Of course, it's wonderful to know that the medical and insurance professions are finally opening their eyes to the fact that hundreds of thousands of children are missing out on therapy as a result of outdated views of autism and autism treatment. But while ABA is an established approach to treating autism, it's certainly not the only option -- and is by no means a magic bullet. While some children with autism really do thrive on ABA, many do not. And very, very few actually "recover" from autism as a result of behavioral intervention.
Compare that reality to this snippet from The Arizona Republic website:
Experts say that many children who get Applied Behavior Analysis, a type of intensive behavioral therapy to improve speech and social skills and reduce disruptive behavior, are able to improve enough to function in regular classrooms.The implication here is that, if only insurers will underwrite the costs of behavioral therapy for young children, additional services may not be needed for the vast majority of people on the autism spectrum. But the reality is that the vast majority of people who do have behavioral (or, in fact, any) intervention do not become "typical" -- and while their behaviors may make it possible for them to "function in regular classrooms," their sensory and cognitive differences may make it impossible for them to actually learn in a typical setting.Some even lose their autism diagnosis completely and become indistinguishable from the peers, supporters say.
While I applaud advocacy efforts to push insurers toward funding autism therapies, I worry that the "cure them while they're young" idea is starting to catch on. Of course, therapy is needed for very young children with autism. But treatments and services are just as critical for people on the spectrum as they move through school and into independent or supported living.
“But while ABA is an established approach to treating autism, it’s certainly not the only option — and is by no means a magic bullet.”
Applied Behavior (not Behavioral) Analysis (ABA) is not the only approach to treating autism, but it is the only approach supported by established scientific evidence. None of the other approaches on this link have any scientific evidence to support them. Some (e.g., biomedical approaches) can be potentially very harmful.
“While some children with autism really do thrive on ABA, many do not”
What is your evidence for this statement? If ABA is carried out by well-trained and qualified individuals, all children will make gains. But, just as with typically developing children, their gains will occur at different rates and will be of different magnitudes.
While it is certainly not the only approach to teaching children with Autism, I think that insurance companies are starting to be required to cover Applied Behavior Analysis because, as Dr. Schlinger pointed out, it is based on many years of solid scientific research.
I use ABA, as well as other good teaching methods, on a daily basis with my students.
However, I also don’t like the goal of making a child “indistinguishable from their peers.” I think that children with Autism are unique individuals (as all children are) and their individual gifts, interests, and strengths should be developed and encouraged while, at the same time, teaching funcional and academic skills.
Nicole Caldwell, M.Ed. of http://www.PositivelyAutism.com/
Regarding Ms. Caldwell’s comment, there is nothing inherent in ABA that makes children “indistinguishable from their peers.” That would be an impossible goal anyway. Our schools already have a similar goal — that all children should master the basics of reading and writing — but that is not a bad thing.
ABA is based on decades of experimentally-derived principles of learning, thus, the principles that apply to all humans and nonhumans alike. But how they are used depends on who is using them, just like any other scientific principle. ANy ABA practitioner recognizes the uniqueness of each individual which is why individualized educational plans are written for each child.
Dr. Schlinger, thank you for clarifying. It was not my intention to imply that there is anything inherent in the science of behavior analysis that aims to make all children “indistinguishable from their peers.”
However, I believe that line originated from the Lovaas study of 1987, is that correct? It is also quoted in many books about ABA. Whether it is possible, or even desirable, or not, it seems to me that it is the goal of many people when they implement an ABA program.
Lisa, I just noticed this quote at the end of your article: “But treatments and services are just as critical for people on the spectrum as they move through school and into independent or supported living.” I completely agree! This is one of the downsides of the insurance programs that I’ve heard about: they don’t provide services for older children or adults. However, I do think that it is certainly an encouraging step in the right direction!
Nicole Caldwell, M.Ed. of http://www.PositivelyAutism.com/
I would also like the insurances to pick speech and play therapy both which have been shown to effective. I do some matching games and a little Aba along with play.
My child has problems with speech that aba or play alone cannot fix.
Though her speech has improved somewhat with play.
Also, no one can replicate the lovass study and many other studies seem to point to that aba has modest effectiveness along the line of play and speech therapy which I feel is often ignored.
Dr. Henry cites me as saying:
“While some children with autism really do thrive on ABA, many do not”
and asks –
What is your evidence for this statement? If ABA is carried out by well-trained and qualified individuals, all children will make gains. But, just as with typically developing children, their gains will occur at different rates and will be of different magnitudes.
To be honest, some of my evidence is anecdotal: I know a number of kids who did not do well with ABA. But of course, as you’ve said, it’s all about the quality of the therapist. One of the problems I’ve seen with ABA is that it is often reduced to poorly-executed discrete trials therapy — which of course isn’t really the same thing as high quality ABA, but is often what is supplied when schools (and I’m guessing insurance companies) get involved.
Top quality therapists are few and far between — and I’m afraid ABA, because it is so structured, lends itself to “packaging” for low-cost, short-term training programs.
Lisa (autism guide)
Responding to Val, as far as I know there is no scientific evidence to support the efficacy of either speech or play therapy (or floor time or a whole host of other therapies being marketed to parents) with children diagnosed with autism. A well-trained applied behavior analyst, perhaps with the help of a speech therapist, can help a child with speech problems, because while the speech therapist may be able to contribute knowledge on what to teach, only the behavior analyst understands HOW to teach.
If the problems are with functional language and not just speech (e.g., articulatory problems), then the speech therapist will be less effective than a behavior analyst.
Replying to Lisa, you are right about the difference between high-quality ABA (which, by definition, it all should be) and people masquerading as applied behavior analysts. Discrete-trial therapy is one small component of a good ABA program but it is not ABA.
Actually, research HAS been done to prove the efficacy of floortime, play therapy, RDI, and various other therapies. There are, however, several problems with the research that are inherent to the design of the therapy.
Where ABA is systematic, easy to replicate, and easy to assess, Floortime in particular is not. In fact, the whole concept behind Floortime is that every program is individualized based on the needs and interests of the child. As a result,while a researcher can certainly say “yes, this child has progressed in various ways through floortime,” it’s very tough to measure relative improvement — or to show a particular percentage-rate of improvement among a group over time. What’s more, very few people outside the Floortime, RDI, Play Project etc. communities are interested in researching those specific treatments. And NO ONE has compared them head-to-head with ABA (I’ve been told it would be too expensive).
This is a HUGE shame, IMHO, because quite frankly I love Floortime, think it’s very effective and positive in its approach, and would love to see it better understood and more commonly used in preschools and schools!
Lisa (autism guide)
I have been working with children with autism for the past 8 years providing ABA based therapy. The children I have worked with have made tremendous progress in communication, reduction of problem behaviors, social skills, self-help skills and academics. I can not say the same for other therapies, as many of the families have tried them and almost always return back to what is researched and proven effective. The principles of Applied Behavior Analysis is not just Discrete Trials, as it is often made to sound. DTT is only one small part of an ABA based program. There are many families currently missing out on the services we provide due to lack of funding. The hardest thing for some of these families is to see the results and then not be able to afford to continue the therapy. It should be covered and hopefully other states will follow behind Arizona.
I think it is very narrow-minded to say that ABA is the only therapy that is worth being covered by insurance. I hope Arizona keeps the ball rolling because ABA is not the be all, end all of autism treatment.
My son doesn’t receive “official” ABA at his elementary school but, more than one of his therapists have gone to ABA workshops to learn better methods to use to teach their students with autism. I think the methods have helped. There is no way we could ever afford to send him to an actual ABA therapist, though.
As a parent, I have to say, I don’t think my son would ever have been able to sit still for his “ABA-like” sessions if he hadn’t received all the other therapies FIRST. He just wouldn’t have been “present” enough to take anything in. We’ve used Floortime, Speech, Occupational and Physical Therapy. It has been obvious to all that the GF/CF diet helps him.
We are not even done with our first stage of chelation therapy and he is already showing increases in the amount of time he can spend sitting for “work” and he is making more verbalizations.
I’ve tried to introduce new things, like supplemnts, one at a time to keep track of any changes. We have to joke sometimes that our life is a “science experiment”.
I think many parents don’t want to have to wait for all the doctors and scientists to get their acts together. They are willing to try things that haven’t been in controlled-double-blind-placebo-testing or whatever. Who wants to sign their child up for testing when they know they might be given a placebo? We don’t have time to wait for that kind of hard science.
I don’t expect my health insurance company to pay for my gluten-free groceries (which are about 3 times more expensive that “regular food”) but it would be nice if his supplements were covered. They are prescribed by his doctor.
I am very glad there are doctors, scientists and teachers out there who have the ability to think outside the emperical box. I won’t hold my breath waiting for the insurance companies to evolve anytime soon.
I agree that there other forms of therapy that do help kids auitsm spectrum/aspergers.
We need broaden the range of therapies
RDI/Son rise proram/floor time/ ABA
All of these have helped groups of children and their families, to learn and cope.
Maybe the focus should not “just” be on cure any skill that is learned and generalized will help our kids function in he real world.
Skills learned will beneft comminites and families by children requiring a LESS DEMANDING LEVLE of residential instruction when they are adults.(Therefore less cost)
The people themselves will have a better self image, they will feel more self suffient,a part of thier communities (giving, they have so much to give )
The families would have less crisis…they could “let go” and do what families should be doing….planning get togethers/holidays …just enjoying eachother’s company sharing what each has accomplished/hopes/dreams.
Parents could work and be a benefit for their community instead of a drain on the system.
Right now we have to be well below the poverty level to recieve the therapies/behaviorial/social/emotional/speech/ot/emergency support/etc (don’t forget the waiting lists…the cost out of pocket..$100
a half hour or more.)
We are asked to transport our kids at the drop of a dime to above/take them home from from school…because THEY do not know how to handle them.
There is very little way the average middle income PARENT COULD do ALL the above w/o sacrificing a career.
Few people “want” to give up thier own lives/jobs for their kids…..we just “have to” becuase at the momment we DO know Autism and our kids the best in our communities.We are the most skilled teachers out there.
I support, supporting those who will get us out fo this viscuos cycle so we can all move on and do what is right.None of these kids/families should suffer uneccessarily.
There is soooooo mush we can DO NOW!
The child who:
Learns to be potty trianed= will not need diapers/changing
learns to dress himself = may become independant/may cook YOU breakfast
Learns to read= will learn about the world around him
“It takes a village………”
sherri
The reality is that we have to introduce legislation that actually has a chance of PASSING. Limitations on age and treatment types are simply politcal reality. I wish things were different, but they’re not…
As my big-haired Texas grandma always says, don’t throw the baby out with the bathwater …
Actually, has any one looked at the history of ABA and their trained therapists? It was so controversial and brutal in those days, they had to reconfigure how and when they certify therapists. That wasn’t all that long ago, either.
That said, there are plenty of ABA therapists that do not even have the experience to be doing this, and often do more harm than good. ABA is not for all kids, however plain Speech and O.T therapy is and that’s what should be made mandatory for insurances to cover. Our private Speech and O.T specialized in kids with autism, to suggest they’d be less effective than an ABA/ behavioral analyst is inaccurate. A Speech therapist can be most effective for a child with autism and behaviors surrounding autism.
We never did ABA and I am glad we never choose to. ABA does work on and teach through repetition and often fails to teach the meaning behind for instance, the joy of wanting to say hello to a peer. My child repeats many things he has no clue of the meaning of it. I can teach my child by repetition al day long, for in fact he’d had made the job of an ABA therapist easy since repetition is his middle name however, going beyond that is what ABA does not do.
My son was diagnosed 14 yrs. ago.
At 4 1/2, his expressive speech was at a
16 mos. level. I was told his speech delay,
0-5, 5 being severe, he was a 5. Speech
therapists had tried to work w/ him from the time he was 2 1/2 with little progress.
We moved to Arizona, and a college student
trained in ABA took him into a room–2 hours
later he came to me and when I asked him his name-he responded “My name is Sam”. In 2 mos.,
he was able to respond to 28 questions, so we
integrated him into a typical classroom w/ an aide.
We were at the state capitol in AZ to see the Senate vote to pass insurance legislation
to stop insurance companies from excluding
kids w/ Autism. This will help families who are insured (at companies w/ over 50 employees ) and take many people off DDD/DES.
Thank you AZ legislature and Gov. Napolitano!
My son got floortime, OT, and speech, first at home in early intervention and then at preschool. His progress has been astonishing, and I doubt that ABA could have done that for him. That being said, I think that some children who are more profoundly autistic and do not respond to other therapies may respond to ABA. It’s all individual.
What the newspaper did not tell you is that we are only the 3rd state to include ABA in addition to ST and OT. Also, this bill extends coverage those diagnosed with Asperger’s and PDD-NOS. Those kids are not eligible for services through the state. Finally, my son with AS can get the OT he needs while his brother with Autism can continue with his therapies.
The media is also mistakenly using the term “cure” for those who have lost their diagnosis by learning to compensate for, and overcome their deficits.
Like Renata, I was at the committee votes, talked to and sent letters and emails to my Senator, Reps and Govenor. This was a hard won battle in a very conservative state. The bill nearly died in committee because the Chairman of Health did not want to even put it on the agenda since he opposes mandates. Baby steps.
I understand the frustration of those who wish that supplements were covered, but we also have to keep in mind what that would mean. No insurance company would cover anything that doesn’t have FDA approval. That means years of trials and only big Pharm. can afford that.