While Autism Spectrum Disorder is far from the only diagnosis we work with, it is quite a prevalent diagnosis for our clientele. For our clients and their families who may have questions about how this diagnosis is made and when evaluation may be beneficial, we hope that the information below may assist you.
How is Autism recognized?
- Concerns are often raised by parents, daycare providers, or others close to a child. Initial screening for Autism should be completed in the form of an M-CHAT-R (Modified Checklist of Autism in Toddlers Revised) by your child’s pediatrician during a regular office visit sometime between 16 and 30 months. Areas of concern are often, but not always identified at this point. The M-CHAT-R is only one of many ways concerns may be flagged.
- Regardless of how these concerns are raised, you should discuss evaluation with your child’s pediatrician. A referral for a formal developmental evaluation can be made to a trained provider such as a developmental pediatrician or child psychologist.
Why pursue early diagnosis?
- There is a vast wealth of research indicating that children with developmental delays/disabilities, including Autism Spectrum Disorder, who receive early intervention services, are more likely to live more independent lives.
- Children who are accurately diagnosed with Autism Spectrum Disorder often will have more comprehensive insurance coverage for appropriate therapies such as Speech and Language Therapy, Occupational Therapy, and Applied Behavior Analysis. Even for the services that are not covered by your primary insurance, many grants and waiver programs require a formal diagnosis for qualification.
What are the steps to getting my child evaluated?
- When you and your family are ready to pursue evaluation, you should reach out to your pediatrician and your insurance provider. Your pediatrician can discuss your concerns and decide if a referral for a formal developmental evaluation is appropriate, your pediatrician should be able to provide this referral. Contacting your insurance provider will ensure that you are being referred to a diagnostician that accepts your insurance plan.
- Once the referral is made, the diagnostician will meet with you and your child to complete the formal evaluation. Even if Autism Spectrum Disorder is ruled out during the evaluation, a different diagnosis is possible and most diagnostic reports include a comprehensive list of recommendations and resources for families to support their child.
- A diagnostic report should then be shared with your child’s pediatrician and insurance company. Most professionals will also ask for a copy of this report as a part of an intake process for Speech Therapy, Occupational Therapy, and Applied Behavior Analysis. The report can also be shared with your child’s school as a part of a Special Education Evaluation
Managing the cost of services
Use of an HSA (Health Savings Account)
Use of an HSA is a common employment benefit that can be used to pay for medical expenses that are not covered by your primary insurance.
Medicaid and other USA state and Federal health assistance:
Most states do not have income or asset tests for Medicaid eligibility for children who have disabilities. However, check for services called “Behavioral Health Rehabilitation Services.” Medicaid Waivers may also be available under the “Katie Beckett Waiver”. A child with special needs often qualifies when the parents’ income exceeds normal Medicaid guidelines.
For complex medical needs-the Medicaid funded program “Special Medical Services” may be helpful. This link has more information.
Monadnock Developmental Services Aid Sources
This page connects to a variety of local and regional grant resources to aid families with paying for medically necessary services for their loved ones.
Spectrum for Hope Fund
This is a grant in New England that partners with the Doug Flutie Foundation for Autism that covers a variety of therapies/social skills and a wide range of other services/items for children diagnosed on the Autism Spectrum. Grants are up to $2,000 per kid or $3,000 per family.
One Sky Community Resources
This organization provides many different forms of support including enrichment opportunities (up to $500 annually) and the In Home Services waiver for support working on ADLs and community access (up to $30,000 annually).
United Healthcare Children’s Foundation:
This grant provides financial relief for families who have children with medical needs not covered or not fully covered by their commercial health benefit plan. Families can receive up to $5,000 annually per child ($10,000 lifetime maximum per child), and do not need to have insurance through UnitedHealthcare to be eligible. The Foundation aims to fill the gap between what medical services/items your child needs and what your commercial health benefit plan will pay for. If a grant is approved by the Regional Board of Directors for your child, the grant will help pay for approved medical services/items after your commercial health benefit plan submits payment, if any. The grant funds are not paid to you or the child outright – you work with the Foundation on submitting invoices/bills for approved medical services/items after your commercial health benefit plan submits initial payment (if any) to the health care provider.
***Social skills training is listed specifically as an exclusion so this would not be an option for social skills groups but would cover all other services offered by Seacoast Keystone Therapy***