There are many who know what to look for, and many more who do not. Maybe your child is not speaking yet while his or her peers are babbling away. That loud noise gives a little bigger jolt to your child than others; or maybe there is that absent giggle in a funny moment or simply an odd stubbornness. Are these unique character traits or the early signs of autism?
Over the past few decades, autism diagnosis has gone through its share of refinements. Autism is a spectrum disorder, which means there are varying degrees of the condition, not to mention those who may have a few traits, but overall may not get the final diagnosis at all. Simplifying its definition, autism affects a child’s "normal development of social and communication skills," according to the National Institutes of Health.
Beverly Burnett, owner of Play and Learn Pediatric Occupational Therapy, has been working with autism patients for more than 30 years. When she first entered the field, it was considered a mental health problem. Thankfully, that perspective has shifted and the Diagnostic and Statistical Manual, which is used to help with diagnosis, has also gone through its share of updates in her time in the field.
There currently is no specific medical test in place to test a child for autism. Instead, specially trained psychologists and physicians administer behavior evaluations, explains nonprofit advocacy group Autism Speaks.
Understanding the sometimes subtle ways autism can manifest in behavior takes equal parts skill and patience, along with a desire to continue driving for needed changes to advance the treatment of the condition. If you have that heart and drive, a career in a specialty like speech therapy, occupational therapy or in applied behavior analysis could work for you if you don’t want to take the route of getting a physician or psychology degree needed for evaluating potential autism patients.
Perhaps the most attractive side to a career in autism care is that there is now a more defined path from the entry-level worker to doctorate level facilitator, and all levels can earn a fair wage while one advances their education and experience.
"It’s across the board, there’s a need for qualified people from psychologists who diagnose these conditions, all the way to those (who provide the care)," said Dr. Nicole Cavenagh, a pediatric neuropsychologist and director of Touro University’s Center for Autism and Developmental Disabilities.
The Centers for Disease Control and Prevention states that autism diagnoses in the country have reached roughly one in 100 children. University of Nevada, Las Vegas professors John Tuman and Sheniz Moonie studied autism rates by compiling statistics from the Nevada Department of Education. They found the state’s schools show 2.37 cases per 1,000 students, up from 0.27 cases per 1,000 in 1995.
According to the CDC, the lifetime cost of care for an individual with autism is roughly $3.2 million. Annual estimates of medical costs for autism are about $35 billion nationwide, according to another autism advocacy group, Talk About Curing Autism.
With heightened diagnoses and care needs, almost half the states have signed bills mandating insurance companies to cover autism care. In 2009, Gov. Jim Gibbons signed Assembly Bill 162 into law, forcing Nevada insurers to cover up to $36,000 a year in behavioral treatments for autistic children.
While the law came into effect in January 2011, Burnett said she hasn’t had the best experience with it.
"We hear autism is supposed to be covered by insurance, but it’s really not been my experience. Providers have a hard time with billing and coding and understanding what to do," she said.
Erik Lovaas, head of the Lovaas Center, which is an applied behavior analysis (ABA) program in town that is also contracted with Clark County School District, said he has had a mixed experiences with insurance companies. Getting paid isn’t always easy.
"You’re always going to come across those companies that are really good at finding loopholes," he added.
Even while the autism care community works through its processes to assure payment, Lovaas said there is still a very clear upward career path in ABA if someone is motivated and has the desire to work with the population. It is a growing field — the gold standard for autism care — and anyone involved with it will tell you there is high demand for qualified people willing to learn.
Lovaas, himself, studied under the tutelage of his father, Ivar, a professor at UCLA who established his own method of ABA treatment, which focuses on one-on-one approaches with young children in order to help them get to as close to normal function as possible. Many finish treatment and are assimilated into Clark County School District classrooms.
Lovaas works by creating what he calls a "contrived environment that increases the opportunities for an autistic child to learn" basic social and communication skills. He refers to those in the ABA field as "behaviorists." ABA tutors and consultants are guided by an individualized treatment plan for each child. Behaviorists use prompts such as guiding one’s hand through activities, gestures and verbal techniques when working with patients.
"Kids with autism don’t have the same learning opportunities in a natural learning environment for typical kids," Lovaas explained, while also adding that about 47 percent of autism patients with "early intensive" intervention can move onto normal education.
"That’s where we want them to go," he added. Lovaas also has clinics in Spain, Aruba, Miami and Washoe County, Nevada.
About four times a year, he reaches out to students at area universities and colleges to talk about careers at his centers. He sees about 100 people at the informational meetings, 20 of which usually come on board with his center.
Many college students and those seeking part-time work enjoy flexible hours with his program and the opportunity to get a taste of the field to see if it is something they may want to pursue full time. To be in a supervisory role, Lovaas requires a bachelor’s degree.
While skill sets can be learned, above all, people need to be responsible and show an aptitude with the patients.
"To get good in this field it requires about five to eight years of supervision. To be really on your game, to go out into the community and deal with different types of autism, you really need to put in the time," he added.
For more information about the program, visit www.thelovaascenter.org.
Legislation and careers
Recent legislation has attempted to create minimum requirements for the various job categories in the autism field. Lovaas said, since the field has grown so rapidly, there is a shortage of "quality" caregivers. Although the guidelines don’t seem too stringent, state statute NRS 641 attempts to wrap some parameters around three specific types of specialists.
"These fields really didn’t exist in a formal way prior to recent legislation," Cavenagh added.
n Certified autism behavior interventionist: If you’ve spent some time being supervised by a behaviorist like Lovaas and have taken some classes on the subject (some ABA classes are offered at UNLV) and want to take the next step to working specifically with the population, a certified autism behavior interventionist position may be for you.
Cavenagh estimates interventionists can make between $10 to $20 an hour, depending on experience level. Requirements include an application to the state’s Board of Psychological Examiners, who assess if you are "of moral character." You must be 18 years old, a U.S. citizen or qualified to work in the U.S., and you need to pass a Nevada law and ethical practice exam.
n Board certified assistant behavior analyst: This position is the next big step in the field of autism care. As in Lovaas’ program, one can take on more of a supervisory role with this credential, and Cavenagh estimates pay to be between $30 to $40 per hour.
You must have a bachelor’s degree in a social science field or special education from an accredited college or university; be at least 21 years old, of good moral character, per the board; a citizen of the U.S. or lawfully entitled to work here; and you must pass the written examination on Nevada law and ethical practice. Other education and training deemed appropriate by the board may be required.
n Board certified behavior analyst: This is a master’s degree level field and probably one for someone who has already put in considerable time studying autism and working with a wide spectrum of patients in the field. Cavenagh estimates a certified behavior analyst can make between $45 to $60 per hour.
This level requires a master’s degree in a social science field or special education from an accredited college or university; be at least 21 years of age, of good moral character; a U.S. citizen or able to work in the country lawfully; and you must earn a passing grade on the Nevada law and ethical practice exam as well.
Occupational Therapy, Speech
The fields of occupational therapy and speech pathology work in coordination with ABA programs in most autism cases. Burnett said she doesn’t necessarily see a shortage of autism-specialized occupational therapists. But the field brings a well-rounded skill set that allows people to work with other populations if autism is not the desired area of emphasis, Cavenagh explained.
Occupational therapists work with people who have physical, emotional or developmental disabilities, to help them resume normal living.
Burnett does however see somewhat of an occupational therapy shortage overall in the valley. She said it could be because of the fact that UNLV and UNR do not have occupational therapy programs. Touro, a private university, has the only occupational therapy program in the state. For more information about the local program, visit www.tun.touro.edu or the American Occupational Therapy Association at www.aota.org for information on other programs around the country.
"A lot of patients, their first visit is with a speech pathologist," she added.
UNLV has a speech pathology program. It is offered to those who already hold a bachelor’s degree. The two-year, roughly 30 credit-hour, program includes a practicum as well. University of Nevada, Reno also has a speech pathology offering.
Like occupational therapy, speech pathology allows you to specialize in all types of communication disorders, in addition to filling needs in autism.
For more information about the many kinds of autism-related careers, Web pages such as www.care.com, www.careerjet.com, www.indeed.com and www.simplyhired.com can give a good sample of the types of positions available in the field. Following up with a local specialist or a local university adviser to learn more about career options is also recommended.