Cordelia Robinson, Ph.D., RN Professor of Pediatrics and Psychiatry CU School of Medicine 1 Issues...
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- Slide 1
- Cordelia Robinson, Ph.D., RN Professor of Pediatrics and
Psychiatry CU School of Medicine 1 Issues and Resources for
Intervention for children with Autism Spectrum Disorder in
Colorado
- Slide 2
- Autism Issues to Keep in Mind 1. There is no definitive
biologic test for ASDs, however they are thought to be highly
heritable. 2. Clinical diagnosis is based on three core behavioral
dimensions: Communication delay or deficit Impaired social
interaction Repetitive behaviors and restricted interests 3. There
is a broad range of functioning among people with a diagnosis.
2
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- 3 Total = 25,451 Autism Spectrum Disorder in Colorado Not based
on current numbers
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- Issue Implications of DSM-V Does away with Spectrum; term is
Autism Combines Social and Communication domains Proposes a
Severity Rating System 4
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- Proposed Dimensional Ratings for ASD in DSM-V Social
Communication Fixated Interests and Repetitive Behaviors Requires
very substantial supportMinimal social communicationMarked
interference in daily life Requires substantial support Marked
deficits with limited initiations and reduced or atypical responses
Obvious to the casual observer and occur across context Requiring
support Without support, some significant deficits in social
communication Significant interference in at least one context
Subclinical symptoms Some symptoms in this or both domains; no
significant impairment Unusual or excessive but no interference
Normal variation Maybe awkward or isolated but WNL WNL for
Developmental level and no interference Proposed DSM Severity
Rating System. Lord, C. (2011). What Would "Better" Diagnosis of
ASDs Look Like?: DSM-5 and Beyond, (AUCD webinar)
http://www.aucd.org/resources/webinar_detail.cfm?event=2504&parent=740.http://www.aucd.org/resources/webinar_detail.cfm?event=2504&parent=740
5
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- Eligibility for Services in Colorado ASD diagnosis eligible for
Part C, Early Intervention Colorado
http://www.eicolorado.orghttp://www.eicolorado.org Early
Intervention Colorado Autism Guidelines for Infants and Toddlers
http://www.eicolorado.org/Files/EIColorado%2
0Autism%20Guidelines%2010-21-10_FINAL.pdf
http://www.eicolorado.org/Files/EIColorado%2
0Autism%20Guidelines%2010-21-10_FINAL.pdf Colorado Medicaid
children with Autism Waiver 75 eligible at one time, waiting list
is over 250 children minimum time on 3 years must go off at age 6
6
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- Eligibility for Services in Colorado Educational system
eligibility based upon educational needs School districts vary
greatly A medical diagnoses of autism does not make a child
eligible for school services 7
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- Eligibility for Services in Colorado Adults Currently only
eligible if meet developmental disability criteria. Currently
Community Centered Boards base criteria almost inclusively on IQ
below 70 8
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- Colorado Insurance Legislation 1. Denial of insurance coverage
- 1993 SB93-113 Insurance Concerning the Coverage for Disorders
Related to Autism in Health Care Coverage Policies Declares Autism
a Medical not a Mental Health Condition 2. Medicaid Children with
Autism Waiver - 2004 SB04-177 to get access to behavioral services
for children with autism 9
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- Colorado Insurance Legislation 3. Access to Mental Health Care
2009 SB09-244 Clarifies access to Mental Health Care for
Co-occuring Conditions 4. Health Insurance Mandated Autism
Treatment - 2009 SB09-244
http://www.autismcolorado.orghttp://www.autismcolorado.org 10
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- What is the Evidence Base for Intensive Treatment for Autism
2000 National Research Council Recommendations of 20 hours per week
of direct intervention fostered the push for insurance legislation
Based on consensus of opinion of those who provided comprehensive
early intervention against community comparison groups Only common
metric across the intervention - hours Research now calling for
more specific documentation of intervention. 11
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- What is the Evidence Base for Intensive Treatment for Autism
AHRQ Report Comparative Effectiveness Review Number 26
http://www.effectivehealthcare.ahrq.gov/ehc/products/106
/651/Autism_Disorder_exec-summ.pdf
http://www.effectivehealthcare.ahrq.gov/ehc/products/106
/651/Autism_Disorder_exec-summ.pdf Behavioral Educational Medical
and related interventions Allied health Comprehensive and
Alternative Medicine 12
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- 13
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- Priorities for Intervention A means of Communication
Predictable Daily Routines
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- Message to Primary Care Keep general health in mind Pay
attention to sleep, nutrition, self care, any hint of self injury
or aggression These questions should be asked specifically
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- Autism Speaks Mission At Autism Speaks, our goal is to change
the future for all who struggle with autism spectrum disorders. We
are dedicated to funding global biomedical research into the
causes, prevention, treatments, and cure for autism; to raising
public awareness about autism and its effects on individuals,
families, and society; and to bringing hope to all who deal with
the hardships of this disorder. We are committed to raising the
funds necessary to support these goals. Autism Speaks aims to bring
the autism community together as one strong voice to urge the
government and private sector to listen to our concerns and take
action to address this urgent global health crisis. It is our firm
belief that, working together, we will find the missing pieces of
the puzzle. Autism Speaks. It's time to listen.
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- Autism Treatment Network
http://www.autismspeaks.org/family-services/tool-kits
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- Autism Treatment Network Autism Speaks provides many
resources
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- The Childrens Hospital Sleep Lab Picture Book of Michael
Getting a Sleep Study
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- Michael is going to Childrens Hospital to be in a sleep study
so that his doctors can learn more about how he sleeps.
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- When you come to the lab, we will see how tall you are and how
much you weigh.
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- Autism Medical Home Website has many suggestions
http://www.waisman.wisc.edu/nmhai
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- Cordelia Robinson Rosenberg, PhD, RN Professor of Pediatrics
and Psychiatry Director, JFK Partners
Cordelia.rosenberg@ucdenver.edu 303-724-7680 23