COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder

Abstract

Engagement in early intensive behavioral intervention has been shown to improve outcomes and lower lifetime care costs for children with autism spectrum disorder (ASD). However, in most regions of the United States, a medical diagnosis of ASD is necessary to access these interventions. A shortage of expert diagnosticians, inefficient evaluation models, and long evaluation wait times result in substantial delays in ASD diagnosis and markedly later entry into services. These delays are increased for children from diverse racial and socioeconomic backgrounds and underresourced regions. Although systemic barriers require ongoing attention, we highlight here the critical role that insurers play in limiting intervention access through application of inappropriate medical review criteria for ASD diagnostic evaluations. Specifically, to consider a medical diagnosis as valid and authorize specialized interventions, many insurers mandate the use of a specific assessment tool(s) instead of allowing qualified clinicians to use a flexible evidence-informed evaluation protocol. This has become especially problematic during COVID-19, when evaluation practices have rapidly shifted to meet demands for remote and/or socially distanced procedures through implementation of telehealth and use of novel diagnostic tools that are not yet accepted by insurers. When insurers erroneously deem ASD diagnoses as invalid, children are unable to benefit from needed interventions, resulting in a cascade of deleterious consequences.