When a child has an autism spectrum disorder, or ASD, it is common for parents to go into denial and assume the little signs and behaviors they are noticing will go away, said Cathy Cantor, a ProMedica physician who has personally been down this road.

Dr. Cantor and her husband, Zack Shaffer, started noticing their son, Zachary, was not hitting the same developmental milestones as his twin sister, Emily, when the children were about 18 months old. Emily was making leaps and bounds in speech, eye contact ,and play, outpacing her brother, Dr. Cantor said. 

All around them, however, family and friends assured them that all kids are different and Zachary would catch up.

“Whether they are being nice or just being politically correct they are gonna say ‘oh he’s just a boy — don’t worry about it or he’ll come around,’ so you know you kinda get that little false hope that it’s gonna be OK because everybody else is telling me he’s fine,” Mr. Shaffer said.

Even though she is a practicing pediatric and internal medicine physician,

Dr. Cantor said it’s different when it’s your own child. “He’ll come around. Gosh it might just be a little delay, so I thought well maybe I’m just making too much of it,” she said.

Autism, a developmental disability that can cause significant deficits in communication, socialization, and behavior, used to be diagnosed separately.

Autistic disorder, pervasive developmental disorder, and Asperger syndrome are now under one umbrella of ASD.

What exactly causes autism and why the disorder is on the rise is in some respects still a mystery, said Melissa Schlotterer, program manager at the ProMedica Autism Early Learning Program.

“They do know that there is some kind of biological component in terms of some abnormal brain development. They also feel there is a genetic component but they know that’s not the single cause, so that’s the tough part right now is really kind of pinpointing what is causing autism,” Ms. Schlotterer said.

The science is clear, however, that there is no correlation between vaccinations and autism, she said. There is ongoing research on a range of environmental factors, such as pesticides and pollution, but nothing conclusive at this point, she added.

About 1 in 68 children in the United States has been identified with ASD. “ at’s 1 in 42 in boys more specifically, and back in 2000 it was 1 in 150 boys,” she said.

“If you look in the past few years the prevalence has drastically increased. There could be more awareness now and there have been changes in state and federal policies, and there could be an actual rise in autism so there could be all these different things that are leading to the rates increasing. It’s probably a combination of all of those things,” Ms. Schlotterer said.

ProMedica opened the Autism Early Learning Program nearly four years ago, which offers behavioral services for children up to six years. It was opened in part as a response to the increase in autism rates and because there was a gap in the Toledo community in providing services for children who are being diagnosed at an early age, around 2 years old, she said.

Three-year-old Zachary’s parents were referred to the ProMedica program about a year ago by his speech therapist.

“Once we had his full evaluation and the autism diagnosis came up I think we had this point one evening when I said what are we gonna do if he’s really autistic and my husband just said ‘then we make him the best little autistic boy he could be,’ ” Dr. Cantor said.

There are about 25 children enrolled full time in the ProMedica early intervention program with Zachary, said Ms. Schlotterer. There are 13 behavioral therapists who work with the children in groups or one-on-one helping them develop the skills they are lacking when they come in the door.

The therapists use a program called Applied Behavior Analysis (ABA) with the children, a technique that uses positive reinforcement and teaches them basic and complex skills — a technique that is backed by years of scientific research, she said.

When the center opened it was the first in the area to use ABA therapy for children and there is a waiting list for children to get into the program, she said. There are now other programs in Lucas County that have board-certified behavior analysts on staff which is a very important question for parents to ask when they are choosing an intervention program for their child, said Catina Harding, executive director of The Great Lakes Collaborative for Autism.

ABA programs are considered the gold standard in autism services, but many such programs in the area have a waiting list, Ms. Harding said.

Dr. Cantor said even though she is a ProMedica employee, she was not aware of the autism program before Zachary’s speech therapist recommended it.

“I could really see where parents would struggle with knowing who to contact. It requires a lot of time on the parents’ part for appointments and time off of work and all those things,” she said.

Zachary’s first year in this program has been “life changing” for her family, Dr. Cantor said.

“He probably had about 50 words that were kind of words when he started. There were probably only 15 or 20 that the average person would recognize as a word. During the first few weeks he came home all of the sudden, he was like ‘I love you mommy’ or ‘I love you daddy’ and it was like we never heard that before and after just a couple months,” she said.

Zachary’s father said a year ago he was nervous about taking him out to public places like ball games or the store because he would get frustrated easily. He would scream, run, bite, and throw tantrums, Mr. Shaffer said.

His behavior has improved so drastically that Mr. Shaffer, who is a stay-at-home father, now takes both kids out in public with no fear. “You can see that it’s starting to connect. He’s putting it together. You can just see it in his eyes that something’s going on,” Mr. Shaffer said.

In fact, Zachary has now surpassed his twin sister in some developmental skills, he said.

“It’s just mind boggling. It has given us hope that he can learn and be happy,” Dr. Cantor said.

The ABA-based early intervention program offered at ProMedica’s Autism Center is intensive, but it is also quite expensive. The cost is more than $37,000 per year for the full day program and the center recently added a half-day program that runs about $20,000 a year, Ms. Harding said.

When a child reaches the age of 3, families can apply for help to defray the cost of intervention programs through an autism scholarship fund administered by the Ohio Department of Education. Those who qualify can receive as much as $27,000 to help pay for these types of programs, Dr. Cantor said.

Ohio is one of a few states in the United States that has not passed autism intervention insurance reform that would allow health insurance plans to cover some of the costs of such a progam, Ms. Schlotterer said.

“Forty-one other states plus D.C. have done it. Michigan has it. It covers ABA intensive therapy so ProMedica is starting a program at its Bixby Hospital in Michigan. They will be able to bill all of their intervention through insurance,” she said.

In Ohio, families can use health insurance to help pay for speech, language, and occupational therapy depending on their health plan, Ms. Harding said. There is a huge gap in Ohio, however, for children under 3 years old who are not eligible for the Ohio scholarship fund which is a major problem as children are being diagnosed with autism as early as 18 months old.

“It is expensive. I could see where for some families that the cost would be a factor,” Dr. Cantor said.

She said in the case of her son, early intervention at the age of 2 has been crucial to his rapid improvement and development.

“If we would have waited until kindergarten or until someone saw an issue within the school district, we would have missed an opportunity and I know that early intervention is the key. I know that cost makes it very scary for parents because it’s like what if he’s not? What if it’s a wrong diagnosis, you know? I think it’s just worth it,” she said.

Contact Marlene Harris-Taylor at mtaylor@theblade.com or 419-724-6091.

First Published September 7, 2015, 4:00 a.m.