Fredericton Liberal Matt DeCourcey: Liberal Party Committed to A National Autism Strategy Addressing Access to ABA/IBI

Fredericton Liberal Candidate Matt DeCourcey

Email received October 2, 2015 from Fredericton Liberal Candidate Matt DeCourcey stating Liberal Party supports creation of a National Autism Strategy addressing ABA and IBI access and coverage under Medicare:

Hi Harold,

Thank you for the email. I apologize for the delay in my response. I want to let you know that the Liberal Party and I fully support the creation of a national autism strategy. Our party recognizes that in certain provinces, autism treatments, including ABA and IBI are covered under provincial Medicare programs and are more readily available in other provinces. Health care access challenges like these are something that the Liberal Party is committed to addressing.

First and foremost, we need a conversation that goes beyond simply mirroring previously made commitments. We need a partner in the federal government that is committed to innovation and collaboration with the provinces and territories to achieve a modern, efficient, equitable system of universal health care. The Liberal Party is committed to that collaboration.

A Liberal government will re-engage the provinces after 10 years of Stephen Harper neglect. We will meet on Canadian health care and negotiate a new Health Accord with the provinces and territories, including an agreement on long-term funding. Furthermore, our party is committed to pan-Canadian collaboration on health innovation. We will work with provincial jurisdictions to overcome obstacles to innovation in health care delivery and access.

Thank you again for your email. I hope that I’ve helped to clarify the Liberal Party’s position on support for those living with autism. If you have any further questions please reach out.

Best,

Matt

Wow! Federal NDP Replies to My Inquiry This Morning Re Negotiations to Include ABA for Autism under Medicare

I confess I was surprised  to get a same day response this evening from the federal NDP to my question this morning addressed to party leader Thomas Mulcair.  The federal NDP committed to continuing the efforts which they have in fact made over the years in Parliament towards creation of an EFFECTIVE national autism strategy.   

To Canada's  federal NDP and leader Thomas Mulcair I say thank you.

8:20 PM (9 minutes ago)

to me

Dear Mr. Doherty:

Thank you for providing such a helpful summary of your discussions with us on this important issue.

New Democrats have a proven record of working with the autism activist community toward increasing awareness and supports for those living with autism spectrum disorders. NDP MPs have, over many years, proposed bills and motions in Parliament toward the creation of an effective national autism strategy. We are committed to continuing that effort as government.

The success of any national autism strategy that includes medically recognized treatments such as Applied Behavioural Analysis and Intensive Behavioural Intervention, depends on the commitment and involvement of provincial and territorial, as well as federal governments. At the moment, for lack of federal leadership, the levels of support vary widely across the country.

Over the past decade, the Harper government has consciously chosen to abandon its leadership role in Canada’s health system and has turned its back on the federal-provincial-territorial cooperation necessary to maintain and improve our public system – including measures to better address autism needs. Stephen Harper has not only refused to renew the national health accord but has unilaterally cut billions of dollars from future provincial/territorial health transfers.

Under Tom Mulcair, an NDP government will live up to its national leadership role and move quickly to re-establish a collaborative working relationship with provincial and territorial governments. A New Democratic autism strategy would be forged within this renewed negotiation and would establish, with provincial and territorial cooperation, access to treatment across Canada.

Canada’s New Democrats | Le NPD du Canada

Ready for change | Ensemble pour le changement

www.ndp.ca

Fredericton NDP Sharon Scott-Levesque Supports ABA Coverage For Autism Under A New Canada Health Act Accord

Hello Harold,

I wish to thank you for your message regarding the inclusion of Applied Behaviour Analysis in Medicare. As you have noted, this is an issue affecting a growing number of Canadian families, and I understand the high costs of treatment are of great concern.

As you know the Canada Health Act requires provinces to cover medically necessary services without naming any particular procedure.  This means that the decision on what to cover has been left up to the provinces, creating a patchwork system where some provinces provide coverage for Applied Behavioural Analysis and others do not.

-

I recognize that this disparity creates a hardship for families and myself and the NDP are interested in working with the provinces to see this disparity eliminated. This is definitely a subject we will raise with the provinces when we negotiate a new Health Accord.

I do support this change and hope we can work together in the future.

Regards,

Sharon Scott- Levesque RN

Fredericton NDP Candidate

Thank you Sharon Scott-Levesque for supporting the inclusion of ABA for autism treatment in a new Canada Health Act accord.  Harold Doherty

Canada Needa a Real National Autism Strategy: Exhibit #1 Saskatchewan

Saskatchewan is Exhibit #1 In the Case for a REAL National Autism Strategy

Canada has long needed a REAL National Autism Strategy, one which includes coverage of autism in medicare to ensure that children with autism disorders received treatment for their autism disorders regardelss of which province their  parents live in. One of the most glaring examples of the need for national autism medical coverage is in the province I once called Canada's Autism Wasteland  province.   Since that commentary on September 2, 2007  little progress appears to have been made judging by the Global story by Amber Rockliffe: Saskatchewan families moving due to lack of autism funding.  Rockliffe reports of  Saskachewan families leaving the province to find treatment for their children's autism disorders; treatment which is not available because of long wait lists and is not usually delivered  in sufficient hours to make a substantial difference in treating their children's autism. 

One of those families that has already made the move is the family of Sheri Radoux:

“Sheri Radoux, has moved south of the U.S. border to Minnesota. “I think the services in Saskatchewan are probably the worst, or one of the worst in Canada, “said Radoux. “We moved down to Minnesota and we got full-time therapy for all our children, paid and funded by the state.”

The Rockliffe report goes on to indicate that Saskatchewan spends half, approximately $7.5 million annually, compared to approximately $15 million, that   Manitoba, with a similar population, spends annually on autism services.

Families leaving provinces, including the province many would consider the birthplace of medicare in Canada, to seek a better life for their autistic children in jurisdictions provincial and American  where a greater value is placed on the lives and futures of autistic children.

Yes, Canada needs a REAL National Autism Strategy.

May Institute National Autism Center Review: Applied Behavior Analysis The One Intervention Determined To Be Effective For Adults With Autism

National Autism Center Completes Most Comprehensive Review of Autism Interventions Identifies Established Interventions for Children, Adolescents, and Adults on the Autism Spectrum 

National Autism Center Press Release 0.1 

Randolph, Mass. – Researchers at the National Autism Center at May Institute today released the results of the largest systematic review to date of interventions for autism spectrum disorder (ASD). Their findings identify 14 “Established Interventions” for children and adolescents that have the most research support, produce beneficial outcomes, and are known to be effective, and one Established Intervention for adults on the autism spectrum.

“The National Standards Project is an ongoing effort designed to give educators, families, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer individuals with ASD the greatest hope for their futures,” said Hanna C. Rue, Ph.D., BCBA-D. Dr. Rue serves as Executive Director of the National Autism Center, May Institute’s Center for the Promotion of Evidence-based Practice.

Leading the way in the field of adult intervention, this latest iteration of the National Standards Project also included an analysis of intervention outcome studies for adults (ages 22 and older) that have never been systematically evaluated before now.

The one intervention determined to be effective for adults, and nearly all of those classified as effective for children and adolescents, are behaviorally based, meaning they are grounded in the methodologies of applied behavior analysis, behavioral psychology, and positive behavior support.

In spite of the burgeoning population of adults with ASD, there is little empirical research to guide intervention for this population. The overwhelming majority of research studies to date focus on interventions for children and adolescents.

“Because of the dearth of research on adult interventions, only 27 studies focused on adults with ASD met our inclusion criteria,” said Dr. Rue. “Although we are pleased to be able to identify one Established Intervention, these results draw attention to the dire need for further research in this area.

“Children with autism grow up to be adults with autism; they will require effective interventions throughout their lifetimes to ensure they reach and maintain their maximum potential,” Dr. Rue added.

The National Standards Project is the only systematic review of ASD interventions for individuals across the lifespan based on behavioral and educational studies. Through a rigorous process utilizing tools and strategies designed and vetted by a team of national experts, the Project’s goal was to analyze the research that was conducted and the impact on participants, and to determine the strength and scientific rigor of that research. The results will help to inform decisions about interventions, or treatments, for ASD.

The report released today, Findings and Conclusions: National Standards Project, Phase 2, updated the Center’s first summary of the ASD intervention literature for children and youth under age 22. Phase 1 of the project was published in 2009. The combined the results of Phases 1 and 2 have produced the largest compilation of studies ever reviewed.

Nationally recognized experts in autism, as well as other leaders representing diverse fields of study, were involved in both phases of the National Standards Project and guided the process of evaluation. Dozens of article reviewers analyzed 1,165 studies related to interventions for ASD throughout both phases of the project. The interventions were subsequently categorized as 1) Established, and producing beneficial outcomes known to be effective; 2) Emerging, with some evidence of effectiveness, but still requiring more research, and 3) Unestablished, and having little or no evidence of effectiveness.

This new report identifies three interventions for individuals under age 22 that were identified as Emerging in 2009 and have now garnered enough scientific evidence of effectiveness to be moved into the Established category.

During the past five years, the National Autism Center has disseminated the results of the first phase of the National Standards Project to hundreds of thousands of individuals throughout the country and around the world through the publication of the National Standards Report.

 The new free report download:  http://www.nationalautismcenter.org/category/press-release/.

About the National Autism Center

The National Autism Center is May Institute’s Center for the Promotion of Evidence-based Practice. It is a nonprofit organization dedicated to serving children and adolescents with autism spectrum disorder (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities. For more information about the National Autism Center, please visit www.nationalautismcenter.org.

About May Institute

May Institute is an award-winning nonprofit organization with 60 years of experience in serving children and adults with autism spectrum disorder and other developmental disabilities, brain injury, mental illness, and behavioral health needs. The organization provides educational, rehabilitative, and behavioral healthcare services to individuals, as well as training and consultation services to professionals, organizations, and public school systems. At more than 160 service locations across the country, highly trained staff work to create new and more effective ways to meet the special needs of individuals and families across the lifespan. Learn more at www.mayinstitute.org.

Autism Canada, With Some Help From the Globe and Mail, Promotes "Weak Evidence" Based Son-Rise Program®

Autism Canada suggests parents of autistic children should change course and head down a different trail, away from strong evidence based interventions like Applied Behaviour Analysis, toward programs with weak evidence base in support of their effectiveness like the Son-Rise Program®. The Globe and Mail has kindlly provided some support for this adventure with a less than thorough analysis or assessment of  the respective approaches and treatments or the possible outcomes for autistic children involved who might lose valuable therapy time during the critical early intervention period between ages 2 and 5. 

As I  previously noted on this site Autism Canada is busy Changing the Course of Autism from the evidence based approach that parents  advocated for across Canada over the last 15 years to an anything goes approach that encourages parents of young autistic children to try autism treatments with weak or no evidence supporting their effectiveness.  On July 3, 2014 the Globe and Mail Health section featured an article with several quotes by Dr. Wendy Edwards and Laurie Mawlam both of whom are affiliated with Autism Canada and their attempts to push Canadian parents of autistic children away from seeking evidence based effective interventions for their children ... Applied Behavior Analysis ... to programs with weak evidence in support of their effectiveness such as  ... the Son-Rise Program®. 

Lee Marshall is the author of the Globe and Mail article Facing down autism: The unconventional (and somewhat controversial) therapy that’s led to recovery  and  may not be responsible for the article title which assumes that the controversial therapy ACTUALLY leads to recovery even though the evidence that recovery results from the program is weak, anecdotal evidence. The article refers to a 2013 Lancaster University study Promoting child-initiated social-communication in children with autism: Son-Rise Program intervention effects a very small study which involved 6 children none of whom had an intellectual disability.  Intellectual disability is a serious complicating condition affecting from 41-44%  (CDC) to 50% (WHO) of persons with autism disorders.

Dr. Wendy Edwards provides her family's personal, anecdotal evidence of the benefits of the Son-Rise Program®.   Doctor or not her family story is still just that .... a family story.     Anecdotal evidence,  like  personal testimonials published promoting Son-Rise, is  considered the weakest form of evidence:

"Anecdotal Evidence"

"Social scientists are wary about the use of stories as evidence for a claim. Anecdotes that are not backed up with systematic and rigorous comparative data are not trusted. Anecdotes are the weakest form of evidence, but they are often the most persuasive. Even scientists can be moved by a telling anecdote that contradicts a mass of statistical evidence. Anecdotes must always be used with care, precisely because we are psychologically susceptible to them." 

Laurie Mawlam, to her credit does acknowledge the substantial gulf between the evidence in support of Son-Rise  compared to ABA although she provides no credible explanation for the lack of evidence in support of the Son-Rise Program®:

"Mawlam of the Autism Canada Foundation said she had a “wonderful” experience using Son-Rise with her son. “While the scientific studies for Son-Rise are nowhere as plentiful as traditional discrete trial [Applied Behavioural Analysis], it doesn’t necessarily mean the treatment is not valid. It may just mean the studies have not been done,” she says."

The fact that Laurie Mawlam had a "wonderful experience" is not evidence of the effectiveness of Son-Rise.  Her weak dismissal of the lack studies providing evidence for Son-Rise is very questionable since the program began its development in the 1970's. There was ample time for studies to have been conducted between then and 2000.  One of the leading reviews of the evidence basis in support of various autism interventions is the Maine Administrators of Services for Children with Disabilities  (MADSEC) Autism Task Force Report (2000). The MADSEC Report reviewed and assessed the evidence basis of the Son-Rise Program®:

"According to Levy (1998), the Son-Rise Program does not guarantee results. The approach is based upon “. . .becoming a student of the child’s world, observing, learning, assisting and supporting the child’s flowering in a loving and non-judgmental environment” (Levy, 1998).

The Son-Rise Program does not seek to provide the child with information, or to teach the child to master predetermined skills. Instead, the program views the child’s current level of performance as being the best that the child can do; if the child could do better, he would (eg, if the child could follow instructions, he would). The Son-Rise program emphasizes total acceptance of the child, and encourages him to become a more motivated and participating individual (Levy, 1998).

Discussion

There have been no peer-reviewed, published studies of The Son-Rise Program’s effectiveness or outcome statistics.

Son Rise: The Miracle Continues chronicles the experiences of Barry and Samahria Lyte Kaufman as they created a program to meet the needs of their young son, diagnosed with autism and an IQ under 30. According the Kaufman (1997), their son currently has a near genius IQ, and no traces of his original condition.

Conclusions

There have been no studies of the Son-Rise Program’s effectiveness. Researchers should consider investigation using research protocols. Professionals considering Son-Rise should portray the method as without scientific evaluation of any kind, and should disclose this status to key decision makers influencing the child’s intervention."

I added the bold underlining for emphasis.  Autism Canada prides itself on being the "PREMIER" source for autism information in Canada.  Its spokespersons, especially medical and other professionals, should disclose to parents attending their conferences and reading their web site  seeking assistance with their children's autism disorders the lack of strong scientific evaluation for the Son-Rise program.

Mawlam does not explain why no scientific studies were done between the 1970's and 2000 to evaluate the Son-Rise program's effectiveness.  By contrast the 2007 American Academy of Pediatrics publication   Management of Children with Autism Spectrum Disorders, affirmed 2010,  assessed the evidence of effectiveness of ABA:

"The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4

The AAP report looked at a number of Developmental and Relationship intervention models including RDI and DIR but found limited studies and primarily anecdotal evidence.  No specific mention was made of the Son-Rise program.

A  January 2014 article in the Canadian Medical Association Journal  Autism spectrum disorder: advances in evidence-based  practice  compared the evidence base of support for ABA and contrasted it with non ABA autism interventions (Son-Rise Program again was not specifically  mentioned):

 "A recent overview of meta-analyses60 found significantly enhanced outcomes associated with early intensive ABA-based treatment (typically for 2–3 yr) in four of five included meta-analyses (effect sizes 0.30 to > 1); these findings have since been bolstered by a sixth meta-analysis.61 Gains appear to be greatest in verbal intelligence quotient (IQ) and language communication domains,62,63 for children with stronger pretreatment skills, if treatment is started earlier,64 and with greater intensity or duration of intervention. 60–62,64 These gains achieved in various domains have been summarized in a recent Cochrane review.63 Although the overall quality of evidence is low, it is the best evidence available. A recent study in Ontario reported predictors of outcome that account for some heterogeneity in treatment response.65

A recent RCT supported the efficacy of ABA-based intervention in toddlers by showing improvements in IQ, adaptive skills and diagnostic classification.37 Models vary, notably by how ABA principles are implemented, but everyday contexts (e.g., free play v. “tabletop”) and activities based on the child’s interests (v. therapist’s agenda) have advantages, including greater generalization of learning.66 Questions remain about which forms and intensities of treatment are most effective for which children. 

Research on non-ABA–based treatments is sparse and shows limited efficacy.67 Translation of evidence-based intervention into community practice is being evaluated, including in Canada.68 A key question is whether effective high-quality programs can be less costly and more sustainable; the findings from Nova Scotia are promising.38 Studies of the effectiveness of treatment programs for older children, youth and adults with ASD are scarce. Benefits have been reported for structured teaching practices, including ABA based interventions, for a wide range of skill deficits and maladaptive behaviours.58"

The studies and reviews of the solid basis of evidence of ABA effectiveness as an autism intervention span several decades while Son-Rise has almost no evidence in support of its effectiveness.  Laurie Mawlam enjoyed the Son-Rise experience with her autistic child which says nothing at all about the results for her child.  Son-Rise paints its program in feel good language and testimonials and tries to diminish ABA using the "robotic" mis-characterizations of ABA.  

Fortunately many Canadian parents of autistic children have fought for evidence based autism interventions.  It has not been an easy fight and the need to continue that fight persists with a patchwork quilt of autism interventions still existing from province to province.  Unfortunately governments and costs are not the only obstacles to obtaining early evidence based autism intervention.  Unfortunately there will always be those professionals and parents who abandon evidence based principles and who are of great help to politicians and civil servants looking for excuses to avoid providing effective evidence based ABA interventions for children with autism disorders. 

Autism Canada appears to be pulling out all the stops in "Changing the Course"   away from evidence based   autism programs. 

Sometimes "Changing the Course" is not a good thing.

Why ABA for Autism? Because Children with Autism Disorders Deserve Evidence-Based Intervention and ABA Meets That Standard

Autism Canada Foundation, a Canadian autism charity,  promotes itself as "The PREMIER Resource for Information on Autism Spectrum Disorders" but  typically downplays the importance of evidence support for ABA as the Premier autism intervention while promoting interventions with less substantial  evidence bases as determined by study and  credible authorities.

 Why criticize Autism Canada Foundation an autism charity? Why ABA for Autism? Why Evidence Based Intervention?  Because, as stated by Couper and Sampson in the Medical Journal of Australia 11 years ago,  ineffective therapies, while they may be immediately harmless, waste the child's valuable therapy time and parents' money.  Delay in implementing effective treatment may have a negative impact on the child's ultimate outcome.  ABA is the only intervention to date that meets the evidence based standard in every credible review, a fact downplayed by the Autism Canada Foundation.

ABA has for many years been confirmed by study and credible authorities as  the most substantially evidence based effective autism intervention.  If parents choose to try other methods they should in fact make informed choices. Autism Canada is a charitable organization which will be staging an autism conference this October called Changing the Course of Autism 2014.  The brochure highlights RDI and the Son-Rise program but makes no express mention of  Applied Behavior Analysis.  

As the following credible reviews indicate RDI and Son-Rise are not supported by the same level of evidence of their effectiveness as ABA ( I can't find any authoritative review mentioning any level of evidence  support for Son-Rise).   What the Autism Canada conference attendees are unlikely to be informed is that when it comes to autism therapies it  is not a close call - ABA was and remains the most substantiated, evidence based, effective autism intervention. 

The US Surgeon General, the MADSEC Maine Administrators of Services for Children with Disabilities (Maine Autism Task Force) Report (2000 revision),  American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders, and a recent article in the Canadian Medical Association Journal all confirm ABA as the most effective autism intervention (specific treatment necessary for associated medical conditions - eg. seizures, gastro intestinal).  And as Couper and Sampson wrote ... Children with autism deserve evidence based intervention:

1. Couper and Sampson - Children with autism deserve evidence based intervention.

Children with autism deserve evidence-based intervention  

Jennifer J Couper and Amanda J Sampson

Med J Aust 2003; 178 (9): 424-425.

Jennifer J Couper and Amanda J Sampson, in the 2003 editorial in the MJA, reviewed some of the evidence in support of the effectiveness  of behavioral interventions for autism. The authors stressed the importance of an evidence based approach to autism interventions:

"While ineffective therapies may be harmless, they waste parents' money and the child's valuable therapy time. Furthermore, the delay in implementing effective treatment may compromise the child's outcome." 

- [Bold Highlighting Added - HLD]

Couper and Sampson reviewed the evidence at that time (2003) in relation to behavioral treatment for autism:

The early intervention that has been subjected to the most rigorous assessment is behavioural intervention. There is now definite evidence that behavioural intervention improves cognitive, communication, adaptive and social skills in young children with autism. In 1987, Lovaas showed apparent recovery, persisting into adolescence, in nine of 19 young children who received an intensive home-based intervention based on applied behavioural analysis, a scientific method of reinforcing adaptive and reducing maladaptive behaviours.5,6 Subsequent studies also showed that behavioural intervention caused significant, albeit somewhat lesser, gains.7-11 This has modified the orthodox view that autism is always a severe, lifelong disability. Criticisms of the adequacy of the design and power of these studies are being addressed by the multisite Lovaas replication Early Autism Project. The first US site has released data (Wisconsin Early Autism Project).12 Again, after three to four years of intensive applied behavioural analysis intervention, about half the preschool children with autism acquired near-normal functioning in language, performance IQ and adaptability. Ninety-two per cent of intervention children acquired some language. Control children who received special education showed no gains in IQ or adaptability.12

2. American Academy of Pediatrics - Management of Children with Autism Spectrum Disorders, (2007, reaffirmed 2010)

The American Academy of Pediatrics article Management of Children With Autism Spectrum Disorders, Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd, the Council on Children with Disabilities (2007), reaffirmed (2010):

"Applied Behavior Analysis

Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community. The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40"

 3. Australasian Society for Autism Research - A Review of the Research to Identify the MostEffective Models of Practice in Early Intervention for Children with AutismSpectrum Disorders - (2012)

As with every other major research review of the effectiveness of early autism interventions only ABA, applied behavior analysis, received the highest rating: E  - Established/Eligible based on evidence.

 4. Canadian Medical Association Journal, Autism spectrum disorder: advances in evidence-based practice (2014)

 An article in the January 13, 2014 issue of the Canadian Medical Association Journal, Autismspectrum disorder: advances in evidence-based practice, confirms what American authorities have told us for decades, from the US Surgeon General to MADSEC and the American Academy of Pediatrics, ABA still represents evidence based, effective best treatment practice while "Research on non-ABA–based treatments is sparse and shows limited efficacy.":

" Autism spectrum disorder: advances in evidence-based practice "What treatments and interventions are available, and are they effective?

 The goal of existing interventions is to facilitate the acquisition of skills, remove barriers to learning and improve functional skills and quality of life.

 Behavioural interventions

  Current best practices for preschool-aged children with ASD include a focus on improving language, cognitive and adaptive skills using applied behaviour analysis (ABA) techniques.58 Applied behaviour analysis refers to the application of empirically derived learning principles(i.e., the antecedent–behaviour–consequence contingency) to produce meaningful changes in behaviour.59 Such strategies are carefully engineered and implemented through a variety of approaches (e.g., discrete trial teaching to more naturalistic learning contexts) to teach skills and reduce problem behaviour. Applied behaviour analysis interventions can be provided in a variety of settings (e.g., home, specialized treatment centres, specialized or public schools) by a range of front-line therapists, ideally supervised by a psychologist or board-certified behaviour analyst who specializes in ASD.

 A recent overview of meta-analyses60 found significantly enhanced outcomes associated with early intensive ABA-based treatment (typically for 2–3 yr) in four of five included meta-analyses (effect sizes 0.30 to > 1); these findings have since been bolstered by a sixth meta-analysis.61 Gains appear to be greatest in verbal intelligence quotient (IQ) and language communication domains,62,63 for children with stronger pretreatment skills, if treatment is started earlier,64 and with greater intensity or duration of intervention. 60–62,64 These gains achieved in various domains have been summarized in a recent Cochrane review.63 Although the overall quality of evidence is low, it is the best evidence available. A recent study in Ontario reported predictors of outcome that account for some heterogeneity in treatment response.65

 A recent RCT supported the efficacy of ABA-based intervention in toddlers by showing improvements in IQ, adaptive skills and diagnostic classification.37 Models vary, notably by how ABA principles are implemented, but everyday contexts (e.g., free play v. “tabletop”) and activities based on the child’s interests (v. therapist’s agenda) have advantages, including greater generalization of learning.66 Questions remain about which forms and intensities of treatment are most effective for which children.

 Research on non-ABA–based treatments is sparse and shows limited efficacy.67 Translation of evidence-based intervention into community practice is being evaluated, including in Canada.68 A key question is whether effective high-quality programs can be less costly and more sustainable; the findings from Nova Scotia are promising.38 Studies of the effectiveness of treatment programs for older children, youth and adults with ASD are scarce. Benefits have been reported for structured teaching practices, including ABA based interventions, for a wide range of skill deficits and maladaptive behaviours.58" [Highlighting added - HLD]

Hopefully conferences such as the Autism Canada Foundation 2014 conference are not seeking to change the course of autism intervention away from evidence based interventions toward largely  anecdotal approaches.  Hopefully attendees and those who access the conference information will be informed of the importance of evidence based support for autism interventions and the level of credible evidence in support of ABA effectiveness, a level of evidence support which remains unmatched by ANY other behavioural, social or educational intervention.