NEWS: Initial proposed revisions to DSM-V released; comments requested

On Wednesday Tuesday, February 10, 2010 the American Psychiatric Association (APA) unveiled the proposed initial draft recommendations for the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual used to diagnose mental disorders. When completed and adopted, the DSM-V would supercede the current version, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

The American Psychiatric Association has set up a website with the proposed initial draft recommendations of the revisions developed by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010. After the April 20th date, the site will still be available for viewing, but comments will not longer be taken.

Further steps before release would be field testing of the proposed revisions and final changes.

The process for developing the DSM-5 began a decade ago, with an initial research planning conference under the joint sponsorship of the APA and the National Institute of Mental Health (NIMH). Additional global research planning conferences, under the auspices of the American Psychiatric Institute for Research and Education (APIRE), the World Health Organization, and three institutes of the National Institutes of Health produced a series of monographs, which helped lay the groundwork for the revisions.

The APA’s DSM-5 Task Force and Work Group members were identified in 2007; they are tasked with reviewing scientific advances and research to develop draft diagnostic criteria in diagnostic categories of psychiatric disorders.

While many changes are planned for the DSM-V, two that were given some attention by the press on Tuesday was the replacement of pediatric bipolar disorder with "Temper Dysregulation Disorder",


and removal of Asperger's Syndrome as a separate diagnosis and placement under the Autism Spectrum Disorder category,



The anticipated release of the DSM-V is May 2013. This release date was delayed from initial projections to allow coordination with the scheduled U.S. implementation on October 1, 2013 of the International Classification of Diseases-10-Clinical Modification (ICD-10-CM) (World Health Organization/WHO) codes for all Medicare/Medicaid claims reporting. Chapter V of the ICD-10-CM is Mental and behavioral disorders. A related development is that the ICD is also in revision to ICD-11 ; that revised version is expected to be released in 2014 or 2015.

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For further reading

American Psychiatric Association DSM-5 Development

[This article discusses the timeline for the DSM-V and steps towards the final version and coordination witht he ICD-10-CM]
Why is DSM-5 Being Delayed?
Alan F. Schatzberg, M.D.
Psychiatric News January 1, 2010
Volume 45 Number 1 Page 3

International Classification of Diseases (ICD)

Media reports
All google news under keyword "DSM-V"

[This article gives a quick rundown on some proposed revisions]
APA Releases Proposed Draft of the DSM-5
Caroline Cassels
Medscape Medical News
February 10, 2010

Revising Book on Disorders of the Mind
By BENEDICT CAREY
New York Times
Published: February 10, 2010

[In reference to the folding of Asperger's Syndrome into the Autism Spectrum Disorders]
Opinion: Disorder Out of Chaos
By ROY RICHARD GRINKER
New York Times
Published: February 9, 2010

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

LEG NEWS: U.S. House Bill - H.R. 4247 on changing restraint and seclusion policy in U.S. schools passes House Committee

Thursday, February 4, 2010, the U.S. House Committee on Education and Labor passed by a bipartisan vote of 34 to 10,
H.R. 4247: The Preventing Harmful Restraint and Seclusion in Schools Act -
"To prevent and reduce the use of physical restraint and seclusion in schools, and for other purposes".

This bill, which would regulate the use of restraint, seclusion and other practices in all U.S. public schools, has been the subject of considerable public attention since its introduction on December 9, 2009.

The impetus for H.R. 4247's introduction by Representatives George Miller, 7th-D, CA & Cathy McMorris Rodgers, 5th-D. WA, was a May 19, 2009 hearing before the House Committee on Education and Labor examining the abusive and deadly use of seclusion and restraint in schools, in addition to an investigative report by the GAO, and the report: School is Not Supposed to Hurt: Investigative Report on Abusive Restraint and Seclusion in Schools by the National Disability Rights Network.

A related bill is S.2860 (Dodd) "A bill to protect students from inappropriate seclusion and physical restraint, and for other purposes"

The next step for H.R. 4247 is the floor of the U.S. House of Representatives.


For further reading

H.R. 4247 at Thomas.gov

Seclusions and Restraints: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers.  GAO-09-719T, May 19, 2009


School is Not Supposed to Hurt: Investigative Report on Abusive Restraint and Seclusion in Schools
National Disability Rights Network, January 2009

Bipartisan Legislation to Prevent Abuse in Schools Clears House Committee
February 4, 2010 12:30 PM

MYTH VS. FACT: Preventing Harmful Restraint and Seclusion in the Schools Act
By Kittredge, Betsy Miller on February 3, 2010 11:05 AM
EdLabor Journal. Committee on Education & Labor
 
H.R. 4247 - Preventing Harmful Restraint and Seclusion in Schools Act
U.S. House Committee on Education & Labor
Full Committee Markup 11:00 AM, February 4, 2010 2175 Rayburn H.O.B
Washington, DC

News of the Day: The Story Behind The Bill
By Kruger, Mike on February 4, 2010 10:30 AM |
School Restraint, Seclusion Bill Clears House Committee
By Michelle Diament, Disability Scoop
February 4, 2010

Past Blog Posts
All past blog posts on the topic and introduction of H.R. 4247 & S.2860

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: British GMC rules that unethical practice used and research rules broken in study for 1998 Lancet article linking MMR and autism

**Update 1/28/10 4:20pm PST: Kathleen Seidel at Neurodiversity Weblog has posted on the GMC decision in some detail, including the full text of the decision, and the specific date of the April hearing on professional conduct and possible professional sanctions
U.K. General Medical Council Rules Wakefield & Co. "Dishonest," "Irresponsible"
2010-01-28 15:25
The Neurodiversity Weblog
Kathleen Seidel
**
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A ruling has been issued by the British General Medical Council (GMC) on a 2 1/2 year investigation of Dr. Andrew Wakefield, and Professors John Walker-Smith and Simon Murch on allegations of unethical practice and non-adherence to the terms of ethics committee approval for the research related to a 1998 Lancet article which linked the measles-mumps-rubella vaccine (MMR) to autism and bowel disease. Subsequent to the article's publication, 10 of the 13 original authors of the study retracted their names from the article.

Wakefield was found to have behaved dishonestly and irresponsibly. Walker-Smith and Murch were determined to have shared responsibility for the breaches of ethical conduct of the research, but neither was stated to have acted dishonestly.

The three will return before the panel in April, at which time the GMC will decide whether there was guilt of serious professional misconduct. Should that determination be made, a  result could be loss of license to practice medicine.

This investigation has been one of the longest in the GMC's history.
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For more information:
Summary of the background and specific inquiries made by the GMC

Murch, S.H., Anthony, A., Casson, D.H., Malik, M., Berelowitz, M., Dhillon, A.P., Valentine, A., Davies, S.E., & Walker-Smith, J.A. (2004).Retraction of an interpretation. The Lancet, 363(9411), 750.
This article is stated by The Lancet to be available free of charge with registration.

Media reports
From the Lancet to the GMC: how Dr Andrew Wakefield fell from grace
Sarah Boseley, health editor
guardian.co.uk, Thursday 28 January 2010 15.37 GMT

MMR scare doctor 'acted unethically', panel finds
last updated at 17:35 GMT, Thursday, 28 January 2010
By Nick Triggle
Health reporter, BBC News 

Andrew Wakefield found 'irresponsible' by GMC over MMR vaccine scare
Sarah Boseley, health editor
guardian.co.uk, Thursday 28 January 2010 20.34 GMT

Doctor in disgrace
January 29, 2010
TimesOnline (UK)

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

LEG. NEWS: Kentucky - Bill Introduced to Establish Licensure of Behavior Analysts

The Kentucky Legislature is currently entertaining the bill HB 159 (Greer and co-sponsors)

(Prefiled by the sponsor(s).)
Jan 5, 2010- introduced in House; to House Standing Committee Banking & Insurance Committee.
Jan 11, 2010: Sent to the House Standing Committee on Local Government

"AN ACT relating to behavioral disorders.
     Create new sections of KRS Chapter 319 to define terms relating to the practice of applied behavior analysis and licensure by the Kentucky Board of Examiners of Psychology; authorize the Board of Examiners of Psychology to promulgate administrative regulations relating to licensure of behavior analysts and assistant behavior analysts and to appoint two (2) behavior analysts to advise the board on matters relating to regulation and licensure of behavior analysts; require licensure to practice applied behavior analysis in the state, to establish licensure requirements, and to prohibit the practice of applied behavior analysis in the state without a license;..." [continued]

FULL TEXT of HB 159

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Reference and related posts

Kentucky Legislature

Kentucky Daily Legislative Calender
Calendar phone line (800) 633-9650

**Added 1/20/10**
Opinion & Declaratory ruling
Kentucky Board of Examiners of Psychology,
"Regarding 'Behavioral Analysts'"
by: Robert J. Illback, Psy.D., Chair
cc: Board members
adopted: August 5, 2002
revised: January 5, 2004
Accessed 1/20/2010

Saturday, May 2, 2009
2009 Bills Proposing Licensure of Behavior Analysts

Monday, May 4, 2009
NEWS: Oklahoma Governor signs HB 2027--creates licensure for BACB Certificants

Monday, May 4, 2009
Articles on Licensure from the journal, Behavior Analysis in Practice

Wednesday, May 27, 2009
NEWS: Nevada passes autism bill May 23, 2009

Wednesday, May 27, 2009
ABAI NEWSFLASH: New Practice Resources at ABA International!

Thursday, July 2, 2009
FYI: AZ "HB 2207: Behavior Analysts" Passes in the Legislature

Sunday, December 20, 2009
December 2009 notes on recent activities of the ABAI Practice Board

Monday, January 11, 2010
ABAI NEWSFLASH: ABA International Announces Model Licensing Act for Behavior Analysts

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

LEG. NEWS: January 12 hearing on Maine LD 1198: "An Act To Reform Insurance Coverage To Include Diagnosis for Autism Spectrum Disorders"

**Update 27Jan2010: At present on the "Status in Committee",
work sessions and public hearings scheduled on LD 1198 are listed as follows,

Public Hearing List

• Mar 30, 2009, 0930AM, Room 427 State House
  

Work Session List

•  UPDATE 2/10/10 - A work session is listed on the legislative website as scheduled for
  February 17, 2010 200PM    Room 427 State House
• Apr 3, 2009, 0930AM, Room 427 State House
• Jan 12, 2010, 0130PM, Room 427 State House (past date)
  
• Jan 19, 2010, 0100PM, Room 427 State House (past date)
• Feb 9, 2010, 0100PM, Room 427 State House (past date)

 Will try to post the exact time and date of such meetings when available, and recommend keeping in touch with Autism Votes-Maine. and the legislative webpage on LD 1198**

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**Update 19Jan2010:  This bill was not reported out of committee on January 12, and another work session was held on Jan 19, 2010, 0100PM, Room 427 , State House**

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Autism Votes sent out a notice today that the Maine legislature's Joint Insurance and Financial Services Committee will be holding a work group on Tuesday, January 12, 2010 to determine the future of LD 1198: "An Act To Reform Insurance Coverage To Include Diagnosis for Autism Spectrum Disorders".

Autism Votes has also issued an action request to those in Maine who have interest in the legislation.

For further reading/related blog posts
Autism Votes Maine page

Status and text of LD 1198 (Maine Legislature site)

Autism Society of Maine on LD 1198

Easter Seals State Profile: MAINE

Thursday, June 11, 2009
NEWS Maine: Board Certified Behavior Analysts Qualify for Reimbursement under MaineCare
Practitioner Issues in Behavior Analysis SIG blog

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

LEG. NEWS: HB 569-FN New Hampshire Autism Insurance Bill passes NH House

**Update 1/25/10 - according to status report at the legislative website, HB 569-FN has not yet had first reading in the New Hampshire Senate or assigned to a committee**

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On January 6, 2010, HB 569-FN - As amended, aka "Connor's Law": clarifying insurance coverage for diagnosis and treatment of pervasive developmental disorder or autism. passed in the New Hampshire House by a vote of 213-147.

The bill now proceeds to the Senate of the New Hampshire General Court.
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For further reading/past blog posts

Connor's Law website

Autism Votes New Hampshire page

LEG. NEWS: New Hampshire autism insurance bill on the calendar for 2010
Friday, December 18, 2009
Practitioner Issues in Behavior Analysis SIG blog

Bill Docket HB 569

The New Hampshire General Court

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: Pediatrics publishes two significant reports on evaluation, diagnosis and treatment of gastrointestinal disorders in individuals diagnosed with ASD

On January 4, 2010 Pediatrics, the official journal of the American Academy of Pediatrics, published online two articles related to the evaluation, diagnosis and treatment of gastrointestinal disorders in individuals with autism spectrum disorders.

Both articles are currently available in free full-text at the Pediatrics website,and professionals working with the ASD population may find them of value for their own education and in their roles in serving individuals with ASD.

The first is a consensus report based on the review of current available evidence by an expert panel (composition of the panel, evaluative process and resulting twenty-three statements described in the full report). Because evidence-based recommendation was not achievable at this time, this consensus report was produced, with a footnote included that,

"The guidance in this article is not intended to advocate for an exclusive course of treatment or to represent a standard of medical care. Individual circumstances will determine variations that may be appropriate."

Buie T, et al "Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report" Pediatrics 2010; 125: S1-S18.
DOI: 10.1542/peds.2009-1878C
http://pediatrics.aappublications.org/cgi/reprint/125/Supplement_1/S1

ABSTRACT:

Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.Pediatrics 2010;125:S1–S18

The second,
Buie T, et al "Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs" Pediatrics 2010; 125: S19-S29.
DOI: 10.1542/peds.2009-1878D
http://pediatrics.aappublications.org/cgi/reprint/125/Supplement_1/S19

includes differential diagnostic and treatment guidelines which make reference to the consensus report.

ABSTRACT:

Children with autism spectrum disorders (ASDs) can benefit from adaptation of general pediatric guidelines for the diagnostic evaluation of abdominal pain, chronic constipation, and gastroesophageal reflux disease. These guidelines help health care providers determine when gastrointestinal symptoms are self-limited and when evaluation beyond a thorough medical history and physical examination should be considered. Children with ASDs who have gastrointestinal disorders may present with behavioral manifestations. Diagnostic and treatment recommendations for the general pediatric population are useful to consider until the development of evidence-based guidelines specifically for patients with ASDs. Pediatrics 2010;125:S19–S29

As a sidebar to the newsstories on the Pediatrics articles, it was noted in one news report that there is a current well-designed and controlled study at the University of Rochester that is anticipated to provide useful information on the effects of the gluten-free/casein-free diet on children with ASD, and that Autism Speaks will be issuing its own recommendations on treatment, including diet, within the year via its Autism Treatment Network.

For further reading/references:

Pediatrics Gastrointestinal Consensus Statement & Recommendations Provide First Step Toward Needed Guidelines for Children with Autism
Autism Speaks

No Proof Yet That Special Diets Ease Autism
Experts say that, for now, parents should work with their child's doctors
By E.J. Mundell
HealthDay Reporter, BusinessWeek

NIMH study NCT00090428, Diet and Behavior in Young Children With Autism.

Autism Speaks Autism Treatment Network

Pediatrics - Official Journal of the American Academy of Pediatrics

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: U.S. Senate passes HR3590: Patient Protection and Affordable Care Act

HR 3590: Patient Protection and Affordable Care Act passed in the U.S. Senate early December 24, 2009 with a 60-39 vote split along party lines.





The bill will now go to a House-Senate conference committee to reconcile HR 3590 and the House-passed bill, HR 3962: Affordable Health Care for America Act, the bill passed in the U.S. House on November 7, 2009. It is anticipated that informal discussions will commence during the holidays prior to the reconvening of the House on January 12, and the Senate on January 19, with an eye to reaching a compromise that can pass both houses of the U.S. Congress and be favorable to President Barack Obama's signature prior to the annual State of the Union address.

For further reading and past blogposts:

Senate approves health care reform bill
CNN
By Alan Silverleib, CNN
December 24, 2009 1:01 p.m. EST

Senate Says Yes To Landmark Health Bill
National Public Radio
by Scott Hensley
December 24, 2009

Next Step: Getting A Health Bill To Obama's Desk
National Public Radio
by Kevin Whitelaw
December 24, 2009

Newsmaker: Obama on Health Reform Politics, Copenhagen Climate Outcome
NEWSMAKER INTERVIEW    AIR DATE: Dec. 23, 2009
PBS Newshour
also mp3 and transcript

Monday, December 21, 2009
Practitioner Issues in Behavior Analysis SIG Blog
NEWS: U.S. Senate health care bill HR 3590 passes crucial hurdle; passage in Senate expected by December 25

Tuesday, December 15, 2009
Practitioner Issues in Behavior Analysis SIG Blog
NEWS: CLASS Act stays in health care reform, and estimate of the Congressional health care reform legislative calendar

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: U.S. Senate health care bill HR 3590 passes crucial hurdle; passage in Senate expected by December 25

The Los Angeles Times reports  that a cloture motion was passed in the U.S. Senate Monday morning at 1 AM EST, allowing HR3590: Patient Protection and Affordable Care Act  to proceed towards expected approval in that chamber this week. The Senate is in recess until 12:00 PM EST Monday/today.

It is also reported that, dependent on HR 3590 passing in the Senate, a conference committee will convene early in 2010 to reconcile the differences between the House [HR 3962]  and Senate [HR 3590]  versions of health care reform legislation.

Politico blog reports that votes on HR 3950 are scheduled for 1 a.m. Monday 12/21 (time past) The second is to be 1 p.m. Wednesday 12/23, and the final one will be at 7 p.m. Thursday 12/24/09, although given the moment by moment developments in health care reform deliberation, these may be subject to change.

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For further reading & Past Blog Posts
Health Bill May Pass Senate By Christmas
NPR Morning Edition
Audio Will be available at 9:00am ET

Senate Democrats get 60 votes to move healthcare bill along
By Janet Hook and Noam N. Levey
December 21, 2009
Los Angeles Times

GOP leader vows to stay to February
By MIKE ALLEN | 12/21/09 3:52 AM EST
Politico

Senate votes to give green light to health care bill
December 21, 2009 4:18 a.m. EST
CNN

Tuesday, December 15, 2009
NEWS: CLASS Act stays in health care reform, and estimate of the Congressional health care reform legislative calendar

Tuesday, December 1, 2009
ACTION OPPORTUNITY: Online petition requests behavior analysis be included in health care reform

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body.
For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: From the December Organization for Autism Research (OAR) Newsletter

About OAR,

"The Organization for Autism Research (OAR) was created in December 2001–the product of the shared vision and unique life experiences of OAR’s seven founders. Led by these parents and grandparents of children and adults on the autism spectrum, OAR set out to use applied science to answer questions that parents, families, individuals with autism, teachers and caregivers confront daily. No other autism organization has this singular focus."

"OAR’s Scientific Council is comprised of 14 leading autism and medical professionals [including Behavior Analysts] serving as an expert information resource for all OAR matters concerning issues of research.  In that regard, the Council assists OAR’s Board of Directors in developing its research strategy, near term priorities, and long-range research objectives.  The Council also provides program guidance and oversight for OAR´s research competition and plays a central role in ensuring the highest quality reviews for prospective OAR research proposals."

Some headlines from this month's December 2009 OARacle

More than 1,000 People Meet to Advance the Future of Adults with Autism

"On November 13, 2009, the Advancing Futures for Adults with Autism (AFAA) National Town Hall was held with the support and participation of OAR. For this, the first such meeting of its kind, more than 1,000 family members, professionals, adults on the spectrum, and community members gathered simultaneously, via live webcast, at 15 satellite locations across the country, as well as through an online virtual site...While many priorities were uncovered through the process, several rose to the top:

• In cross-cutting strategies, many felt it was essential to change funding streams so that financial assistance follows the person. In addition, accessibility to necessary supports should be ensured, and the availability of qualified and motivated personnel should be increased.
• Two housing strategies that met with overall approval were to support person-centered service models and expand both public and private funding for residential services.
• Regarding employment of individuals, attendees throughout the country felt the need for support, both during school years in the form of vocational skills training and through adulthood in the form of employment supports.
• When discussing community-life strategies, nearly all agreed that one priority is essential--the need for first responders to be educated about the behaviors that might arise when encountering individuals with autism in emergency/first-response situations.
  

A preliminary report, distributed to attendees that day, summarized the day’s activities, including conclusions drawn and demographic information..."

FULL STORY


OAR President Presents to Autism Speaks’ Scientific Advisory Committee

"...On November 5, OAR President Peter Gerhardt, Ed.D., along with Marsha Mailick Seltzer, Ph.D., met with the Autism Speaks Scientific Advisory Committee (SAC) to discuss the needs of adolescents and adults with autism at the SAC’s annual meeting held on the campus of the University of North Carolina...Dr. Gerhardt spoke about some of the factors that may impact effective transition in practice. Stressing that the poor outcome data are more a function of a significant systems failure than an actual failure of people with autism, Dr. Gerhardt noted that if transition planning is to be effective (at any age), it must incorporate intensive community–based instruction, direct attention to skills subsumed under the heading of adaptive behavior, and result in a significant degree of inclusion in the community where the person with autism lives..."

FULL STORY

• The Organization for Autism Research (OAR)
• To subscribe to the OARacle E-Newsletter

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Website: Practitioner Issues in Behavior Analysis SIG

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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: CNN reports on ABA-autism best-outcome story

CNN's Kiran Chetry reported on the American Morning program earlier this week of an autism treatment success story due to an early intensive applied behavior analysis, aka "ABA" or "EIBI", therapy program...and a video accompanying the story tells a million words.

Jake Exkorn was diagnosed with autism at 2, and after two years of an intensive ABA/EIBI program was able to have diagnosis removed. Now at the age of 13, Jake is a typical teen. Significantly, his parents chose applied behavior analysis/ABA because it was the scientifically evidenced treatment, and the treatment recommended to them. to start as soon as possible and as intensively as they could afford, by an expert in the field of autism and autism treatment.

Video 5:46 (there may be a brief commercial intro):

From the story,

“...He hit all of the developmental milestones. He walked, he talked, he played,” says Jake’s mother Karen Exkorn. But at 17 months, Karen says the light began to fade from Jake's face..'I knew that I wanted treatment for Jake that had science behind it. And a lot of treatments don't. But the one that had the most science behind it was a treatment called ABA.'...Day after day, 40 hours a week, they plugged away – hoping to help Jake relearn what autism had taken away.
'Going into this there were no guarantees. Nobody ever mentioned the word recovery to us so that wasn't our goal ever.'...After a year of ABA therapy, Jake showed progress. Then, at age four – a turning point. When Karen took him for ice cream, without prompting, Jake told the man what flavor he wanted: 'Nilla.'
'The man had no idea that this was this defining moment in my life, but this was huge. This was huge. And this marked the beginning of spontaneous language for Jake.'
What soon followed was an even bigger milestone. At Jake's 4 year check-up, Karen was told her son no longer had symptoms of autism. The doctor said Jake had recovered...."
FULL ARTICLE

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Note: Some legitimate points are raised in the reader comments at CNN that not all children may have the outcome in this story; at this time there are no interventions guaranteeing recovery or best outcome (as Jake's mother herself notes in the story), however behavior analytic interventions are currently the most scientifically evidenced and have an established track record as a treatment of choice for children with autism. Other comments were about lack of availability through public programs or insurance reimbursement, and even when available through private pay, of the inability to afford or finance an ABA therapy program of the intensity that Jake's family was able to apply. On an encouraging note, many commenters also shared that they know, have a family member, or have a child themselves who was able to have removal of diagnosis, development of typical skills and function, or significant improvement in ability and quality of life by application of an intensive ABA/EIBI therapy program.

NEWS: Behavioral Training Improves Connectivity and Function in the Brain

 Sat. 12/12/09 - added NPR All Things Considered radio interview of Marcel Just, where he discusses the importance of the intensity of the repeated reading practice applied to the children in the study experimental group, as well as the significance of white matter of the brain in synchronizing signals between different areas of the brain. The quality of the improvement of white matter correlated with the improvement in reading ability in the experimental group, and that reading programs of typical intensity did not effect these improvements. The program also touches on other skills and psychiatric disorders, including autism, that are influenced by the quality of white matter found in the brain.



A newly published study in Neuron shows that neuronal myelination and connectivity, as detected by diffusion tensor imaging (DTI). is enhanced by intensive behavioral training.





Children with poor reading skills who underwent an intensive, six-month/100 hour training program to improve their reading ability showed increased connectivity in a particular brain region, in addition to making significant gains in reading, according to a study funded in part by the National Institute of Mental Health (NIMH). The study was published in the Dec. 10, 2009, issue of Neuron.

 

Source: Timothy Keller, Ph.D.; Marcel Just, Ph.D.

While the relationship between training, performance and brain function has been well known, the significance is that the diffusion tensor imaging (DTI) neuroimaging was able to show specific changes within the brain of improvements towards typical structures and suggest what those improvements consist of,

"We have known that behavioral training can enhance brain function." said NIMH Director Thomas R. Insel, M.D. "The exciting breakthrough here is detecting changes in brain connectivity with behavioral treatment. This finding with reading deficits suggests an exciting new approach to be tested in the treatment of mental disorders, which increasingly appear to be due to problems in specific brain circuits.

One of the study authors, Carnegie-Mellon researcher Marcel Just, reiterated Director Insel's point,

"Our findings support not only the positive effects of remediation and rehabilitation for reading disabilities, but may also lead to improved treatments for a range of developmental conditions related to brain connectivity, such as autism," noted  Just."

The article is, Keller, T.A.& Just, M.A. Altering cortical connectivity: Remediation-induced changes in the white matter of poor readers. Neuron, 64(5), 624-631.
doi:10.1016/j.neuron.2009.10.018

Summary/Abstract

Neuroimaging studies using diffusion tensor imaging (DTI) have revealed regions of cerebral white matter with decreased microstructural organization (lower fractional anisotropy or FA) among poor readers. We examined whether 100 hr of intensive remedial instruction affected the white matter of 8- to 10-year-old poor readers. Prior to instruction, poor readers had significantly lower FA than good readers in a region of the left anterior centrum semiovale. The instruction resulted in a change in white matter (significantly increased FA), and in the very same region. The FA increase was correlated with a decrease in radial diffusivity (but not with a change in axial diffusivity), suggesting that myelination had increased. Furthermore, the FA increase was correlated with improvement in phonological decoding ability, clarifying the cognitive locus of the effect. The results demonstrate the capability of a behavioral intervention to bring about a positive change in cortico-cortical white matter tracts.

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References:
Image source: Timothy Keller, Ph.D.; Marcel Just, Ph.D.

National Institute of Mental Health (NIMH)
Press Release
December 09, 2009
Behavioral Training Improves Connectivity and Function in the Brain

Keller, T.A.& Just, M.A. Altering cortical connectivity: Remediation-induced changes in the white matter of poor readers. Neuron, 64(5), 624-631.
doi:10.1016/j.neuron.2009.10.018

Excellent media article on the study with background info on brain white matter research and its significance in other skills, IQ, and psychiatric disorders, as well as recent research demonstrating levels of brain plasticity thought improbable in the relatively recent past.
Learning, adaptation can change brain connections, CMU researchers say
Thursday, December 10, 2009
By Mark Roth, Pittsburgh Post-Gazette

March/April 2006
MIT Technology Review
Diffusion Tensor Imaging

Diffusion Tensor Imaging (.pdf)
www.usa.siemens.com/medical
MRI Hot Topics
Keith Heberlein, PhD, John Grinstead, PhD, Heiko Meyer PhD,
Christopher Boyea, MBA, RT(R)(MR), Milind Dhamankar, MD,
Siemens Medical Solutions, USA

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: Easter Seals North Texas merges with DFW Center for Autism

This merger has been announced in the press today,

Fort Worth (TX) Business Press
Easter Seals North Texas merges with autism center
BY BETTY DILLARD
December 09, 2009

Some of the article highlighted below; see the full article for full text or the announcement at Easter Seals North Texas,

"The DFW Center for Autism  in Grapevine has merged with Easter Seals North Texas and adopted a new name, Easter Seals North Texas Center for Autism...there will be no disruption in treatment or care...

The Grapevine center was founded in 2003 and serves families and children with its Texas Star Academy full-inclusion preschool and through research, training and behavior programs. Easter Seals North Texas, a leading provider of services for people with autism, serves families in 34 North Texas counties overcoming challenges caused by disabilities.

'The center’s programs will remain fully intact and function just as we have in the past providing high-quality treatment and inclusive, intensive intervention using Applied Behavior Analysis,' ...
The center said it will continue to offer and expand its research and collaboration with the Department of Behavior Analysis at the University of North Texas , support and training for public and private educational treatment entities and outreach services designed to support and educate families and children."

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: December 9 Introduction of Federal Bill on School Restraint and Seclusion

 [Edited 12/8/09, 11PM - to add additional useful references - see below**]


On Wednesday December 9, 2010, U.S. House Representatives George Miller D- 7th district, CA,  and Cathy McMorris Rodgers, R-5th district,WA are expected to introduce bipartisan legislation in the U.S. House to address a serious national problem of abusive restraint and seclusion within U.S. schools. A press conference is scheduled for 11:00am EST on December 9 which will be webcast from the website of the House Committee on Education and Labor. Senator Chris Dodd, D-CT is anticipated to shortly introduce similar legislation in the U.S. Senate.

The impetus for the bill's creation was a GAO report issued on May 19, 2009 and testimony before the House Committee on Education and Labor which documented cases of inappropriately applied restraint and seclusion resulting in trauma, injury and in some cases, death. The report and testimony illuminated a disturbing situation and evoked strong reactions by the legislators and administration representatives.


The Obama Administrations Education Agenda: Sec. Duncan on Seclusion & Restraint
Education Secretary Arne Duncan responds to the May 19 hearings

Some practices went beyond misapplication to the point of abuse; where procedures meant to be applied in strictly defined situations or as emergency procedures were used routinely and for the purposes of punishment. Issues raised during the May 19 hearings were lack of accountability, training of those applying these procedures, and that there are available underused alternatives such as Positive Behavioral Interventions and Supports.


Examining the Abusive and Deadly Use of Seclusion and Restraint in Schools: Rep. Andrews - Q&A
Comments of Representative Rob Andrews, District 1, NJ May 19, 2009 during the House Committee on Education and Labor hearing

Currently there are no Federal policies for these practices in schools - in contrast to hospitals, group homes and residential treatment facilities. States' policies are inconsistent, with only 7 states at the time of the hearing requiring training in use of restraint, and 19 states having no defined standards in the use of restraint and seclusion.


Dodd Discusses New Report on Use of Seclusion and Restraint in Schools
Senator Chris Dodd comments on report, "School is Not Supposed to Hurt: Investigative Report on Abusive
Restraint and Seclusion in Schools". National Disability Rights Network, January 2009
Jan 14, 2009

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References and past blog posts:

Congress To Address Abusive Restraint And Seclusion In Schools
By Michelle Diament
Disability Scoop
December 7, 2009, updated December 8, 2009

Announcement: FEDERAL LEGISLATION TO BE INTRODUCED!!!!!!!!!
The Coalition for Positive Behavioral Interventions and Supports
December 7, 2009
[Note: A press release is posted at this site]

**Position Statement of the Association of Professional Behavior Analysts (APBA)
The Use of Restraint and Seclusion as Interventions for Dangerous and Destructive Behaviors
Adopted November 7, 2009

NEWSFLASH: GAO Report and House Committee hearing on Seclusion and Restraint in Public and Private Schools
Practitioner Issues in Behavior Analysis SIG blog
May 19, 2009
[links to the GAO report, report on the testimony, and other media stories and reports on improper use of restraint and seclusion in schools]

**Use of Restraint and Seclusion in Schools Decried
Bazelon Center for Mental Health Law Reporter
5/27/09

**Report Points Way to School Success for Children with Mental Health Needs
Documents Integration of School-Wide Positive Behavior Support with Mental Health
Bazelon Center for Mental health Law
"...June 7, 2006— “Way to Go—praise for a child and a roadmap for policymakers”..."

**Restraint Rules for Children's Psychiatric Residential Treatment Centers
Bazelon Center for Mental health Law

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Website: Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG and SIG members and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, http://www.abainternational.org

NEWS: Pediatrics Article Reports Positive Results of Intervention Model for Toddlers with ASD

A story being reported on by  CNN, and  Time, as well as other media outlets in reference to a newly published (November 30) Pediatrics article,

Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et. al. (2009). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, Published online November 30, 2009
(doi:10.1542/ peds.2009- 0958)
Link to the abstract; purchase required for full access.

"Objective: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).

Methods: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community.

Results: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.

Conclusions: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism."

The main significances are the very young ages of the enrolled children and the experimental design of randomized controlled trials (RCT); it should be noted that some need for longitudinal followup to see if gains are maintained is discussed in the last paragraph of the full study, and that while 7 of the 24 student treatment group improved to PDD-NOS classification, 2 of the students in the treatment group moved from PDD to an Autistic Disorder diagnosis as well during the course of the study. The overall effect described for the treatment group was of significant benefit compared to the "community based" comparison group and spoke to a potential general benefit of early application of ESDM at the intensity and competency of service delivery as described in the Pediatrics article.

Two quotes from the news reporting,

CNN: "...[Sally] Rogers acknowledges that this study is only the first step. "Every piece of science needs to be replicated before it becomes fact, so we are currently doing a replication study," she said...."

Time: "...Whether the Early Start Denver Model will prove to be more effective than other therapies remains to be seen. Leading autism researcher Tristram Smith, an ABA expert at the University of Rochester, who lauds the new study for its methodological rigor, notes that the gains made by children in the intervention group were similar to those reported in studies of ABA models. "I do think there is a need for head-to-head studies," says Smith. Also needed is high-quality research on how to match individual children with the therapy that suits them best."

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Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or individual SIG member authors and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website,  

NEWS: Behavior Therapy Effectively Complements Medication for Treatment of Behavior Problems in PDDs

For those interested in the use of medications, behavior therapy, the combination of both in treating serious behaviors in pervasive developmental disorders, and use of Randomized Controlled Trials (RCTs) this blog post by Michelle Diament of Disability Scoop will be of interest. It describes that the most effective results for treatment of problem behaviors in the study group of 4-13 year-olds with autism was a combination of parent training in use of behavioral therapy and medication vs. medication alone, with the improvements derived from parent training continued to increase over time. The research article itself will be something you will want to read and is posted below; at the current time the research article is available in free open access from the Journal of the American Academy of Child & Adolescent Psychiatry's December issue.


I found this statement in the Disability Scoop blogpost made by Thomas R. Insel, Director of the National Institute of Mental Health (NIMH), to be of particular interest,

“Medication alone has been shown to help with some symptoms of autism, but its potential is limited...This study shows promise of a more effective treatment protocol that could improve life for children with autism and their families."

ABA International members Eric Butter, Ph.D. and James A. Mulick, Ph.D. are two of the team of researchers who authored the research article.

Behavior Therapy Plus Medication Most Successful For Kids With Autism
By Michelle Diament
November 23, 2009
Disability Scoop 11/23/09

"Children with autism experienced fewer behaviors and needed less medication when their parents used behavior therapy in addition to medication, new research shows."

Aman, M.G., McDougle, C.J.,Scahill, L., Handen ,B., Arnold, L. E., et. al.(2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: Results from a randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry,48(12),1143-1154.
doi: 10.1097/CHI. 0b013e3181bfd669

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Related:
NIMH Press Release
November 20, 2009
Parent Training Complements Medication for Treating Behavioral Problems in Children with Pervasive Developmental Disorders

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Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or individual SIG member authors and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website,

NEWS: Calif.: "Ruling deals a blow to denials of autism treatment"

Ruling deals a blow to denials of autism treatment

Refusing to cover a costly behavioral therapy because the care provider lacks a state license violates California law, a Los Angeles County judge finds.

By Lisa Girion
Los Angeles Times
October 27 2009

"A tactic used by insurance companies to deny expensive behavioral therapy to autistic children has been deemed illegal by a Los Angeles judge..."

The complete article can be viewed at:
http://www.latimes.com/business/la-fi-autism27-2009oct27,0,7328448.story

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Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or individual SIG member authors and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website,

NEWS: Autism Speaks Launches TV Ad Campaign Calling on Congress to End Insurance Discrimination Against Children with Autism

Autism Speaks, the nation's largest autism science and advocacy organization, launches a new national television advertising campaign calling on Congress to put an end to private insurers' blatant discrimination against children with autism.

New York, NY (PRWEB) July 8, 2009 -- Autism Speaks, the nation's largest autism science and advocacy organization, today launched a new national television advertising campaign highlighting private insurers' blatant discrimination against children with autism and calling on Congress to put an end to it as part of the broader health care reform effort. The thirty-second ad, "Neighbors," will air nationally on CNN, CNBC, and MSNBC.

"Neighbors" depicts two young boys who are next door neighbors - one, whose insurance has given him access to autism therapies is shown playing with other kids; the other, who has been deprived of access to therapies, sits alone on his lawn, socially isolated. The TV spot ends with a call to action, urging the American public to call United States Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) to tell them that any national health care reform plan that does not include autism insurance reform is unacceptable.

Short of finding a cure for autism, there is nothing that can have a more significant impact on the lives of people with autism and those who love them than putting an end to insurance discrimination

Fourteen states have already acted to amend insurance laws and require insurers to cover medically-necessary, evidence-based autism therapies. In the other 36 states, insurers explicitly exclude coverage of these behavioral therapies from policies, which places a significant financial burden on families seeking to provide their children with necessary services. Applied behavior analysis therapy (ABA), recognized as an effective, evidence-based treatment for children with autism, costs upward of $50,000 a year - a cost well beyond the means of most American families. A federal law would supersede state laws and require all insurers to cover ABA.

"Short of finding a cure for autism, there is nothing that can have a more significant impact on the lives of people with autism and those who love them than putting an end to insurance discrimination," said Bob Wright, co-founder of Autism Speaks. "During the presidential campaign, President Obama committed to ending autism insurance discrimination, and the pending comprehensive health reform legislation is clearly the way for that promise to be fulfilled. Now is the time to finally right this terrible wrong."

To learn more about Autism Votes, an initiative of Autism Speaks focussed on federal and state legislative advocacy, please visit Autism Votes.

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Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or individual SIG member authors and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed
to their website,