July 22, Autism 101. Detroit Wayne Mental Health Authority. Children s Initiatives. 1 Jamesena Ingram, M. Ed., C.A.S.

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1 July 22, 2013 Autism 101 Detroit Wayne Mental Health Authority Children s Initiatives 1

2 2 Autism: Defined Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. Characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. They include autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. With the May 2013 publication of the new DSM-5 diagnostic manual, these autism subtypes will be merged into one umbrella diagnosis of ASD. Autism Speaks

3 3 Autism: Facts Autism now affects 1 in 88 children (1 in 54 boys) More children will be diagnosed with autism this year than with AIDS, diabetes & cancer combined Both genetic and environmental factors influence brain development Autism is the fastest-growing serious developmental disability in the U.S. There is no known cause identified

4 4 Autism: Warning Signs Pediatric healthcare providers should (a) tell parents and (b) recommend an immediate evaluation if the child shows two or more of the following signs: Impairment in Social Interaction: Lack of appropriate eye gaze Lack of warm, joyful expressions Lack of sharing interest or enjoyment Lack of response to name Impairment in Communication: Lack of showing gestures Lack of coordination of nonverbal communication Unusual prosody (little variation in pitch, odd intonation, irregular rhythm, unusual voice quality) Repetitive Behaviors & Restricted Interests: Repetitive movements with objects Repetitive movements or posturing of body, arms, hands, or fingers Repetitive interest to only one topic area

5 5 Autism: Red Flags o No big smiles or expressions by 6 months o Does not babble by 12 months o Does not gesture by 12 months o Does not have single words by 16 months o Does not have meaningful 2-word phrases by 24 months o Loses language or social skills (CDC)

6 6 Autism: The Cost With appropriate early intervention services, up to 50% of children diagnosed with autism will be able to attend general education in their home schools Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention Autism has $90 billion annual cost, growing to $ billion in the next 10 years

7 7 Autism: Issues Involved Autism is a spectrum Possible cognitive impairment Mental health issues Sensory issues Dietary issues

8 8 Autism: Why age matters ASD can be reliably diagnosed by 18 months Symptoms can present as young as 6 to 12 months old Average age of diagnosis for Caucasian child is 6 years old; Minority child is much higher

9 9 Autism: What we know works With early diagnosis and intensive early intervention, the cost of lifelong care can be reduced by two-thirds. The lifetime cost for a child with autism who does not receive proper treatment is $3.7 million (Ganz, 2008). For children who receive intensive early intervention it is reduced more than 80% to $650,000, and these children make significant progress (Ganz & Bouder, 2010).

10 10 Autism: In Michigan There are more than 15,000 children in Michigan diagnosed with autism Approximately 20% of these15,000 children reside and receive special education services in Wayne County (3,009 children from zero to 26 years of age) More than 40% of these children reside in the tricounty area (Wayne, Oakland, Macomb) Less than 20% of Michigan s children with autism receive access to successful supplemental therapies and services (Dr. Catherine Lord).

11 11 Medicaid Autism Benefit The Autism Medicaid and MI-Child Benefit covers children ages 18 months through 5 years who are diagnosed with Autism Spectrum Disorder (ASD); The Autism Diagnostic Observation Schedule-2 nd Edition (ADOS-2) will be used to determine diagnosis; The Autism Diagnostic Interview Revised (ADI-R) will be used for a developmental family history. There are two levels of intensity within ABA services: Early Intensive Behavioral Intervention (EIBI) is provided an average of hours a week (determined by behavior intervention plan) Applied Behavioral Intervention (ABI) is provided to children whose family does not choose EIBI, or children with Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS) or Asperger s Disorder. It is provided an average of 5-15 hours a week. Provider Qualifications: Applied Behavioral Analysis (ABA) services are to be supervised by a Board Certified Behavioral Analyst (BCBA); Other appropriately qualified licensed or limited licensed psychologist (LP, LLP), or a master s prepared Child Mental Health Professional (CMHP) working within their scope of practice. If a child is screened for ASD by their Primary Care Physician (PCP) and a referral for further evaluation is needed, the PCP must contact the Pre-Paid Inpatient Health Plan (PIHP ) within the patients geographical service area; The PIHP is responsible for the Autism Benefit evaluation, assessment, diagnosis and services for applied behavioral analysis for eligible Medicaid and MI-Child recipients and for the related medically necessary services under the Mental Health Specialty Services The PIHP will contact the child s parent (s) to arrange follow-up appointment for a diagnostic evaluation

12 12 Autism: References Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders Autism and Developmental Disabilities Monitoring Network, United States, 2012;61 (No.SS-3) Corsello, Christina M. (2005). Early Intervention in Autism. Infants & Young Children, Vol. 18, No.2, pp Ganz, Michael. (2007). The Lifetime Distribution of the Incremental Societal Costs of Autism. JAMA Pediatrics, Mandell, David, et. al. (March 2009). Racial/Ethnic Disparities in the Identification of Children with Autism Spectrum Disorders. American Journal of Public Heath, 99 (3), Wetherby, A., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34,

13 13 Autism: Resources Autism Every Day 7 Minute Version (video)

14 14 Contact Information Jamesena Ingram, Autism Compass Consulting, LLC Phone Number: Address: