shows state policy and practice variables for children with autism in the Part C early intervention system. The lead Part C agency for the majority of states was the department of health or health and human services (67%). One quarter (24%) of states used the department of education as the lead agency; the use of departments of developmental disability/mental retardation was relatively infrequent (9%).
Autism-specific early intervention policies and practices
In all states, referrals to early intervention could be made by anyone; however, referrals came most commonly from outside the system (family members and healthcare professionals) in 74% of states. Thirty-three percent of the agencies reported that most referrals constitute children who are already receiving early intervention services and are referred for an autism evaluation by their early intervention provider.
Requirements regarding the types of professional who could make an ASD diagnosis were quite variable. Many states (39%) required a specific type of licensed healthcare professional (i.e., physician or psychologist); 22% of states required an appropriate licensed professional but did not specify a specific discipline; others mandated that a multidisciplinary team be involved in assessment and diagnosis (15%). Only one state (2%) accepted a diagnosis from a school psychologist or school team. Twenty-two percent of states had no requirements for the diagnostician. Twenty-two percent of states reported that the diagnostician, regardless of credentials, must have specific experience with autism.
Only 7% of states required that professionals use a specific battery for all early intervention intake evaluations. All states left the choice of ASD-specific diagnostic instrument to the professional making the diagnosis. Some states (13%) recommended but did not require specific tools, including the Autism Diagnostic Observation Scale (Lord et al., 2000
) (4 states); the Autism Diagnostic Interview (Lord, Rutter, & Le Couteur, 1994
) (1 state); the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1986
) (1 state); the Autism Behavior Checklist (Krug, Arick, & Almond, 1980
) (1 state) and the Gilliam Autism Rating Scale (Gilliam, 1995
) (1 state).
States differed in which DSM-IV diagnostic codes under pervasive developmental disorder (which includes Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Delay-Not Otherwise Specified) would qualify a child for early intervention services. While the levels and definitions of development delay/impairment varied from state to state for Part C eligibility, in nearly all states (98%) Autistic Disorder automatically qualified a child for Part C services. Most other pervasive developmental disorders also qualified children for care in a majority of states, including Pervasive Developmental Disorder—Not Otherwise Specified (85%), Asperger’s Disorder (74%), Rett Syndrome (72%) and Childhood Disintegrative Disorder (39%). In 13 states (28%) at least one diagnosis on the ASD spectrum was excluded from Part C services if no other developmental delay was present. States were least likely to include Childhood Disintegrative Disorder (48%) and Asperger’s Disorder (24%).
A majority of the states (65%) reported that they provided all 17 early intervention services mandated for states participating in IDEA Part C, but no autism specific services; 35% of states indicated they provided specific ASD treatment programs, including behavioral, occupational therapy/sensory integration, or speech and communication interventions, to children with ASD. Within the states that provided no autism-specific services, 40% of respondents emphasized that they offered individualized services to meet the unique needs of each child, regardless of diagnosis. Many states (45%) also noted that children with ASD typically received more intensive services than other children with developmental delays and may receive services such as behavioral intervention, decreased teacher:child ratio, specialized sensory integration services, or services provided through a Medicaid waiver.
Eleven percent of states endorsed specific intervention methods for ASD, and all of these states also reported an increased number of hours of service for these children. Twelve percent of these states endorsed an eclectic model incorporating many autism-specific methods, 9% allowed service agencies to choose treatment methods and 61% reported that they endorsed no specific method. Specific methods mentioned included the National Research Council guidelines (Lord et al., 2002) (4%), TEACCH (6%), Floor Time (9%), The Denver Model (6%), Discrete Trial Training (9%), Incidental Teaching (6%), teaching within functional routines (3%), Pivotal Response Training (3%), Positive Behavioral Support (3%) and the Prizant SCERTS method (3%).
Twenty percent of states had guidelines for diagnostic assessment and 26% had guidelines for treatment for children with ASD. An additional 27% percent reported that, at the time of the interview, guidelines for diagnostic assessment were currently in development; 30% were developing treatment guidelines. All states indicated that they followed general Part C guidelines for individualizing intervention, providing functional treatment in the natural environment and including families as an integral part of the intervention process.
As shows, there was no statistically significant associations between any of the state policies and practices variables measured in this study and the proportion of children ages 3–5 years receiving services for autism through the special education system. On average, states with a larger population of children ages 3–5 year had a greater proportion of children receiving autism services. There was no association, however, between the percent of 3 to 5 year-olds receiving special education services and the proportion receiving autism services.
Autism-specific early intervention policies and practices as a function of the proportion of children served for autism in special education