When suspicions arise regarding the state of a child on the autism spectrum, it is recommended to undergo testing as early as possible.
- According to the National Health Insurance Law, diagnostic services are included in The Healthcare Basket and are the responsibility of the Kupat Cholim.
- A diagnosis that includes physical, neurological, developmental and emotional examinations, in accordance with the rules of The Health Ministry directive (based on the DSM-5), is admissible in the relevant state institutions to obtain the rights given to people on the autism spectrum.
- Diagnoses made according to the older definitions of the DSM-4 are valid to claim a Disabled Child Benefit for Children on the Autism Spectrum, if made by 06.01.2014 (regardless of the date of filing the claim).
Target audience and prerequisites
- Children up to age 18 whose parents or professionals believe that they are on the autistism spectrum.
Where to Turn
- Refer to the secretary of the Kupat Cholim or Child Development Clinic.
- For a listing of child development clinics on the Health Ministry website.
- The medical examination will be carried out by a physician who is one of the following:
- A psychiatrist for children and youth
- A specialist in Neurology and Child Development
- A developmental pediatrician with work experience of at least 3 years in a recognized Child Development Institute
- Alongside the medical examination, the child must undergo diagnosis by one of the following:
- A clinical psychologist with recognized clinical training in the field of children
- A developmental psychologist (or specializing in such under guidance)
- A rehabilitative psychologist or educational psychologist - provided they have a proven training in the field of autism diagnosis
- In the diagnosis other health care professionals will participate, as appropriate.
Establishing the Diagnosis
- Diagnosis should be made according to the definitions set forth in the DSM-V. These definitions do not include concepts such as autism, Asperger's, PDD-NOS, or PDD, but only Autistic Spectrum Disorder (ASD).
- The diagnostic criteria will relate to the level of severity in each of the areas listed in the DSM-V:
- Communication and social interaction (including three criteria)
- Repetitive behavior (including 4 criteria)
- In order to be diagnosed with autistic spectrum disorder (ASD), a child must fulfill all three criteria in the communication and social interaction area, and at least two of the four criteria of the repetitive behavior area.
- In the area of communication and social interaction a current or past expression of the following symptoms is necessary:
- Impaired social or emotional interaction that extends, for example, from an abnormal social approach, failure maintaining dialogue, minimal sharing of interest and feeling, up to the failure to initiate and respond to social interaction.
- Impaired nonverbal communication for the purpose of social interaction that extends, for example, from incorrect eye contact and body language, a failure to understand gestures to the total lack of facial expressions and non-verbal communication.
- Impairment in the development, maintenance and understanding of relationships, starting, for example, from difficulties in adapting behavior in different social contexts, simulated game difficulty, difficulty to connect, to a lack of interest in friends.
- In the area of repetitive behavior a current or past expression of at least 2 of the following symptoms is necessary:
- Stereotypical or repetitive behavior, motor activity, use of objects or language.
- Persistence and inflexibility on patterns of behavior (e.g. distress following a small change, rigid thinking, the use of fixed walking path, food pickiness).
- Restricted or rigid interests (e.g. excessive interest in an unusual object).
- Overreaction or under-reaction to sensory input or unusual interest in a sensory environmental aspect (e.g. lack of response to pain or temperature, an abnormal response to sound, extensive use of smelling or contact).
- The diagnosis must determine the degree of difficulty in each section - mild, medium or severe, based on the severity of symptoms and the difficulty caused by them in social integration of the child in everyday life.
- In order diagnose the child as suffering from ASD, ensure that:
- There were symptoms at an early stage of development (although it is possible to be expressed meaningfully only at a later stage when the need social ability exceeds capability).
- The symptoms cause significant difficulties in social or occupational functioning.
- The disturbances are not explained by impaired general intelligence or mental retardation.
- For children who have intellectual disability (mental retardation) in addition to the ASD - their social fitness should be lower than that corresponding to the level of intellectual disability.
- In addition to determining the level of severity of the various criteria, the diagnosis will include a reference to developmental and cognitive level (depending on age), as well as functional assessment, and assessment of autism symptoms.
- In the professional reports it should be noted the means by which the diagnosis is established, and which components of the instrument were impaired in the subject.
- The diagnosis will be recognized only if there is agreement by the physician and psychologist who carried out the diagnosis.
Tools to assist in the diagnosis
- For developmental / cognitive evaluation:
- Up to age 3: Development diagnosis - MULLEN (BAILEY-III or BAILEY-II can be used if unfamiliar with this instrument)
- Ages 3 to 7: Cognitive diagnosis through WPPSI-III (If unable to deliver WPPSI, deliver alternative cognitive tests matched according to age and ability of the patient).
- Ages 6 to 7: Cognitive diagnosis through WISC-IV.
- For functional assessment VINELAND-II or ABAS-II should be used.
- Assessing symptoms of autism should include identification and evaluation questionnaires:
- Parental questionnaires (such as CARS-2, SCQ, SRS-2)
- teacher / educator reports (such as SRS-2)
- It is also recommended to use ADOS and ADI Diagnostics-R, if necessary, provided there is proper training for it.
- Using psychological diagnostic tools should be done only by a psychologist.
- Diagnostic Tools are updated periodically and the updated tools should be used.
- Increasing evidence shows that the earlier treatment is started, the better the results. Therefore, it is preferable that diagnosis is performed as early as possible.
- A diagnosis will also enable the family (the parents and siblings) to undergo genetic counseling, and make it easier to identify similar disorders among siblings and treat them if necessary.
- It is possible to fund privately the diagnosis done by private professionals recognized by the Ministry of Health.
Laws and Regulations
- Directive from the director if the Ministry of Health 15/13 10.11.2013 - Diagnosis of Children on the Autism Spectrum
- Disability directive (disabled child) number 1952 של המוסד לביטוח לאומי מיום 08.04.2014 - Medical diagnosis for purposes of determining entitlement to a disabled child benefit for children on the autism spectrum האוטיסטי according to the guidelines of the DSM-5
- ALUT and the Ministry of Social Affairs and Social Services: Booklet for parents whose children have been diagnosed as being on the autism spectrum - First Steps
- Autism diagnosis on the ALUT website
- ALUT - Autism Diagnosis
- Original translation performed by The Shira Pransky Project as part of a grant from The Fellowship Fund.