March 29, 2013 | Bobby Buckner , MS, BCBA
The prevalence of autism is increasing, though it is still unclear whether the increase is due to greater numbers of children being affected by the disorder or better methods of detecting it. Autism is characterized by difficulty communicating and relating to others. Children with autism may also engage in repetitive behaviors that interfere with learning and may display other challenging behaviors such as aggression, self-injurious behavior, and disruption to the physical environment. These challenging behaviors often arise secondary to the child’s difficulty expressing his or her wants and needs (Tiger, Hanley, & Bruzek, 2008). Autism now affects 1 in 88 children in the United States (ADDM, 2012), and this has created a demand for newer and better evidence-based treatments. Since autism cannot be cured, most treatments for the disorder focus on the behavioral and educational needs of children with autism. Children with autism may also require medical intervention to address co-occurring medical conditions (e.g., seizures). The demand for effective treatment has unfortunately given rise to a number of “therapies” that have dubious value or can, in some cases, be harmful (Green & Perry, n.d.).
Applied behavior analysis (ABA) is an effective treatment for autism with strong empirical support (Goldstein, 2002; Odom, Brown, Frey, Karasu, Smith-Canter, & Strain, 2003; McConnell, 2002; Horner, Carr, Strain, Todd, & Reed, 2002). Practitioners of ABA use principles of learning to teach children with autism new skills, maintain established skills, and decrease and eliminate challenging or interfering behavior. ABA has proven to be particularly effective at addressing deficits in communication (Sautter & LaBlanc, 2006) and social skills (Strain & Schwartz (2001). Children may experience large and robust improvement when they receive ABA through early and intensive behavioral intervention (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Sallows & Graupner, 2005). Under this model, children receive ABA beginning before age four but as early as possible, and they receive ABA for 20 to 40 hours per week for two to three years (ASAT, n.d.).
Cost of such intensive intervention varies, but can be quite high. Autism Speaks estimates that the costs associated with autism are $60,000 per child each year (Autism Speaks, n.d.). Intensive ABA represents a large portion of that expense, and until relatively recently many of these were out-of-pocket expenses for families, leaving many families unable to access this highly effective treatment. Thirty-seven states now have laws related to insurance coverage for autism and 31 specifically mandate coverage in at least certain situations (NCSL, 2012). Behavioral intervention is but one of the services covered under these mandates. This movement is making accessing ABA realistic for many families that otherwise would be unable to afford it. It is also creating a demand for licensure of behavior analyst in addition to the current credential as a Board Certified Behavior Analyst. It is important, however, that families of children with autism understand that licensing, in those states where it is required, and board certification do not guarantee that a behavior analyst is qualified. It is recommended that consumers become familiar with the training and experience of any behavior analyst with whom they consult. This is important now more than ever because insurance coverage means more families are seeking ABA for their child with autism.
Association for Science in Autism Treatment (ASAT) (n.d.). Early intensive behavioral intervention/treatment. Retrieved from: http://www.asatonline.org/treatment/procedures/early.htm
Autism and Developmental Disabilities Monitoring (ADDM) Network (n.d.). ADDM Network fact sheet. Retrieved from http://www.cdc.gov/ncbddd/autism/states/addm_fact_sheet_2012.pdf.
Autism Speaks (n.d.). Facts about autism. Retrieved from http://www.autismspeaks.org/what-autism/facts-about-autism.
Goldstein, H. (2002). Communication intervention for children with autism: A review of treatment efficacy. Journal of Autism and Developmental Disorders, 32, 373-396.
Green, G. & Perry, L. (n.d.). Science, pseudoscience, and antiscience. Retrieved from http://www.asatonline.org/treatment/articles/sciencepseudoscience.htm
Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders. 32, 423-446.
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.
McConnell, S. (2002).Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351-372.
National Conference of State Legislatures (NCSL) (2012). Insurance coverage for autism. Retrieved from http://www.ncsl.org/issues-research/health/autism-and-insurance-coverage-state-laws.aspx
Odom, S. L., Brown, W. H., Frey, T., Karasu, N., Smith-Canter, L. L., & Strain, P. S. (2003). Evidence-based practices for young children with autism: Contributions from single-subject design research. Focus on Autism and Other Developmental Disabilities, 18, 166-175.
Sallows, G.O., Graupner, T.D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110, 417-438.
Sautter, R.A., LeBlanc, L.A. (2006). Empirical applications of Skinner’s Analysis of Verbal Behavior with Humans. The Analysis of Verbal Behavior, 22, 35-48.
Strain, P.S., & Schwartz, I. (2001). ABA and the development of meaningful social relations for young children with autism. Focus of Autism and Other Developmental Disabilities, 16, 120-128.
Tiger, J.H., Hanley, G.P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice, 1, 16–23.