COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder.
COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder.
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COVID-19 疫情凸显了自闭症谱系障碍儿童的获取障碍。
DOI：
10.1097/dbp.0000000000000988
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Ciccarelli,MaryR
中科院分区：
文献类型：
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作者：
McNallyKeehn,Rebecca;Tomlin,Angela;Ciccarelli,MaryR
参与早期强化行为干预已被证明可以改善自闭症谱系障碍（ASD）儿童的结局1并降低终身护理成本2。然而，在美国的大部分地区，ASD的医学诊断是必要的，以获得这些干预措施。缺乏专家诊断医生，3低效的评估模型，4和漫长的评估等待时间5导致ASD诊断的严重延迟和明显延迟进入服务。对于来自不同种族6、7和社会经济背景8、9以及资源不足地区的儿童来说，这些延误的情况更为严重。[10]尽管系统性障碍需要持续关注，但我们在此强调，保险公司通过应用不适当的ASD诊断评估医疗审查标准，在限制干预获取方面发挥着关键作用。具体而言，为了将医疗诊断视为有效并授权进行专业干预，许多保险公司强制使用特定的评估工具，而不是允许合格的临床医生使用灵活的循证评估协议。在2019冠状病毒病期间，这一点变得尤其成问题，因为评估做法迅速转变，通过实施远程医疗和使用尚未被保险公司接受的新型诊断工具来满足对远程和/或社交距离远的程序的需求。当保险公司错误地认为ASD诊断无效时，儿童无法从所需的干预措施中受益，从而导致一连串的有害后果。
Engagement in early intensive behavioral intervention has been shown to improve outcomes1 and lower lifetime care costs2 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, 3 inefficient evaluation models, 4 and long evaluation wait times5 result in substantial delays in ASD diagnosis and markedly later entry into services. These delays are increased for children from diverse racial6, 7 and socioeconomic backgrounds8, 9 and underresourced regions. 10 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.