If you’ve spent time researching Autism Centers in your region, you’ve likely noticed that almost all will require families to have an official Autism diagnosis before a child can enroll in services. And, though this is common practice among clinicians, it’s not always clear why a diagnosis is a requirement for care. In this article, we’ll answer that question and help you take the first steps toward accessing assessment services.
What is Autism?
According to the CDC, “Autism Spectrum Disorder (ASD) is a developmental disability caused by differences in the brain . . .” In most individuals, these differences in brain development will affect social skills, communication, and behavior to varying degrees. Delays can usually be identified early in life, often before a child’s second birthday.
A common misconception is that individuals with Autism “look” a certain way. In reality, there are no real “physical” attributes associated with ASD. Signs of Autism are typically behavioral in nature – for example, regressions in learning (losing a previously learned skill), lack of emotion, repetitive gestures (stimming), avoidance of eye contact, elopement, self-harming behaviors, limited imaginative play, challenges with transitions or social skills, etc. For a more comprehensive list of characteristics, click here.
Why is a Diagnosis Typically Required for Services at an Autism Center?
Now that we understand what Autism is, we can look more in-depth at two key reasons why a diagnosis is a critical part of ensuring your child gets access to high-quality care.
1. It helps our clinicians understand your child’s strengths and challenges.
An Autism evaluation, usually referred to as a Comprehensive Diagnostic Evaluation for Autism (CDE) or a Comprehensive Multi-Disciplinary Evaluation (CMDE) in Minnesota, is a thorough, detailed assessment of your child’s development.
The CDE/CMDE is actually made up of several “smaller” assessments that evaluate for Autism (like the ADI-R or ADOS-II), speech and language delays, sensory processing disorders, mental/emotional health concerns, and more. You can think of these smaller assessments as individual puzzle pieces and the CDE/CMDE as the fully completed puzzle.
That full puzzle is what provides us with an accurate diagnosis of Autism and any other co-occurring disorders, for example, Autism plus ADHD or a speech delay. But, those smaller puzzle pieces are just as important as the full puzzle. They provide our clinicians with detailed information to help us understand where your child thrives and where they might need help. In short – a diagnostic report gives us the information we need to create effective, tailored, treatment plans for your child.
2. Insurance Carriers Require an Official Diagnosis to Provide Coverage
A second reason why nearly all therapy providers require a diagnosis is to ensure families receive coverage for services through their health insurance plan.
Most carriers, with the exception of Hawki (in Iowa) and some trade union plans, will include at least partial coverage for ABA therapy services. However, insurance companies require providers, like Midwest, to submit a copy of a child’s CDE/CMDE before they will approve coverage.
This is a critical piece of the enrollment process because therapy costs add up quickly. For example, an average 2-year-old with Level 2 Autism will require 30-40 hours of early-intervention ABA therapy each week (keep in mind this is a general scenario that won’t apply to every child on the Spectrum in this age group.) On average, therapy services cost around $150/hour. That’s more than $5,000 per week for care. It’s a bill that, understandably, most families can’t afford to pay out-of-pocket. Using insurance coverage, families end up paying far less, in some cases, just a copay for each appointment.
How to Get a Diagnosis
If you think your child might be on the Autism Spectrum, it’s important to consult with a medical professional who can help kick off the evaluation process. Sometimes this means starting with your child’s Primary Care Provider (PCP) or pediatrician who will likely do a few preliminary screenings before referring your family to a Psychologist or Developmental Pediatrician for a full assessment.
An Autism evaluation is a lengthy process. It usually takes several hours, so the provider can observe the child’s behavior, conduct a family interview, and more. After completing the observation and interview portions of the assessment, the clinician will analyze the results and schedule a follow-up visit to discuss results and recommend next steps for treatment and support, if needed.
Helpful Resources for Next Steps
List of Diagnostic Providers
M-CHAT at Home Autism Screener (Please note the M-CHAT is not an official diagnosis it’s tool to help you understand if you should seek an assessment from a qualified provider)