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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2016

Identifying Autism Spectrum Disorders and Referring for Treatment

Autism spectrum disorders (ASDs) comprise a range of developmental disorders and traits that span a spectrum of severity. These diagnoses are defined by the presence of unusual behaviors and interests, along with significant impairments in social interaction and communication.

ASDs are increasingly prevalent, affecting about 1 of every 42 boys and 1 of every 189 girls, but early detection and referral for appropriate treatment and education can help many patients on the spectrum make tremendous strides. 

Effective treatment for an ASD requires coordination and collaboration across several disciplines. Pediatricians play an invaluable role in the early identification of children with ASDs, because they are often the first point of contact for parents who present children with recognizable signs of these disorders.

Early signs can include problems with the following areas:

  • Communication, both verbal (spoken) and non-verbal (unspoken, such as pointing, eye contact, and smiling)
  • Social, such as sharing emotions, understanding how others think and feel, and holding a conversation
  • Routines or repetitive behaviors (also called stereotyped behaviors), such as repeating words or actions, obsessively following routines or schedules, and playing in repetitive ways
Optum/UBH autism specialty network

Optum/United Behavioral Health (UBH), Harvard Pilgrim’s behavioral health benefits partner, has built an autism specialty network, including applied behavioral analysis-certified practitioners, to meet the growing demand for treatment of ASDs. The network development approach includes both individual and agency-based providers who offer intensive behavioral treatment for ASD diagnoses, including licensed mental health clinicians, as well as board-certified behavior analysts. After an ASD diagnosis has been made, and Optum/UBH has been notified, an Optum/UBH intake coordinator will transfer the member to an autism care advocate, who will coordinate the review and authorization process for appropriate treatment.

DSM-5 and changes to classification of ASDs

As the prevalence of ASDs grows, so too does our understanding of this spectrum, which contains a significant diversity of symptoms and levels of severity. In 2013, DSM-4 — the authoritative guide to diagnosing mental disorders — was replaced by an upgraded edition, DSM-5. With this change came some key changes in the way we classify ASDs. Previously, conditions like autistic disorder/autism; Asperger syndrome; and pervasive developmental disorder, not otherwise specified (PDD-NOS) were categorized separately as individual disorders. With DSM-5, these sets of traits characterized by problems with communication and social interaction and atypical, repetitive behaviors are now considered part of the same umbrella: autism spectrum disorder. This change improves the diagnosis of ASD without limiting the sensitivity of the criteria, or substantially changing the number of children being diagnosed.

How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at 800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum/UBH at 888-777-4742.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator