NABA Statement on Autism Treatment

The Necessity of Applied Behavior Analytic Treatments for Children Diagnosed with Autism Spectrum Disorders

Autism Spectrum Disorders (ASDs) are among the most prevalent developmental disorders and estimated to affect 1 in 91 United States children (Kogan et al, 2009). ASDs lead to substantial deficits in language and social interaction and, for many children, lead to excesses in maladaptive behavior problems such as stereotyped behavior patterns, aggression, self-injury, and frequent tantrums. For many years, these disorders were not thought to be treatable, and prognosis was considered poor for a child diagnosed with an ASD. Because of this, the costs to the quality of life for children and families and the immense financial burden to public education and health systems were high. However, this no longer has to be the certain and predictable future for these children, families, and systems of care.

Successful education and treatment for children diagnosed with ASDs does exist. Interventions using the principles and techniques of Applied Behavior Analysis (ABA) have been documented to repeatedly show effective treatment outcomes with children diagnosed with ASDs (Buchanan & Weiss, 2006). Hundreds of well controlled studies have demonstrated successful treatment of one or two specific behavioral excesses and deficits associated with ASDs (Matson et al., 1996). Additionally, outcome studies have shown positive initial and long-term effects of intensive ABA intervention for children diagnosed with ASDs (e.g., Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Eikeseth et al., 2002; Sallows & Graupner, 2005; Howard et al. 2005). In fact, many of these “outcome studies” report similar results: about ½ of children are nearly indistinguishable from their peers and do not need specialized supports inside of their educational environments following early and intensive behavioral intervention. Those who achieve that favorable outcome are often still reported to make substantial gains in learning, communication, and socialization. The number of studies reporting these successful outcomes using ABA interventions continues to grow year after year.

From this overwhelming body of scientific work, multiple national and state commissions (National Research Council, 2001; MADSEC, 2000; State of New York, 2001,United States Surgeon General, 1999; Nevada Autism Task Force, 2008) and national independent evaluators (National Autism Center, 2009) have determined that ABA interventions are empirically-supported treatments that produce positive changes in the symptoms of ASDs. Some reports have also suggested ABA is a cost efficient treatment option given the substantial long-term cost of providing these children with specialized health, education, and supported living services (Jacobsen, Mulick, & Green, 1998; Nevada Autism Task Force, 2008).

ASDs are believed to arise from medical conditions. Medical providers, such as neurologists, pediatricians, and psychiatrists, provide these diagnoses. Most insurance companies, however, do not provide benefits that cover treatments delivered by behavior analysts despite their efficacy. It is not unusual for intensive behavioral treatments to eclipse $50,000/year, and treatment often continues for multiple years. The costs of ABA are significant and, despite the availability of effective treatments, many families cannot afford these services.

For legislators in Nevada, this was unacceptable. With careful analysis of the research, the enormous costs to families, and paralyzing effects of the long-term costs to our public education and health systems, legislators voted 60-2 to mandate insurance companies to cover the costs of these necessary ABA treatments. Through Assembly Bill 162 (AB 162), private and state-run health insurance programs will be required to cover ABA interventions for children with ASDs starting in January, 2011.

Nevada was the 11th state to pass this monumental legislation. 22 other states have also passed similar legislation requiring insurance coverage for children with ASDs, and 9 other states have legislation requiring limited insurance coverage. In many other states, similar legislation is currently being examined as states become increasingly aware of the need to get these children treatment as soon as possible.

Legislators running for governmental office need to be educated and aware of these facts and figures. Effective, evidence-based treatments are a medical necessity for children with ASDs. Without a way for most families to pay for them, our educational, health, and public long-term care systems will shoulder enormous costs for these untreated children. Of course, the most difficult outcome to swallow will be that these children could have been helped, and likely will not be, if those running for office choose to repeal this autism insurance mandate.

The Nevada Association for Behavior Analysis requests its members and the Nevada community to exercise your voting rights by supporting candidates that support AB 162 and similar mandates across the country that provide financial support for ABA treatment for children and families dealing with ASDs.

Disclaimer:

The views and opinions expressed in this statement are solely those of the 2010-2011 Board of the Nevada Association for Behavior Analysis. Nothing in the views and opinions expressed in this statement may be implied to come from the Association for Behavior Analysis International (ABAI), its other affiliated chapters, or its special interest groups. ABAI, its affiliates, or special interest groups were not involved in the creation of this statement and may not endorse the opinions contained herein.

References:

Buchanan, S. M. & Weiss, M. J. (2006). Applied behavior analysis and autism: An introduction. Ewing, NJ: COSAC.

Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavior treatment at school for 4-to-7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification,26, 49-68.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Jacobson, J. W., Mulick, J. A., & Green, G. (1998). Cost-benefit estimates for early intensive behavioral intervention for young children with autism-general model and single state case. Behavioral Interventions, 13, 201-226.

Kogan, M. D., Blumberg, S. J., Schieve, L. A., Boyle, C. A., Perrin, J. M., Ghandour, R. M., Singh, G. K., Strickland, B. B., Trevathan, E., & van Dyck, P. C. (2009). Prevalence of parent-reported diagnosis of Autism Spectrum Disorder among children in the US, 2007. Pediatrics, 1-9.

Lovaas,O. I. (1987). Behavioral treatment of normal educational and intellectual functioning in young children with autism. Journal of Consulting and Clinical Psychology, 55, 3-9.

MADSEC Autism Task Force (1999). Executive Summary. Portland ME: Department of Education.

Matson, J. L., Benavidez, D. A., Compton, L. S., Paclawskyj, T., & Baglio, C. (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433-465.

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97, 359-372.

National Autism Center (2009). National Standards Report. Randolph, MA: National Autism Center.

National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord and J. P. McGee (Eds.) Division of Behavioral and Social Sciences and Education. Washington D.C.: National Academy Press.

Nevada Autism Task Force (2008). 2008 report of the Nevada Autism Task Force: An action plan for Nevada’s legislators and policymakers. Retrieved Dec, 2009 from […]

New York State Department of Health Early Intervention Program (1999). Clinical practice guidelines: The guideline technical report-Autism/pervasive developmental disorders, assessment and intervention. Albany, NY: New York State Department of Health.

Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110, 417-438.

U.S. Department of Health and Human Services (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.