HJAR Mar/Apr 2025

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 11 diagnostic evaluation. 1,4,7 InArkansas, children withMedicaid who have a well-established autism diagnosis can qualify for certain waiver programs that provide evidence-based therapies such as applied behavioral analysis. 8 To be eligible for state programs and services, state-specific requirements for a diagno- sis include: documented delineation of the DSM-5 autism criteria symptoms that the child exhibits or an autism-specific measure (AutismDiagnostic Observation Schedule- 2nd Ed. or Childhood Autism Rating Scale- 2nd Ed.), and documented agreement on the diagnosis by at least two of any three clini- cians with the following disciplines — psy- chology (doctorate level), speech language pathology, and medicine (these should be trained subspecialists such as develop- mental behavioral or neurodevelopmental pediatricians, psychiatrists, neurologists, or general pediatricians comfortable and adept at giving an initial diagnosis). Acomprehen- sive evaluation may include but is not lim- ited to assessments of thinking, adaptive, and motor skills; hearing and vision evalua- tions; and sensory processing assessments. 1 Once an autism diagnosis is given, addi- tional steps include identifying co-occur- ring conditions with autism — medical or behavioral diagnoses — and management of these; medical workup for possible etiolo- gies such as genetics testing; or neuroimag- ing, metabolic testing, and EEG if indicated based on presenting symptoms. 1,9 To align with state requirements, the UAMS James L. Dennis Developmental Cen- ter (DDC) adopts a team-based approach and conducts comprehensive evaluations in two- to three-clinician multi-disciplinary teams that include developmental pediat- rics, speech, and psychology. ADDC evalu- ation is typically comprised of a diagnostic interview and medical history and examina- tion; IQ/cognitive tests; adaptive skill mea- sures; an autism-specific measure such as the CARS-2 (ChildhoodAutismRating Scale) or theADOS-2 (AutismDiagnostic Observa- tion Schedule, 2nd Edition), which is con- sidered the “gold standard” measure; and full feedback to the caregivers regarding the impressions and recommendations made by the team. 10 What Are the Barriers to Timely Screening, Evaluations, and Care for Autism? There are several identifiable barriers to accessing medical care for autism as follows: 1. Primary care clinicians cite gaps in knowledge and low comfort level in managing initial concerns of ASD and giving continued care to children with ASD. 11,12,13 2. There is a shortage of qualified subspe- cialists that can diagnose and manage autism concerns, and autism evalu- ations require time and effort, which translates to long wait lists for an appointment. 11 3. There is also a lack of resources and qualified therapists and teachers who are experienced in helping children with ASD. 4. As Arkansas is a rural state, families face logistical difficulties such as allot- ting time and transportation for evalu- ations and visits. 5. Limited parental literacy may also affect a family’s ability to answer questionnaires or carry out recommendations. 6. Low-income families may not have financial coverage for medications, therapies, and other out-of-pocket expenses to care for a child withASD. 11 7. Non-English-speaking caregivers con- tend with a lack of bilingual therapists or providers and difficulties finding translated resources. To implement best practice for autism evaluations and quality care, these barriers need to be addressed to realize real change. There are several strategies that may help mitigate these barriers. For example, some families may need help with transportation services and interpreter services to facilitate access to medical care and come to a center for an autism evaluation. Moving through the healthcare and educational system can be overwhelming and confusing for families, especially after receiving an autism diag- nosis. Therefore, well-staffed care coordi- nation and family navigation services can assist families by bridging them to appro- priate resources and clarifying providers’ recommendations. Sustained and robust financial coverage for medications and developmental therapies that children need potentially leads to improved quality of life and developmental outcomes. Adequate funding for programs that pro- vide additional autism training for primary care providers may help PCPs in building their comfort level and knowledge base in managing developmental concerns and providing continuing care for children with autism. Currently, clinicians, particularly speech language pathologists, who have the requisite training and skills to evalu- ate autism concerns, are restricted in using certain billable codes for their assessments. Therefore, expanding reimbursement for these rendered services may help sustain clinicians in providing these much-needed evaluations. Lastly, early-career physicians may feel incentivized and motivated to pur- sue interests in intensive subspecialty train- ing in developmental and behavioral pedi- atrics if there is competitive compensation for graduates compared to other medical disciplines. 11 While screening and referral are criti- cal pieces of the equation for getting chil- dren to the help they need, it is important for our state to also problem solve how we can better educate our PCPs to feel comfort- able with identifying autism, helping them learn about resources in the state so they can guide their patients. It is also impor- tant to provide the billing codes and clinic time to allow for the appropriate screening and assessment of autism. Having a bet- ter understanding of the steps required for screening and assessment helps our state identify how to better address the issues that maybe created challenges to this end. n