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Before Robyn Kartchner got married and started a family, she studied human development in college.
So when her firstborn son, Owen, wouldn't nurse or gaze at her, she said, she suspected autism.
"When he was an infant we really struggled to bond," she said. "He didn't want to be held or comforted. He didn't seem comfortable in his own skin."
But it wasn't until October that Owen, now almost 3, was diagnosed. The impetus: a Utah lottery for applied behavior analysis (ABA) therapy, paid for by Medicaid.
The diagnosis, and the pilot program, are "doing miracles," she said.
Not all rural families in the program have faced delays and struggles in finding reliable, qualified providers. The Kartchners live in Monticello, a tiny town in the far southeastern corner of Utah near the Navajo Reservation.
Owen won a spot in December and his therapy with Affinity Autism Services started at the end of January.
Diagnosed with autism and attention deficit hyperactivity disorder, he tends to "float from one activity to the next," said his mom. Physically, he developed quicker than most kids. He was walking by 10 months and navigating stairs by age 1.
But he struggled socially.
"He started to become terrified of other children and closing himself off," Kartchner said. "He would hold his ears and rock when heard loud noises."
Owen's parents have government jobs with good insurance, but it doesn't cover ABA.
Kartchner works in special education in the San Juan County School District, through which her son received "early intervention," speech and occupational therapy.
It wasn't enough.
"Schools don't have the time or funding," she said, explaining that Owen was given 30 minutes of therapy twice a month.
But the connection came in handy when Affinity hired a woman handpicked by Kartchner, who met her through the school district.
"I know parents are frustrated. My best advice to them is, contact your school district and get a hold of early intervention and start networking. They may know of someone who is interested and qualified to do the job," she said.
Kartchner told Affinity her main goal was to get Owen potty-trained.
"They said, 'Slow down there. Let's start by getting him to recognize his name,'" she said.
A board-certified behavior analyst regularly checks in via Skype, providing feedback to his tutor and parents, and tweaking his therapy plan.
In five months he has gone from being nonverbal to saying "momma" for the first time, said Kartchner. "He's requesting things and no longer needs the communication app on his iPod."
In rural Utah, said Kartchner, "We have to be realistic. We have this great opportunity, and I'm going to do as much as I can to make it successful."