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Applied Behavior Analysis: Medically Necessary Treatment for Autism Spectrum Disorders

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Title: Applied Behavior Analysis: Medically Necessary Treatment for Autism Spectrum Disorders


1
Applied Behavior Analysis Medically Necessary
Treatment for Autism Spectrum Disorders

West Virginia Autism Insurance Stakeholders
Roundtable July 13, 2012 Stonewall Resort
2
What is Autism? What is Autism Spectrum
Disorder
  • Autism spectrum disorder (ASD) and autism are
    both general terms for a group of complex
    neurodevelopmental disorders.
  • These disorders are characterized, in varying
    degrees, by difficulties in social interaction,
    verbal and nonverbal communication and repetitive
    behaviors.

3
What is Autism Spectrum Disorder? (ASD)
  • It includes
  • autistic disorder,
  • Rett syndrome,
  • childhood disintegrative disorder,
  • pervasive developmental disorder-not otherwise
    specified (PDD-NOS) and
  • Asperger Syndrome

4
What is Autism? What is Autism Spectrum Disorder
  • ASD can be associated with
  • intellectual disability,
  • difficulties in motor coordination
  • attention
  • physical health issues such as
  • sleep and
  • gastrointestinal disturbances.

5
What is Autism? What is Autism Spectrum Disorder
  • Autism appears to have its roots in very early
    neurodevelopment. However, the most obvious signs
    of autism and symptoms of autism tend to emerge
    between 18 months and 3 years of age.

6
A national public health crisis
  • Autism statistics from the U.S. Centers for
    Disease Control and Prevention (CDC) identify
    around 1 in 88 American children as on the autism
    spectruma ten-fold increase in prevalence in 40
    years.
  • An estimated 1 out of 54 boys and 1 in 252 girls
    are diagnosed with autism in the United States.

7
What is Autism? What is Autism Spectrum Disorder
  • By way of comparison, more children are diagnosed
    with autism each year than with juvenile
    diabetes, AIDS or cancer, combined.
  • ASD affects over 2 million individuals in the
    U.S. and tens of millions worldwide.

8
Applied behavior analysis (ABA)
  • Behavior analysis
  • A natural science approach to understanding and
    changing behavior focus is on interactions
    between behavior and environment
  • A distinct discipline with theoretical,
    experimental, and applied branches and specific
    research methods, scientific journals, and
    scholarly/professional organizations
  • Applied behavior analysis (ABA) Application of
    scientific principles of behavior (e.g., positive
    reinforcement) to improve socially significant
    behavior to a meaningful degree
  • Many applications in addition to ASD treatment
  • Based on the work of many researchers and
    practitioners over 40 years

9
ABA in practice
  • An approach comprising many evidence-based
    techniques or procedures for changing behavior
  • Stresses positive reinforcement and scientific
    evaluations of effectiveness
  • Highly individualized
  • Flexible and dynamic intervention is adjusted
    continuously based on data
  • Delivered in a range of settings homes,
    hospitals, clinics, schools, workplaces,
    community, etc.
  • Effective for improving functioning and reducing
    problematic behaviors in people of all ages, with
    and without disabilities, when implemented by
    professionals with bona fide training and
    experience in the discipline

10
ABA in practice
  • ABA is a distinct profession not the same as
    clinical psychology, developmental psychology,
    educational psychology, counseling, special
    education, occupational therapy, etc.
  • The internationally accepted credentialing
    program for professional practitioners of ABA is
    managed by the nonprofit Behavior Analyst
    Certification Board, Inc. (BACB see
    www.BACB.com)
  • Accredited by the National Council for Certifying
    Agencies, Institute for Credentialing Excellence
  • BACB-certified behavior analysts are recognized
    as qualified providers in autism insurance laws,
    Medicaid laws, and other laws and regulations in
    many states, and by the U.S. Department of
    Defense TRICARE health plan under its ABA benefit
    for military children with ASD.

11
ABA Evidence-based treatment for ASD
  • Hundreds of published studies document the
    effectiveness of many specific, focused ABA
    techniques for building a wide range of important
    skills and reducing problem behaviors in people
    with ASD of all ages, in a variety of settings.
  • At least 11 controlled between-groups studies
    show that multiple ABA techniques combined into
    early comprehensive, intensive treatment programs
    can produce large improvements in symptoms and
    skill deficits in many young children with ASD
    when treatment is directed by qualified
    professional behavior analysts.

12
ABA Medically necessary treatment for ASD
  • As a neurological disorder, ASD is clearly a
    medical condition. It is diagnosed by a physician
    or a licensed psychologist.
  • The CDC (Centers for Disease Control and
    Prevention) identifies autism as a
  • "national public health crisis."

13
ABA Medically necessary treatment for ASD
  • A number of other government and national health
    organizations recognize ASD as a medical
    condition, including
  • -The U.S. Surgeon General
  • -National Institutes of Health
  • -National Institute of Child Health and
  • Human Development
  • -American Academy of Pediatrics
  • ALL of these organizations recognize and
    recommend ABA as the only proven method for
    treating ASD.

14
ABA Medically necessary treatment for ASD
  • On March 27, 2012, Florida Federal Judge Joan
    Lenard held that applied behavior analysis is
    medically necessary and not experimental as
    defined under Florida statutory and
    administrative law and federal law.

15
ABA Medically necessary treatment for ASD
  • Plaintiffs have established through their expert
    witnesses that there exists in the scientific and
    medical peer-reviewed literature a plethora of
    meta-analyses, studies and articles that clearly
    establish ABA as an effective and significant
    treatment to prevent disability and to restore
    children to their best possible functional level
    and restore their developmental skills. Florida
    Federal Judge, Joan Lenard

16
ABA Medically necessary treatment for ASD
  • The treatment for all other neurological
    disorders (such as traumatic brain injury,
    seizure disorders, ALS, Parkinson's Disease) is
    considered medically necessary. As a neurological
    disorder, ASD is no different.

17
ABA Medically necessary treatment for ASD
  • Medically necessary treatments ameliorate or
    manage symptoms, improve functioning, and/or
    prevent deterioration.
  • ASDs are neurodevelopmental conditions that
    manifest in behavioral symptoms, i.e., behavioral
    abnormalities in three core domains social
    interaction, communication, and interests and
    activities.
  • ABA treatment has proved effective for
    ameliorating those core symptoms as well as
    building other skills that enhance functioning
    and health in people with ASD, such as
  • Hygiene and self-care skills
  • Personal safety skills
  • Eating a healthy diet
  • Sleeping
  • Cooperating with medical and dental procedures

18
ABA Medically necessary treatment for ASD
  • ABA interventions have also proved effective for
    decreasing behaviors that directly jeopardize the
    health and welfare of people with ASD, such as
  • Self-injurious behaviors
  • Property destruction
  • Pica (ingesting inedible items)
  • Aggression
  • Elopement
  • Obsessive behaviors
  • Hyperactivity
  • Fearful behaviors

19
Summary
  • Contemporary ABA intervention for ASD rests on
    more than 40 years of scientific research.
  • At present, no other approach to ASD intervention
    has comparable scientific support
  • Best available scientific evidence indicates that
    competently directed and delivered early
    intensive ABA intervention is especially
    effective for ameliorating and preventing
    symptoms of ASD.

20
Summary
  • ABA intervention is now deemed medically
  • necessary for people with ASD by many public
  • and private health plans around the U.S.
  • Health insurance coverage of ABA
  • intervention for ASD provided by
    professionals
  • credentialed by the Behavior Analyst
  • Certification Board
  • can save millions in health care and other
  • costs over time.

21
For more information on ABA for ASD, please see
  • www.autismspeaks.org/whattodo/what_is_aba.php
    (Autism Speaks)
  • www.behavior.org/autism (Cambridge Center for
    Behavioral Studies)
  • www.apbahome.net (Association of Professional
    Behavior Analysts)
  • www.asatonline.org (Association for Science in
    Autism Treatment)

22
For qualifications to practice ABA, please see
  • Behavior Analyst Certification Board --
    www.BACB.com
  • Association of Professional Behavior Analysts --
    www.APBAhome.net
  • Association for Behavior Analysis Autism Special
    Interest Group Consumer Guidelines -
    http//www.autismsig.org

23
Acknowledgement
  • We would like to express our sincere thanks to
    Gina Green, PhD, BCBA-D, Executive Director of
    the Association of Professional Behavior
    Analysts, for permission to redistribute her
    materials.

24
References
  • Association for Science in Autism Treatment -
    reviews of evidence on autism treatments
    http//www.asatonline.org/resources/autismtreatmen
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    interventions for reducing problem behavior in
    persons with autism A quantitative synthesis of
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  • Cuvo, A. J., Reagan, A. L., Ackerlund, J.,
    Huckfeldt, R., Kelly, C. (2010). Training
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25
References
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26
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27
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28
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