Parents can be confused at the wide variety of evaluations for autism. Currently there is no set standard for autism screenings and evaluations. As a result there are many different screenings and diagnoses discussed by medical professionals.

There's a mental health bible, the DSM-IV TR, that is considered 'the' medical definition of autism. Based on the DSM definition of autism several different diagnostic tests have been developed.

Autism Screenings

Some tests for autism are simple screenings of a few behaviors and delays, such as M-CHAT, that suggest further testing.  These screenings though only indicate that a child may have autism.  The screens though are usually easy to do, take 10 minutes, and are inexpensive. Unfortunately, the autism screenings also have a lot of false positives: children who might have autism,  need further evaluations, but in the end don’t have autism but instead may have another medical condition.

Autism Diagnoses

The more careful evaluations for autism result in an autism diagnosis.  These more difficult and expensive evaluations can use one doctor or a whole team examining the child in a variety of settings.  Genetics tests, brain wave measurements, social and behavioral questionnaires, blood tests, IQ tests, hearing tests, vision tests, can all be performed to make sure a child doesn’t have another disorder besides autism, or even along with autism. All of these other medical conditions that can look like autism, then, make an autism diagnosis very difficult.

Other conditions that can look like autism or are associated with autism include fragile X syndrome, epilepsy, extreme child abuse, mental retardation, hearing or vision problems, language delays, sensory disintegration, depression, and other mental illnesses. Or, these difficulties can be happening at the same time a child suffers from autism.

A thorough autism diagnosis, while expensive and time-consuming, tries to make sure another medical problem hasn't been missed.

In some sense the autism evaluation only helps rule out other medical conditions. Few Arkansans can afford to directly treat autism, an out of pocket medical expense.

If your child has language and other developmental deficits, treatment can begin as soon as possible at school, DDTCS, early intervention, or doctor’s prescription for therapy.

There are a few specific Arkansas programs and money available to those with an autism spectrum disorder. The type of diagnosis is critical in the following situations:

1. The $500 Arkansas tax credit for autism.  For the tax credit you’ll need a team diagnosis from a psychologist and a doctor.
2. The HCBW, or big waiver. The Arkansas Medicaid waiver, that has no premiums and doesn’t count family income for determining benefits, requires a 3-part autism diagnosis. A speech pathologist and psychologist must work with a doctor to make an autism spectrum disorder diagnosis. To get on the wait list for HCBW requires the 3-part diagnosis. Dennis Developmental Center diagnosis will meet the criteria. Contact your local DHS caseworker for further information on how to apply for the HCBW. Click here for some DHS guidance on how to create the 3-part diagnosis from an existing autism diagnosis.
3. The $5000 grant program in the fall of 2009 had the same diagnosis criteria as the HCBW, a 3-part diagnosis.
4. Tricare requires a physician to diagnose autism with these additional details on their website.
5. The new autism waiver.  The diagnostic evaluation needed for this program has not been established for the program that begins in the summer of 2010.  There's a good chance, though, it will follow the 3-part HCBW evaluation.

My list of situations requiring a specific type of autism diagnosis should not be considered complete.  There are probably other programs that require their own specific autism diagnosis. Also, the autism evaluation criteria can change for these organizations, so please contact them for up-to-date information.

Update on Tuesday, March 9, 2010 by EyeContactArkansas

Here's a later story for additional guidance on the ACS or Big Waiver autism diagnosis.  Diagnosis preferably states autism, not autism spectrum disorder. Individuals with Asperger's will have a slightly harder time with the waiver as discussed in this story here.

It’s very upsetting to be told that your child has an autism spectrum disorder.  Most parents will tell you it’s one of the worst days of their lives. After lengthy interviews and exams there's a conference to tell you the diagnosis of autism.  After that the family or individual is on their own to find needed services.  This site lists a few useful resources for those with a new diagnosis of autism.

In addition, an autism diagnosis is a preexisting condition that will prevent your child from buying individual health insurance. Arkansas is a state with medical underwriting, where insurance companies can get records of your health before setting premiums or allowing any coverage at all. A person with an autism diagnosis cannot get past medical underwriting. That person can, however, enroll in group medical coverage or medicaid programs.

Any time a doctor or therapist lists “autism” as the medical cause on the billing form, your claims will often be denied. After an autism diagnosis, many patients must constantly refile claims. Make sure your doctor or therapist lists the correct, covered, medical condition.  Autism is excluded from medical insurance coverage, although you can receive treatment for many of the conditions around autism: ADHD, anxiety, fine motor skill delays, etc.

An autism diagnosis in many ways gives you a general picture of your child’s difficulties, but new frustrations appear soon. The worst frustration is that while there’s the generally accepted autism treatment method, ABA therapy, there is almost no funding for the expensive treatment. It’s like looking at Thanksgiving dinner through the plate glass window. You may be hungry, you need food, but you’re not getting any. Currently the intensive autism therapies are out of reach for most Arkansas families.

One point of frustration for parents is that many entities can make an initial screening for autism, but don’t.  Parents easily find internet checklists and often guess autism, but professionals in daily contact with the child rarely share their opinion. Parents often spend time hearing hints to read books on autism and suggestions to go to “Dennis” but have no understanding of what’s going on.

These other possible sources of an autism diagnosis are:

• School IEP teams
• Pediatricians
• Assorted therapists
• Psychiatrists
• Many doctors

Why so little advice from professionals? I think it’s because many of the above groups are very reluctant to tell the parents the bad news: “Your child has a disability that almost no one will pay to treat,” “I kinda think he might have—well—autism.  Ask someone who knows more.” “I can diagnose autism but can’t help you.  You have a 5-minute visit." Why give a diagnosis of autism when there are no resources, no 800 numbers to call for state help?

Also, a definitive autism diagnosis takes a lot of time with consultation among many different professionals.  The isolated professional will feel very uncomfortable stepping forward to give a diagnosis of autism, a diagnosis that can be overruled by a more experienced evaluation team.

ACCESS School of Little Rock offers autism diagnoses.  An Access psychologist and speech therapist work with the child's physician to develop a 3-part autism diagnosis.

UAMS Schmeiding Center in Lowell. A branch of the Dennis Developmental Center, the Schmeiding Center can also offer expert diagnosis of autism.

UAMS Dennis Developmental Center in Little Rock. The Dennis Center has several developmental pediatricians on staff to diagnose autism.  Dennis also has a full staff of other specialists to help with a diagnosis.  Their diagnosis is the 3-part diagnosis needed for HCBW.

The major complaint with the Dennis Center is the long wait.  Families can wait for 6 months or more for an initial appointment.  Currently Dennis is trying to make sure the most severely delayed children are seen first. Younger children are also seen more quickly.  If you have a child of above age 7, the wait may be a year or more.

Update on Tuesday, October 20, 2009 by EyeContactArkansas

Pediatrics Plus in Conway now offers Diagnostic Services for all developmental disabilities including autism.  Their evaluation uses a neuropsychologist, social worker, occupational therapist, and speech therapist. An OT and ST evaluation, IQ test, followed by a ADIR history with the parent begins the autism evaluation.  A psychological examiner gives the child the ADOS test for autism. Afterwards the social worker visits the child in a school or daycare environment. With all of this information Pediatrics Plus then gives a diagnosis or referral for further medical testing if needed.

The program has just started taking BCBS insurance and will be adding other private insurance shortly. Pediatrics Plus does not have an MD on staff but does consult heavily with the family's current doctors.

Please contact Jenny Kabantac, 501-329-5459 for more information.

Update on Tuesday, October 20, 2009 by EyeContactArkansas

The University of Tennessee Boling Center in Memphis, TN can do evaluations for autism.  The Boling Center accepts both Arkansas medicaid and private insurance.

Public schools must by federal IDEA law provide free evaluations for developmental disabilities. If you the parent are ever worried about your child meeting developmental milestones, write a letter to your local school district's special education department.  In the letter request the school evaluation program called "child find." The school must now meet with you and schedule an evaluation, even if your child is too young for school or attending private schools.

Public schools in Arkansas will usually not screen and diagnose for autism.  The schools, will, however, begin therapy services for your child such as speech, social skills, and occupational therapy.

Public school special education services don’t depend on an autism diagnosis either, only that the child has disabilities that affect his or her education. Federal IDEA law does recognize autism as a specific disability that needs consideration for an IEP and other school services. In general children are better protected under IDEA law than under the more lenient 504 plans. However, many schools seem to place children with autism into other disability categories such as speech impairment. Whether or not a family feels that this disability category is suitable should be discussed at the IEP meeting.

As long as your child is getting services you feel her or she needs, no matter what the medical diagnosis, you should feel comfortable with the school's special education approach.

There is one huge hazard in being in the wrong IEP disability category.  Autism is a disorder that causes many behavioral difficulties in children.  When the district checks off "speech impairment" or other difficulty, you the parent may be downplaying the behavioral troubles of your child.  It doesn't matter if he or she is an angel 95% of the time, then has an uncontrollable tantrum.  Your child may need a positive behavior support plan or exemption from the school's normal rules of discipline.