Autism Spectrum Disorders
What is Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) is a neurodevelopmental disorder, a group of conditions that are manifested in early childhood. Children with ASD have two common characteristics: 1) persistent deficits in social communication, interaction, and relationships, and 2) the presence of restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric Association, 2013). The symptoms of ASD vary widely from person to person, but repetitive behaviors and difficulties with social skills are the two hallmark characteristics of the illness.
Professionals diagnose ASD only when the condition causes significant impairment. ASD may affect an individual's behaviors, relationships, and functional abilities mildly, moderately, or severely. ASD is estimated to be prevalent in one of every 68 children, occurring more frequently in boys than in girls (Centers for Disease Control, 2014).
How Can Employers Help?
Autism spectrum disorders (ASD) are costly to society in financial and human terms. Mothers of children with ASD earn 35% less on average, compared to mothers of children with other health conditions and 56% less than mothers of children with no health concerns (Cidav, Marcus, & Mandell, 2012). ASD is associated with $3,020 higher healthcare costs and $14, 061 higher aggregate non-healthcare costs, including $8,610 higher school costs, compared with costs for children without ASD (Lavelle et al., 2014).
Employers are investing care and attention toward people with ASD in a number of ways, including:
- Advancing access to effective treatment for employees with dependents who have autism
- Taking steps specific to hiring individuals with ASD and supporting their workplace performance.
Employers Expand Treatment Coverage
Specific benefits and resources for the treatment of ASD have historically varied from employer to employer, but many employers are looking to address ASD through expanded benefits coverage. While there is no cure for ASD, authorities agree that early identification and intervention often improve cognitive and language skills and may help build social skills, positive behaviors, and adaptive abilities (Agency for Healthcare Research and Quality, 2011). The evidence base for effective ASD treatment is somewhat limited, but generally ASD may be treated in a variety of ways, including behavior/development programs, medications, and education/learning programs (Agency for Healthcare Research Quality, 2011). Some employers cover a variety of interventions to help individuals and families with behavior, communication, and social skills. These interventions include speech, occupational, and physical therapy, and additional treatments, such as Applied Behavioral Analysis (ABA).
A number of employers offer health care benefits specifically for diagnosis and treatment of children with ASD (Autism Speaks, 2012). Legislation in 37 states and the District of Columbia address autism, and at least 31 states require autism coverage (National Conference of State Legislators, 2012). These state laws do not apply to employers with self-funded health plans.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA; U. S. Department of the Treasury, 2010), however, is federal legislation that does apply to all employers with 50 or more employees. The MHPAEA should be considered as employers examine how to address ASD. While this federal parity law does not require any specific diagnosis to be covered, if a state law does mandate coverage, then the plan has to comply with the state law if it is an insured plan. In addition, several provisions under the Affordable Care Act help employees and family members with ASD; e.g., through elimination of preexisting condition restrictions, coverage of ASD screening, and family coverage of young adults up to age 26 (U.S. Department of Health & Human Services, n.d.).
Hiring people with ASD
Some employers are looking at ways to tap some of the generally shared strengths of individuals with ASD and accommodate some of their typical impairments. For example, people with ASD may be able to sustain attention to certain repetitive tasks that others might find boring, and some have exceptional memory and visual spatial skills. On the other hand, many people with ASD have great difficulty with eye contact and making conversation—skills that managers typically look for when screening potential job candidates.
Employers who have initiated hiring programs for individuals with ASD include: Walgreens , Specialisterne, AMC Theatres, TIAA-CREF, Target, Home Depot, SAP, and Outback Steakhouse (Autism Speaks, n.d.; Cook, 2012; Ladika, 2012; Leotta, 2007; Moisse, 2013; Standifer, 2012).
In addition, the Autistic Self Advocacy Network (2014) has partnered with Freddie Mac since 2011 to create paid internships for college students and recent graduates who have ASD.
Tips For Employers
On Benefit Plans:
- Work with parent groups and health plans to redesign benefits, provide educational seminars, and identify high-quality providers who specialize in ASD treatment.
- Consider expanding coverage for speech, occupational, and physical therapy for habilitative services, or services that help an individual acquire skills they have not yet developed (in contrast to rehabilitative services for someone who has lost skills due to illness or injury).
- Consider providing coverage for Applied Behavioral Analysis (ABA) and advocating for appropriate health plan network quality and access.
- Consider providing access to an autism care navigator, i.e., someone who is trained in ABA and experienced in working with children with ASD who can help families understand what resources are available to them through the employer, the community, the school system, and state and government entities.
- Offer assistance with educational rights, estate planning, and child care for employees with children who have ASD.
- Consider offering respite care services for parents
- Engage with ASD advocacy groups, such as the National Autism Association, the Autism Society, and Autism Speaks to tap into potential new hires and to meet local experts who may help you in your planning process.
- Examine your hiring and training processes through the lens of a person with restrictive interests and impaired social skills, and make changes accordingly.
- Discuss with your team how certain work tasks might be adapted for employees with special needs, such as sensory aversions. Refer to the Job Accommodation Network's website for ideas on successful employee management strategies.
Asperger Syndrome Training and Employment Partnership (ASTEP): Programs and partnerships that support long term employment of people with Asperger Syndrome and high functioning autism.
Autistic Self Advocacy Network (ASAN): Information about internships for students with autism.
Job Accommodation Network (JAN): Assistance for employers in workplace accommodations for individuals on the autism spectrum.
Office of Disability Employment Policy, U.S. Department of Labor: Information about Employment First State Leadership Mentoring Program for individuals with disabilities.
U.S. Department of Labor: Four-step reference guide for building an inclusive workforce.
- Agency for Healthcare Research and Quality. (June 30, 2011). Therapies for Children With Autism Spectrum Disorders: A Review of the Research for Parents and Caregivers. Retrieved from http://www.effectivehealthcare.ahrq.gov/ehc/products/106/709/aut_fin_to_post.pdf
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Autism Speaks (2012). Self-funded employer tool kit. Retrieved from http://www.autismspeaks.org/sites/default/files/docs/gr/erisa_tool_kit_r__sf_.pdf
- Centers for Disease Control and Prevention. (2014, March 28). Prevalence of autism spectrum disorder among children aged 8 years— Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Morbidity and Mortality Weekly Report, 63(SS02), 1–21. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6302a1.htm?s_cid=ss6302a1_w
- Cidav, Z., Marcus, S. C., & Mandell, D. S. (2012). Implications of childhood autism for parental employment and earnings. Pediatrics, 129(4), 617–623.
- Cook, G. (2012, November 29).The autism advantage. New York Times magazine section. Retrieved from http://www.nytimes.com/2012/12/02/magazine/the-autism-advantage.html?_r=0
- Lavelle, T. A., Weinstein, M. C., Newhouse, J. P., Munir, K., Kuhlthau, K. A., & Prosser, L. A. (2014). Economic burden of autism spectrum disorders. Pediatrics, 133(3):e520–529. doi: 10.1542/peds.2013-0763
- Ladika, S. (2012, July 15). Companies find fruitful results when hiring autistic workers. Workforce. Retrieved fromhttp://www.workforce.com/articles/companies-find-fruitful-results-when-hiring-autistic-workers
- Leotta, J. (2007). Walgreens: a prescription for opportunity. Solutions Marketing Group. Retrieved from http://www.disability-marketing.com/profiles/walgreens.php4
- National Business Group on Health. (2010). Autism fact sheet. Retrieved from http://www.businessgrouphealth.org/pub/f3145aad-2354-d714-5156-205832959df6
- National Business Group on Health (May, 2012). A guide for employers using comparative effectiveness research: therapies for children with autism spectrum disorder. Retrieved from http://www.businessgrouphealth.org/pub/f31242c3-2354-d714-5176-350fbd4e4d2b
- National Conference of State Legislators. (2012, August). Insurance coverage for autism. Retrieved fromhttp://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx 13. U.S. Department of Health and Human Services. (n.d.). The Affordable Care Act and autism and related conditions. Retrieved from http://www.hhs.gov/autism/factsheet-aca-autism.html
- U. S. Department of the Treasury, U. S. Department of Labor, and U. S. Department of Health and Human Services. (February 2, 2010). Interim final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Retrieved from http://workplacementalhealth.org/Business-Case/Mental-Health-Parity/Text-of-the-Interim-Final-Rule.aspx?FT=.pdf