Follow the link to the full HSAC report released on 2-12-13:  https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6181-ENG
 
 
Minnesota urged to cover unproven autism care
  • Article by: MAURA LERNER , Star Tribune
  • Updated: February 12, 2013 - 11:14 PM

Aid program would pay millions for behavior therapy still being studied.

The state of Minnesota is being urged to pay for an intensive -- and controversial -- form of autism therapy for children on Medical Assistance, even though scientists are uncertain of its effectiveness.

The recommendation, from a state advisory panel, would create the first "autism-specific strategy" for thousands of families covered by the state health care program for the poor and disabled.

Under the plan, which would need both legislative and federal approval, the state would pay for a treatment known as early intensive behavior therapy, which advocates say is the best hope for children with autism. In some cases, the treatment can include up to 40 hours a week of one-on-one therapy and cost up to $100,000 a year.

"This is a major victory," said Amy Dawson, founder of the Autism Advocacy & Law Center in Minneapolis. She noted that the advisory group had rejected a recommendation to limit the number of hours or set an age limit for the treatment.

The report, released Tuesday by the state's Health Services Advisory Council, was an attempt to clarify confusion about Minnesota's autism policy, according to Lucinda Jesson, Human Services commissioner.

Officially, the state agency and most private insurers have refused to cover intensive autism therapy because of questions about its cost and effectiveness.

But in 2011, the Star Tribune disclosed that the Department of Human Services was, in fact, paying millions of dollars for the identical therapy for some children -- many from middle class or wealthy families -- while refusing it to low-income children in its managed care programs.

The agency said Tuesday it has been working to address those concerns and ensure that all children in its programs receive equal benefits. The proposed reforms would add $12 million in state funds to cover the additional costs.

Autism, which is marked by difficulties with speech, behavior and social interaction, is now diagnosed in 1 in 88 children, according to federal estimates. About 17,000 people with autism are covered by the state's Medical Assistance program, also known as Medicaid.

Last year, the Legislature asked the health advisory council, made up largely of physicians, to recommend whether the intensive therapy was worth covering.

On Tuesday, the group gave its answer: Yes, under certain conditions.

"Many providers believe that intervening early and intensively in a child's life offers the most potential to reduce symptoms," the council wrote in a 58-page report. "While the literature ... is far from robust, it is still the best studied of ASD (autism spectrum disorder) interventions."

The group concluded that the therapy should be covered, even while scientists continue to study its impact. The panel backed off from a proposal to cap the number of hours at 25 per week or limit the treatment to young children, following objections from many families and treatment centers.

Instead, the group said that the state should determine "the appropriate amount of hours" based on the child's individual needs.

Experts say it is difficult to determine what kinds of autism treatments work best for all patients, in part because the symptoms can vary so dramatically from person to person.

The changes would apply only to the state's Medical Assistance program, not private insurance plans.

In a separate report released Tuesday, researchers from the University of Minnesota said state officials should do more to provide housing and other services to children with severe autism, because access to those services "is uneven" across the state.

Jesson said the agency is "making it a priority" to work with counties and tribes to expand services to autistic children, and will explore "autism-specific housing" as part of a pilot project in several counties.

Maura Lerner • 612-673-7384


Link to the Star Tribune Article: 
http://www.startribune.com/local/190925251.html?source=error
 
 
Check out this latest article on the topic of recovery or "loss" of an ASD diagnosis. 
http://www.nytimes.com/2013/01/17/health/some-with-autism-diagnosis-can-recover-study-finds.html?_r=0
 
 
Does your child spit out food, turn his head, swat at the spoon, throw food and cry or scream during mealtime?  Do you ever wonder if other parents encounter the same difficulties during mealtime?  If you answered "yes" to both, you're not alone. For children with developmental or intellectual disabilities, they face a variety of challenges in their life.  Pediatric food refusal happens to be one of the most common types of problems these children face (Kerwin, 1999). 

To qualify for a formal feeding disorder diagnosis, a child must refuse or be unable to eat a sufficient amount or variety of food that results in the child losing weight or failing to gain weight or meet their nutritional needs (Shore & Piazza, 1997).  A child with a feeding disorder may refuse to consume solid foods entirely or may be food selective in which only certain types or textures of foods will be accepted (i.e., smooth textures like pudding, yogurt, applesauce or mashed potatoes are rejected or only crunchy, brown peanut butter flavored cookies, granola bars and pretzels are consumed).  In other cases, children may display food selectivity based upon the presentation of the food, such as consuming plain white rice only but rejecting white rice if combined with vegetables, sauces, herbs or wild rice.  A peanut butter sandwich might be consumed but only if the peanut butter and jelly are each distributed on their own piece of bread without the pieces touching on the plate.  Over time, the variety of foods a child will consume shrinks and/or the list of rules about how certain foods must be presented in order to accept them grows, resulting in further weight loss and nutritional deterioration for the child. 

While approximately 25% of typically developing children experience a feeding disorder, the rates are as high as 80% for children with developmental disabilities.  Thus, this is a common problem challenging caregiver.  Pediatric food refusal is classified into one of three categories:  organic (medical), non-organic (behavioral) or mixed .  The research indicates that children who engage in food refusal of the non-organic or mixed type engage in refusal because often the demand to consume the foods is withdrawn.  This results in an increase in refusal or other problem behaviors in the future during mealtimes (Woods, Borrero, Laud and Borrero, 2010)

If you are concerned with your child's nutrition or if your child is displaying some of the symptoms described above, your child should be evaluated by a medical professional (i.e., pediatrician) to determine if your child's nutrition is deficient and the cause.  Your child's doctor will determine if a referral to other professionals, such as a speech pathologist, registered dietitian or OT, is necessary.  If medical variables have been ruled out and it is determined the problem is behavioral in nature, a Board Certified Behavior Analyst with specialized training in using Applied Behavior Analysis (ABA) can work with your child to increase acceptance of a wider array of foods and liquids.  At Alliant Behavioral Pediatrics, we treat mild to moderate cases of pediatric food selectivity that are not organic (medical) in nature.  Contact us at info@alliantbehavioral.com so we can determine if we can assist you in your child's needs.  Listed below are other recognized, qualified professionals specializing in the treatment of pediatric feeding disorders.   


RESOURCES
University of Nebraska Medical Center:  Munroe-Meyer Institute
Dr. Cathleen Piazza

http://www.unmc.edu/mmi/pfdclinic.htm
http://www.unmc.edu/mmi/cathleenpiazzaphd.htm

The Marcus Autism Center-Pediatric Feeding Disorders Program
Dr. David Jaquess

http://www.marcus.org/default.aspx?id=37

University of MN:  Pediatric Feeding Clinic
http://www.uofmchildrenshospital.org/Specialties/Rehabilitation/Programs/index.htm


REFERENCES
Woods, J., Borrero, J., Laud, R., & Borrero, C.  (2010).  Descriptive analyses of pediatric food refusal:  The structure of parental attention.  Behavior Modification, 34(1), p. 35-56.

Kerwin, M. (1999).  Empirically supported treatment in pediatric psychology:  Severe feeding problems.  Journal of Pediatric Psychology, 24, 193-214.

Shore, B, & Piazza, C.  (1997).  Pediatric feeding disorders.  In E.A. Konarski, J.E. Favell, & J.E. Favell (Eds.), Manual for the assessment and treatment of the behavior disorder of people with mental retardation (pp. 65-89).  New York:  Guilford.

 

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