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Tuesday, April 12, 2011

ABA: The Good, the Bad, the Contentious

Today, autism in children has become more prevalent than childhood cancer, juvenile diabetes and pediatric AIDS combined, according to a national autism organization, and TRICARE now covers Applied Behavior Analysis therapy to treat eligible beneficiaries.

Autism Speaks, a national autism science and advocacy organization, defines autism as "a group of complex developmental brain disorders." Today, about one in every 110 children is diagnosed with autism.

April is Autism Awareness Month, a month that's been observed by the Autism Society since the 1970s, according to their website. Autism Awareness Month highlights the growing need for concern about autism and its potential treatments.

Many different types of treatment exist for an autistic individual. However, one of the more prominent techniques that has gained status recently is ABA therapy. According to the National Institute of Child Health and Human Development, ABA may help reduce problem behaviors associated with autism and teach vital new skills.

As part of the growing recognition of ABA therapy, TRICARE now covers this type of treatment for eligible beneficiaries. It's part of TRICARE's Autism Services Demonstration, an enhanced benefit under the ECHO program. ECHO - or Extended Care Health Option - is TRICARE's benefit for individuals with disabilities.
With autism legislation blocked three years in a row at the state Capital, Eric Littleton said he is interviewing for jobs out of state and will be leaving Oklahoma as soon as he can find work.

“The policies that are currently being promoted do not reflect the values or the faith that the people of Oklahoma embrace, and I continue to cry out to my brothers and sisters to speak out on this unbiblical status quo,” Littleton said.

A series of reforms were passed in 2009 geared to help children with autism. Sooner Success is a program that trains primary care physicians and pediatricians to be specialists in diagnosing autism from birth to age 3. Twenty Oklahoma doctors are specialized in diagnosing autism, he said.

Solomon Littleton was 5 years old in 2008 when he contracted the rare neurological disease Landau-Kleffner syndrome. Eric and Marci Littleton saw their son’s normal life deteriorate with a loss of motor skills. Soon Solomon could no longer feed himself, toilet or dress himself. His behavior became erratic as he would slam his body into walls at home.

House Bill 1248 by state Rep. Randy Grau, R-Edmond, was intended to include children with autism spectrum disorders in the state’s high risk insurance pool. The bill was killed in March by the Appropriations and Budget Committee. The high risk pool was created by the Legislature in 1995 to serve those who have been denied health insurance due to a serious health condition.

House Speaker Kris Steele, R-Shawnee, said he wants to delay consideration of Grau’s bill pending evaluation of a new Sooner Start program that is based on Senate Bill 135. SB 135 went into effect in January. It was authored by Steele and state Sen. Ron Justice.
Maura Lerner reports at The Minneapolis Star-Tribune:

Eric Larsson, a Minneapolis psychologist and leading advocate, says ABA is more than just a treatment -- it's a way to rescue children "from the ravages of autism." He tells parents that nearly half of children can recover if they start ABA soon enough. "They're coming to us because they want to cure their child," he said. "Just like you or I would do if we had cancer."

But other autism experts say the benefits of ABA treatment have been blown out of proportion. They say there is scarce evidence that it's really better than less costly alternatives.

"A lot of claims out there are inflated," said Barbara Luskin, a psychologist with the Autism Society of Minnesota. "Autism is a difference in the way your brain is. You're not going to cure it."

This year, for the third year in a row, the Minnesota Legislature is debating whether to require the state's health insurance plans to cover ABA treatment for autism, a speech and behavior disorder that is said to affect 1 in 110 children nationally.

More than 20 states have adopted such mandates since 2007, says Lorri Unumb of Autism Speaks, a national advocacy group. Ultimately, she hopes it will become the law of the land as part of national health reform.

"There is no controversy at all about whether ABA is the gold-standard treatment," says Unumb, a lawyer and senior policy adviser. "The only discussion is whether we can afford it."

But among medical experts, there is no consensus that ABA is necessarily the best, says Dr. James Moore, an autism specialist at Children's Hospitals and Clinics of Minnesota.

"If we all believed it, then we wouldn't recommend anything else," Moore said.

In Minnesota, health plans typically pay for certain types of autism treatment, such as speech and occupational therapy. But most draw the line at ABA, calling it costly and unproven.

"The concern is that you've got desperate parents," said Glenn Andis, a psychologist and senior vice president of Medica Health Plans, which opposes the mandate. "You've got a provider who says they've got all the answers, and they're going to cure their kids? Need I say more?"