HappyChucks   For Families Navigating the Autism Waters

If you're fairly early in your journey into autism, this is a very important post. If you've been at this for awhile now, you still might find a few good ideas, but it'll take some effort to pull off a change!

This month marks the 7-year anniversary of Calvin's first home ABA program. That means we've been gathering paperwork from doctors, schools, therapists, the internet, etc. etc. for 7 years. And we've been making our own notes and journals as well, just trying to help make sense of what's going on at any given time. (why is he sleeping better, or worse? why did his bowel movements change? etc. – you know what I'm talking about..)

Well, here's what our filing cabinet looks like today. (yes, it's a mess!)

I could tell you the 8 schools Calvin has attended so far, and the dates he was at each one of them, but you'll need to give me a couple of hours to dig through everything first. What was the med trial we did when he was 4 or 5 that had horrible side effects? I'll need more time to find that answer, too.

You see, at the time things are happening, they seem so easy to remember. But a few years and a couple thousand pieces of paper later the details get fuzzy. If I was starting down this road today, here's what I would do differently..

Keep track of key events in a digital format (on your computer) in a highly flexible format with dynamic search capabilities. Here are some ideas, depending on your level of tech-savvy.

Create a personal blog. You can visit www.blogger.com and build a personal blog in less than 5 minutes, and it's free. You can easily checkmark (or uncheck) boxes so that the blog is not available to search engines, and can only be read by those you give permission to. This makes it a private blog, not available to the public. (although I would still avoid writing personal info like SSN, DOB, etc.)

You can create categories to assign to each post (you can even assign multiple categories to a post.) I would create categories for: ABA, Fidget Items (or Stims), Hab, Homeopathy, Horses, Illness, Medication, Music, OT, PT, Speech, School, Sleep, Social Settings, Vacation.

Write a short post whenever something noteworthy happens, with a few of the details & highlights which can jog your memory later. IEPs, Doctor Visits, Medications prescribed, Sleep patterns (he slept through the night for a week straight – yea!). Etc. The blog will time stamp each entry for you.

Over time, you'll be able to search by category, or by words, or by time, and you'll find the posts that match your criteria. Then you'll see the date you wrote it, so it will be very easy to go find the specific IEP you're looking for in your file cabinet. ;-)

Buy Microsoft One Note (<$100). (info here) Imagine having an unlimited amount of notebooks, and each one can have anything in it. A quick, handwritten note. A webpage printed directly to your notebook. Contact information for the doctor's office. etc. You can have a notebook for each of the categories, and you can add anything which pertains to that category to them.

You will find One Note fairly intuitive if you use Microsoft Office products already. It's not quite as fast and easy as the blog idea, and it's not free. On the other hand, it's more robust in what you can store, and it's on your computer so privacy is never a concern.

Use Microsoft Word or Excel. There's no reason you can't build your own journal with either one of these. It may not be as fancy or as dynamic, but either option is a whole lot better than paper stuffed into a file cabinet. Again, I would focus on making notes regarding key people and events. I would try to use the Category Words at the end of each entry, which will help you find things later.

The process can be as simple as opening Word and beginning to type – no different from opening a spiral notebook to write a journal entry. It can also be very detailed with tables, filters, drop-down categories, and more. Those of you who know how to use the power of Excel could build something pretty fancy.

Other thoughts

I'm sure there are other options out there – Outlook Journal comes to mind as another alternative. There are also some great scanners available which have come down in price. I've heard that you can get a commercial-size scanner to scan different sizes of papers and convert the paper text into searchable text for about $700. Someday I might consider one of these to sort through our mountain of paper.

BACKUP YOUR DATA! Regardless of the method you choose, please backup your data. Always think about this: what happens if your computer doesn't turn on tomorrow? CD-ROMs, DVDs, External Hard Drives, www.mozy.com – there are many choices available, please use one.

Arizona's Instrument to Measure Standards is a standardized test that all Arizona students must take, and pass, before graduation. The test is adjusted for each grade level, and the results are reported publicly in statistical analysis format – rankings are available to view by school, by district, by race, by sex, by grade, etc.

Calvin recently finished his first ever attempt at the AIMS test, and we as parents couldn't be more proud of him – for so many reasons..

He took the same test as every other 3^rd grader in the state. The only modifications were in how the questions were presented to him (one at a time), and he was able to indicate his answers using letter cards, rather than darkening in a circle with a #2 pencil. (his proctor then darkened in the appropriate circle for him).

He completed the entire test. Every section. And for the most part did not require the allotted amount of time.

He did not have any coaching or verbal cues regarding the questions. Each question was simply laid in front of him for him to read on his own, and he could select his answer whenever he was ready.

He asked a couple of times to go back and change a prior answer (and each time corrected an incorrect answer.)

I don't think we'll ever get to see his individual results, and his teachers aren't allowed to give us any specific information. But we've heard "unofficially" that he did an outstanding job (probably better than most of the typical 3^rd graders out there.)

Considering this is the first year he's ever been in an "academic" environment, and considering it was just a couple of years ago when we were told, in an IEP, that he didn't know more than 15 words *receptively* - this was a big accomplishment.

For Calvin, his teachers, his therapists (and previous therapists), and for Cheryl and me – this was really satisfying news.

Great job, buddy. I'm so proud of you.

When we first mention to somebody that Calvin gets Music Therapy, they almost always assume it's a bunch of kids sitting around in a circle and singing songs together, as if they're thinking "oh, the autistic boy likes to sing songs – how nice."

On one hand it makes me a little bit angry, because nothing could be further from the truth. Neurologic Music Therapy can have a profound effect on people who have difficulty controlling their bodies, such as people with autism, cerebral palsy, and those suffering from the effects of a stroke. (On the other hand, I can't blame them, because I didn't know anything about it before Calvin's diagnosis.)

Over the years, Calvin's NMT sessions became the most important hour of his week, and the people from the clinic were terrific with him. Cheryl & I began to get involved in any way we could, both with Neurologic Music Therapy Services of Arizona (NMTSA) and with Kris' Camp, a summer camp which shares many of the same protocols as NMTSA.

Last month Suzanne Oliver, the Executive Director of NMTSA, invited me to join her organization's Board of Directors. It's one of the biggest compliments I've ever received. (it's also one of the most nerve-racking – I hope I don't goof it up!) Now I get a chance to give back even more to the one person, outside of our family, who has given, and continues to give, the most to Calvin.

I strongly recommend you check out NMTSA if you live in Arizona, and to look into NMT services in your own state if you live elsewhere.

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Something happened this weekend that was so great, so exciting, so unfathomable not too long ago, that I had to share...

You see, for most of his life, Calvin's been a "bolter." When he was younger he pegged the needle on the ADHD sliding scale, and staying in one place was not something he could do. When you couple that with an irresistible urge to follow any given impulse with complete gusto and reckless abandon, you get a bolter.

We've chased Calving through shopping malls, grocery stores, parks, doctors offices, Target (on too many occasions), and even a parking lot (only once – but that's because we're paranoid about it!) Over the last couple of years Calvin has gained better control over his body, and he's become more of a wanderer than a bolter, but we are still very aware of our surroundings at all time.

Yesterday Calvin & I went to Home Depot to buy a few things. He drove the cart for me (80% independently), helped me pay for our stuff, and drove the cart out to our car. We opened the back of the van to load our bags, when Calvin casually took a few steps away. There weren't any cars around, so I gave him some leeway, although I was ready to sprint after him. He walked down the driver's side of the van, around the front, and opened the passenger door. He climbed in, sat down, and closed the door behind him! Then he looked back over his other shoulder to see me, and gave me a huge, proud-of-himself, smile. It was awesome – a highlight I'll keep in my "best of" memories for a long time...

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Last month I wrote about the Arizona Autism Insurance Bill (Steven's Law) passing the Senate's Health & Appropriations Committee by unanimous vote. Last week the bill passed the House, and this week the Senate followed suit. All that remains is for the governor to sign the bill into law, and we will have insurance coverage for everyone on the autism spectrum – cue the trumpets and the ticker-tape parade to start the party. Well, maybe it's not quite that easy...

Since this looks like it's destined to become a reality, I wanted to talk about some of the positive effects we'll see from Steven's Law, as well as some possible unintended consequences. These thoughts aren't in any particular order – more of a stream of consciousness writing.

Full disclosure: I'm a free-market capitalist, with an undergrad degree in finance and a master's degree in business administration. I left a job with a Fortune 500 company to go into business for myself, where my family's well being depends 100% on my ability to provide recognized value in an industry where many are seen as commodities (one no different from another.) The point is I don't generally agree with government regulation of private business, unless not doing so would cause the public great harm.

Who's covered? People who work for companies with more than 50 employees. Unfortunately Arizona has a very high rate of self employed and small businesses; these people will not be covered.

How many people will be affected? I don't know... How many people in Arizona with children on the autism spectrum work for larger companies? It has to be a fairly significant number, otherwise the law would be virtually useless. But how many actually – 2,500 families? 10,000? 25,000? The larger the number, the more effect it will have on some of my other points.

Earlier diagnoses. We all know how important early diagnosis is, and this law will help facilitate earlier diagnosis and intervention for many families.

Long-term decrease in the State's burden. More kids getting more treatment, and higher quality treatment, at earlier ages, should lead to higher-functioning adults, on average & in theory. Whether these adults are mainstreamed into the productive fabric of society or they still need help with daily living skills (and everywhere in between), a higher functioning population will require less state-provided care over the 60+ years of our kids' adult lives.

Increased Insurance Rates for all. How many families did we say would be covered by insurance mandated through the new law – 2,500 or more? (pulled completely out of thin air – I don't have any supporting documentation.) If each family receives $25,000 per year in benefits, that means the insurance companies are going to pay out $62,500,000 per year! (2,500 families * $25,000 each). This isn't money they were able to plan for by running profitability studies or devising new programs; it's money the government simply mandated they pay out. They are going to seek to recapture some of this lost money, and the best way they have to do that is to have everybody share the pain – higher rates all the way around.

This actually becomes an indirect tax, as the State reduces their financial exposure via DDD by passing the burden to the insurance companies, who then pass the hat to all their policy holders. In effect, everyone with health insurance in Arizona is going to subsidize this program a little bit. It's not really any different from simply increasing the sales tax by a sliver of a percentage point.

Supply & Demand of Therapists. (follow me on this one.)

More people having access to therapy will increase the demand for therapy, which could cause a shortage of therapists, leaving some families without services at all.

The shortage in therapists will allow the providers to raise their rates; some of the increased revenues will be shared with the therapists in the form of higher wages. This will attract more, and higher quality, therapists to Arizona. Some will move from other states, while others will seek out this major in school.

If the inflow of new therapists happens too quickly, it could lead to an oversupply of therapists. This could lead to a class system, where the high-end providers charge the most money and have the highest quality therapists (and serve the wealthy and the large-company-insured families), while the lower quality therapists work at providers who accept DDD payment and serve the less fortunate and less-insured families.

Eventually the insurance companies and DDD will come together to create a price list of allowable charges, which they hope will even the playing field. Even then, however, there wouldn't be a great incentive for the good therapists to leave the high profile clinics to go work in the lower quality clinics. In this scenario, it would take a very long time to self-correct.

This is a quick list off the top of my head; I'm sure there are other costs and benefits we haven't yet touched on. I'll update this list as I think of things worth sharing, and I' love to hear your thoughts as well - feel free to comment below...

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Last week, in the first of 3 cases to go to trial, federal health officials concluded that childhood vaccines contributed to symptoms of autism in a 9-year old Georgia girl (as reported by the Atlanta Journal Constitution.)

The details from the court case are not yet completely available, but the result is. The U.S. Department of Health and Human Services has concluded that the family of Hannah Poling, of Athens, GA, is entitled to compensation from a federal vaccine injury fund. The amount of compensation is still being determined.

Obviously, this is going to add fuel to the vaccination debate fire. It's going to get even hotter when we look at the week's events in total. Let's take a look at how the week unfolded.

1. Senator, and Republican front-runner for the presidential nomination, John McCain was quoted as saying "there's strong evidence" that thimerosal is responsible for the increased number of diagnoses. This brings up a wave of federal spin following Senator McCain's comments.

2. The Center for Disease Control and Prevention, the American Academy of Pediatrics, the American Medical Association, the Food and Drug Administration, and the Immunization Safety Review Committee all stated that no scientific evidence points to a link between the two.

3. The associate director of the American Council on Science and Health expressed disappointment that McCain seemed to be poorly briefed on the issue. "I would hope that, as president, he would have advisers who would get it right. I attribute this to a misstep rather than policy."

4. The program director of the Arizona Partnership for Immunization says "...It doesn't surprise me that someone would not completely understand what the science is indicating." The group advises parents to discuss any vaccination concerns with their pediatricians (and we already know what the American Academy of Pediatrics says. – emphasis mine.)

5. The U.S. Department of Health and Human Services concluded that a family is entitled to compensation due to a vaccine's contribution to a girl's autism diagnoses.

Hmmmm. I wonder what Senator McCain really knew...

I'll stand by my article from last month – there are more questions than answers on this topic, and anyone who accepts the vaccination schedule as 100% safe across the board, dismissing any and all correlation between vaccines and autism, is probably earning a living from an organization who espouses that view.

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Ah, Springtime. It is absolutely beautiful out right now – warm enough to bask in the sun during the day, but it still cools off nicely at night. It's the perfect time to get outside and... Pull Some Weeds!

I don't know about you, but our yard's a mess right now. All the nice rain we had this winter set up perfect conditions for weeds to grow like crazy – especially in the desert-landscaping sections! I started to pull weeds, using my hands &/or a hoe, but they overwhelmed me after awhile, so I reached for the spray.

I hate spraying RoundUp or other herbicides, since Calvin is so sensitive to chemicals. Not to mention Jonas is still only 3 (for a few more weeks, anyway) and plays back there every day – he's awfully young to be exposed to harmful chemicals.

Last week, on the advice of a friend, I sprayed a section of weeds with White Vinegar. Plain ole, store-brand, $2.99 per gallon, white vinegar. And it worked great! Maybe not quite as fast as RoundUp, but a week later you couldn't tell the difference; the weeds are dead. This week I'll spray vinegar on the rest of the weeds.

I haven't tried using vinegar on weeds growing in the grass, as I'm afraid it will kill the grass, too. Maybe I'll dilute it and try it on a small area..? I've used Weed B Gone (another herbicide) the last couple of years. It works great, but I'd much rather have a natural, non-toxic remedy. If anyone out there has any ideas, please share.

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Saturday night's Wine & Cheese Event capped off one of the craziest weeks we've had in a long time, and the results were worth the effort! Everyone seemed to enjoy themselves, and the event went off without a hitch. (well, except a slight technical glitch.. darn Macs.) I saw a lot of great things during the night, but there were a few things I was most happy with:

Success. We ended up just short of our goal, but our goal was set high. This event raised a record amount for Kris' Camp – yea! And that was without a handful of notable people friendly to our cause, who couldn't attend for one reason or another.

Next year. After moving to a new venue last year, and then implementing some new behind-the-scenes changes for this year, we've set the stage to do even better next year. I'm confident we're going to beat this year's numbers by a long shot next year.

Raffle Winner. Watching the drawing for the winner of the Plasma HDTV raffle was the highlight of the event. The winner is a special needs teacher and reading specialist, who works at Kris' Camp during her summer "vacation". She is one of the most energetic and engaging people you'll ever meet, and our kids love her without exception. I think the whole room was rooting for her to win (as a second choice anyway, if they didn't win!), and was genuinely happy to see her accept the prize.

Here's a BIG THANK YOU to everyone who participated &/or attended. We really appreciate your support!

Here's a BIG CONGRATULATIONS to everyone involved in putting this together – you all did a great job and made this a great event!

We'll see you at Kris' Camp this summer, and then we'll do it all again next year! ;-)

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Kris' Camp is a travelling summer camp program offering intensive therapy and education to children with autism and their families. We've been involved with the amazing folks from Kris' Camp for the last few years, and have been fortunate enough to attend camp the last two summers.

Cheryl is chairing the Silent Auction this year, which is going to be held this Saturday at St. Stephen's Hall – 16^th Street & Northern. I'm proud of the work Cheryl & her team (Michelle, Jen, and Tiffany) have put into this, and I'm looking forward to a great event!

Anyone is welcome to attend, buy raffle tickets, or make a donation. If you're reading this and you live in Arizona, there's no reason not to attend – you'll meet some great people, have a fun evening out, and help out a terrific cause.

This is a great organization, and we've seen firsthand how much they help families. Please click the flyer below for more information (and ignore the rsvp date!)

It'd be great to see you there!

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I had a chance to attend the KEEN (Kids Enjoy Exercise Now) town hall meeting earlier this week, and I came away from the meeting impressed with the people who are running it and with what they're trying to accomplish. They are absolutely dedicated to their mission, and they have a track record of success. They also have some pretty impressive corporate ties, sponsors, and "friends". Just as importantly, or maybe even more so, is that they know what they are and what they are not.

KEEN is not going to replace your current ABA program, or your other therapies, or your summer school/camp programs. They are not going to attempt to implement a full-scale, follow-the-rules game of basketball, baseball, or soccer. They are not imitating Special Olympics (although some of their athletes have gone on to compete in Special Olympics.)

KEEN is going to provide an outlet for your special needs athlete to burn off some steam, in whatever capacity he/she is capable of. They are going to provide one-on-one support in a semi-chaotic and free-flowing environment, where each athlete will be playing sports of his/her own choice and at his/her own pace. They encourage friendships among the athletes, volunteers, and parents. But mostly, they provide something for the athletes (and volunteers) to look forward to each week, and to enjoy. They provide side effects of increased coordination, self-esteem, and confidence. (and a little respite for parents!)

Applications are being accepted for athletes and volunteers. More info:

When? The program is scheduled to start on March 30^th. It's expected to be on Sundays and run for one hour. Exact times have not yet been determined.

Where? The initial location will be the Boys & Girls Club on 23^rd Ave & Missouri.

Cost? Free to both athletes and volunteers.

Commitment? Athletes will be asked to make a commitment to attend each week, as there will be a waiting list to join. Volunteers will have no commitments at all – show up whichever weeks you can.

Sign up form. as an Athlete or a Volunteer.

More Info? Visit http://www.keenphoenix.org/ for all the details.

I hope to see you there!

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I just saw the most powerful video I've seen in a long time.

Amanda Baggs is 27-years old. She is autistic, and is non-verbal. She performs many of the odd, repetitive tasks that we've all grown accustomed to. And she needs help with simple daily tasks (cooking, cleaning, etc).

But Amanda Baggs is NOT unintelligent. Armed with a Dynavox, a Dell Computer (she types 120 words per minute), and a Sony digital camera that can record video, she shot, edited, and uploaded this amazing video.

8:36 video. The first 3 minutes or so show Amanda and some of her "stims". The remaining 5 minutes show her discussing what she's doing and why.

I saw this video on an article at wired.com. The article talks about the video, and Amanda, in much greater detail.

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I read an article this morning from Dr. Ann Milanese, director of Developmental Pediatrics at the Connecticut Children's Medical Center in Hartford, who highlighted some great points with regard to how therapy can be more effective.

1. Children are children first, and they have symptoms of autism second.

Think about that for a minute. We push Calvin to work as hard as he can, and he's made great progress over the years. But we also realize that some of his progress has probably come from simply growing up; all kids can do more at 8 than they could at 4, right?  Also, just because a kid has autism doesn't mean he/she doesn't have fun - kids like having fun, and fun means different things to different kids.

2. Autism is a spectrum disorder with a good deal of variability in the way the symptoms express themselves.

I'm sure most of you already know this... Duh. But I think this point is still lost on the public at large. Autistic kids have different strengths and weaknesses, and are all unique individuals, just like typical kids. There isn't a one size fits all description available.

3. Therapy is more likely to be successful if it's fun. I think Dr. Milanese's point is that, while you need to work to develop weaknesses, no kid is going to prosper if they're not having fun.

We used therapy, especially in Calvin's early days of strict ABA-style, to hammer on his weaknesses. Basically, here's the program – now let's work our way through it (using rewards/motivators and breaks when necessary.) Calvin made a lot of progress under this program, but it's true that his most successful times were when we could figure out how to incorporate something he enjoys into the process of working on something he didn't. Even today, we try to mix hard work with play. Whenever we get greedy and demand a lot of hard work, all in succession, we'll also see lots of avoidance behaviors.

I don't think that's very different from anybody else, either. Our youngest, Jonas, doesn't enjoy work for work's sake. But if you get him playing an educational game he'll soak in every last bit of knowledge. I'd have to say I'm the same way – I'm older and have the discipline to force myself to work on improving my weaknesses, but I get a lot more out of it when it's fun!

People are people. Kids are kids. And autism can make learning and communicating a challenge...

Deal with it. Hit it hard. Make it fun!

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KEEN (Kids Enjoy Exercise Now) is a non-profit organization which offers children of all ages, and with all disabilities (including autism), the chance to participate in various sports in a fun and encouraging environment. And best of all, it's FREE to the participants & their families. KEEN has several programs in the Washington DC area, and have recently added branches in Chicago, Los Angeles, New York, and a few other cities. Beginning next month, they'll add Phoenix to their list.

8:43 KEEN video

If you're interested in learning more about KEEN in Phoenix, you can visit their website, or you can attend a Town Hall meeting next week:

What:	A town hall meeting to learn more about KEEN and how this unique program will soon be available to kids with disabilities in the Phoenix area.
Who:	Parents, volunteers, agencies, organizations, and other interested parties.
Where:	Sonnenshein Nath & Rosenthal, LLP 2398 E Camelback Rd, Suite 1100 Phoenix, AZ 85016
When:	Tuesday, February 26, 2008 6:00 – 7:30 pm
RSVP:	If you plan to attend, or would like more information, please call by Friday, February 22 at 602-508-3939, or email at info@keenphoenix.org

We've had some mixed success with programs like these in the past, but I'm looking forward to meeting the KEEN folks and giving this a try. I'm amazed that they've been able to do all this without charging for services.. We've met a few people and organizations over the years who have great intentions and want very badly to make a difference, but funding, volunteers, and resources often becomes too big an obstacle to overcome, and they eventually either change to a pay-for-service model or their services and energy deteriorate over time. The fact that KEEN has some history and has been successful in other locations is giving me reason to hope.

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This is a very serious question, and I think the answer lies in 2 different parts.

1. What is there to gain (or lose) by testing? If it will make a difference in the services available to your little one, it might be worth your while.

2. How fair is the test? If the test can be administered in a fair manner, then it might be worth considering.

Our local school district wanted to test Calvin a few years ago, and we almost shouted NO! in unison.

First of all, their assessment of his abilities was the lowest of everyone he worked &/or played with.

Secondly, there was nothing to gain by testing – it didn't matter if he did really well, since they had already proven they couldn't teach him. But if he did not score well, they would have the option of moving him into a lower-functioning class where he wouldn't need to be "taught".

Thirdly, they couldn't administer a fair test. They agreed that he had (has) apraxia and is non-verbal, yet they weren't willing to make accommodations for the test. Everyone else who worked with Calvin (ABA, Speech, OT, PT, NMT, and friends and family) would attest that he knew everything that was being spoken to him. He just needed to communicate via alternative communication methods, such as PECS (Picture Exchange Communication System), word cards, or Facilitated Touch.

This is one of those questions that doesn't have a right or wrong answer, per se. Just think about who wants the test, and why, and remember that the results will become part of your little one's permanent record...

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We had some exciting news last week, as the Arizona Autism Insurance Bill (officially known as SB1263, and commonly called Steven's Law) passed through the Health & Appropriations Committee by unanimous vote. This was no due to the large support shown by our local parents, friends and families, who turned up en masse to the candlelight vigil and to the committee hearings at the capitol. My guess is that the large support for the bill helped the committee to realize the long-term benefit of getting more children more therapy, and at an earlier age.

The bill has yet to be passed into law, but the unanimous vote is a good sign.

Here are some additional facts, articles, and opinions (mine), in no particular order..

Highlights – beginning January 1, 2009, insurance companies will be required to cover Speech, OT, PT, ABA (behavioral therapy), Diagnosis, and Psychiatric/Psychological care.

AZCentral.com's coverage. Here's an article describing what went down last week.

State Senate. Here's a link to the bill's fact sheet from the State Senate's web site.

Loophole – Large Employers Only. This bill will mandate coverage for group plans for employers with more than 50 employees. That's a terrific start, but Arizona's economy is driven by small businesses – there will be a very large number of families who are unaffected by this bill. (mine included. As a self-employed Realtor, I don't currently have a group plan for more than 50 people.)

Restricted Coverage. It's great to see coverage for the basics (speech, ot, pt, aba), but some of Calvin's biggest gains have come from the 'non-traditional' providers: Neurologic Music Therapy Services of Arizona has been our rock – Calvin's most important hour each week since he was 2 years old; dieticians & allergists, biomedical, vitamin supplements, and homeopathic remedies will also not be covered.

Overall this is a gigantic win for both the ASD community and the State of Arizona. I do hope, however, that over time the coverage is expanded to include more families and more treatments. I also think we're going to see a change in the supply & demand equilibrium when this goes into effect next year, with some short term pain but long term benefits, but that's a topic for another post...

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