Showing posts with label ABA. Show all posts
Showing posts with label ABA. Show all posts
This Sat! - Discover Effective Strategies to Get Your Child to Swallow Medication
Like anything else, administering and teaching your child to swallow oral medications are behaviors that can be learned.
This workshop will discuss how to use principles of applied behavior analysis (ABA
We will talk about effective procedures to teach successful tablet and capsule swallowing, as well as cough syrup. Teaching these skills can be important in order to make sure your child is receiving all his/her nutritional needs to keep him/her healthy. We will also go over environmental variables that can be changed to facilitate successful pill swallowing.
This workshop will discuss how to use principles of applied behavior analysis (
We will talk about effective procedures to teach successful tablet and capsule swallowing, as well as cough syrup. Teaching these skills can be important in order to make sure your child is receiving all his/her nutritional needs to keep him/her healthy. We will also go over environmental variables that can be changed to facilitate successful pill swallowing.
Autism Patients in California Dealt Insurance Setback
The Department of Managed Health Care declines to require carriers to pay for applied behavior analysis, an expensive therapy that insurers contend is an educational service, not medicine.By Lisa Girion, LA Times
California regulators said Monday that insurers must provide speech, occupational and physical therapies to their autistic members but rejected pleas to require insurers to cover the cost of behavior therapy that aims to help patients live in society.
Parents of children with autism have argued in lawsuits and in complaints to regulators that insurers, by refusing to pay for an array of autism care, are ignoring the Mental Health Parity Act. The 2000 state law requires insurers to treat mental conditions the same as medical conditions.
Autism is the fastest-growing serious developmental disability in the U.S., more prevalent than childhood cancer, juvenile diabetes and pediatric AIDS combined. There are an estimated 185,000 Californians with autism.
The state now treats about 37,000 significantly impaired autistic children, delivering a variety of services, including applied behavior analysis -- at a cost of more than $320 million a year.
California regulators said Monday that insurers must provide speech, occupational and physical therapies to their autistic members but rejected pleas to require insurers to cover the cost of behavior therapy that aims to help patients live in society.
At issue is so-called applied behavior analysis, a therapy that teaches patients skills such as self-feeding and stopping injurious behaviors such as head banging. The therapy can cost as much as $70,000 a year per patient.
Autism is the fastest-growing serious developmental disability in the U.S., more prevalent than childhood cancer, juvenile diabetes and pediatric AIDS combined. There are an estimated 185,000 Californians with autism.
The state now treats about 37,000 significantly impaired autistic children, delivering a variety of services, including applied behavior analysis -- at a cost of more than $320 million a year.
The disorder impairs communication and socialization and is often marked by repetitive behaviors such as rocking and head banging. Its cause is unknown, and there is no cure.
The state's major insurers and HMOs routinely refuse to pay for applied behavior analysis, arguing, most recently, that it is an educational service, not medicine. The insurers also say that covering applied behavioral analysis will drive up premiums for everyone, although studies from other states have found such increases to be minimal.
Parents disputing the denials have been winning appeals to regulators in recent months as research on the effectiveness of the therapy has become more widely recognized.
In 15 of 16 recent disputes over insurance denials of applied behavior analysis for individual children, state-impaneled physician-reviewers have declared the therapy to be medically necessary. Those decisions required the insurers to pay for the treatment. The 16th case is pending.
The Department of Managed Health Care stepped into the controversy Monday, sending insurers a letter seeking to clarify their coverage obligations to cover autism and related disorders.
Parents lauded the department for making it clear that insurers must cover speech, physical and occupational therapies for their autistic members. But they were disappointed by its failure to address applied behavioral analysis.
Some said the letter set up the likelihood that parents would have to fight case by case to convince the department that the therapy should be covered. Only if they won that round would parents be able to take their case to an independent medical review panel, where they have been winning.
If not, it could be game over for parents.
"I have a problem with their staying silent on the most effective therapy," said Bay Area parent advocate Kristin Jacobson.
"Does every child who needs insulin -- or cancer treatment -- have to take it all the way to the Department of Managed Health Care?" she said. "This is the only thing where every family has to fight it every time. And that didn't stop today."
Applied behavior analysis teaches skills by breaking them down into numerous steps and drilling them with positive reinforcement.
Some studies have shown that as much as 47% of children who receive the therapy are able to enter school with no further intervention and few, if any, symptoms of the condition, said Gina Green, executive director of the National Assn. of Professional Behavior Analysts.
Eight states have laws that explicitly require insurers to cover certain autism treatments. In California there is no specific autism law. But autism is one of the conditions that was supposed to be addressed by the Mental Health Parity Act.
State officials defended the plan. "We're doing all we can within the limits of the law to make sure what should be covered is covered," said Tim LeBas, assistant director of the Department of Managed Health Care's Office of Health Plan Oversight.
Department spokeswoman Lynne Randolph acknowledged that the department would review coverage denials for applied behavior analysis case by case, trying to distinguish medical applications of the therapy from educational ones.
"We would say yes in certain instances," she said.
Kaiser Permanente and other insurers have vigorously opposed an interpretation of the law requiring them to cover the therapy.
The department's letter said it would develop regulations to formalize the requirements on insurers and to "provide additional clarity through an open and public process."
Kaiser said Monday's letter was "a step forward" but left some issues unresolved.
Charles Bacchi, interim president of the California Assn. of Health Plans, said the trade group looked forward to gaining further guidance through ongoing regulatory audits with individual insurers, as well as through the development of new regulations.
The courts may influence the course of autism coverage as well. Kaiser is the target of two proposed class-action lawsuits that accuse the company of violating the Mental Health Parity Act and other laws by routinely denying medical care, including applied behavior analysis, to its members.
Scott Glovsky, a Pasadena lawyer representing Kaiser members in one of the suits, said it was a shame that the department failed to address applied behavior analysis therapy.
"ABA is what children with autism spectrum disorders need the most," he said.
The decision applies to insurance policies held by more than 21 million Californians and supervised by the Department of Managed Health Care. That includes health maintenance organizations and some preferred-provider organizations offered by several companies, including Kaiser, Anthem Blue Cross, Blue Shield, Health Net and PacifiCare.
Harvey Rosenfield, founder of Consumer Watchdog, a Santa Monica advocacy organization, said the department might have crossed the line on "underground rule-making" by trying to change the rules by letter rather than through the formal adoption of regulations, which is a public process.
"This is a state agency winking at the HMOs and inviting them to deny claims to autistic children," Rosenfield said. "This is going to be a license to steal for the HMOs, and they are giving it away without even holding a hearing, which is just an outrage, and also, I think, illegal."
The state's major insurers and HMOs routinely refuse to pay for applied behavior analysis, arguing, most recently, that it is an educational service, not medicine. The insurers also say that covering applied behavioral analysis will drive up premiums for everyone, although studies from other states have found such increases to be minimal.Parents disputing the denials have been winning appeals to regulators in recent months as research on the effectiveness of the therapy has become more widely recognized.
In 15 of 16 recent disputes over insurance denials of applied behavior analysis for individual children, state-impaneled physician-reviewers have declared the therapy to be medically necessary. Those decisions required the insurers to pay for the treatment. The 16th case is pending.
The Department of Managed Health Care stepped into the controversy Monday, sending insurers a letter seeking to clarify their coverage obligations to cover autism and related disorders.
Parents lauded the department for making it clear that insurers must cover speech, physical and occupational therapies for their autistic members. But they were disappointed by its failure to address applied behavioral analysis.
Some said the letter set up the likelihood that parents would have to fight case by case to convince the department that the therapy should be covered. Only if they won that round would parents be able to take their case to an independent medical review panel, where they have been winning.
If not, it could be game over for parents.
"I have a problem with their staying silent on the most effective therapy," said Bay Area parent advocate Kristin Jacobson.
"Does every child who needs insulin -- or cancer treatment -- have to take it all the way to the Department of Managed Health Care?" she said. "This is the only thing where every family has to fight it every time. And that didn't stop today."
Applied behavior analysis teaches skills by breaking them down into numerous steps and drilling them with positive reinforcement.
Some studies have shown that as much as 47% of children who receive the therapy are able to enter school with no further intervention and few, if any, symptoms of the condition, said Gina Green, executive director of the National Assn. of Professional Behavior Analysts.
Eight states have laws that explicitly require insurers to cover certain autism treatments. In California there is no specific autism law. But autism is one of the conditions that was supposed to be addressed by the Mental Health Parity Act.
State officials defended the plan. "We're doing all we can within the limits of the law to make sure what should be covered is covered," said Tim LeBas, assistant director of the Department of Managed Health Care's Office of Health Plan Oversight.
Department spokeswoman Lynne Randolph acknowledged that the department would review coverage denials for applied behavior analysis case by case, trying to distinguish medical applications of the therapy from educational ones.
"We would say yes in certain instances," she said.
Kaiser Permanente and other insurers have vigorously opposed an interpretation of the law requiring them to cover the therapy.
The department's letter said it would develop regulations to formalize the requirements on insurers and to "provide additional clarity through an open and public process."
Kaiser said Monday's letter was "a step forward" but left some issues unresolved.
Charles Bacchi, interim president of the California Assn. of Health Plans, said the trade group looked forward to gaining further guidance through ongoing regulatory audits with individual insurers, as well as through the development of new regulations.
The courts may influence the course of autism coverage as well. Kaiser is the target of two proposed class-action lawsuits that accuse the company of violating the Mental Health Parity Act and other laws by routinely denying medical care, including applied behavior analysis, to its members.
Scott Glovsky, a Pasadena lawyer representing Kaiser members in one of the suits, said it was a shame that the department failed to address applied behavior analysis therapy.
"ABA is what children with autism spectrum disorders need the most," he said.
The decision applies to insurance policies held by more than 21 million Californians and supervised by the Department of Managed Health Care. That includes health maintenance organizations and some preferred-provider organizations offered by several companies, including Kaiser, Anthem Blue Cross, Blue Shield, Health Net and PacifiCare.
Harvey Rosenfield, founder of Consumer Watchdog, a Santa Monica advocacy organization, said the department might have crossed the line on "underground rule-making" by trying to change the rules by letter rather than through the formal adoption of regulations, which is a public process.
"This is a state agency winking at the HMOs and inviting them to deny claims to autistic children," Rosenfield said. "This is going to be a license to steal for the HMOs, and they are giving it away without even holding a hearing, which is just an outrage, and also, I think, illegal."
What do you think about this latest development?
Share your comments below.
Help Get the ABLE Accounts Act Passed
Dear Autism Advocate,
The ABLE Accounts Act of 2009 – or Achieving a Better Life Experience Act – has been introduced in Congress. S.493 and H.R. 1205 will encourage individuals with autism and other disabilities and their families to save, tax-free, for disability-related expenses. Similar in many respects to existing 529 college savings plans, these accounts will be exempt from federal taxation, provided certain rules are met.
Robert Casey (D-PA), Orrin Hatch (R-Utah), and Christopher Dodd (D-CT) introduced S. 493, with Senators Richard Burr (R-NC), Edward Kennedy (D-MA), and Sam Brownback (R-KS) signing on as the bill’s original co-sponsors. Senator Ander Crenshaw (R-FL) introduced the companion bill in the House, H.R. 1205, with Congressmen Patrick Kennedy (D-RI), Cathy McMorris Rodgers (R-WA), and Kendrick Meek (D-FL) joining Crenshaw as original cosponsors.
How to Get ABLE
Accounts Act Passed
1. CALL YOUR FEDERAL SENATOR AND HOUSE REPRESENTATIVE
Let them know that you are a constituent and that these bills will help your family.
CLICK HERE TO FIND THE NAME OF YOUR FEDERAL LAWMAKERS
2. SEND EMAILS TO YOUR FEDERAL LAWMAKERS
Urge them to co-sponsor the ABLE Accounts Act.
CLICK HERE TO STAY INFORMED - AT AUTISMVOTES.ORG
Receive updates and alerts about the ABLE Accounts Act and other autism legislation.
Let everyone you know hear about the introduction of the ABLE Accounts Act.
Elizabeth Emken
Vice President, Government Relations
Autism Speaks
U.S. Vaccine Court Denies Family's Autism Case
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - A special U.S. court ruled against three families on Thursday who claimed vaccines caused their children's autism.
The Vaccine Court Omnibus Autism Proceeding ruled against the parents of Michelle Cedillo, Colten Snyder and William Yates Hazlehurst, who had claimed that a measles, mumps and rubella vaccines had combined with other vaccine ingredients to damage the three children.
"I conclude that the petitioners have not demonstrated that they are entitled to an award on Michelle's behalf," Special Master George Hastings, a former tax claims expert at the Department of Justice, wrote in the Cedillo ruling.
The families sought payment under the National Vaccine Injury Compensation Program, a no-fault system that has a $2.5 billion fund built up from a 75-cent-per-dose tax on vaccines.
No judges but instead three "special masters" heard the three test cases representing thousand of other petitioners.
They asked whether a combination vaccine for measles, mumps and rubella, or MMR, plus a mercury-containing preservative called thimerosal, caused the children's symptoms.
"The evidence does not support the general proposition that thimerosal-containing vaccines can damage infants' immune systems," Hastings wrote, after reviewing tens of thousands of documents and hours of oral arguments.
Michelle's parents argued that she was a normal baby until she received the vaccine.
Experts say parents often link vaccines with their children's symptoms because they are vaccinated at an age when autism and related disorders are often first diagnosed.
NO EVIDENCE
Two Institute of Medicine reports, in 2001 and 2004, reviewed the evidence and determined there was no link between vaccines and autism. Many other studies have also shown no link, but a small and vocal group of parents continue to press the cases.
"Considering all of the evidence, I found that the petitioners have failed to demonstrate that thimerosal-containing vaccines can contribute to causing immune dysfunction, or that the MMR vaccine can contribute to causing either autism or gastrointestinal dysfunction," the ruling from Hastings said.
"I further conclude that while Michelle Cedillo has tragically suffered from autism and other severe conditions, the petitioners have also failed to demonstrate that her vaccinations played any role at all in causing those problems."
Hastings also rejected an argument that some children may be genetically "hypersusceptible" to mercury.
More than 5,300 cases had been filed by parents who believed vaccines may have caused autism in their children and were seeking payment under the National Vaccine Injury Compensation Program. Under the program, someone injured by a vaccine does not have to prove the vaccine actually caused his or her injuries.
All they need to do is establish that vaccines sometimes cause that particular condition or injury, as the three test cases sought to prove. The no-fault payout system is meant to protect vaccine makers from costly lawsuits that drove many out of the vaccine-making business.
(Editing by Alan Elsner)
Teen's Family Transformed After Autism Intervention
Part II
By Linda Saether CNN
Until recently, the Bilson household was under siege. Thirteen-year-old daughter Marissa, who has autism, ruled the roost, screaming shrilly until she got her way and enjoying special privileges that didn't extend to her siblings, Brittany, 15, and Brendan, 6.
By Linda Saether CNN
Until recently, the Bilson household was under siege. Thirteen-year-old daughter Marissa, who has autism, ruled the roost, screaming shrilly until she got her way and enjoying special privileges that didn't extend to her siblings, Brittany, 15, and Brendan, 6. The family couldn't go out in public because of Marissa's tantrums, and they couldn't take her into stores because she'd shoplift what she wanted, or just scream until she got it.
But that was before.
Today, the Bilsons' family life is a lot calmer and quieter. That's because Marissa and her parents, John and Mary, are following the rules that were made during a five-day intervention. The intervention was provided to them free by the group Autism Partnership, or AP. Usually this type of treatment costs about $20,000 a week, and it's not covered by insurance, but because CNN was allowed to videotape the entire process, AP waived the fee for the Bilsons.
The intensive, one-on-one, in-home therapy was meted out by behavioral therapist Rick Schroeder, who used a technique of behavior modification known as "applied behavior analysis" or ABA. ABA essentially breaks down behavior patterns in order to reward good behavior and not reward bad behavior. Essentially, it's all about laying down the rules and sticking to them in a way that Marissa can understand.
Marissa -- who before the therapy was, in Schroeder's words, "out of control" -- now has rules to follow, something she didn't have before. Marissa's mother also learned some lessons about her daughter that week. "I learned that Marissa is smart," Mary Bilson said. "Smarter than I thought."
These days inside the Bilsons' cozy house, there is a lot less screaming and more boundaries are in place. The balance of power is tipping back into the hands of the parents and away from Marissa and her tantrums.
These days inside the Bilsons' cozy house, there is a lot less screaming and more boundaries are in place. The balance of power is tipping back into the hands of the parents and away from Marissa and her tantrums.
But there is still work to be done; the only difference is that now the Bilsons -- not Schroeder -- will be in charge.
The theory remains the same: "It's all about the teaching," Schroeder explains. "With a child like Marissa, we can't sit down and discuss it with her -- she's just not going to get that. So we have to take it in small steps. Make them understandable and move on, one step at a time."
That's just what the Bilsons are doing: One step at a time. They have increased the amount of time that Marissa has to practice her new behavior, from a starting time of 20 minutes a day toward a goal of 60 minutes.
In a recent e-mail, Mary Bilson wrote that the initial rewards that Schroeder had used with Marissa have lost their appeal, and Marissa wasn't interested in working for them anymore. However, Bilson added, she has discovered other rewards the teen is eager to work toward.
As a result, said Mary Bilson, her once unruly teen has continued to follow the rules that were put in place during that weeklong intervention: Marissa no longer goes into sister Brittany's room, she no longer monopolizes the family computer, and her once-frequent screaming fits have all but stopped.
Possibly best of all, Marissa can now go out in public without creating a scene -- a goal Mary Bilson was eager to achieve, because before, the Bilsons "could never go out together as a normal family."
In other words, one week of intervention therapy has done more than simply give Marissa some rules to follow and the household some much needed quiet. It has brought this once-divided family back together.
Autism 911: Help for a family in chaos
By Linda Saether, CNN Medical Producer
CARD Note: You can follow the Bilsons' progress on CNN American Morning 6 a.m. to 9 a.m. through February 4.
Seal Beach, CALIFORNIA (CNN) -- The Bilson family is like many other families: three kids, a cat, and a small, lovely home with lots of family photos and carved wooden wall signs with sayings like "Live, Laugh, Love."But step inside their house after 4 p.m. most weekdays and you'll want to cover your ears because of the noise -- the screaming, to be exact. These are not the shouts of sibling rivalry or parental annoyance. This is the high-pitched, ear-shattering sound of a 13-year-old girl. More accurately, it is the sound of a frustrated, irritated, very loud teenager with autism.
Marissa, the middle Bilson child, was diagnosed with autism when she was a toddler. Her mother, Mary, a nurse, knew something wasn't right early on, when young Marissa's tantrums were off the charts and seemingly unwarranted.
But during the first few years, doctors told Mary Bilson that her daughter was fine and this behavior would eventually pass. They were wrong on both counts.
Marissa's behavior has not passed; it has, in fact, become worse. According to Bilson, Marissa and her tantrums rule the household. "I don't want to hear her screaming and tantruming, so we pretty much let her do what she wants," Bilson says. "We" means Mary, her husband, John, and their two other children, Brittany, 15, and 6-year-old Brendan.
Keeping the peace means that, when it comes to Marissa, the rules are different. She is allowed unlimited time on the one family computer. She is allowed access to her siblings' rooms and possessions. She is allowed to eat dinner at the computer instead of the family table.
But before you sit in judgment of the Bilsons, and suggest they just need a firm hand to keep their middle child in line, consider one thing: They are trying to cope with a child with severely impaired social sensibilities.
"Do you think people who don't have children with autism know how tough it is to deal with them?" CNN's senior medical correspondent, Elizabeth Cohen, asked Marissa's mom in a recent interview. "No," Mary Bilson replied. "And I don't see how they could."
She's right -- we can't, because many of us have never seen autism in action, day in and day out.
Autism is described on the National Institutes of Health Web site as a "developmental disorder that appears in the first three years of life, and affects the brain's normal development of social and communication skills." According to the Centers for Disease Control and Prevention, autism and related disorders affect about one out of every 150 babies born each year.
Autism manifests itself in many different ways. Although there are some common threads, like language issues, repetitive movements and difficulties connecting to others, specific behavioral patterns are largely unique to the individual. "Children with autism are all different; they are like snowflakes," explains Dr. Ronald Leaf, co-director of the group Autism Partnership.
The one thing that Leaf believes they all have in common is that "they are not expected to do enough." Leaf insists we have set the bar too low for what we think children and adults with autism can do. "They are highly teachable," he says. "You just have to have a good teacher."
A good teacher is exactly what Bilson was looking for to help her with Marissa. The family had already tried various programs, starting when Marissa was a toddler -- but nothing completely worked for her. And as Marissa entered her teen years, her behavior grew worse. Mary knew that her daughter needed to be reined in, and it needed to be done now.
"She is getting older. She's 13 and her tantrums are louder and longer than they used to be. It's just so inappropriate. It was OK when she was much younger, but now that she's going to be an adult soon, she can't be behaving this way," Bilson says with tired resignation.
But what could the Bilsons do? This family doesn't have a lot of extra money, and most programs either aren't covered by insurance or have long waiting lists. The costs are staggering, according to the Web site FightingAutism.org. Families with autistic children can expect to spend $30,000 annually to provide proper medical, educational and other assistance necessary for dealing with an autistic child.
Enter Autism Partnership, or AP. This group, founded in 1994, offers extensive therapeutic services to children and adults with the disorder. One of its most unique programs is an intensive one-on-one, at-home intervention service that is similar in scope to what happens on the television show "Nanny 911." It's not cheap -- about $2,500 per day, typically for a five-day period (with additional days on an "as needed" basis).
Most of AP's work is grounded in a behavior modification technique known as Applied Behavioral Analysis or ABA. Essentially, the method breaks down behavior patterns, rewarding proper behavior while being careful not to encourage improper responses.
And that is exactly how AP therapist Rick Schroeder hopes to reshape Marissa Bilson's worst behavior. The group, which met Marissa while working in her school, offered the Bilson family a free week-long intervention with the proviso that CNN be allowed to record the process.
The week started off with a day of observation -- a day with lots and lots of screaming and tantrums, that left Schroeder stunned. He had observed Marissa at school where, he says, she was much less demonstrative.
But Schroeder is still eager and ready to tackle the challenge. "I think the family is starting to realize something needs to change, and that's very good," he says after his day of observation. "As far as Marissa's behavior goes -- and the level that she is capable of going to -- she's pretty much out of control, for sure."
CARD Reveals Outcome of First Arizona Early, Intensive Behavioral Therapy Study
In 2006 the Arizona state Legislature and Governor Janet Napolitano approved $3.6 million funding for a two-year comprehensive outcome study to evaluate the effectiveness of early, intensive Applied Behavior Analysis (ABA) as a treatment for autism.
The Center for Autism and Related Disorders, Inc. (CARD) was selected to administer the treatment and spearhead the study in Phoenix. Now, one year later, the 16 children have shown promising results.
Amy Kenzer, PhD, BCBA, CARD’s manager of Research and Development says, “At this point, all of the children in the Arizona grant have received services for approximately a year and a half. Following one year of treatment, several children showed significant improvements as measured by standardized assessments and parent report, including two children who gained 50 IQ points. Many of the children also started full day Kindergarten this fall and are doing very well in their new classrooms.”Kenzer will present the complete outcome report on February 14, 2009 at the Autism/Asperger Conference held at the Anaheim Convention Center in Anaheim, California. Her presentation begins at 1:30pm. Attendees will learn about the therapy utilized with all 16 children, the results of the therapy after one year, and the current status of the children.
About Amy Kenzer, PhD, BCBA:
Dr. Amy Kenzer, Research and Development Manager at the Center for Autism and Related Disorders, has over 10 years of experience in the field of Behavior Analysis and Autism.
Dr. Amy Kenzer, Research and Development Manager at the Center for Autism and Related Disorders, has over 10 years of experience in the field of Behavior Analysis and Autism.
Dr. Kenzer earned her Ph.D. from the University of Nevada, Reno and is a Board Certified Behavior Analyst. Her research interests include outcome-level analyses of ABA-based interventions, component analysis of ABA-based teaching techniques, fluency instruction, and basic learning processes in children with autism.
About the Center for Autism and Related Disorders, Inc. (CARD):
The Center for Autism and Related Disorders, Inc. (CARD) was established in 1990 and is among the world's largest and most experienced organizations effectively treating children with autism and related disorders. CARD operates 20 satellite offices throughout the United States and abroad. CARD has treated thousands of children around the world. Its services include assessments, supervision, parent/teacher training and one-to-one therapy.
The Center for Autism and Related Disorders, Inc. (CARD) was established in 1990 and is among the world's largest and most experienced organizations effectively treating children with autism and related disorders. CARD operates 20 satellite offices throughout the United States and abroad. CARD has treated thousands of children around the world. Its services include assessments, supervision, parent/teacher training and one-to-one therapy.
Following the principles of Applied Behavior Analysis (ABA), a treatment for autism that has been thoroughly researched and empirically validated by the scientific community, CARD develops individualized treatment plans.
CARD Winter 08 Newsletter - Hot off the Press!
To read the latest autism news around the nation and inside of the Center for Autism and Related Disorders, Inc - please click here.
ABA: Addressing Cognitive and Emotional Development in Children with Autism
By
Doreen Granpeesheh, PhD, BCBA
Jonathan Tarbox, PhD, BCBA
Click here for a complete read of the article featured in Autism Advocate, Dec 2008 issue.
For other recent articles by Dr. Granpeesheh, click here.
Doreen Granpeesheh, PhD, BCBA
Jonathan Tarbox, PhD, BCBA
Click here for a complete read of the article featured in Autism Advocate, Dec 2008 issue.
For other recent articles by Dr. Granpeesheh, click here.
Defining Autism
Defining Autism
Autism is a pervasive developmental disorder that is marked by the presence of impaired social interaction and communication and a restricted repertoire of activities and interests. The prevalence of autism has been estimated to affect as many as 1 in 150 children and is four times more common in boys than in girls.
Children with Autism show a great variance of symptoms ranging from severe impairment in the use of nonverbal behaviors that regulate social interaction to a failure to develop peer relationships appropriate to age.
Their impairment in communication is also marked and sustained and can affect both verbal and nonverbal skills. Autistic children may have a delay in or a total lack of spoken language. In children who do speak, there may be a delay in the ability to sustain a conversation with others, or a stereotypic and repetitive use of language.
Children with Autism may also show a lack of varied, spontaneous make believe play or social imitative play and often have restricted, repetitive and stereotyped patterns of activity.
Children with Autism may have a range of behavioral symptoms including hyperactivity, short attention span, impulsivity, aggressiveness, self-injurious behavior and temper tantrums. They may show unusual responses to sensory stimuli as observed by a lack of response to pain or a hypersensitivity to particular sounds. In addition, children with Autism often have unusual eating and sleeping habits and are described as being either agitated and irritable or aloof and detached.
Because autism is a severe, chronic developmental disorder that results in significant lifelong disability, the goal of treatment is to promote the child's social and language development and minimize behaviors that interfere with the child's functioning and learning. Intensive, sustained special education programs and behavior therapy early in life can increase the ability of the child with autism to acquire language and ability to learn.
Special education programs in highly structured environments appear to help the child acquire self-care, social, and job skills. Only in the past decade have studies shown positive outcomes for very young children with autism. Given the severity of the impairment, high intensity of service needs, and costs (both human and financial), there has been an ongoing search for effective treatment.
Diagnosis
The diagnosis of autism is a complex and often controversial issue. The most accepted standards for diagnosis come from the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM – IV), published by the American Psychiatric Association. The MADSEC report provides a useful, succinct description of the diagnosis and relevant factors comprising it.
Autism is included under DSM-IV’s pervasive developmental disorders. This is a category of disorders in which many basic areas of infant and child psychological development are affected at the same time, and to a severe degree.
Autistic disorder has three major hallmarks: qualitative impairment in social interaction, qualitative impairment in communication, and restricted, repetitive and stereotypical patterns of behavior, interests, and activities. Onset in delays is very early, prior to three years of age.
To meet DSM-IV diagnostic criteria for autism, children will display impairment in social interaction in at least two ways, impairment in communication in at least one way, and restricted, repetitive and stereotypical patterns of behavior, interests and activities in at least one way.
According to DSM-IV, impairment in social interaction is manifested in at least two of the following ways:
a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
Autism is a pervasive developmental disorder that is marked by the presence of impaired social interaction and communication and a restricted repertoire of activities and interests. The prevalence of autism has been estimated to affect as many as 1 in 150 children and is four times more common in boys than in girls.
Children with Autism show a great variance of symptoms ranging from severe impairment in the use of nonverbal behaviors that regulate social interaction to a failure to develop peer relationships appropriate to age.
Their impairment in communication is also marked and sustained and can affect both verbal and nonverbal skills. Autistic children may have a delay in or a total lack of spoken language. In children who do speak, there may be a delay in the ability to sustain a conversation with others, or a stereotypic and repetitive use of language.
Children with Autism may also show a lack of varied, spontaneous make believe play or social imitative play and often have restricted, repetitive and stereotyped patterns of activity.
Children with Autism may have a range of behavioral symptoms including hyperactivity, short attention span, impulsivity, aggressiveness, self-injurious behavior and temper tantrums. They may show unusual responses to sensory stimuli as observed by a lack of response to pain or a hypersensitivity to particular sounds. In addition, children with Autism often have unusual eating and sleeping habits and are described as being either agitated and irritable or aloof and detached.
Because autism is a severe, chronic developmental disorder that results in significant lifelong disability, the goal of treatment is to promote the child's social and language development and minimize behaviors that interfere with the child's functioning and learning. Intensive, sustained special education programs and behavior therapy early in life can increase the ability of the child with autism to acquire language and ability to learn.
Special education programs in highly structured environments appear to help the child acquire self-care, social, and job skills. Only in the past decade have studies shown positive outcomes for very young children with autism. Given the severity of the impairment, high intensity of service needs, and costs (both human and financial), there has been an ongoing search for effective treatment.
Diagnosis
The diagnosis of autism is a complex and often controversial issue. The most accepted standards for diagnosis come from the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM – IV), published by the American Psychiatric Association. The MADSEC report provides a useful, succinct description of the diagnosis and relevant factors comprising it.
Autism is included under DSM-IV’s pervasive developmental disorders. This is a category of disorders in which many basic areas of infant and child psychological development are affected at the same time, and to a severe degree.
Autistic disorder has three major hallmarks: qualitative impairment in social interaction, qualitative impairment in communication, and restricted, repetitive and stereotypical patterns of behavior, interests, and activities. Onset in delays is very early, prior to three years of age.
To meet DSM-IV diagnostic criteria for autism, children will display impairment in social interaction in at least two ways, impairment in communication in at least one way, and restricted, repetitive and stereotypical patterns of behavior, interests and activities in at least one way.
According to DSM-IV, impairment in social interaction is manifested in at least two of the following ways:
a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
b) failure to develop peer relationships appropriate to developmental level;
c) a lack of spontaneous seeking to share enjoyment, interests or achievement with other people;
d) lack of social or emotional reciprocity.
Impairment in communication is manifested by at least one of the following:
a) delay in, or total lack of, the development of spoken language, not accompanied by an attempt to compensate through alternative modes of communication;
b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others;
c) stereotyped and repetitive use of language or idiosyncratic language, and
d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Restricted, repetitive and stereotyped patterns of behavior, interests and activities are manifested by at least one of the following:
- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus;
- apparently inflexible adherence to specific, non-functional routines or rituals;
- stereotyped and repetitive motor mannerisms, such as hand or finger flapping, or complex whole body movements;
- persistent preoccupation with parts of objects. (DSM-IV, 1994). (MADSEC, 2000, p. 7)
While the diagnostic criteria described above are widely applicable, it is important to note that very child with autism is unique, and there is no such thing as a “average” child with autism. Each child anifests unique strengths and skill deficits and it is important to keep in mind that treatment must therefore be oriented to an assessment of the unique needs of each individual person, not simply prescribed based on a diagnosis.
References
Maine Administrators of Services for Children with Disabilities (MADSEC) (2000). Report of the MADSEC Autism Task Force.
Dr. Doreen Granpeesheh on How Biomedical Intervention Improves ABA Success
Autism Action Plan founder Dr. Kurt Woeller interviews Doreen Granpeesheh, PhD, BCBA at the Defeat Autism Now (DAN!) conference.
Interview - Part One
Interview - Part One
Also:
Dr. Granpeesheh explains
Red Flags to Look For That Can Indicate Autism
Red Flags to Look For That Can Indicate Autism
Want to view other indepth interviews on autism by Dr. Granpeesheh? Click here.
You can also visit: www.centerforautism.com.
Positive Behavior Management: Tips for Parents and Professionals
Presented by Jonathan Tarbox, PhD ,BCBA
CARD Research and Development Director
Click here to see his complete presentation.
CARD Research and Development Director
Click here to see his complete presentation.
What is ABA?
What is Applied Behavior Analysis?
Behavior Analysis is the scientific study of behavior. Applied Behavior Analysis (ABA) is the application of the principles of learning and motivation from Behavior Analysis, and the procedures and technology derived from those principles, to the solution of problems of social significance. Many decades of research have validated treatments based on ABA.
Behavior Analysis is the scientific study of behavior. Applied Behavior Analysis (ABA) is the application of the principles of learning and motivation from Behavior Analysis, and the procedures and technology derived from those principles, to the solution of problems of social significance. Many decades of research have validated treatments based on ABA.
The Report of the MADSEC Autism Task Force (2000) provides a succinct description, put together by an independent body of experts:
Over the past 30 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of:
- populations (children and adults with mental illness, developmental disabilities and learning disorders)
- interventionists (parents, teachers and staff)
- settings (schools, homes, institutions, group homes, hospitals and business offices), and
- behaviors (language; social, academic, leisure and functional life skills; aggression, selfinjury, oppositional and stereotyped behaviors)
Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).
“Socially significant behaviors” include reading, academics, social skills, communication, and adaptive living skills. Adaptive living skills include gross and fine motor skills, eating and food preparation, toileting, dressing, personal self-care, domestic skills, time and punctuality, money and value, home and community orientation, and work skills.
ABA methods are used to support persons with autism in at least six ways:
1. to increase behaviors (eg reinforcement procedures increase on-task behavior, or social interactions);
2. to teach new skills (eg, systematic instruction and reinforcement procedures teach functional life skills, communication skills, or social skills);
3. to maintain behaviors (eg, teaching self control and self-monitoring procedures to maintain and generalize job-related social skills);
4. to generalize or to transfer behavior from one situation or response to another (eg, from completing assignments in the resource room to performing as well in the mainstream classroom);
5. to restrict or narrow conditions under which interfering behaviors occur (eg, modifying the learning environment); and
6. to reduce interfering behaviors (eg, self injury or stereotypy).
ABA is an objective discipline. ABA focuses on the reliable measurement and objective
evaluation of observable behavior.
Reliable measurement requires that behaviors are defined objectively. Vague terms such as anger, depression, aggression or tantrums are redefined in observable and quantifiable terms, so their frequency, duration or other measurable properties can be directly recorded (Sulzer-Azaroff & Mayer, 1991). For example, a goal to reduce a child’s aggressive behavior might define “aggression” as: “attempts, episodes or occurrences (each separated by 10 seconds) of biting, scratching, pinching or pulling hair.” “Initiating social interaction with peers” might be defined as: “looking at classmate and verbalizing an appropriate greeting.”
ABA interventions require a demonstration of the events that are responsible for the occurrence,
or non-occurrence, of behavior. ABA uses methods of analysis that yield convincing, reproducible, and conceptually sensible demonstrations of how to accomplish specific behavior changes (Baer & Risley, 1987). Moreover, these behaviors are evaluated within relevant settings such as schools, homes and the community. The use of single case experimental design to evaluate the effectiveness of individualized interventions is an essential component of programs based upon ABA methodologies. This is a process that includes the following components:
a) selection of interfering behavior or behavioral skill deficit
b) identification of goals and objectives
c) establishment of a method of measuring target behaviors
d) evaluation of the current levels of performance (baseline)
e) design and implementation of the interventions that teach new skills and/or reduce interfering behaviors
f) continuous measurement of target behaviors to determine the effectiveness of the intervention, and
g) ongoing evaluation of the effectiveness of the intervention, with modifications made as necessary to maintain and/or increase both the effectiveness and the efficiency of the intervention. (MADSEC, 2000, p. 21-23)
As the MADSEC Report describes above, treatment approaches grounded in ABA are now considered to be at the forefront of therapeutic and educational interventions for children with autism. The large amount of scientific evidence supporting ABA treatments for children with autism have led a number of other independent bodies to endorse the effectiveness of ABA, including the U.S. Surgeon General, the New York State Department of Health, the National Academy of Sciences, and the American Academy of Pediatrics (see reference list below for sources).
Discrete Trial Training
Discrete trial training (DTT) is a particular ABA teaching strategy which enables the learner to acquire complex skills and behaviors by first mastering the subcomponents of the targeted skill. For example, if one wishes to teach a child to request a a desired interaction, as in "I want to play," one might first teach subcomponents of this skill, such as the individual sounds comprising each word of the request, or labeling enjoyable leisure activities as "play." By utilizing teaching techniques based on the principles of behavior analysis, the learner is gradually able to complete all subcomponent skills independently. Once the individual components are acquired, they are linked together to enable mastery of the targeted complex and functional skill. This methodology is highly effective in teaching basic communication, play, motor, and daily living skills.
Initially, ABA programs for children with Autism utilized only (DTT), and the curriculum focused on teaching basic skills as noted above. However, ABA programs, such as the program implemented at CARD, continue to evolve, placing greater emphasis on the generalization and spontaneity of skills learned. As patients progress and develop more complex social skills, the strict DTT approach gives way to treatments including other components.
Specifically, there are a number of weaknesses with DTT including the fact the DTT is primarily teacher initiated, that typically the reinforcers used to increase appropriate behavior are unrelated to the target response, and that rote responding can often occur. Moreover, deficits in areas such “emotional understanding,” “perspective taking” and other Executive Functions such as problem solving skills must also be addressed and the DTT approach is not the most efficient means to do so.
Although the DTT methodology is an integral part of ABA-based programs, other teaching strategies based on the principles of behavior analysis such as Natural Environment Training (NET) may be used to address these more complex skills. NET specifically addresses the above mentioned weaknesses of DTT in that all skills are taught in a more natural environment in a more “playful manner.” Moreover, the reinforcers used to increase appropriate responding are always directly related to the task (e.g., a child is taught to say the word for a preferred item such as a “car” and as a reinforcer is given access to the car contingent on making the correct response). NET is just one example of the different teaching strategies used in a comprehensive ABA-based program. Other approaches that are not typically included in strict DTT include errorless teaching procedures and Fluency-Based Instruction.
At CARD all appropriate teaching approaches based on the well grounded principles of applied behavior analysis are utilized.
References
Baer, D., Wolf, M., & Risley, R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91 - 97.
Baer, D., Wolf, M., & Risley, R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20, 313 - 327.
Maine Administrators of Services for Children with Disabilities (MADSEC) (2000). Report of the MADSEC Autism Task Force.
Myers, S. M., & Plauché Johnson, C. (2007). Management of children with autism spectrum disorders. Pediatrics, 120, 1162-1182.
National Academy of Sciences (2001). Educating Children with Autism. Commission on Behavioral and Social Sciences and Education.
New York State Department of Health, Early Intervention Program (1999). Clinical Practice Guideline: Report of the Recommendations: Autism / Pervasive Developmental Disorders: Assessment and Intervention for Young Children (Age 0-3 years).
Sulzer-Azaroff, B. & Mayer, R. (1991). Behavior analysis for lasting change. Fort Worth, TX : Holt, Reinhart & Winston, Inc.
US Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Autism Glossary - What it All Means
ABC: Autism Behavior Checklist - a diagnostic tool
ADA: Americans with Disabilities Act
ADD: Attention Deficit Disorder
ADHD: Attention Deficit Hyperactivity Disorder
ADI: Autism Diagnostic Interview - a diagnostic tool developed in London by the Medical Research Council
ADOS: Autism Diagnostic Observation Scale
AIT: Auditory Integration Training
AS: Asperger's Syndrome
ASA: Autism Society of America
ASD: Autism Spectrum Disorders
ASL: American Sign Language
CBCL: Achenbach Childhood Behavior Checklist - a diagnostic tool
CHAT: Checklist for Autism in Toddlers - a diagnostic tool
DAN Protocol: an assessment protocol that examines the underlying disorders causing autism
DD: Developmental DisabilitiesDVD: Developmental Verbal Dyspraxia
F
FC: Facilitated CommunicationFCT: Facilitated Communication Training
G
GARS: Gilliam Autism Rating Scale
H
HFA: High-functioning Autistic
I
ICF: Intermediate Care Facility
FC: Facilitated CommunicationFCT: Facilitated Communication Training
G
GARS: Gilliam Autism Rating Scale
H
HFA: High-functioning Autistic
I
ICF: Intermediate Care Facility
IDEA: Individuals with Disabilities Act
IEP: Individualized Education Plan
IFSP: Individualized Family Service Plan
IHP: Individualized Habilitation Program
IPP: Individual Program Plan
NOS: Not Otherwise Specified
O
OCD: Obsessive Compulsive DisorderODD: Oppositional Defiant DisorderOT: Occupational Therapist
P
PDD: Pervasive Developmental Disorder
O
OCD: Obsessive Compulsive DisorderODD: Oppositional Defiant DisorderOT: Occupational Therapist
P
PDD: Pervasive Developmental Disorder
PDD NOS: Pervasive Developmental Disorder Not Otherwise Specified
PECS: Picture Exchange Communication System
PEP: Psycho-educational Profile
PEP-R: Psycho-educational Profile Revised
PRT: Pivotal Response Training
SI: Sensory Integration
SIB: Self-Injurious Behavior
SIT: Sensory Integration Therapy
T
TEACCH: Treatment and Education of Autistic and Related Communication Handicapped Children
T
TEACCH: Treatment and Education of Autistic and Related Communication Handicapped Children
Dr. Doreen Granpeesheh Appears on California PBS Talk Show this Week
Orange, CA – Doreen Granpeesheh, PhD, BCBA, Founder and Executive Director of the Center for Autism and Related Disorders, Inc. (CARD) will once again be featured on the KOCE – PBS (California) award-winning talk show, Dialogue with Doti and Dodge. The show, hosted by Jim Doti and Kristina Dodge airs tonight, December 09, at 11:30pm, and again this Sunday, December 14, 2008 at 11:00am.You can also watch the show anytime, by clicking here.
The show includes a discussion about causes, treatments and most importantly the issue of recovery which has been a controversial topic. Some believe it is not possible to achieve “recovery” and others say it should not be a goal of individuals with autism. Dr. Granpeesheh will define recovery and discuss the science behind recovery. She will also present proof in the form of her newly released film, Recovered: Journeys Through the Autism Spectrum and Back, directed by Michele Jaquis. The film tells the story of four children diagnosed with autism, who achieved success using treatments rooted in Applied Behavior Analysis. The documentary includes clips of therapy sessions along with interviews of the children who are now teenagers, their parents, therapists, and Dr. Granpeesheh.
Dr. Granpeesheh will also touch on issues of treatment funding, and will be joined by Nancy Alspaugh, the executive director of ACT Today! (Autism Care & Treatment), a non profit organization with a mission to expand access to effective autism treatment.
Dr. Doreen Granpeesheh is world renowned for her therapy method and recovery rates. She has treated tens of thousands of children with autism in her career and has seen significant recovery rates.
A highly recognized psychologist in the field of autism, Dr. Granpeesheh recently earned one of the Autism Society of America’s highest honors – the Wendy F. Miller National Recognition Award for Professional of the Year (2007). The award recognizes significant contributions made by a psychologist, psychiatrist, physician, and other professionals in the autism field. That same year, Dr. Granpeesheh was elected to the Autism Society of America (ASA) Board of Directors. She also serves on the Defeat Autism Now (DAN!) Executive Council and the US Autism and Aspergers Association (USAAA) Scientific Advisory Board.
Dr. Granpeesheh will also touch on issues of treatment funding, and will be joined by Nancy Alspaugh, the executive director of ACT Today! (Autism Care & Treatment), a non profit organization with a mission to expand access to effective autism treatment.
Dr. Doreen Granpeesheh is world renowned for her therapy method and recovery rates. She has treated tens of thousands of children with autism in her career and has seen significant recovery rates.
A highly recognized psychologist in the field of autism, Dr. Granpeesheh recently earned one of the Autism Society of America’s highest honors – the Wendy F. Miller National Recognition Award for Professional of the Year (2007). The award recognizes significant contributions made by a psychologist, psychiatrist, physician, and other professionals in the autism field. That same year, Dr. Granpeesheh was elected to the Autism Society of America (ASA) Board of Directors. She also serves on the Defeat Autism Now (DAN!) Executive Council and the US Autism and Aspergers Association (USAAA) Scientific Advisory Board.
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