You don’t understand why your child acts the way she does, or perhaps, you’ve always wondered why you act the way you do; you suspect an autism spectrum disorder and you’re ready to seek some answers.
Where do you begin?
The first thing is to understand why a diagnosis or formal evaluation is important. First, and foremost, while there may be some overlap with respect to treatments for a variety of developmental conditions, it is best to be as specific as possible to address the needs of your child and to target the interventions that will have the greatest effect.
Secondly, but potentially as important, is the fact that in order to obtain the necessary services for your child from the public school system or other public agencies, you will need to prove that he or she needs the services. Unfortunately, they won’t take your word for it.
Even if you don’t need to rely on public institutions to provide services for your child, more likely than not, you may still be dealing with a health insurance provider and they are just as discriminating with respect to what services they will provide for which conditions (See Health Insurance Advocacy pages for more information).
In short, unless you are completely financially independent, you will need a professionally administered educational and/or psychological evaluation or diagnosis in order to begin the vitally necessary services for your child.
Diagnosis or Evaluation: Is There a Difference?
Yes. While the two terms are often used interchangeably, there is a difference. Diagnosis refers specifically to the conclusion/s drawn after a medical (including psychological) examination. This will often involved the use of a series of standardized tests (especially with very young children) and, assuming the examiners are able to make a definitive diagnosis, it will involve a diagnostic code that is used by health agencies and insurance companies for billing purposes.
A medical diagnosis of an autism spectrum disorder differs from an educational evaluation primarily in the different criteria used for each arena.
While there are significant areas in the criteria used by each group, it is possible for a child to qualify medically as having an autism spectrum disorder but not qualify for special education services and it is also possible, although not as likely, for a child to be considered eligible for special education services and not meet the DSM-IV criteria used in the medical arena.
So which is better to get?
Unfortunately, both may be necessary to obtain. Some school districts will accept a medical diagnosis of an autism spectrum disorder in lieu of doing their own educational evaluation. Some will incorrectly require a medical diagnosis in order to provide educational services. If this true in your case, please see the educational advocacy section of this website for more information.
However, in most cases, other public institutions and health insurers will only accept an educational evaluation as supporting or background information to help them make decisions. They will likely still require a medical diagnosis.
In theory, any licensed psychologist or psychiatrist trained to use the DSM-IV can make a diagnosis of an autism spectrum disorder. In practice, that licensed professional will very likely need to have a significant amount of experience with autism in order to make a qualified diagnosis.
One approach to diagnosis is the use of a multi-disciplinary team of (usually) a psychologist or psychiatrist, a speech therapist and an occupational therapist. While these comprehensive examinations are beneficial in drawing an accurate picture of the child’s strengths and weaknesses that make for an excellent blue print for how to proceed with treatment; they are often expensive, not always covered by health insurance and very time-consuming. The examinations can take up to 20 hours to complete and as long as several months to schedule, administer and provide feedback in the form of detailed reports.
With such importance on early intervention with any developmental disability — especially something as potentially pervasive as an autism spectrum disorder — an approach toward diagnosis and evaluation is to go take the shortest path and the one that offers the least resistance. Your school district’s Child Find, Early Childhood Education and/or autism team are charged by the state and federal governments to perform such evaluations in a timely fashion and to provide services as quickly thereafter as is practical.
Start there, but don’t stop there.
Check your area resources to see if there is a qualified, licensed psychologist who has experience making diagnoses on the autism spectrum. If not, expand your geographical search circle until you find one.
You can stop there and you should have enough to seek public services and supports as well as satisfy the health insurers.
If you would still like to pursue a full, multi-disciplinary team evaluation at this point; you will likely not have lost as much time while you were waiting to schedule the comprehensive tests, etc., involved in such an approach. Again, these examinations will prove invaluable in addressing your child’s needs in the future.
Summary:
Step One: Submit a written request for an educational evaluation from your local school district. Thoroughly review the educational advocacy section of this website before you begin and be sure to call the Autism Society of Colorado office or your local educational advocate. Consult our community resource database for assistance if things don’t go as anticipated.
Step Two: Seek a psychological examination by a licensed psychologist with some experience with autism spectrum (and other developmental) disorders.
Step Three: Check to see if that provider can bill your insurance or if they will be able to assist you in insurance billing.
(NOTE: This is generally backward from the practice of checking with the insurer to find a qualifying practitioner before contacting the provider. The reason for finding the provider first is that it is important to find someone with experience in diagnosing autism spectrum disorders. This will be particularly true if there is reason to believe the diagnosis may be challenged at some time in the future. Yes, you are less likely to find someone who accepts your specific insurance plan, but if the diagnostic appointment is a covered benefit, most plans will have some provision for submitting charges for out-of-network providers. It will be worth the potentially added expense and effort.)
Step Four (optional): Seek a multi-disciplinary diagnosis. School district evaluations should also involve input from a variety of disciplines but again, such evaluations, while helpful, will likely not be accepted outside of a public school environment and, quite frankly, will likely not be as thorough.
Use the Autism Society of Colorado’s Community Resource Database and other resources to help locate providers in your area. Just because you don’t find it in our database, it doesn’t mean there isn’t such a provider in your area. It just means no one told us about them.
If you find someone in your area who is not in our database, please let us know.
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