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Wednesday, February 13, 2013

Minnesota, Autism, and "Unproven" Therapy

Two key studies about the needs of individuals with autism spectrum disorders have been posted on the DHS website. The studies address health care benefits for needed services and housing solutions for children and adults.
Autism Spectrum Disorders: Report to the Minnesota Commissioner of Human Services (PDF) is a study of treatments for autism conducted by the Health Services Advisory Council (HSAC). HSAC is panel of medical experts that advises DHS about health care benefits for enrollees in publicly funded programs.
Study on Housing with Supports for Children with Severe Autism (PDF) was completed by the University of Minnesota under a contract with DHS and takes a comprehensive look at housing and service options currently available as well as best practices.

The studies will inform DHS efforts to develop strategies specifically for people with autism.
This session Gov. Dayton has a budget proposal to establish a benefit set for children with autism spectrum disorder. The fact sheet, Reform 2020: Intensive Services for Children with Autism Spectrum Disorder (PDF), is on the DHS website. More information on autism and autism spectrum disorders is on DHS' website.
The Minneapolis Star-Tribune takes a negative view.  In a news article titled "Minnesota Urged to Cover Unproven Autism Care," Maura Lerner writes:
The state of Minnesota is being urged to pay for an intensive -- and controversial -- form of autism therapy for children on Medical Assistance, even though scientists are uncertain of its effectiveness.
The recommendation, from a state advisory panel, would create the first "autism-specific strategy" for thousands of families covered by the state health care program for the poor and disabled.
Under the plan, which would need both legislative and federal approval, the state would pay for a treatment known as early intensive behavior therapy, which advocates say is the best hope for children with autism. In some cases, the treatment can include up to 40 hours a week of one-on-one therapy and cost up to $100,000 a year.
As the report uses the term, this therapy includes ABA. While no one could deny that much more research is necessary, the use of the word "unproven" is highly questionable.  (Note that reporters do not write their own headlines.)   From the Kennedy Krieger Institute (click link to find citations mentioned below):
Over the past 40 years a large body of literature has shown the successful use of ABA-based procedures to reduce problem behavior and increase appropriate skills for individuals with intellectual disabilities (ID), autism and related disorders. Several review articles and meta-analyses have been published summarizing this large body of literature. Six of these articles (DeMyer, Hingtgen, & Jackson,1981; Herbert, Sharp, & Gaudiano, 2002; Hingtgen & Bryson, 1972; Kahng, Iwata, & Lewin, 2002; Matson, Benavidiz, Compton, Paclawskyj, & Baglio, 1996; Sturmey, 2002) collectively reviewed thousands of published studies spanning the years 1946 to 2001. Each of these reviews supported efficacy of ABA-based procedures in the assessment and treatment of problem behavior associated with autism, mental retardation and related disorders. Similarly, three meta-analyses (Didden, Duker, & Korzilius, 1997; Lundervold & Bourland, 1988; Weisz, Weiss, Han, Granger, & Morton, 1995) that collectively analyzed hundreds of studies published between 1968 and 1994 concluded that treatments based on operant principles of learning were more effective for reducing problem behavior displayed by individuals with ID as well as typically-developing individuals than were alternative treatments. The large body of literature reviewed in these studies provides empirical evidence indicating that procedures developed using ABA-based principles are effective at assessing and treating a variety of socially important behaviors engaged in by individuals with a variety of diagnoses. Furthermore, ABA-based approaches for educating children with autism and related disorders have been extensively researched and empirically supported (e.g., Howard, Sparkman, Choen, Green, & Stanislaw, 2005; Koegel, Koegel, & Harrower, 1999; Krantz & McClannahan, 1998; Lovaas,1987; McGee, Morrier, & Daly, 1999; Strain & Kohler, 1998)
The federal Office of Personnel Management agrees about the evidence behind ABA.