After Colorado Arbitrator's Decision, More Information About Lovaas Model of Applied Behavioral Analysis

Last month, an arbitrator ruled in favor of a Colorado family which fought to have its health insurance company reimburse them for autism-related services for their young daughter—specifically for Applied Behavior Analysis (ABA) sessions which the insurance company denied. The arbitrator ruled that the insurer, Anthem Blue Cross Blue Shield, improperly denied the family's claims for two years worth of services worth about $110,000.

You can read more background in this Autism Bulletin story from December 9: Colorado Family Wins Insurance for Autism Services. One of the points the arbitrator made in her decision was that "Anthem erroneously equates ABA therapy with Lovaas therapy—an approach which has received considerable justifiable scientific criticism. ABA therapy is based upon incidental teaching and pivotal response training, which Dr. Strain testified is the standard of care when dealing with autistic children."

That quote puzzled me because I had read Ole Ivar Lovaas, now a professor emeritus at University of California at Los Angeles, was one of the founders of ABA. So I wrote to the Los Angeles-based Lovaas Institute, which provides autism services using Lovaas' method, and asked them to help me understand more about them and what this arbitrator could have been talking about.

Below is the response I received from Scott Cross, clinical director, and Vincent J. LaMarca, of the institute's human resources department. Both cite their credentials as board-certified behavior analysts, or BCBAs.

On behalf of Dr. Lovaas and the Lovaas Institute, thank you for your inquiry. I can understand from the blog posting why you would have questions about the relationship between “Lovaas therapy” and ABA.

First, you are correct that in laymen’s terms “Lovaas therapy” is “a type of ABA.” In fact, we are more likely to refer to our program as the “Lovaas Model of Applied Behavior Analysis.” We provide behavioral treatment, based on the principles of applied behavior analysis, researched under the direction of Dr. Lovaas, and replicated by other professionals at other sites throughout the world.

Second, the quote from the arbitrator is somewhat curious. On one hand, it states “Lovaas therapy…has received considerable justifiable scientific criticism.” On the other hand, it promotes applied behavior analysis (ABA) by mentioning the Surgeon General report and the National Institute of Mental Health’s publication. This is curious because, after stating, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior,” the Surgeon General report’s next sentence states, “A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993).” The National Institute of Mental Health’s publication also mentions Dr. Lovaas. Immediately after citing the Surgeon General report, it states that the work of Dr. Lovaas “laid a foundation for other educators and researchers.”

It’s possible that what is really meant in the arbitrator’s decision is that Anthem was wrong in making a decision on applied behavior analysis by only consulting studies associated with the Lovaas Model of Applied Behavior Analysis. Applied behavior analysis is a scientific discipline with a wealth of research. While Dr. Lovaas is honored to have contributed to that research, it is but the tip of the iceberg. One need only peruse the Journal of Applied Behavior Analysis to understand why a claim that ABA therapy is “investigational and experimental” is incorrect. There are a multitude of research articles demonstrating the efficacy of applied behavior analysis in teaching new skills to children, adolescents, and adults with autism.

Finally, it is somewhat disconcerting that the testimony, as depicted in the arbitrator’s decision, appears not only to place the Lovaas Model and applied behavior analysis in opposition (as it shouldn’t), but also to downplay some of the Lovaas Model’s treatment procedures in early intervention. It is an enormous oversight that discrete trial teaching (while not the only ABA instructional strategy) is left out of the testimony as an important component of an ABA program. Consider that all of the multi-site replications have been initially discrete trial based and have explicitly stated so in their method sections.

Behavioral treatment for children with autism is currently undergoing a lot of branding, with Verbal Behavior, the Lovaas Model, and Pivotal Response Teaching as the three names used most frequently. To what extent this is helpful or harmful to treatment is an important discussion in which we at the Lovaas Institute are currently taking part with other professionals. We would agree that there is a need for researchers to clarify the similarities and differences of different approaches as well as to study which approaches are more helpful for which children.

In the meantime, I would point out that while the Lovaas Model of Applied Behavior Analysis may have received scientific criticism, the National Academy of Science report (mentioned by Dr. Strain) also states that the Lovaas Model (a.k.a. Young Autism Project) “has generated the most rigorously controlled early intervention research published to date.”

And since that publication in 2001, two replication studies of the Lovaas Model have been published by independent authors, again demonstrating the effectiveness of our approach (Sallows & Graupner, 2005 and Cohen et al., 2006).

Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation, 110 (6), 417-438.

Cohen, Howard, Amerine-Dickens, Mila, Smith, Tristram. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27 (2), 145-155.

Sincerely,

Scott Cross, PhD, BCBA

Vincent J. LaMarca, BCBA