Autism rates throughout the U.S. have been climbing steadily within the last 20 years. One possible explanation is that there is a greater attention to detection of autism at an earlier age. Autism specialists can arrive at excellent detection rates in children as young as 18 months, in many cases. Some children, adolescents, and adults with autism have gone undiagnosed for a variety of reasons. The manifestation of the condition may have been mild or subtle. The medical professionals in a person’s life may not be trained in detection of signs of autism. The person may have been misdiagnosed with other conditions, such as ADHD, personality disorders, cognitive impairment, or anxiety. Insurance may not have covered autism evaluations and treatment, which leads to underutilization of diagnostic and treatment services.
In the state in which I practice, Michigan, there is a legislative mandate that autism diagnostic and treatment services must be covered by insurance. This has led to an explosion of autism diagnostic and treatment centers in the major metropolitan areas of the state. In addition, Tik Tok and other social media platforms sensitize individuals to signs and symptoms of a variety of medical conditions. These factors have increased our collective awareness of autism. With this proliferation of interest in diagnosis and treatment of autism comes the potential that there will be a lessening of rigor in the diagnosis and treatment of autism. The “bandwagon” mentality is a real thing in healthcare, and must be very seriously managed by a greater awareness and understanding of what constitutes good care.
10 Warning Signs of sub-standard care in the diagnosis and treatment of Autism
- Online questionnaires – Publicly available, online questionnaires cannot and do not diagnose autism. They may serve as screening tools but they do not diagnose any mental health condition, including autism.
- Virtual evaluations – Standards of care require, in most cases, that initial diagnoses of autism require in-person evaluations. Anyone who is saying virtual autism evaluations are as valid and reliable as in-person evaluations should be viewed with skepticism.
- One-test diagnosis – No one diagnostic test diagnoses autism. There are many elements of autism which require a complex battery of tests, specifically chosen for an individual’s age and symptoms.
- No speech/language evaluation – For children, adolescents, and some adults, a language evaluation is a necessary component of the evaluation, unless language scores are available for review from an alternate site. Particularly for children and adolescents, the evaluator should be asking about recent language testing, by a speech and language pathologist, or arrange to have it done as part of the autism evaluation. In older adolescents and adults, language skills can many times be inferred by a person’s educational and work history so that outside language scores do not need to be established.
- Evaluator is not properly trained – The evaluator needs to be proficient in the diagnosis of a wide variety of other mental health conditions as a way of making a specific diagnosis of autism as opposed to some other mental health condition. Differentiating autism from other, similar, or overlapping conditions, is a critical skill and needs to be within the evaluators scope of practice.
- Developmental history is not taken – Autism is a developmental disorder. In all cases of diagnosis, the evaluation needs to explore early manifestations of autism, not just current concerns. A comprehensive evaluation of development and developmental concerns is necessary.
- Insurance and payment issues are not thoroughly discussed prior to the evaluation – In Michigan, insurance coverage of autism evaluations and treatment is very complicated. In many cases, insurance will not cover an evaluation or treatment unless specific “approved” or “participating” providers are used. Paying out of pocket for evaluations can also be problematic. In some cases, an autism evaluation must be made by an insurance “approved” provider in order to have subsequent autism related therapy services covered by insurance, even if the evaluation was paid out of pocket. An autism evaluator who does not explain the costs and limitations of their evaluation should be avoided.
- The evaluation does not include a feedback session or assistance to next-steps – One of the most important steps in any psychological evaluation is the feedback session, where the evaluator spends time working with the individual or family to understand the results of the evaluation in common-everyday language and in a manner that helps a person take the next step towards help.
- The overall medical health, mobility, life stressors, and family/community supports are not factored into the diagnostic process – It is extremely important that the evaluator has a clear sense of the resources and limitations available to the person being evaluated and how these factors may impact the diagnostic process. These elements are also important in guiding the individual or family to follow up services.
- The evaluator lacks follow up resources to offer the patient or the patient’s family – No one wants to be evaluated by someone who renders a diagnosis and leaves the patient/family left without local resources to manage the diagnosis. An evaluator who guides you only into their treatment center should be seen with skepticism. The evaluator should have a very knowledgeable understanding of the local autism community and what resources are available.
Dr. Bloom has been doing autism evaluations in Michigan for 15 years. He sees patients of all ages, toddlers to adulthood. He is on staff at two Blue Cross Approved Autism Evaluation Centers, in Oakland County (direct service) and Genessee County (consultative service.) Dr. Bloom also does autism evaluations at his office at Start My Wellness in Ferndale, Michigan for selected cases. If you would like additional information about autism evaluation and treatment, please provide your email address and Dr. Bloom or someone from Start My Wellness will contact you.