During the last legislative session, Senate Bill 2054 was introduced to require the Insurance Commissioner to analyze the projected costs of providing insurance coverage for screening, diagnosis and treatment of autism spectrum disorders. This column came out in favor of the bill.
Sensory processing disorder is another separate but related developmental illness that warrants the same consideration.
SPD is a condition in which people are unable to process sensory inputs to respond to the environment in a healthy functional way. We all need the ability to integrate visual, auditory, tactile and spacial cues from the world around to be able to manage our activities of daily living.
Recent research has found that patients with SPD have hard-wired brain abnormalities in the microstructure of their white matter that distinguishes children with this illness from normal children and also from those who have autism and attention deficit hyperactivity disorder.
While it is common for attentive parents and teachers to have early suspicions of SPD, a formal diagnosis requires specialty trained neurologists, neuropsychologists, occupational therapists or speech therapists. The SPD Foundation estimates that the condition affects approximately 4 million Americans.
SPD is accepted as a bona fide diagnosis in the manual Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. But unlike autism spectrum disorder, it is not included in more standardized classifications, such as the Diagnostic and Statistical Manual of Mental Disorders, which would make the malady more conducive to insurance coverage.
Appropriate health care coverage for mental health is a long-standing problem.
Before the Mental Health Parity Act was signed into federal law in 1996, health insurers were not required to cover any mental health services. The MHPA requires that annual or lifetime dollar limits on mental health benefits be the same as limits for medical and surgical benefits. Since then, requirements for mental health coverage have continued to expand under both federal and state legislation, but more is needed. Both autism spectrum disorders and sensory processing disorders should be covered.
Today TRICARE, a military health care program, is the only insurance carrier that offers enough coverage for therapists to be able to make a meaningful and sustainable improvement for those with SPD. The problem is TRICARE is available only to military personnel, military retirees and their dependents.
SPD patients need programs that offer intensive occupational therapy and speech and language services. It is essential that care employs brain, motor and sensory-based treatment with the goal of promoting independence, community integration, communication and social skill development. It should also include both fine and gross motor skill development, therapy for self-help and individual skill achievement. SPD is an illness that benefits from collaborative, multidisciplinary team care. Family support, respite care and caretaker education are also critical.
Proper care for those suffering from SPD can be expensive, and for now the only ones with adequate access seem to be those either with TRICARE insurance or family resources. As with autism, early intervention is important and minimizes the risk of secondary problems ranging from major depression to social isolation to drug addiction to antisocial behavior and homelessness.
Some legislators and payers are concerned that additional coverage for mental illness will add an onerous financial burden to an industry in transition. However, the chances are that appropriate care for those with SPD will be cheaper than emergency visits and hospital admissions that result from lack of access to necessary mental health services. Early intervention and evidence-based therapies for these children, their families and their caretakers is essential.
The Sensory Processing Disorder Foundation, a Colorado nonprofit, offers educational programs, conducts SPD research and provides resources for parents and help to individuals and families living with SPD. For more information, visit SPD Foundation.net or call 303-794-1182.
———
Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions info@manakaiomalama.com.
