Throw Baby & Bath Water OUT; Autism Mandate Effect

| by Val

     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 throwing the autism affected baby out with the bath water.

     ABA effectiveness is only scientifically verifiable a child at a time, via analysis comprised for that child alone; the current autism insurance mandate advocates' logic behind supporting treatment models based on group application and response is false; even so, these group model outcomes actually prove lack of result for the majority in the spectrum. ABA type treatments are best applied, and the benefits best understood - one child at a time. It 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 ABA models that have been studied, and therefore advocated for, by the autism elite (Dawson among the many others), are models that have applied non-scientific group result (instead of focusing on each individual child's response). Dawson's approach assures an increase in the likelihood of less favorable results during programming. Indeed the mandate advocates have provided a rush to judgement ABA environment; an 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 presented by Dawson and others, do not result in ongoing improvement for the affected child.

     Dawson and others 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 autism insurance mandates will mean for the majority of autism affected families. The mandates haven't even meant that much for many families already. (Hey Dawson et al, what would have been wrong with emphasizing public schools as the setting for your endeavors - since they are already funded? And lending a hand with that type of endeavor. Oh, that's right - you and yours would not get the funding.)

     As it stands - or since mandates won't 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 via the insurance mandates. The autism elite have made up their own rules as far as what ABA programming is actually proven to do; in so falsifying, they have literally thrown many a baby out with the bath water. They have made impossible, the good that ABA might have actually done over the longer term. Dawson and others 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, but this has always been the case - with or without earliest intensive intervention.

     ABA strategy is good for the autism spectrum, but not if it is applied in the way that Dawson and others 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 long term benefit for the majority of autism spectrum individuals. There will be no longer term cost savings for society, as unscientifically forecasted by Dawson et al. 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. ABA is not autism treatment, it is an applied science of human behavior that INFORMS effective autism treatment. (see comments here) 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.


     Here is further explanation about some methods that can be applied in the overall ABA type teaching process. The ABA concept 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 above 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)


     Here is more information with regard autism programming that has received recent attention and validation in the scientific community - as having possibility or proven plausibility of being efficacious: 

  • Pivotal Response
  • Combined Programming
  • Early Start Denver Model
  • DIR


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 one box does not fit all. 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.