Autism Spectrum Disorder in Colorado

Report
Issues and Resources for Intervention for
children with Autism Spectrum Disorder in
Colorado
Cordelia Robinson, Ph.D., RN
Professor of Pediatrics and Psychiatry
CU School of Medicine
1
Autism Issues to Keep in Mind
1.
2.
3.
2
There is no definitive biologic test for ASD’s, however they are
thought to be highly heritable.
Clinical diagnosis is based on three core behavioral dimensions:
 Communication delay or deficit
 Impaired social interaction
 Repetitive behaviors and restricted interests
There is a broad range of functioning among people with a
diagnosis.
Autism Spectrum Disorder in Colorado
Autism Spectrum Disorders in Colorado
ASD/IQ >70
without needs
6,108; 24%
ASD/IQ >70
with needs
9,163; 36%
Not based on current numbers
3
ASD/IQ <70;
10,180; 40%
Total = 25,451
Issue – Implications of DSM-V
 Does away with Spectrum; term is Autism
 Combines Social and Communication domains
 Proposes a Severity Rating System
4
Proposed DSM Severity Rating System.
5
Proposed Dimensional Ratings for
ASD in DSM-V
Social Communication
Fixated Interests and
Repetitive Behaviors
Requires very substantial support
Minimal social communication
Marked interference in daily life
Requires substantial support
Marked deficits with limited
initiations and reduced or
atypical responses
Obvious to the casual observer and
occur across context
Requiring support
Without support, some significant
deficits in social communication
Significant interference in at least one
context
Subclinical symptoms
Some symptoms in this or both
domains; no significant
impairment
Unusual or excessive but no
interference
Normal variation
Maybe awkward or isolated but
WNL
WNL for Developmental level and no
interference
Lord, C. (2011). What Would "Better" Diagnosis of ASDs Look Like?:
DSM-5 and Beyond, (AUCD webinar)
http://www.aucd.org/resources/webinar_detail.cfm?event=2504&parent=740
.
Eligibility for Services in Colorado
 ASD diagnosis eligible for Part C, Early
Intervention Colorado http://www.eicolorado.org
 Early Intervention Colorado Autism Guidelines for
Infants and Toddlers
http://www.eicolorado.org/Files/EIColorado%2
0Autism%20Guidelines%2010-21-10_FINAL.pdf
 Colorado Medicaid children with Autism Waiver
75 eligible at one time, waiting list is over 250
children minimum time on 3 years must go off at
age 6
6
Eligibility for Services in Colorado
 Educational system eligibility based upon
educational needs
 School districts vary greatly
 A medical diagnoses of autism does not make a
child eligible for school services
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Eligibility for Services in Colorado
Adults
Currently only eligible if meet developmental
disability criteria. Currently Community
Centered Boards base criteria almost inclusively
on IQ below 70
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Colorado Insurance Legislation
1. Denial of insurance coverage - 1993
SB93-113 Insurance Concerning the
Coverage for Disorders Related to Autism in
Health Care Coverage Policies Declares
Autism a Medical not a Mental Health
Condition
2. Medicaid Children with Autism Waiver - 2004
SB04-177 to get access to behavioral
services for children with autism
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Colorado Insurance Legislation
3. Access to Mental Health Care – 2009
SB09-244 Clarifies access to Mental Health Care
for Co-occuring Conditions
4. Health Insurance Mandated Autism Treatment - 2009
SB09-244 http://www.autismcolorado.org
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What is the Evidence Base for Intensive
Treatment for Autism
2000 National Research Council Recommendations of 20
hours per week of direct intervention fostered the push for
insurance legislation
• Based on consensus of opinion of those who provided
comprehensive early intervention against community
comparison groups
• Only common metric across the intervention - hours
• Research now calling for more specific documentation of
intervention.
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What is the Evidence Base for Intensive
Treatment for Autism
 AHRQ Report Comparative Effectiveness Review Number 26
http://www.effectivehealthcare.ahrq.gov/ehc/products/106
/651/Autism_Disorder_exec-summ.pdf
 Behavioral
 Educational
 Medical and related interventions
 Allied health
 Comprehensive and Alternative Medicine
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Priorities for Intervention
 A means of Communication
 Predictable Daily Routines
Message to Primary Care
 Keep general health in mind
 Pay attention to sleep, nutrition, self care,
any hint of self injury or aggression
These questions should be asked specifically
Autism Speaks Mission
At Autism Speaks, our goal is to change the future for all who struggle with
autism spectrum disorders.
We are dedicated to funding global biomedical research into the causes,
prevention, treatments, and cure for autism; to raising public awareness
about autism and its effects on individuals, families, and society; and to
bringing hope to all who deal with the hardships of this disorder. We are
committed to raising the funds necessary to support these goals.
Autism Speaks aims to bring the autism community together as one strong
voice to urge the government and private sector to listen to our concerns
and take action to address this urgent global health crisis. It is our firm
belief that, working together, we will find the missing pieces of the puzzle.
Autism Speaks. It's time to listen.
Autism Treatment Network
http://www.autismspeaks.org/family-services/tool-kits
Autism Treatment Network
Autism
Speaks
provides
many
resources
The Children’s Hospital
Sleep Lab
Picture Book of Michael
Getting a Sleep Study
Michael is going to Children’s Hospital to be in a sleep
study so that his doctors can learn more about how he
sleeps.
When you come to the lab, we will see
how tall you are and how much you
weigh.
Autism Medical Home
Website
has many
suggestions
http://www.waisman.wisc.edu/nmhai
Cordelia Robinson Rosenberg, PhD, RN
Professor of Pediatrics and Psychiatry
Director, JFK Partners
[email protected]
303-724-7680
23

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