Redefining Autism:Legal and Clinical Implications of the New Diagnostic Criteria. Presenters: Dr. Elizabeth Roberts-NYU Child Study Center and Andrew Leninberg, Attorney at Law 11/28/2012

This presentation by Dr. Roberts was an excellent review of the current sub-types as listed in the DSM-IV. These include PDD-NOS, Autism, and Asperger’s Syndrome. Then process and procedures currently utilized to diagnose were clearly explained, such as, the Autism Diagnosis Interview R, Krugs Asperger Disorder Index, observation, Schedule 2 of the ADOS-2, and rating scales like “Friendship Questions” and “Social Responsiveness” lists. Key elements of diagnoses include deficits in social communication, social reciprocity, and behavior such as repetitive play and repetitive motor behavior. The various assessments were explained as well as test criteria. A common set of behaviors are noted.

Proposals of the DSM-V indicate that these subtypes are being replaced with Autism Spectrum Disorder (ASD). Diagnoses will be made purely by behavioral symptoms than further distinction by severity levels. The issues raised by this change include different disorders being diagnosed by different clinicians, as well as changes in diagnosis could be made differently from year to year. It was noted that there is a fear that higher functioning individuals will no longer have a diagnosis and will not be able to access services. An uncertainty exists about how this will be perceived by state, educational entities, and insurance companies.

Additionally, legal ramifications of changes in and Autism diagnosis were discussed. This includes Parity Laws affecting insurance coverage for children with Autism. According to IDEA, if a child is classified he/she is entitled to FAPE in the least restrictive environment as long as services are required for an appropriate education. Currently, children with Autism diagnoses must present with 6 out of 12 behaviors in the areas of social interaction, communication and behavior. The proposal under the category of ASD in the DSM-V will include three deficits in the singular category of communication and social interactions and two repetitive behaviors. Mr. Leninberg indicated that New Jersey may not be affected by the change as the definition is so broad. A new category will be introduced: Social Communication Disorder. These individuals who would be considered high functioning could be left out of ASD with the new DSM-V. These individuals present with some social and communication deficits as Autism but not the repetitive behaviors. Potentially, qualification for services could fall under the classification category of Communication Impaired.

In summation, these changes should not affect services under the Department of Developmental Disability (DDD) for the purposes of DDD eligibility according to Mr. Leninberg. He also noted that needed ABA services can be provided through insurance of mental health benefits at the “Parity” level. Under Federal statutes, individuals with mental disorders or developmental disabilities cannot be discriminated against in receiving ABA therapy. Medicaid must pay for screenings, PT, OT and speech and language treatments of Autism. Behavioral therapy is a health care service covered under an IEP. It is not just academics alone to qualify for services.