Obtain a Diagnostic Evaluation

Obtaining a diagnostic evaluation for autism for your child is a crucial step in understanding their needs and providing appropriate support. If you suspect that your child may be on the autism spectrum, ACES, a network of trusted autism therapy clinics, can guide you through the process and offer expert assistance. With our team of Board Certified Behavior Analysts and our extensive understanding of ABA therapy, we can help you achieve accurate diagnoses and create personalized treatment plans for your child.

1. Signs and Symptoms of Autism
   If you suspect your child may have autism, review the common signs of ASD and attend or participate in a screening for autism.

2. Schedule a Diagnostic Evaluation
   Connect with a doctor or diagnostician. Ask your local doctor or insurance company for in-network recommendations. Take the first available appointment as appointments book quickly.

3. Prepare for Your Evaluation
   Discuss your areas of concern. Gather information needed for your appointment. Be sure to ask for comprehensive reporting from your diagnosis.

4. Get Started with ACES
   Is ACES in-network with your insurance provider? The ACES team can verify benefits and get you started with ABA services.

5. Connect with Support and Networks
   Get engaged with community resources to support you on your journey.

If you want insurance to cover applied behavior analysis (ABA) therapy or other autism-related services, at ACES or anywhere else, a crucial step is to obtain a diagnostic evaluation. While some families private-pay for services, the vast majority use insurance and the bottom line is: no evaluation, no reimbursement.

If you’re considering treatment for your child, you’ve already been through a lot. To reassure you about the road ahead, here’s a guide to how families like yours have found their way to effective therapies and support.

1. Learn What to Look For

It could be a pediatrician asking probing questions. It could be sensing that your child isn’t keeping up in play group. It could be wondering what’s normal when it comes to emotional regulation. If something is leading you to suspect autism, here’s what to look for:

• By 9 Months: Little or no back-and-forth sharing of sounds, smiles, or facial expressions. Lack of imitated gestures such as waving or pointing.

• By 12 Months: Lack of babbling that includes long and short chain sounds like “bababa.” Limited use of gestures such as reaching, showing, pointing, or waving. Little or no response to name. First words are not emerging or not increasing in use.

• By 16 Months: Lacks consistent use of single words. Not saying “mama” and “dada” with the intent to gain attention. Does not turn pages of a book or give hugs to stuffed animals. Does not seek help to fix a toy or get an object. Lacks imitation of simple movements such as marking paper with a crayon.

• By 24 Months: Very few or no meaningful two-word phrases (not including imitating or repeating). Limited pretend play and reduced interest in other children as compared with peers. Not following simple instructions. Doesn’t comfort others in distress. Doesn’t calm within 15 minutes of a tantrum.

• Between 2 and 3 Years: Lacks interest in discovering “why” and “how.” Doesn’t consistently show interest in longer stories. Cannot identify own body parts. Not using three- and four-word phrases to express self. Not comfortable with feeding utensils. Less interest in hugs and giving affection. Higher activity level than peers.

2. Schedule a Diagnostic Evaluation

If your child has some of the above signs, it does not necessarily mean they have autism. However, the American Academy of Pediatrics recommends autism screening for children showing these signs between the ages of 14 and 24 months.

Getting a diagnosis can vary a bit by state and insurance plan. A licensed clinical psychologist or physician can diagnose autism in all states. In some, other health professionals can do so as well. And some insurance plans will require a full psychological evaluation.

Ask your pediatrician to provide a diagnosis, or to refer you to a neurologist, developmental psychologist, or developmental pediatrician. If self-referring, call the customer service number on your insurance card and ask for an in-network provider who can do an autism diagnostic evaluation.

3. Schedule and Prepare for the Appointment

Once you receive a list of in-network providers, call and take the first available appointment — these can fill up fast.

If you’ll be seeing a psychologist, they’ll use a combination of parent interview, developmental history, and current levels of functioning. They’ll also spend some time playing with your child before reaching a conclusion. They’ll be guided by an assessment tool called ADOS-3: The Autism Diagnostic Observation Scale.

If a physician will be doing the evaluation, they’ll use a combination of a symptoms checklist, observation, developmental history, and current levels of functioning to reach (or rule out) a diagnosis. They’ll be on the lookout for conditions that sometimes mimic autism, such as genetic disorders, other developmental delays, severe speech and language delays, and environmental factors.

Here are some things you can do to prepare:

• Be ready to share your child’s strengths as well as areas of concern.

• Have as much information as possible on behaviors to discuss such as frequency, severity, duration, as well as common locations and/or potential triggers.

• Bring snacks — these evaluations can last a few hours.

• Diagnosticians will also benefit from seeing your child play or handle objects, so consider bringing a few items like a favorite toy.

4. Get the Report

It will take the diagnostician a few days or weeks to compile a formal report. Be sure to mention during the visit that you’d like to be notified as soon as it’s available and request a physical and digital copy. After all, this document is the “keys to the kingdom” for obtaining services such as ABA therapy.

5. Learn About ABA (and Learn More About Insurance)

Assuming your child receives an autism diagnosis, it’s time to chart the path forward for the best possible academic and social outcomes. Like many educators and health-care professionals, ACES advocates early intervention with ABA therapy. ABA is based on the principles of behaviorism, which state that behaviors can be learned and modified through reinforcement.

Contact your insurance provider again and ask to speak to someone about your ABA benefit. Be sure to specifically ask for in-network, outpatient services. ACES is in-network with more than 100 insurance plans and we would be happy to help you determine the details of your plan. Most policies require members to participate financially, yet many ACES families wind up paying less for their child’s therapeutic program than other families pay for traditional preschools.

If copays or coinsurance will be an obstacle, there are still options, such as publicly funded secondary insurance. There are even nonprofits and foundations that award grants, similar to college scholarships.