Durham office with multi-disciplinary autism services open

Leaders don’t expect changes in wake of autism diagnosis shift
Jan. 06, 2013 @ 07:02 PM

During a recent behavior therapy session in Durham, Kimberly Tyler held out two different Play-Doh molds, and asked 11-year-old Chloe Young to choose between them.

Tyler, an assistant behavior analyst with the Carolina Center for Applied Behavior Analysis and Autism Treatment, was working with Chloe, who has a severe form of autism, a developmental disorder.

The exercise was to help her to learn to verbalize her own choices instead of echoing or repeating what another person says, Tyler said. They also painted her nails, since one OF her goals is to tolerate grooming, she said.

Their activities are broken into small steps, Tyler said. Chloe is offered reinforcement through activities that she said are motivating to her.

Located in a building on Yorktown Avenue in Durham, the office is where Tracy Vail, an autism consultant and speech pathologist, has helped to launch a facility that combines different service providers for people with autism.

Vail co-owns Let’s Talk, a speech and language services company. In addition to Let’s Talk and the Carolina Center for Applied Behavior Analysis and Autism Treatment, two other providers are in the building. Pediatric Possibilities, an occupational therapy practice, leases space there, as does a psychologist with a practice called Spectrum Services.

The office got off the ground in November, Vail said. Not all of the office space is leased. The providers have their own patient bases, she said, and three of the four providers have other office locations in addition to the one in Durham.

Vail said the idea is that the providers can work collaboratively to provide services for patients.

“We’re starting with just the clinical services …, and the idea being that no one person could meet all the needs of the people with autism,” she said.

Molli Young, Chloe’s mother, works in the office in Durham. Her daughter didn’t talk until she was 7, she said. She said the behavior therapists fed off of what does motivate her.

“She had no interest in even trying to talk; she had no motivation for it,” she said. “They’ve really gotten to know her, and kind of feed off of her motivation, and work with her so well.”

Young said her daughter was previously going to The Mariposa School for Children with Autism in Cary, but she believes her daughter outgrew the program. She said they moved to Cary so she could continue Applied Behavior Analysis therapy.

Young said she hopes that if the practice accepts her daughter’s insurance, which is TRICARE, the health insurance program for members of the military, she can see other service providers with offices in the building. She said she was applying for Medicaid.

While she said she hasn’t had an issue getting coverage for treatment for autism for her daughter, she said she has heard parents of children with milder autism with complaints about coverage.

“It seems like, there’s still problems with it, there probably always will be, it’s definitely something they have to work on,” she said.

Changes in how autism is diagnosed

According to the Centers for Disease Control and Prevention website http://www.cdc.gov/ncbddd/autism/index.html, autism spectrum disorders are a group of developmental disabilities that can lead to social, communication, behavioral challenges.

In May, American Psychiatric Association is expected to publish changes to the diagnostic criteria for autism in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5. The manual is used by clinicians and researchers to diagnose and classify mental disorders.

The changes include creating a single category, autism spectrum disorder, instead of diagnosing people with one of three types of autism – autism disorder, Asperger syndrome or Pervasive Developmental Disorder Not Otherwise Specified.

“What happened was that the people who have done research in this area…looked at the data…and they found that you really could not, based on the clinical data, differentiate those three disorders,” said Dr. Dan Blazer, a professor of psychiatry and behavioral sciences at Duke University Medical Center.

Blazer said he was on a task force charged with leading groups to come up with recommendations for changes to the diagnostic manual, and with reviewing changes recommended by other groups. He said he was involved in reviewing the changes to the diagnostic criteria for autism.

Blazer said there have been concerns that children with Asperger syndrome will not meet the new criteria, and would lose access to treatment. But Blazer said studies have shown that most people diagnosed with one of the three types were captured using the new criteria.

 “What this does is provide a more logical way to make the diagnosis other than what we’ve done before,” he said.

Dr. Richard D’Alli, an associate professor of psychiatry and pediatrics and chief of Child Development and Behavioral Health division at Duke University Medical Center, also spoke in support of the new diagnostic criteria.

On the “bright side,” D’Alli said the change will probably mean that clinicians will have a more specific and reliable set of criteria to use to make a diagnosis, so that when one is made, it is accepted by a broader range of clinicians.

He said it won’t change how multi-disciplinary providers offer treatment.

 “It isn’t suddenly going to make invalid using this treatment for people with Asperger disorder, or people with NOS,” he added. “The treatments are designed to help the children, and the adolescents…based on the specific deficits.”

He also said he doesn’t know that the change would affect any way that autism is covered by insurance providers.

 “If you look at DSM-5 as an attempt to right-size the net such that criteria are more reliable, crisper, and more like to capture people with the disorder than those without the disorder, then it’s potentially true that things would improve that access by the insurance companies,” he said.

Vail said she believes the changes probably won’t exclude anyone from services, although she said people may be diagnosed with Asperger syndrome who may not want to pursue services under the autism label.

 “It probably won’t exclude anybody from gaining services,” she said.