New on Autism Bulletin's Sidebar: Special Education and Disability News from PatriciaEBauer.com

Readers new to Autism Bulletin should check out what I call the "sidebar" which is the column on the right side of this website that has lists and links to other resources. I've added a new one today.

PatriciaEBauer.com is the blog and website providing news and commentary on disability issues authored by Patricia E. Bauer, a veteran journalist and editor. She notes on her website bio that she and her husband helped to establish the Pathway Program at UCLA, a post-secondary program for young adults with intellectual disabilities. They are the parents of two young adults, one of whom has Down syndrome and is a survivor of leukemia.

Note for e-mail subscribers: other resources in the sidebar include autism news via GoogleNews, links to reports and books I have found useful, recent court decisions involving special education law, other resources and some how-to articles such as how to plan a community outing.

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

Where Do Autism Services Fit in Your Views on the Presidential Race?

With the Iowa caucuses and New Hampshire primary just weeks away, the question came up at a gathering I attended over the weekend: how important is a presidential candidate's stance on autism services to your vote?

The consensus I heard among four voters at the table was that the issue has to be on the candidate's list of action items. Last month, Sen. Hillary Rodham Clinton of New York made autism an issue in her campaign by pledging to fund $700 million per year to expand research, diagnostic efforts and services for both children and adults with autism spectrum disorders. (See "Autism Issue Makes Ripple in Presidential Race as Clinton Promises to Spend $700 Million Per Year." A number of Democrats—Barack Obama, John Edwards, Christopher Dodd and Bill Richardson—mention support for autism services in their record. I couldn't locate any recent notes online for any of the Republican candidates.)

With so much going on in the country and world, it seems difficult at this stage of the presidential race to isolate autism as a campaign issue—even for those of us for whom it is a constant, daily presence. So I'm asking you, Autism Bulletin readers, to weigh in. I've created a poll below, where you can click on your choice for the most important issue. If you don't see your issue listed, you can post your comment below. E-mail subscribers can go here to see the poll.

Arizona Advocates Preparing for Autism Insurance Push; Group Publishes Autism Speaks Report on Coverage Costs, Benefits

Arizona advocates for health insurance coverage for autism services are planning to hold a rally Tuesday, January 29, 2008, at 6 p.m. in front of the state Capitol building in Phoenix. The event is part of a campaign to get insurance coverage for autism services in the state for children and young adults under age 21.

Advocates have set up a website, AZAutismInsurance.org, as a home page for news and information about the effort. In addition to keeping Arizona advocates up to date, the group's website hosts an important document that advocates around the country could find useful.

The 23-page document, "Arguments in Support of Private Insurance Coverage of Autism-Related Services," prepared by the national advocacy group Autism Speaks in October, lays out in clear language eight reasons why a state like Arizona should pass laws that mandate insurance coverage of autism services.

The report includes cost estimates based on studies in other states—a few dollars a month added to the average health insurance policy—and benefits: access to services now out of reach of many affected children. The report explains how existing services and government programs, including Medicaid, fall short of what's needed for a growing population of those diagnosed with autism spectrum disorders. And it brings up an argument heard before: it pays to provide services to children, to help them grow and develop, so that it costs less to provide supports later in life.

The following is a rundown of the arguments, excerpted from the beginning of the report:

Argument 1: Mandated private health insurance coverage will provide services that are desperately needed by children with autism, who have greater health care needs than children without autism.

Argument 2: Treatments for autism are difficult to access, often inadequate, and frequently delayed. Denied coverage by private group health insurance companies, parents are often forced either to pay out-of-pocket or forego the treatments their children need.

Argument 3: Mandated private insurance coverage will bring effective autism services within the reach of children who need them. The efficacy of Applied Behavior Analysis (ABA), the centerpiece of this legislative mandate’s benefits, has been established repeatedly.

Argument 4: Government and scientific organizations have endorsed Applied Behavior Analysis (ABA) and other structured behavioral therapies.

Argument 5: To combat the difficulty many families face in accessing Applied Behavior Analysis (ABA) and other structured behavioral treatments through public insurance, three states have passed autism insurance mandates that specifically require private insurance companies to provide coverage of these therapies, thus creating a public-private partnership for the provision of care.

Argument 6: The costs of this insurance reform are small and will have very little impact on the cost of health insurance premiums for the individual consumer.

Argument 7: By improving outcomes for children with autism, mandated private insurance coverage will decrease the lifetime costs of treating and providing services and will actually result in an overall cost savings in the long-run.

Argument 8: Without passage of legislation requiring private health insurance coverage for autism, the costs associated with autism will continue not only to affect families, but will have far reaching social effects as well.

It will be interesting to see how the discussion plays out in Phoenix. A cursory check of the Arizona State Legislature's website indicates that there are no current bills filed relating to autism yet; I will look to update readers when I learn more information.

Also see from Autism Bulletin's archives:

* Michigan to Hold Hearing on Autism Insurance Legislation

* Articles related to health insurance

Michigan to Hold Hearing on Autism Insurance Legislation

Michigan State Rep. Kathy Angerer, a Democrat from Dundee who chairs the House Health Policy Committee, has filed two bills that would require health insurance companies to cover diagnosis and treatment for autism spectrum disorders. Angerer's House panel is scheduled to hold a hearing on the measures, Dec. 13 at 9 a.m. in Room 519 of the House Office Building in Lansing. Thanks to the bloggers at Autism Insurance in Michigan for passing along word of this hearing and links to the legislation.

The wording of the legislation is below; what's interesting to note is the specific items covered—speech, OT, ABA, PT and early intervention services. The bill does not mention age restrictions as in states like South Carolina and Texas.

"More and more children across our state are being diagnosed with autism, leaving an increasing number of Michigan families struggling to keep up with the high costs of treatment," Angerer said in a statement. "Proper screening and treatment of autism is crucial to a child's development, and experts agree that early diagnosis and treatment is vital to increasing the chances that a child will reach their full potential. Excluding autism from coverage is not only arbitrary and unfair – it sets back efforts to understand and treat this disorder, which threatens to increase health care costs for everyone down the road."

Angerer is the lead sponsor of two house bills, No. 5529 and No. 5527, each of which calls for coverage of autism-related services. The bills have parallel Senate versions (Nos. 784 and 785) sponsored by Sen. Tupac Hunter, a Detroit Democrat (again, noted by Autism Insurance in Michigan.)

Language in the Michigan Bills

Here's specifics on what the House bills cover. Bill No. 5529 states that authorized hospitals, medical facilities, health maintenance plans:

shall provide coverage for the treatment of autism spectrum disorder, including, but not limited to, coverage for therapeutic evaluations and interventions, speech therapy, intensive early intervention, applied behavioral analysis, and Lovaas behavioral therapy.

Coverage for autism spectrum disorder under this section is subject to the same terms and conditions that the insurer or health maintenance organization applies to the treatment of other disorders. However, an insurer or health maintenance organization may confirm a diagnosis or review the appropriateness of a specific treatment plan in order to insure that coverage under this section is limited to diagnostic and treatment services.

As used in this section, "autism spectrum disorder" means a neurobiological condition that includes autism Asperger Syndrome and Rett's Syndrome.

The other bill, No. 5527 has the exact same wording regarding coverage of services, and what autism means, except it applies to "a health care corporation group or nongroup"; in other words, other kinds of health insurance organizations and health care organizations.

Also see in Autism Bulletin archives:

* Past coverage of health insurance

Also, an updated version of the Autism Insurance Map is below (e-mail subscribers, click here if you have trouble seeing it):