Serving Children with Autism in South Carolina: An Update Charles R. Hatcher III, MD Developmental-Behavioral Pediatrics Greenville Health System Anne M. Kinsman, PhD Division of Pediatric Psychology Greenville Health System Daniel Davis, LMSW Director, DDSN Autism Division
Autism Spectrum Disorder (ASD) Complex disorder of brain development involving: Social Communication Deficits Atypical Behavior
DSM 5 Criteria A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history: 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back and forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
DSM 5 Criteria B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history: 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment; (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movements).
DSM 5 Criteria C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
Autism Spectrum Disorder (ASD) Complex disorder of brain development involving: Social Communication Deficits Atypical Behavior
Screening and Evaluation: Children Under 3 years M-CHAT (16-30 mo) Fail Pass Clinical Judgement/Parental Concern BabyNet STAT (18-36 mo) ABA, etc. DB Peds and Psychology ABA, etc.
Screening and Evaluation STAT does NOT equal diagnosis
DBPeds and Psy Access Requires physician referral Upon referral Under 3 years old Social Work contact Over 3 years old Intake paperwork
DBPeds and Psy Access AFTER contact occurs or paperwork is returned, THEN placed on waiting list Wait list based on age <42 months old 1 month 3.5-6 years old 4-6 months 6-8 years old 6-8 months
ABA ABA (Applied Behavior Analysis) is a validated method that can be used to teach important skills to and provide treatment for children with Autism Spectrum Disorder and other developmental disabilities. It can also be used to address problem behavior.
ABA Services Can start through BabyNet if failed STAT Beyond 3 years old: DDSN/PDD waiver Rollover if: Diagnosis given by/on 3 rd birthday Must be receiving ABA for 30 days prior to 3 rd birthday
DDSN/PDD Waiver PDD waiver Parents can self-refer by phone Application Under 3 doesn t need Dx Over 3 must have Dx Services provided 3-10 years old Diagnosed with ASD/PDD before 9 th birthday Transitioning to: Autism Spectrum Disorder Services Interim Process Phase Two
ASD Services Interim Process Requirements Medicaid Number Date of PDD services expiration (if applicable) Results of diagnostic encounter Attestation letter from qualified provider (MD, Psychologist) Comprehensive assessment report that confirms the presence of ASD DSM-V criteria Checklist for Autism in Toddlers (CHAT) or Modified-CHAT assessment form, if applicable Medical summary (last visit note, problem list) Speech and language therapy notes, if applicable Family history Past therapies profile sheet (what, how often, how long, outcomes) Genetic testing, if applicable Prior Authorization or Denial Letter from member's primary insurance carrier
Ryan s Law Requires insurance companies doing business in SC to cover ABA services Exemptions Federal employees Tricare Small businesses (<50 people) Self-insured GHS Parents should contact their provider to determine coverage.
TEFRA / Katie Beckett Based on: Level of care Child s income DDSN/PDD waiver covers if denied Requires documentation of denial
School Services Child Find Will start initial eval at 30 months School placement after 3 years old Can provide additional services through school
School Services Parents encouraged to share diagnostic reports Important for appropriate IEP Should be aware that school has to do separate evaluation (variable extent)
SC Autism Society Service coordination Autism-specific Parent School Partnership Up-to-date information
Family Connection Excellent resource for families Programs Events Other families Parent Training Information Center IEP/Education Connection Not autism-specific
Behavioral Therapy DDSN County Mental Health Private providers Be familiar with your community s services Ideally incorporates family therapy
Surveillance Monitor for associated conditions: ADHD Anxiety Language Development Oppositional/Behavioral Disorders Sleep Problems
Genetics ASD is a disorder of both genetics and environment No single genetic cause Current recommendations lean towards genetic testing as part of the diagnostic evaluation Estimated yield: 30-40% Constantly improving
Genetics Benefits Education/support Prenatal counseling Targeted management Possible prevention of comorbidities Greenwood Genetics Center contracts with DDSN/BabyNet to provide testing at no cost Referral can even be initiated through DDSN
Take Home Points Refer early Refer Early REFER EARLY! Refer to BOTH BabyNet/DDSN and DBP Screening Diagnosis (pre-educate) Confirm DDSN contact Team management approach