Autism specific measures. Further, there is limited informa-
tion in these journals regarding the reliability and validity
of Autism specific measures to help guide school psycholo-
gists’ assessment choices. Additionally, many school psy-
chologists reported that they did not engage in best practice
evaluations for Autism. In other words, they were not using
assessments to explore differential diagnoses (Aiello et al.
2017).
Despite similarities between IDEA eligibility criteria for
Autism and DSM-5, IDEA requires that those deficits must
adversely impact student’s educational performance (Stichter
et al. 2017a, b). This often challenges special education
teams to determine whether social competence deficits are
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4036
severe enough to adversely impact student’s educational per-
formance. Furthermore, one of the most challenging parts
of conducting evaluations for autism identification at school
is assessing social skills deficits. This is challenging due to
the complexity of social competency and lack of assessment
tools available to properly evaluate this skill (Shulman et al.
2020). The diagnostic assessment in school settings often
emphasize academic achievement over social competency
and social skills are frequently assessed through reports from
other people (parents, teachers) with limited information
gathered from the target student and their peers (Shulman
et al. 2020).
To adhere to multiple criteria outlined in IDEA, schools
are expected to conduct several assessments to measure
adaptive behavior, cognitive ability, language skills, execu-
tive functioning, and social competence during the evalua-
tion process (Stichter et al. 2017a, b). However, there is no
universal test that is reliable in identifying Autism in every
single student in special education (Stichter et al. 2017a, b).
The goal of the special education team is to assess the sever-
ity of the student’s needs in order to choose and implement
the most effective interventions to support student’s aca-
demic performance and social competence. However, taking
into consideration the differences among clinical diagnostic
assessments (ADOS, DSM5), IDEA special education eli-
gibility, state and regional variances in identification stu-
dents with ASD, it is not clear if students with ASD differ
in their characteristics based on meeting different eligibility
requirements. To this end, it is important to understand how
children with clinical diagnosis and/or educational eligibility
differ in characteristics in order to understand how those dif-
ferences could potentially impact treatment considerations.
The purpose of this study is to investigate if educational
eligibility and clinical diagnosis of autism are associated
with specific language, social emotional, and other key char-
acteristics. More specifically, among students with autism,
what characteristics are differentially associated with their
diagnosis and can therefore be targeted for evidence-based
treatments?
Method
Participants and Settings
The current quasi-experimental study includes data obtained
during a 4-year cluster-randomized trial designed to assess
the efficacy of the Social Competence Intervention-Adoles-
cent (SCI-A; Stichter et al. 2010, 2016) program as com-
pared to “business as usual” (BAU) social programming
conducted 34 publicly funded middle schools in one Mid-
west state. Description of the SCI-A program, various BAU
settings, and the methodology involved in the efficacy testing
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Journal of Autism and Developmental Disorders (2021) 51:4033–4042
is beyond the scope of the current paper, but details can
be found in previously published or presented reports (see
Stichter et al. 2016, 2017a, b).
Participating districts/schools nominated and consented
students meeting designated inclusion criteria consistent
with social interventions similar to SCI-A and that were
necessary given the cognitive-behavioral underpinnings of
the intervention: absence of intellectual disabilities (based
on full-scale IQ scores above 75 from a reliable test1), par-
ticipation in general education with peers for at least one
course per day, absence of a primary mental health diagno-
sis (e.g., exclusion of students for whom their sole or pri-
mary diagnosis was for major mental health such as bipolar
disorder) or major behavioral incidents (e.g., exclusion of
students with highly aggressive incidents or incidents that
results in repeated out-of-school suspension), and identified
social needs consistent with characteristics and challenges
often associated with high functioning autism (e.g., difficulty
expressing and/or reading emotions, deficit in problem solv-
ing skills, emotional dysregulation; Solomon et al. 2004).
Although seeking students with needs consistent with ASD,
neither a documented ASD diagnosis nor special education
eligibility in the Autism category was explicitly required.
This criteria was important as access to consistent outside
medical providers trained in diagnosing ASD varies signifi-
cantly in the targeted area. Additionally, the nature of the
current study was to capture how schools were evaluating
students for targeted needs. Each school had to have at least
four students who met eligibility criteria to meet the mini-
mum size needed for an SCI-A group and thus to remain
in the study. Since evaluation of the effectiveness of social
programming is not the focus of the current study, all avail-
able data from all consented students is pooled regardless
of their SCI-A or BAU assignment and was collected prior
to the start of SCI-A programming.
Students
Parent consent was obtained for students (n = 155 SCI-A;
n = 137 BAU). For inclusion in the current study, students
had to (a) have an IQ score from a reliable test that was
within the inclusion criteria and (b) have a minimum three
indicators of autism (i.e., at least one indicator beyond
school-based report). After consent, 3 students did not
have the minimum number of indicators, 5 students were
determined ineligible based upon misreported IQ (i.e.,
below inclusion threshold), and 1 student moved from the
1
 Two tests/scores were considered reliable in the current study:
WASI Abbreviated Scale of Intelligence (WASI; Wechsler 1999) Full
Scale IQ score or WISC-IV Wechsler Intelligence Scale for Children-
4th Edition (WISC-IV; Wechsler 2003) Global Ability Index score.
Journal of Autism and Developmental Disorders (2021) 51:4033–4042 4037
Table 1  Student characteristics (n = 283)
n %
Grade level
 6th grade 114
 7th grade 92
 8th grade 77
Gender
 Male 238
 Female 45
Special education eligibility autism 158
Emotional disturbance 54
Other health impairment 36
Specific learning disability 4 1.4
Speech impairment 8 2.8
Section 504 Plan 13
No eligibility 8 2.8
school before reliable IQ criteria could be verified. Table 1
includes demographic characteristics of the current analytic
sample of 283 students. All data were obtained prior to the
Spring semester. Most students were male (84.1%), ages
ranged from 11.38 to 15.40 years (M = 12.92, sd = 0.92).
Participants had cognitive functioning at or above the study
inclusion criteria (M = 99.83, sd = 14.12). The majority of
students were eligible for special education services; most
qualifying under the categories of Autism, Emotional Dis-
turbance, or Other Health Impairment. Students had a wide
variety of reported diagnoses, with 69.6% of students hav-
ing at least one secondary mental health diagnosis reported,
and 32.8% having more than one diagnosis reported. Over
40% of students (n = 115) had some form of ASD reported,
and of this number, 55 students had a secondary diagnosis
of ADHD.
Measures
External Diagnosis
As part of the referral process for the RCT, each school
reported what diagnosis, if any, the student had on file
(n = 283 reports, 100% of total study sample). Diagnoses
provided by an external medical or psychological profes-
sional outside of the school/district (i.e., special education
eligibility categorization did not count as a diagnosis) that
were included in school records are reported here. This rep-
resents an ecologically valid approach to understanding the
types of information to which schools have access. On the
designated form, Autism, Asperger’s Syndrome, and Perva-
sive Developmental Disorder-Not Otherwise Specified were
listed categories in an effort reflect varying DSM diagnostic
criteria over the past decade.
Special Education Eligibility
Upon referral to the project, schools reported if the student
was eligible for special education services with an individ-
40.3 ual education plan (IEP) or 504 plan (n = 283 reports, 100%
32.5 of total study sample). If the student had an IEP, schools
27.2 reported the corresponding eligibility category. For analytic
purposes, we created a binary code for the presence of an
84.1 IEP in the Autism category (0 = no Autism IEP; 1 = Autism
15.9 IEP).
55.8
19.1 Autism Diagnostic Observation Schedule (ADOS‑2; Lord
12.7 et al. 2012)
The ADOS-2 is a semi-structured observation during tasks
4.6 and interactions with a trained administrator that assesses
students’ behaviors characteristic of autism. Scores are
assigned within domains: (a) reciprocal social interaction,
(b) communication, and (c) restricted, repetitive, and stereo-
typed patterns of behavior. Administrators utilized the Mod-
ule 3 version (appropriate for adolescents with fluent speech
abilities) and have met research reliability standards desig-
nated by the measure’s developers. The scoring algorithm
uses a priori selected items (coded as 0 = no evidence of
abnormality to 2 = definite evidence of abnormality) to cal-
culate domain scores on Social Affect (SA, range 0–20) and
Restricted Behavior (RRB, range 0–8) that are summed to
form a Total Score (range 0–28), with higher scores indicat-
ing greater severity of symptoms. The ADOS-2 Classifica-
tion category is based on the participant’s total score: Non-
spectrum (Total = 6 or less), Autism Spectrum (Total = 7–8),
or Autism (Total = 9 or more).
In the current study as part of the a priori methods and
analysis plan, 60% of consented students were randomly
selected to participate in the ADOS-2 (n = 158). Only 60% of
children were randomly selected within each school district
due to the high cost associated with the ADOS-2 assess-
ment and the requirement to conduct it by the highly quali-
fied trained professionals. In addition, some students in the
SCI-A condition of the RCT provided consent to participate
in an ancillary study and participated the same research-reli-
able ADOS-2 procedures (n = 20). All ADOS-2 observations
were conducted at school during the school day at the onset
of each student’s participation in the study. All examiners
conducting the ADOS-2 were members of the research team
who had passed all official research-reliability standards per
the ADOS-2 developers. Although some schools reported
students had an existing ADOS score on file, these scores are
not considered in the analysis of concordance of ASD indi-
cators as we could not verify the research-reliable status of
the examiner. Additionally, some students’ tests were given
using non-comparable forms (e.g., not Module 3, n = 6,
7.8%) or were given well before the middle school years
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(46.1% of school-reported ADOS administered before age
9; 14.5% before age 6). To maximize sample size and power
in the current study, data from both the random sample and
the additional SCI-A condition are included (n = 178, 62.9%
of total study sample).
Children’s Communication Checklist‑2 (CCC‑2; Bishop 2006)
For each student, one school professional who knew the
student well completed the CCC-2 via an online data col-
lection system mid-late Fall semester (n = 281, 99.3% of
total study sample; 2 did not complete it). The CCC-2 is
designed to distinguish youth with and without pragmatic
language and social interaction difficulties (characteristics
of ASD), and data demonstrate it has discriminant valid-
ity to distinguish participants with high functioning autism
from typical controls, particularly among youth with higher
IQ (sensitivity = .88, specificity = .53; Bishop 2006). The
CCC-2 includes 70-items across 10 subscales. Four scales
(A–D: speech, syntax, semantics, coherence) assess areas
often associated with specific language impairment. Four
scales (E–H: initiation, scripted language, context and non-
verbal communication) assess pragmatic aspects of language
and communication. Two scales (I–J: social relations, inter-
ests) assess non-language domains characteristic of ASDs.
Each scale contains seven items, five that assess challenges
and two that assess strengths in the given domain (reverse
scored). Respondents rated the frequency of each behav-
ior on a 4-point scale (0 =  < once a week/never to 3 = sev-
eral times (> 2) a day/always). Items in each subscale are
summed with subscale scores ranging from 0 to 21, with
higher scores indicating greater challenges; raw sums
are converted to a norm-referenced scaled score (M = 10,
SD = 3). According to psychometric testing (Bishop 2006),
scales have adequate internal consistency (α = .73–.88) and
inter-rater reliabilities (ICCs = .62–.83). The CCC-2 demon-
strates discriminant validity in its ability to distinguish par-
ticipants with HFA from typical controls, particularly among
youth with high IQ (sensitivity = .88, specificity = .53).
School Social Behavior Scales (SSBS; Merrell et al. 1993)
The SSBS is a behavior screening tool designed to assess
children’s’ social and emotional behaviors, identify students
with challenging behaviors and provide interventions. The
scale can be implemented by teachers and school person-
nel in grades K through 12. The SSBS instrument consists
of two separate scales: Social Competence and Antisocial
Behavior and includes 65 descriptions of appropriate and
not appropriate social behaviors; raters report behaviors on
a 5-point Likert scale. The SSBS has strong internal con-
sistency (.94–.98), split-half reliability (.91–.98), test–retest
reliability at (.76–.83) for the Social Competence scale and
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Journal of Autism and Developmental Disorders (2021) 51:4033–4042
.60–.73 for the Antisocial Behavior scores (Crowley and
Merrell 2003). Validity of SSBS scales have been demon-
strated by multiple studies including criterion-related valid-
ity (Merrell and Gill 1994), convergent and discriminant
validity, and strong sensitivity to theoretically based group
differences (Merrell and Gill 1994; Merrell et al. 1993). It
has been shown that the SSBS scale has evidence of strong
classification accuracy of students with different special edu-
cation groups (Crowley and Merrell 2003).
Data Analysis Plan
To protect against Type 1 error, while also considering Type
2 error in this exploratory work, MANOVAS were deter-
mined to be the best choice for group difference analyses
given several related dependent variables can be included
while also considering two independent variables within
the same model. ADOS-2 classification (Autism, Autism
Spectrum Disorder, no Autism) and educational diagnosis of
Autism (i.e., yes or no) were entered as the two independent
variables into five separate MANOVAS with the following
dependent variables: pragmatic language, language form and
structure, social emotional competence and relations, other
autism characteristics (i.e., academics, interests), and anti-
social behavior. Each of these dependent variables included
subscales from the CCC-2 and SSBS. Next, where MANO-
VAs yielded significant differences for one or both of the
independent variables, univariate analyses were conducted
to determine specific subscales with significant mean differ-
ences. When univariates documented differences then fol-
low up analyses explored mean differences (i.e., a Tukey for
ADOS given it yields three groups). Cohen’s d scores were
also computed for significant mean analyses to determine
magnitude of effects; effect sizes of .20 are considered small,
.5 are medium, and .8 or above are large (Cohen 1988).
Results
Multiple Analyses of Variance
Of the five MANOVAs run, two were significant, one was
approaching significance and two were not significant. The
MANOVA with dependent variables related to social com-
petence and social relations yielded significant differences
among groups with and without ADOS diagnoses F = 3.47,
p = .001. Groups did not differ based on an IEP diagnosis of
autism F = .56, p = .69 F = .48, p = .87. Differences among
groups were documented in univariate analyses for all three
subscales, which are presented in Table 2. Tukey follow-
up comparisons documented significant mean differences
between the group of students with autism and the group
without autism for all subscales with the group with autism
Journal of Autism and Developmental Disorders (2021) 51:4033–4042 4039

Table 2  Univariate statistics and student group means (SDs) for ADOS-2 significant results
Rating scale Autism Autism spectrum Non spectrum F ratio p Tukey d

Pragmatics
 Initiation 8.71 (4.62) 7.79 (4.25) 6.77 (4.04) 1.54 .217 – –
 Script lang 5.06 (2.88) 4.26 (2.83) 3.12 (3.16) 3.72 .026 A > NS .66
 Context 7.96 (3.86) 6.42 (4.39) 4.76 (4.21) 6.49 .002 A > NS .79
 Nonverb com 9.59 (4.52) 7.32 (4.49) 5.88 (4.99) 5.98 .003 A > NS .79
Social skills
 Soc relation 9.79 (4.08) 8.00 (4.03) 6.88 (3.89) 5.31 .006 A > NS .70
 Peer prob 30.75 (10.83) 31.37 (9.91) 42.65 (15.15) 8.52 .001 A > NS; AS > NS 1.02; .97
 Social comp 85.32 (22.94) 87.47 (23.09) 102.23 (31.45) 4.24 .016 A < NS .70
Other common
 Academics 23.87 (7.27) 24.47 (7.52) 27.06 (7.73) 1.77 .174 – –
 Interests 8.39 (4.08) 6.63 (3.32) 5.29 (3.69) 5.55 .005 A > NS .76

having more impaired social functioning. Two of the effect
sizes were in the medium approaching large range and the
SSBS subscale peer problems and relations had a large effect
size of 1.02. Also on this subscale, the group of students
with autism spectrum disorder had higher peer relations
problems than their peers without autism and the magni-
tude of the effect was also large. No other differences were
documented for the autism spectrum group and either other
group.
The MANOVA with other autism characteristics (i.e.,
subscales of interests, academics) was significant for
ADOS-2 Diagnosis F = 2.76, p = .028. Again, the MANOVA
was not significant for the independent variable IEP diag-
nosis F = .60, p = .55. In the follow-up univariates, the aca-
demic subscale was not significant but the interests subscale
was significant; Tukey follow up analyses documented that
the group with autism had higher scores on restricted inter-
ests than the no autism group with a medium effect size.
The group with autism spectrum disorder did not differ from
either group.
For the MANOVA including pragmatic language charac-
teristics (i.e., CCC-2 Initiation, CCC-2 Scripted Language,
CCC-2 Context, and CCC-2 Nonverbal Communication),
IEP diagnosis of autism was not significant F = .58, p = .68.
However, the independent variable ADOS-2 classification
was approaching significance F = 1.89; p = .06. Given the
exploratory nature of this research and that the finding was
approaching significance, univariates are reported for the
ADOS-2 classification and pragmatic language subscales.
Three of the four univariate analyses were significant includ-
ing scripted language, context, and nonverbal communica-
tion (see Table 2). Follow up Tukey analyses were conducted
for the three significant univariates and documented group
differences between the groups with an autism diagnosis
and those without an autism diagnosis. The group with
an autism diagnosis had mean scores that reflected more
pragmatic language skill problems than those without an
autism diagnosis for all three subscales and the effect sizes
ranged from .66 to .79, which are considered medium effect
sizes approaching large (Cohen 1988). The group with a
diagnosis of autism spectrum disorder did not differ from
either of the other groups on the three pragmatic language
subscales.
The MANOVA with dependent variables including
language form and use characteristics was not significant
for IEP diagnosis F = .252; p = .91 or ADOS-2 diagnosis,
F = 1.74, p = 09. Accordingly, no additional univariate analy-
ses were conducted. Given it was not significant, the uni-
variates were not presented in Table 2. Language form and
use included the CCC-2 subscales speech, syntax, seman-
tics, and coherence. Finally, the MANOVA with dependent
variables related to antisocial behavior subscales (i.e., SSBS
scales Hostile/Irritable, Antisocial/Aggressive, and Defiant/
Disruptive) was not significant for IEP diagnosis, F = .73,
p = .53 or ADOS-2 Diagnosis F = .39, p = .89. Accordingly,
no follow up univariates were conducted.
Discussion
Although autism has only been recognized as an educational
category for 30 years, extensive research has been conducted
to determine evidence based practices for the unique needs
of students with autism, including social competence. In
order to effectively match students with effective interven-
tions, classification systems need to be sensitive to the char-
acteristics that are most valid and distinguish those students
with a specific disability from those without. Without a clear
understanding of classification systems, and the associated
characteristics of students with specific classifications, a pri-
mary aim of determining eligibility is compromised.

13

4040
A central finding of this study includes that an educa-
tional eligibility classification was not associated with char-
acteristics of autism but ADOS-2 classification of autism
(i.e., autism, autism spectrum disorder, no autism) was
associated with key characteristics. More specifically, in this
study we found that the educational diagnosis of Autism did
not distinguish between students with and without autism
on key characteristics of language, peer and social relations
and competence, or academics and other interests. This is
a significant finding in that it isn’t clear how students with
autism were determined eligible for an IEP if they did not
differ from peers with other disabilities on key social and
language outcomes. This can be a result of the absence of
consistent standards and procedures for identifying students
under the Autism category at school. Due to the inconsist-
ency of assessment and evaluation requirements across
school districts and states, the misidentification or/and under
identification of students most likely to occur (Barnard-Brak
2019; Barton et al. 2016).
ADOS-2 classifications are challenging to provide for all
children and youth suspected as having autism. However this
study documented the ADOS classification discriminated
between groups of those with autism and without autism.
The group with ASD (ADOS-2) was significantly differ-
ent from the group without autism on peer relations but not
on any other characteristics. The ADOS/ADOS-2 can be
time-consuming and requires an extensive training to con-
duct this assessment, which makes it challenging to imple-
ment in school setting. However, as this study clearly found,
when an ADOS has been conducted for a student referred for
evaluation, it is an important piece of data to be used by the
team (Stichter et al. 2017a, b). ADOS-2 classification proved
to be a more solid diagnostic measure for important and
differential characteristics associated with autism. Further-
more, ADOS-2 scores did not differentiate among groups on
characteristics not associated with autism (e.g., aggression),
which further supports the utility of the ADOS-2 for autism
and associated characteristics.
Taking into consideration the current discrepancies
among clinical (ADOS-2) diagnosis and educational eligibil-
ity, state and regional differences in identification of students
with Autism, and the use of interventions labelled as specific
for students with ASD (West et al. 2013; Cook and Cook
2011), the field needs to create a more universal process/
standard for special education eligibility under Autism cat-
egory to ensure that students are identified in a timely man-
ner and matched to the appropriate services. If the universal
process for identifying students with ASD is not feasible,
another possible approach might be to research and match
interventions based on the student’s deficit area (i.e., social
competence) rather than disability label or diagnosis. As
confirmed by research, there are students who are deemed
not eligible for special education services under Autism
13
Journal of Autism and Developmental Disorders (2021) 51:4033–4042
category but may still need support with skills development
(i.e., social competence) (Bateman et al. 2015; Christiansen
2016; Doehring and Volkmar 2016; Sansosti and Sansosti
2013). Moreover, there are students with diagnosis other
than ASD who may benefit from interventions designed spe-
cifically for students with Autism Spectrum Disorder (Lyons
et al. 2016; Walker and Barry 2018; West et al. 2013). The
national lists of interventions for a specific label such as
WWC for Autism may not be functional as there are no uni-
versal standards for identifying this disability label at school
level which question the relevance of services delivered to
students identified. Practitioners need to understand how to
identify students with specific needs and what interventions
to implement to meet their needs instead of using eligibility
criteria which may differ vastly from one school district to
another, from one state to another and create less then opti-
mal benefit for some students.
Limitations
There are several limitations to this study. First, the data
were was collected in one Midwest state. Also, although the
groups were formed purposely for this study, the specific
inclusion criteria for the study limits the generalizability
of the results to other groups and other states. The current
study has the limitation of excluding students with comorbid
intellectual disabilities, mental health diagnosis, and major
behavior challenges. Therefore, further research should be
conducted to understand the process of identification at
school and the provision of special education services to
diverse students with ASD who may have more severe social
skills deficits and comorbid diagnoses. Finally, the depend-
ent variables reported were all teacher ratings and do not
include parent or student reports or direct observation data.
Implications
This study is important to researchers and practitioners who
try to match appropriate interventions to students based on
their needs. Important outcomes associated with an ADOS
classification of autism include more problems across char-
acteristics of social problems including difficulties in social
skills, peer relations and overall social competence as well as
the pragmatic use of language. As individuals with Autism
have deficits in social communication and social-emotional
reciprocity this creates challenges in establishing friendships
and increases risks of being bullied by peers (Zablotsky et al.
2014). Students with Autism are reported to have higher
risk of being rejected than children with other disabilities
by their typically developing peers (Zablotsky et al. 2014).
Despite reported average intellectual abilities and successful
academic performance, students with Autism are more likely
to experience extreme difficulties developing social skills
Journal of Autism and Developmental Disorders (2021) 51:4033–4042 4041
competence and building connections with peers (Carter
et al. 2013), and thus, they require interventions and sup-
ports for social competence development. In this study we
found a large effect size for the differences between students
with autism and ASD and their peers without autism on peer
relations and the magnitudes for these effects were large.
Finally, the findings from this study have implications for
school evaluation teams. Specifically teams should consider
making decisions concerning provision of special education
services to students based on the students’ areas of deficits
and needs rather than medical diagnosis or eligibility label.
This approach will allow access to interventions for students
who may not have an official diagnosis of Autism or may
belong to a different disability category but still experience
significant difficulties in the area of social competence. In
addition, this method will potentially reduce the research to
practice gap as it will promote understanding among practi-
tioners on how to identify students and interventions which
work for them rather than just implementing evidence-based
interventions without recognizing the individual needs of
every student with disability.
Acknowledgments  The research reported here was supported by the
Institute of Educational Sciences, U.S. Department of Education,
through Grant R305A100342 and R305A130143 to the University of
Missouri. The opinions expressed are those of the authors and do not
represent views of the Institute or the U.S. Department of Education.
Author Contributions  Conception or design of the work was done by
JS and MH. Data collection was done by JS, MH and RO. Data analysis
and interpretation was done by JS, MS and MH. Drafting the article
JS, MS and NB. Critical revision of the article was done by JS, MS
and NG.
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