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. An adult with an autism diagnosis cannot get past medical underwriting, but starting in 2011 the Obama healthcare changes require that all children be accepted into private insurance pools. Adults will all be accepted in 2014. However, insurance can still charge a higher rate based on your pre-existing condition.

In fall 2011 Arkansas has started a private insurance mandate for autism therapy coverage. The mandate only applies to non-ERISA insurance, the teachers' insurance pool, and the state employees' pool. 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 unless you are in one of the private insurance mandate groups. After an autism diagnosis, many patients must constantly refile claims. Even getting an autism diagnosis is rarely covered by insurance. 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. The new private insurance mandate will provide ABA services for non-ERISA private plans, state employees, and teachers insurance pools.

Public schools in Arkansas will usually not screen and diagnose for autism.  A few school personnel have been trained in autism assessment, including CIRCUIT professionals. CIRCUIT is a statewide group, many of whom have extensive training in ADOS autism assessment. Please contact them via their website HERE for help.

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.

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.

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 and spring 2011 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 2011.  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.

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.

Around the U.S., an autism diagnosis is most frequently done by an individual clinical psychologist, developmental pediatrician, neurologist, or psychiatrist, according to the IAN survey by the Kennedy Krieger Institute. Only 11% of the time is a diagnosis given by a team of school professionals.

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.