School Evaluation and a Requested Autism Diagnosis
A school-based physical therapist is asked to evaluate a 7-year-old student who has difficulty with gait, balance, and playground mobility. The classroom teacher tells the PT that the student 'probably has autism' and asks the PT to put that diagnosis in the school report so the district will approve a one-to-one aide. The parent has signed the school's consent for a PT evaluation but has not authorized release of medical records. The PT's examination shows toe-walking, mild ankle tightness, and age-appropriate strength; the PT suspects a sensory processing issue but has no formal training in autism diagnosis. The district's special-education coordinator wants the PT to state that the student 'needs physical therapy for autism' and to recommend a specific number of weekly sessions for the entire school year. The PT also receives a phone call from the student's private pediatrician asking for the PT's 'diagnosis' before the physician will see the child.
1. Using Missouri's scope-of-practice definition, identify what the PT may and may not include in the evaluation and school report.
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Missouri's physical therapy scope is built around evaluating and treating movement dysfunction and physical impairments through physical agents, exercise, manual techniques, and related interventions. The PT may document gait deviations, ankle range-of-motion limitations, balance deficits, strength findings, functional mobility, and the effect of those findings on school participation. The PT may recommend school-based PT if the child needs skilled intervention to access education.
The PT may not diagnose autism or a sensory processing disorder. Those are outside the PT's examination findings and training in this scenario. The PT also should not write 'physical therapy for autism' as if autism were the treatment target. A defensible report says what was measured, what impairment is present, what functional problem it creates, and what PT intervention is recommended, with a plan for reassessment. The PT can note that the teacher raised concerns about social communication and that those concerns were not assessed by the PT and should be referred to the school team or physician.
2. How should the PT respond to the teacher, coordinator, and pediatrician? Include documentation language that stays within scope.
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To the teacher, the PT should say plainly: 'I cannot diagnose autism; I can document the motor and mobility findings and recommend that the school team evaluate the concerns you raised.' To the coordinator, the PT should provide functional findings and a PT recommendation rather than a medical label: 'Student has toe-walking, limited ankle dorsiflexion, and balance deficits that affect playground mobility; skilled PT is recommended to address these impairments and to reassess in eight weeks.' The PT should avoid committing to a full-year frequency without a reassessment plan; frequency should be tied to goals and expected progress.
To the pediatrician, the PT cannot release the evaluation without a signed authorization from the parent, because the school consent covers the evaluation, not disclosure to an outside physician. With authorization, the PT may share the PT evaluation and findings, but should not offer an autism diagnosis. Documentation should distinguish 'PT findings' from 'team concerns' and should state that autism was not assessed by the PT.