One in 68 Children has Autism

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Some considerations when working on improving communication deficit

November 18, 2013 2:21 pm Published by

Children and adults diagnosed with Autism Spectrum Disorder have persistent deficits in social communication and social interaction across multiple contexts as one of the symptoms. This impairment is usually manifested in lack of social-emotional reciprocity, poor integration of verbal and nonverbal communication and difficulties adjusting behavior to suit various social contexts. Delays in communication usually vary in severity ranging from monotone speech about preferred topic to a total absence of verbal communication. Often individuals with ASD do not effectively perform the single most important task of communication and language, and that is expressing their wants and needs (i.e. making requests, exhibiting mands) and, as a result, they have very little control over what happens to them in their daily lives.

Further, multiple researches has shown that communication impairment is correlated with an increased risk of challenging behavior and reduced opportunities for community involvement and therefore it is understandable why a huge amount of intervention research has focused on developing successful procedures for improving communication skills of individuals with ASD.

 In most cases, the traditional developmental model of language represents the basis for teaching communication and language skills, however in this model, the primary unit of communication and language is the word and words, signs, pictures, or symbols are taught without much regard to the circumstances present during instruction. For example, some expressive language is taught as “labels” (“car”, “table”, “spoon”), some as “answers to questions or responses to statements” (“more”, “fine”, “please”, “hello, my name is___ “) and some as “generalized requests” (“eat”, “drink”, and “break”). For children and adults with ASD, the words, signs, or pictures they learn in one circumstance, don’t tend to occur in other circumstances without additional instruction. In many cases, this result in little to no expressive language or communication responses that are useful or important to the person, in other words, the person does not learn how to make specific requests (i.e. “no mands”).

Very often, this also results in problem behaviors. Individuals begin to communicate by screaming, dropping to the floor, hitting, spitting, kicking, biting, etc. and, if these behaviors result in what the individual wants, even intermittently, these same behaviors function as either specific or generalized requests (“problem mands”) and tend to occur again and again…Then, usually a clinician is asked to conduct a functional assessment in order to develop a plan to reduce the frequency of the problem behaviors and replace these behaviors with more appropriate alternatives. Often, these “replacement” behaviors are either a limited array of receptive skills (following directions or completing assigned tasks) or “generalized requests” for attention, escape, or access to categories of preferred items and activities (i.e. eat, drink, play, more, please, etc.)

When the only “replacement” behaviors are receptive skills, we are teaching poor speakers to be better listeners and when the “replacement” behaviors are generalized requests, we are teaching poor speakers to be non-specific speakers.

Neither is adequate…

Ideal practice should include teaching individuals to make specific requests (SPECIFIC MANDS) and expanded array of receptive skills (following directions, completing assigned tasks, waiting, sharing, and accepting no) (GENERALIZED COMPLIANCE).

In other words we should be teaching poor speakers to be effective, specific speakers who have more control over what happens in their daily lives while also teaching them to be good listeners in a wide variety of commonly occurring situations. Under these circumstances we could expect to see that when individuals have more control and power over what happens in their daily lives they tend to exhibit far lower rate of problem behavior.

Nevena Savic, MA

 

Autism Insurance Reform in New York [Guest Blog]

November 16, 2012 4:01 pm Published by

by Andrew M. Cohen, Esq.

As most people know by now, autism is a developmental disorder that usually appears within the first three years of life. It affects the brain’s normal development of social and communication skills. While symptoms can vary in severity, children with autism may have difficulty with speech (both verbal and nonverbal), social interaction, making and maintaining eye contact, pretend play, sensory issues, perseverative behaviors, intense tantrums, and/or repetitive body movements. The Centers for Disease Control and Prevention estimate that 1 in 88 children have autism spectrum disorders (ASDs). While there is currently no cure, autism is a treatable condition.

While more and more health care professionals are aware of the signs of autism, a health care professional experienced in the diagnosis and treatment of autism is usually needed to make an actual diagnosis. To date, some private health insurance companies have been covering the testing and diagnosis of ASDs, however, the majority of insurance companies have not offered such benefits.

When dealing with autism and spectrum disorders, early and intensive treatment usually produces substantially greater long term benefits. Applied Behavioral Analysis (ABA), medications, speech therapy, occupational therapy and physical therapy are commonly used as part of a comprehensive treatment plan. ABA programs are usually done early on in the child’s home, under the supervision of a behavioral psychologist. It is a one-on-one approach, which teaches a variety of skills. The goal is to get the child as close to “normal” developmental functioning as possible. Access to ABA―which has been found to be among the most effective treatments for autism spectrum disorders―has been limited because families are forced to struggle with their ability to pay out of pocket for this treatment.

In the past few years, many states have adopted legislation to include health coverage for these disorders and New York is the 29th state to implement such a law. In 2011, Governor Cuomo signed into law a bill (co-sponsored by Long Island’s Senator Charles Fuschillo, Jr.) that advocates for those with autism and ASDs. This new law is being viewed as one of the most comprehensive autism insurance reform measures in the country. Scheduled to take effect on November 1, 2012, this law provides coverage of “medically necessary” autism therapies, such as ABA, with a maximum annual benefit of $45,000 per covered individual. In addition to covering ABA, the new law will also cover behavioral health services, medications, diagnostic services, psychiatric and psychological services, therapeutic care, and assistive technology (as long as the services are medically necessary and prescribed or ordered by a licensed physician or licensed psychologist). Under the new law there is no limit on the number of visits per year, nor is there an age limitation, thereby extending this coverage to children and adults alike. Furthermore, an individual cannot be terminated from health insurance coverage due to the diagnosis of or treatment for ASDs. It should be noted, however, that these services are still subject to deductibles, co-pays and co-insurance, similar to those imposed on other health benefits. It should also be noted that this new law only applies to state regulated insurance plans. Accordingly, companies with self-funded insurance plans are not required to provide coverage under the new regulations. New York’s Medicaid program, which provides invaluable services to the disabled, does not provide coverage for ABA.

Today, the prognosis for people with autism is much more optimistic than it was in the past, when individuals with a cognitive disability were forced into institutional settings. While those with the diagnosis will continue to face challenges throughout their lives, the hope and goal is to have the greatest number of persons afflicted with autism and spectrum disorders remain with their families, and to enable them to live to their fullest potential within their communities. The severity of the disorder and the amount of treatment and therapy a person receives often determine the prognosis for the future. The ability for many families to now seek appropriate therapy as a covered benefit under their health insurance plans will likely be a welcomed economic relief to thousands of families dealing with these issues.


Andrew is the principal of the Law Offices of Andrew M. Cohen located in Manhattan and Garden City, and he is the father of three daughters, one of whom has multiple disabilities and graces the cover of his business brochure. His practice focuses on Trusts & Estates and Elderlaw, with an emphasis on planning for families with a disabled child. Andrew is a charter member of the Academy of Special Needs Planners, a national organization of attorneys who are dedicated to providing high quality legal services to the disabled community and, in May 2010, he was selected by Exceptional Parent magazine to receive its Maxwell J. Schleifer Distinguished Service Award. Andrew was added to the Long Island Board of Directors of Easter Seals New York in February 2011 and he was an advisor to Parents magazine for its March 2011 commentary on special needs planning. Andrew believes that it is crucial for parents of individuals with special needs to make all of the arrangements necessary to protect and provide for each family member, and he is a frequent lecturer on this topic. Visit www.amcohenlaw.com for additional information about Andrew and his practice.

Providing for a Child with Autism [Guest Blog]

February 1, 2012 4:19 pm Published by

by Andrew M. Cohen, Esq. 

For many families that include a child with autism, the questions concerning who will take care of the child in the future and where the money to support that child will come from are daunting thoughts. Some parents choose to postpone planning rather than deal with the difficult reality that faces them; however, early, careful planning can secure a disabled individual’s future long after his or her parents have passed away. 
Parents and grandparents who continually put money and other property in the child’s name, even as part of jointly held accounts, could be doing a disservice to that child. A disabled individual is actually precluded from receiving means based government entitlements, such as Medicaid and Supplemental Security Income (SSI), when assets held in that person’s name exceed a specified amount. By contrast,completely disinheriting the child and relying solely on the government is not necessary and hardly qualifies as sound planning. Smart, proper planning is best achieved by creating a scenario that includes full eligibility for the government assistance, as well as whatever private resources the family can leave to provide a more comfortable future for their family member. This best of both worlds approach is accomplished with a Supplemental Needs Trust. 
The Supplemental or Special Needs Trust is often referred to as the cornerstone in formulating a plan to care for a child with disabilities. It is typically established as part of a comprehensive estate plan and funded with an inheritance and/or life insurance products, such as a second to die policy. If drafted correctly, the assets that fund a Trust will provide the “extras” for a beneficiary (the disabled individual) without affecting or disqualifying the beneficiary from those important government programs. The child retains the right to receive these means based benefits because this type of Trust is not considered a countable resource by the government. Once the Trust is established, it’s usually managed by a person known as a Trustee, generally someone similar in age to the disabled individual; there are also organizations and institutions that provide Trustee services. It should be noted that when a Trust is funded with money or assets of the beneficiary, such as a recovery from a lawsuit or a gift/inheritance directly to the disabled individual from another family member, payback rules apply with regard to the government benefits received by a disabled individual over the course of his or her lifetime. 
When properly created, a Supplemental Needs Trust provides a comfortable and secure future for the individual with autism, enhancing the quality of his or her life by providing funding for the “luxuries” in life not supplied by the government, while not affecting that person’s rights to receive government benefits.
Andrew is the principal of the Law Offices of Andrew M. Cohen located in Manhattan and Garden City, and he is the father of three daughters, one of whom has multiple disabilities and graces the cover of his business brochure. His practice focuses on Trusts & Estates and Elderlaw, with an emphasis on planning for families with a disabled child. Andrew is a charter member of the Academy of Special Needs Planners, a national organization of attorneys who are dedicated to providing high quality legal services to the disabled community and, in May 2010, he was selected by Exceptional Parent magazine to receive its Maxwell J. Schleifer Distinguished Service Award. Andrew was added to the Long Island Board of Directors of Easter Seals New York in February 2011 and he was an advisor to Parents magazine for its March 2011 commentary on special needs planning. Andrew believes that it is crucial for parents of individuals with special needs to make all of the arrangements necessary to protect and provide for each family member, and he is a frequent lecturer on this topic. Visit www.amcohenlaw.com for additional information about Andrew and his practice.

ABOUT US

QSAC is a New York City and Long Island based nonprofit that supports children and adults with autism, together with their families, in achieving greater independence, realizing their future potential, and contributing to their communities in a meaningful way by offering person-centered services.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.