SERVICE SYSTEM ELIGIBILITY
A distinction needs to be considered between diagnosis and service eligibility. Diagnosis relates to whether or not the individual meets the specific constellation of symptoms required for the clinical disorder. Service eligibility relates to whether or not the individual with a specific diagnosis has functional deficits in the areas of the agency’s program services and focus. For example, educational/academic or learning problems are the focus deficit area for the Department of Education programs, work deficits for the Vocational Rehabilitation and Social Security Disability programs, adaptive behavior deficits for the Division of Developmental Disabilities Services, developmental delay for Child Development Watch, etc. The Department of Education, Vocational Rehabilitation, Social Security Disability, Child Development Watch (Birth to 3 Program) and Division of Developmental Disabilities Services programs each address some of the disorders within the autism spectrum or pervasive developmental disorders. Specific eligibility criteria for these agencies programs are shown in the Appendix.
Evaluation, Assessment & Diagnoses
A challenge exists in the appropriate and valid diagnoses of autism spectrum and pervasive developmental disorders. There are no medical tests that can be conducted to make diagnoses with the exception of Rett’s Disorder. A Rett’s DNA Test is now available that will confirm the presence of the disorder. For the other pervasive developmental disorders the diagnosis must be made on the basis of behavioral and social functioning and developmental history prior to 36 months of age. This is especially problematic in adults. Recently, a number of assessment instruments have been developed with standardized norms. These instruments are based upon behavioral observations, structured interviews and developmental histories. When used to assist with the diagnostic process they add a degree of objectivity to the clinical information and data being collected and permit the use of norm referenced scoring of the data. Best practices guidelines are supporting the use of assessment instruments in the diagnostic practices. The American Academy of Pediatrics, Committee on Children with Disabilities (2001) noting the diagnostic challenges stated “Pediatricians with adequate training and experience are encouraged to use autism-specific diagnostic tools to make the definitive diagnosis and additional diagnostic tools to search for etiologic or co-morbid disorder.” The Department of Education Administrative Manual notes an educational classification of autism is established “using specialized, validated assessment tools that provide specific evidence of the features of ASD” (Administrative manual, Section 188.8.131.52). A list of some of the instruments is included in the Appendix.
Autism Surveillance and Registration Program
Recently, the Division of Public Health initiated an Autism Surveillance and Registration Program. The registry collects basic descriptive information on individuals with autism from birth through age 17. For the purposes of the Registry, diagnoses from the ICD-9 autism spectrum disorder and DSM-IV pervasive developmental disorders are