Autism and ABA Translated: Jacobson, Mulick and Green 1998

The fight to ensure that children with autism disorders receive treatment for their disorders engages many different people with many different priorities.  Autism advocates do meet political leaders and civil services officials who genuinely care.  But we also encounter those whose only concern is the bottom line, the mighty dollar.  To persuade these people that autistic children deserve treatment for their autism disorders you have to speak their language.  That is exactly what Jacobson, Mulick and Green did in 1998 with their paper Cost-Benefit Estimates For Early Intensive Behavioral Intervention For Young Children With Autism-General Model And Single State Case, Behavioral Interventions, Behav. Intervent., 13, 201-226 (1998)(headnote):

"Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost-bene®ts of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder-not otherwise specified (PDD-NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD-NOS can attain intellectual,academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost-benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI e€ects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3-22 years, and from $656,000 to $1,082,000 per child for ages 3-55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost-benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI."

Characterizing ABA Treatment for Autism as Experimental is Arbitrary and Capricious

Anti-ABA activists at the Universite de Montreal and elsewhere in Canada and the US will probably be upset over the news that Blue Cross has settled a lawsuit brought in Michigan reimbursing parents of autistic children for the costs they paid out for ABA treatment for their autistic children.

As indicated by Jon Hood on the Autism News, Blue Cross had initially defended the suit on the basis that ABA was experimental and therefore not required to be provided under their health insurance policies. Lawyers for the parent plaintiffs in the case "argued that characterizing ABA as experimental was arbitrary, capricious, and possibly even illegal."

Some choice remarks from the article at the Autism News:

"Blue Cross acknowledged in a 2005 draft policy that ABA is anything but controversial. That draft explicitly noted that ABA is “currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by” a number of professional organizations, including the Association for Science in Autism Treatment.

Additionally, as the draft pointed out, the earlier the treatment is applied, the better the child’s prognosis for a normal and productive life.

During a court deposition, Dr. Calmaze Dudley, Blue Cross’s medical director, said that he would “probably” employ the therapy if he had a child with autism.

Fortunately for Canadian autistic children the same American studies and reviewing agencies referred to in the Autism News report have provided the foundation for much of the successful parental advocacy for ABA coverage that has occurred in some Canadian provinces.

Unfortunately the Canadian government still refuses to get involved in helping autistic children across Canada. While the Canadian Institutes of Health Research have no qualms about funding the recent study proving that high functioning autistics are up to 40 percent faster at Raven's Standard Progressive Matrices (RSPM) problem-solving than non-autistics it doesn't spend a single dime to ensure that autistic children in Canada receive the ABA treatment that even American commercial health insurance providers acknowledge is the the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders.

autism

Autism Treatment of Choice

As pointed out on Nesrhtens… ABA and thoughts… Sigmund Eldevik, Richard P. Hastings, J. Carl Hughes, ErikJahr, Svein Eikeseth, and Scott Cross have published an article in Journal of Clinical Child & Adolescent Psychology, Volume 38, Issue 3 May 2009 , pages 439 - 450, Meta-Analysis of Early Intensive Behavioral Intervention for Children With Autism, which reports the results of an examination of 34 Early Intensive Behavioral Intervention studies "9 of which were controlled designs having either a comparison or a control group". The article authors found large full scale intelligence changes and moderate adaptive behavior changes.

The authors concluded that:

"at present, and in the absence of other interventions with established efficacy, Early Intensive Behavioral Intervention should be an intervention of choice for children with autism. "

It will be interesting to see if ABA critical researchers respond with anything positive, that is to say, with word of an evidence based effective alternative. My best is that the usual nonsensical rhetoric will flow from the usual anti-ABA activists who will offer absolutely no evidence based alternative. Or they will simply argue that autistic children, even the severely autistic, should unlike all other children, simply be left to develop on their own with no effective assistance.

autism