Disarray Undermines Autism Insurance Mandates

| by Val

     Applied Behavioral Analysis (ABA) type programming serves an important purpose in the lives of autism affected children, but the actual term does not identify a singular method that provides an end game of scientifically proven results. Creating falsehood about what ABA can accomplish as current autism insurance mandate advocates are doing, will result in ineffectiveness due to overall programming disarray from flawed intervention models.

     ABA effectiveness is only scientifically verifiable a child at a time, via analysis engaged upon for that child alone. The truest form ABA is:

  • Applied as a tailored treatment to a singular child with ongoing interpretation of those singular results.
  • Applied via the ongoing use of multiple methods that are either retained or eliminated according the individual child's response.

     The current autism insurance mandate advocates' logic behind pushing for ABA like treatment models that have been based on group application and overall group response, is lacking.  The researched group model outcomes actually prove lack of result for the majority in the spectrum...over many decades worth of research.

     The ABA teaching models that have been researched and advocated for by the autism elite assure an increase in the likelihood of less favorable results during programming. Indeed the mandate advocates have provided a rush to judgement ABA environment, ripe for failure. In so doing, insurance will be legally able to deny many more requests for payment of intervention services, once the failed ABA models do not result in ongoing improvement for the affected child.

     Autism insurance mandate advocates say that ABA is just like a medical treatment (unproven claims) but they also provide a model that does not prescribe proper treament. Their prescription is akin to giving a person with a broken leg a piece of paper that says the leg will get better, while not providing the surgery required, and leaving a cast on for a day; that is what the current autism insurance mandates prescription will mean for the majority of autism affected families. The mandates haven't even meant that much for many families already.

     As it stands - or since mandates will not have a leg to stand on. Insurance will not be required to fund any affected child's program once lack of benefit is evidenced. Without favorable outcome - game over. This is what the autism elite have brought to every family; they have made up their own rules as far as what ABA programming is actually proven to do. In so falsifying, they have literally allowed ABA disarray. Mandate advocates have made impossible, the good that ABA might have actually done over the longer term for more autism affected individuals. These advocates have assured less success, less adaptation, less overcoming by affected children and their families - simply because they chose to sell so many false conclusions about what ABA is actually going to accomplish. Sure a minority of autism affected children are going to realize high functioning or even normal function; but this has always been the case - with or without earliest intensive intervention.

     While ABA strategy can be good for the autism spectrum, it will not be if it is applied in the way that mandate advocates have packaged and sold it to the lawmakers. Autism insurance mandates are going to prove to be very anticlimactic for the majority of families affected by autism. There may be a shorter term benefit for some, but there is no longer term benefit for the majority of autism spectrum individuals. There will be no longer term cost savings for society, as unscientifically forecasted by the mandate movement. There will be a result of segregation, since focus has been taken away from the long term reality of autism and the need for schools and communities to see it as something that can be dealt with, lived with - over a lifetime if need be! 

     Applied Behavioral Analysis types of intervention are comprised of a variety of methods. The term ABA does not define a singular program, or method, that can easily be applied with regard to the treatment needs of the very broad autism spectrum. An example - of what ABA can look like:

"In-home report: The behavioral intervention home program that Sarah was involved in was one of behavior modification based on operant conditioning theory. This type of programming is also known as ABA (Applied Behavior Analysis) or discrete trial training. When behavior modification is used with children with autism, the child’s behaviors are divided into deficits and excesses. Skills which are deficient are taught and behaviors that are excessive are decreased. Each skill to be taught is broken down into its most simple individual components. The child is then prompted to exhibit the desired simple skills and rewarded for success. Prompts may be used initially to elicit the behavior then are gradually removed so that the child is able to demonstrate independent performance of the behavior. As a result, the behavior is strengthened and gradually acquired. Once individual components of the behavior have been acquired, each component is chained together to produce behaviors which are more complex and functional. As new behaviors are learned, inappropriate behaviors are not rewarded. As a result, these inappropriate behaviors decrease in strength and gradually extinguish. This results in inappropriate behaviors being replaced by more functional and desirable behaviors which enable the child to more successfully communicate and learn."

     ABA does, in some cases, decrease the strength of inappropriate behaviors and allow for increase in more functional behaviors. Here is an example of some methods that were identified and utilized in order to allow for a shorter term response of improvement. Keep in mind that methods in ABA type programs vary tremendously while you consider the following explanation of methods:

"The program included: discrete-trials, hour-intensive massed trials, naturalistic behavioral strategies, incidental teaching, preschool and pivotal response. During the sessions, the therapist would present discrete/massed trials (drills), but they also engaged young Sarah in a predetermined fun activity between drills. The fun activity involved the therapist utilizing a more naturalistic, incidental teaching strategy. Pivotal response was represented in the process, as elimination of some stimulatory behaviors appeared to coincide with Sarah's acquisition of new skills. The first year had Sarah involved in 8 hour per day programming, and the second year 4 to 6 hours per day. (Long term result in Hello, Dr. Wells)"

Additional info on researched methodologies that can be included in ABA type teaching programs - not even close to a complete list:

Pivotal Response Study (Source) "...This study confirms what we have been seeing at our clinic since we began providing Pivotal Response Treatment in 2007," Dr. Robert Daniels, executive director of the Chicago Children's Clinic, said in a statement. "Parents can be trained to be the best clinicians for their children."

Combined Programming (Source): ...In the January issue of the Journal of Positive Behavior Interventions, Ingersoll contends that advocates of the behavioral and developmental approaches should set aside their differences and use the best practices from each to meet the needs of the student and the strengths of the parent or teacher. 

Early Start Denver Model: It appears that JAAPA sees promise in Early Start Denver Model findings but a little more follow up needs to be done to determine overall implications of earliest intervention's lifelong benefits...What is clear, is that communication skills are the biggest benefit derived from earliest intervention strategies - with autistic features remaining.


From JAAPA: ...Intensive intervention, using the Early Start Denver Model, in children with autistic disorder or pervasive developmental disorder may improve early learning, especially language development, and adaptive behavior after 2 years of treatment. This study did not find a benefit of treatment on behavior and did not report on the long-term benefits, if any, of the intervention.


Developmental Individual Difference, Relationship Based  (Source): ...More than 2,200 families received notice this week of a preliminary settlement in a class-action lawsuit that, if approved by a judge, would force the Eastern Los Angeles County Regional Center to continue to provide the treatment, known as the DIR model (for "developmental, individual difference, relationship-based")...DIR is the basis for Floortime, a popular method in which a therapist follows a child's lead during play activities to develop communication and social skills.


     Most agree that it is essential to do all that we can for those within the autism spectrum. Since the spectrum covers such a wide and diverse range of ability, what needs to be emphasized is the fact that most experts agree that not enough is known about long term benefits that are gained from intense earliest intervention. Additionally, ABA cannot be built and should not be described as an one box fits all program. Each individual child will need a program that is very specific to their deficits, excesses and intellectual ability.

     What professionals and families are really looking for is prolonged purposeful and meaningful interactions with their affected loved one who does not perceive the world typically -  meaningful interaction that might be beneficial. ABA is not the cure all for autism - especially not for those on the severe end of the spectrum who have intellectual disability that does not prove to normalize with programming. Many who have been in the field of autism have already seen that at some point intense early intervention needs to be able to morph into something that fits with an individual's ability to respond, and their ability to continue to have a meaningful learning experience.

     The autism intervention insurance mandates have already proven to be very anticlimactic for the majority of those affected by autism. The initial placebo effect wears off. I continue to question why those who advocate for these insurance mandates did not come alongside public schools who were already endeavoring to reach and teach those within the autism spectrum; such a better fit for the purpose of including autism affected children in with society. Public school services are already available to every child. As it stands now, the insurance mandates will have the unintended consequence of disincentivizing schools with regard to including the more severely involved autism affected individuals.  This puts public service at disadvantage, a further disarray of programming.