Applied Behavior Analysis: Medically Necessary Treatment for Autism Spectrum Disorders West Virginia Autism Insurance Stakeholders Roundtable July 13, 2012 Stonewall Resort
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.
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
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.
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.
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 spectrum–a 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.
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.
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
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
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.
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.
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."
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.
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.
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
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.
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
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
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 anddelivered early intensive ABA intervention is especially effective for ameliorating and preventing symptoms of ASD.
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.
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)
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
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.
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