1. Applied Behavior Analysis:
Medically Necessary Treatment for
Autism Spectrum Disorders
West Virginia Autism Insurance
Stakeholders Roundtable
July 13, 2012
Stonewall Resort
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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.
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3. What is Autism Spectrum
Disorder? (ASD)
Itincludes:
autistic disorder,
Rett syndrome,
childhood disintegrative disorder,
pervasive developmental disorder-not
otherwise specified (PDD-NOS) and
Asperger Syndrome
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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.
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5. What is Autism? What is Autism
Spectrum Disorder
Autismappears 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.
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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 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.
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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.
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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
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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
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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.
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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.
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12. ABA: Medically necessary
treatment for ASD
Asa neurological disorder, ASD is clearly a
medical condition. It is diagnosed by a
physician or a licensed psychologist.
TheCDC (Centers for Disease Control and
Prevention) identifies autism as a:
"national public health crisis."
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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.
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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.
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15. ABA: Medically necessary
treatment for ASD
“Plaintiffshave 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
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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.
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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
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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
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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.
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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.
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21. For more information on ABA for
ASD, please see…
www.autismspeaks.org/whattodo/what_is_ab
a.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)
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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
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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.
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