Autism Re-Evaluations: The When, Why, & How

Meet Noah – he is a 5-year-old boy who was diagnosed with autism when he was 2 years old. Noah has been receiving Naturalistic Developmental Behavioral Intervention (NDBI), an evidence-based approach to Applied Behavior Analysis (ABA) at a clinic in Birmingham, Alabama for the past few years. He has made excellent strides in therapy, including his ability to communicate using his augmentative and alternative communication (AAC) device, tolerate having his teeth brushed, and work toward independence in toilet training. While considering treatment goals, Noah’s family is notified that an autism re-evaluation will be required to continue accessing these services. Does this sound familiar?

Understanding Autism Re-Evaluations

You may be asking yourself, “If my child already has an autism diagnosis, why do I need to go through the evaluation process all over again?” If you relate to most families in the United States, you probably made numerous phone calls, sat on long waitlists, and dealt with the costs (both time and financial) of getting your child evaluated for autism. And that doesn’t even include navigating the process of initiating therapies! We recognize that you, your child, and their providers have been collaboratively working together to identify goals and devise treatment plans to fit your family’s unique needs.

Although your Board-Certified Behavior Analyst (BCBA) is likely conducting regular assessments to monitor progress and adjust your child’s treatment plan, some insurance providers require autism re-evaluations to continue providing coverage for ABA services. These re-evaluations are commonly required every two to three years, and they are essentially a confirmation of medical necessity. Although many autistic children receive school-based services through an Individualized Education Program (IEP), which also involves re-evaluations every few years, these are educational rather than medical in nature. Instead of using these evaluations to access healthcare, they are intended to determine whether children continue to qualify for special education services and adjust their IEPs as needed. This means that – you guessed it – they will not be accepted by your insurance company.

Streamlining the Re-Evaluation Process

At Upward Behavioral Health, we aim to make this process more streamlined and accessible for families who are facing a potential “service limbo” while awaiting re-evaluation. If your child has an autism diagnosis and has been benefitting from their ABA services, there’s no need to reinvent the wheel. In other words, we do not need to put your child through extensive testing because the goals of these evaluations are very different from their initial evaluation. Instead, we prioritize the following:

1) Confirming the continued presence of a DSM-5-TR diagnosis of Autism Spectrum Disorder (ASD). This may be done using tools such as the ADI-R, CARS-2, SRS-2, and/or MIGDAS-2, depending on your insurance provider’s requirements.

2) Providing updated scores on measures of developmental and adaptive functioning as needed. This may include measures such as the DP-4 and Vineland-3.

3) Reviewing records (e.g., initial evaluation, IEP, ABA treatment plan) and integrating this information with the above data into a written report.

4) Making recommendations to support access to evidence-based interventions, which may include continuing ABA services, and providing other resources based on family concerns.

What to Expect During the Re-Evaluation

Our autism re-evaluations are conducted virtually via telehealth, which can help to fill a critical gap in services! There are several perks of using this approach to evaluation:

· Reducing transportation and geographic barriers to care for families in rural and underserved areas. We are licensed to provide evaluations in almost every state.

· No lengthy waitlists, which allows us to schedule evaluations sooner and complete documentation in a timely manner.

· Ability for families to participate in evaluations from the comfort of their home, which gives us the opportunity to see your child in a more naturalistic observation and can potentially reduce anxiety associated with being in an unfamiliar clinical setting.

Supporting Families Through the Process

If you are an ABA provider who could benefit from additional referral sources for autism re-evaluations, or you are a parent of a child in need of a re-evaluation for ongoing ABA services, reach out to us! Dr. Kathleen “Katie” Ramsey, licensed clinical child psychologist, has expertise in autism evaluation. Our team would be honored to support you in navigating this process, ensuring continuity of care, and reducing barriers to accessing services. To schedule a free 15-minute consultation call and learn more, visit: Schedule An Appointment | Upward Behavioral Health.