Over the last several decades, Autism emerged in the world of clinical research and the social zeitgeist. As of 2018, research indicates that Autism occurs in approximately 1 in 54 children or in 2.5% of the United State population (Baio et al., 2018; Kogan et al., 2018). Autism is a neurodevelopmental condition characterized by challenges with social-communication and the presence of restricted and repetitive behaviors (RRBs), with symptoms beginning in early developmental years (APA, 2013).
In order for a child to receive a clinical diagnosis of Autism, one must participate in a comprehensive evaluation with a credentialed professional, including clinical psychologists, psychiatrist, developmental pediatricians or providers who have received training on standardized assessments.
In the state of Michigan, Blue Cross Blue Shield (BCBS) and Blue Care Network (BCN) insurance providers require an Approved Autism Evaluation Center (AAEC) conduct the evaluation. AAECs are state-regulated evaluation sites that undergo routine credentialing to ensure that clinicians are following evidence-based and validated practices to diagnose Autism. Obtaining an AAEC evaluation is necessary for BCBS and BCN authorizing additional therapeutic services to treat Autism, including speech therapy, physical therapy, occupational therapy and/or Applied Behavioral Analysis (ABA).
How do I know if my child needs an AAEC?
If your child demonstrates any challenges related to language/communication, physical development, independently completing activities of daily living (ex: feeding, dressing, toileting), fine/gross motor, or significant behavioral challenges (ex: physical aggression towards self or others).
What if my child is evaluated by a non-AAEC?
There are many highly qualified clinicians who diagnose Autism; however, BCBS/BCN will NOT authorize additional services without an AAEC.
What is a Bridge Authorization?
In some cases, BCBS/BCN will accept a non-AAEC evaluation to temporarily initiate supportive therapies, while a family is placed on a wait-list for an AAEC evaluation. Please consult with your insurance provider regarding acceptance of bridge authorizations.
How do I find an Approved Autism Evaluation Center?
Please communicate with your insurance provider to obtain a verified list of providers. A list of credentialed sites can be found here: https://www.bcbsm.com/content/dam/public/Common/Documents/approved-autism-evaluation-centers.pdf
What does an Autism Assessment Involve?
A standard Autism evaluation will include the following:
1) Cognitive Assessment (WISC-V, WJ, Stanford Binet, Leiter-3)
2) Adaptive Assessment (Vineland, ABAS-3)
3) Comprehensive Developmental and Behavioral Interview (ADI-R)
4) Social-Communication/Behavioral Assessment (ADOS-2)
This information serves as a starting point for families navigating the world of Autism assessments for their children. It should be noted that every single child is unique and it is highly recommended that families consult with their pediatrician and/or provider in order to obtain information about Autism evaluations.
Additional Resources:
Autism Alliance of Michigan - https://autismallianceofmichigan.org/
AAEC Sites - https://www.bcbsm.com/content/dam/public/Common/Documents/approved-autism-evaluation-centers.pdf
Adventures in Autism podcast with Megan Carranza
Citations
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., ... & Dowling, N. F. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1.
Kogan, M. D., Vladutiu, C. J., Schieve, L. A., Ghandour, R. M., Blumberg, S. J., Zablotsky, B., ... & Lu, M. C. (2018). The prevalence of parent-reported autism spectrum disorder among US children. Pediatrics, 142(6).