Autism and Health Insurance

On March 5th, 2010, Raleigh’s News and Observer published an article about insurance companies not covering mental health and “behavioral” treatment for individuals with Autism Spectrum Disorders (ASD), including Aspergers. I have been leading social skills groups for children and teenagers with Aspergers and other ASD’s for over a decade and have been confronted repeatedly with the fact that various insurance companies do not cover this service if a child’s diagnosis is an ASD. They do, however, cover the same services if a child has a different diagnosis, such as an Anxiety or Mood Disorder, or Attention Deficit Hyperactivity Disorder (ADHD). Since problems with social interactions are at the heart of Aspergers and Autism, this, to me, is a supreme – and infuriating – irony. These children and adolescents are generally extremely socially awkward and often oblivious to social cues and the nuances of social interaction the rest of us find natural and obvious. Participation in a social skills group with similar peers is the ideal way to help such youngsters. Through such groups, these children learn to interact more and more appropriately. They make friends, first in group, and eventually outside of group as well. Their behavior becomes less awkward and they become able to compromise, to take turns, and to see things from the perspective of others, generally for the first time in their lives. While I have no doubt that this type of intervention is the best way to help kids and adolescents with ASD’s, I certainly understand and share the frustration of their parents when this best practice is not covered.
Fortunately for their parents’ pocketbooks – though unfortunately for the children themselves – many of the kids with whom I work have other diagnoses in addition to Autism or Aspergers. Many have Anxiety Disorders or Obsessive Compulsive Disorder. Others have Mood Disorders, in part because as they approach adolescence and begin to realize how different they are from their peers, their social isolation and repeated experiences of rejection become increasingly frustrating to them and they become depressed, dejected, and withdrawn. When a diagnosis other than Autism is present, my social skills groups are generally covered by their insurance. But this service – so essential and beneficial to treat their core disorder: Autism – is not covered on that basis. This, to me, is utterly ridiculous. I would call on all insurance companies to recognize that Autism Spectrum Disorders are brain-based mental health problems like any other and to cover effective and appropriate treatment of ASD’s through interventions such as social skills groups.