NEWS: California - District Court decision revives Arce v. Kaiser Foundation Health Plan, Inc.

Prefacing note: While this report is being shared as a "news item of interest" as a public event in progress, it seems relevant at this time to state that this report is not taking an editorial position on the legal aspects or allegations of this case nor the specific claimants, nor does this constitute legal interpretation. Please see the court documents for relevant specifics.

On Wednesday, January 27, 2010, a decision authored by Justice Laurie D. Zelon of the Court of Appeals of California, Second District, Division Seven was handed down in California reversing a lower court ruling, and remanding to trial court with directions; this decision allows a previously filed suit to proceed to trial. The suit filed by Arce alleges that an insurer improperly denied applied behavior analysis and speech services as categorical practice and that such denial on the specified basis constitutes violation of California's Mental Health Parity law (AB88: Insurance Code §§10144.5   & Health and Safety Code§1374.72 ). Another aspect of the case in question is the provision of service by providers that are not licensed or state certified. The case in question is ARCE v. KAISER FOUNDATION HEALTH PLAN, INC.

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For more information
2nd Appelate District
updated 1/31/2010 05:05PM
Case information - Arce et al. v. Kaiser Foundation Health Plan, Inc. et al.

Decision transcript
From Leagle, inc.
ARCE v. KAISER FOUNDATION HEALTH PLAN, INC.
ANDREW ARCE, a Minor, etc. et al., Plaintiffs and Appellants, v. KAISER FOUNDATION HEALTH PLAN, INC., et al., Defendants and Respondents.
B215861.
Court of Appeals of California, Second District, Division Seven.
Filed January 27, 2010.


CALIFORNIA LAW
Mental Health Parity aka AB 88,
Insurance Code §§10144.5   & Health and Safety Code§1374.72

Other  articles and reports related to ARCE v. KAISER FOUNDATION HEALTH PLAN, INC. and regulation of ABA coverage
C.A. Revives UCL Action Against Kaiser Over Autism Services
By KENNETH OFGANG, Staff Writer
Metropolitan News-Enterprise
Thursday, January 28, 2010

Appeals court allows Arce vs. Kaiser autism class action to proceed
January 30th, 2010 at 1:48 pm
State Regulators Might Require Health Plans To Cover Autism Therapy
Monday, November 16, 2009
California Healthline

Letter dated 2/24/2009 from Consumer Watchdog to Cindy Ehnes, Director ,California Department of Managed Health Care

Applied Behavior Analysis — the Los Angeles lawsuit
Sam Miller, The Orange County Register
August 15th, 2008, 8:11 am

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ABA chapters in/for California
CalABA
Public Policy and Practice page

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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: 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.

ANNOUNCE: Early Registration for 2010 ABA International Autism Conference Ends Soon!

The Association for Behavior Analysis International (ABAI) has sent out a reminder of the December 18, 2009 early registration deadline for the two-day single-track event,

ABA International 2010 Autism Conference 

Translational Science and Effective Practice
Friday, January 22 – Sunday, January 24, 2010
Location: Hyatt Regency Chicago

To register

Hotel and travel information for the conference

( To obtain the special group rate for accommodations at the time of reservation, attendees must mention that they are with the Association for Behavior Analysis International. Cut off date for the group rate is December 30, 2009, although it is recommended that reservations be made as soon as possible).

BACB & APA CE credit is available for the presentations

An abbreviated description of the Autism Conference is below.

A full schedule for the conference is also available on the web

Friday January 22, 2010
Evening

• Opening Reception, 
• Poster Session 1
• Exhibitors, Bookstore, and 
• Author Signing Fair (8:00 p.m. – 9:00 p.m.)
  

Saturday January 23, 2010

Opening Remarks

• Travis Thompson, Ph.D. (University of Minnesota) and Gregory P. Hanley, Ph.D., BCBA (Western New England College)

Morning session
Chair: Gregory P. Hanley, Ph.D., BCBA (Western New England College)

• Early Behavioral Intervention and Family Psychological Adjustment.
  Bob Remington, Ph.D. (University of Southampton)
  
  
• A Comparison of Methods for Collecting Data on Students' Performance During Discrete Trial Teaching.
  Dorothea C. Lerman, Ph.D., BCBA (University of Houston, Clear Lake)
  
  
• Intensive Early Behavioral Intervention and Brain Development.
  Travis Thompson, Ph.D. (University of Minnesota)
  
  
• Discussion and Audience Q & A
  Craig H. Kennedy, Ph.D., BCBA (Vanderbilt University) 

Afternoon session
Chair: William L. Heward, Ed.D., BCBA (The Ohio State University)

• Augmentative Communication Strategies with Children with Autism and Severe Disability.
  Joe Reichle, Ph.D. (University of Minnesota)
  
  
• A Standardized Approach for Individualizing School-Based Interventions for the Challenging Behaviors of Students with Autism.
  Glen Dunlap, Ph.D. (University of South Florida)
  
  
• Identifying Effective and Preferred Behavior-Change Programs: A Case for the Objective Measurement of Social Validity.
  Gregory P. Hanley, Ph.D., BCBA (Western New England College)
  
  
• Discussion and Audience Q & A
  Dorothea C. Lerman, Ph.D., BCBA (University of Houston, Clear Lake)
  

Evening

• Poster Session 2
  

Sunday January 24, 2010
Morning session
Chair: Travis Thompson, Ph.D. (University of Minnesota)

• The Science and Practice of Discrete-Trial Training: Why Some Teaching Procedures Are More Effective Than Others.
  Kathryn Saunders, Ph.D., (University of Kansas)
  
  
• Assessment and Treatment of Feeding Problems in Autism.
  Cathleen C. Piazza, Ph.D., (Munroe-Meyer Institute)
  
  
• Interaction of Health Conditions and Environmental Factors in Challenging Behavior in Autism.
  Craig H. Kennedy, Ph.D., BCBA (Vanderbilt University)
  
  
• Discussion, Audience Q & A, and Closing Remarks
  Gregory P. Hanley, Ph.D., BCBA (Western New England College) and Travis Thompson, Ph.D. (University of Minnesota)
  

For questions or assistance, please contact  convention@abainternational.org.

Association for Behavior Analysis International
550 West Centre Ave, Suite 1
Portage, MI 49024
Phone: 269-492-9310
Fax: 269-492-9316
http://www.abainternational.org

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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: 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

STATES: Missouri Prefiles Two Autism Insurance Reform Bills

Missouri joins the District of Columbia in filing legislation seeking health insurance reform for the treatment of autism.

This week, two autism insurance reform bills including coverage of applied behavior analysis and Behavior Analysis Certification Board (BACB) certificants were prefiled for consideration in the upcoming Missouri legislative session.


SB 618      Requires health carriers to provide coverage for the diagnosis and treatment of autism spectrum disorders under certain conditions
Current Bill Summary (with link to full text of the Senate bill).
Last action: Prefiled 12/1/09

HB 1311 Provides health insurance coverage for the diagnosis and treatment of autism spectrum disorder
No bill summary is available at this time
Last action: Prefiled 12/1/09

Both bills include applied behavior analysis, recognize the BACB Certification and propose reimbursement to Certificants in a capacity as direct or supervisory provider. Limit of coverage for ABA treatment of autism is $72,000/year.

Both bills have the support of Missouri Governor Jay Nixon, and House Speaker Ron Richard states that he has reversed his position of last year and would support the bill that emerges from the House - in contrast to last year when the Speaker declined to bring a similar Senate passed bill to the Missouri House floor.  An interim committee has been working, prior to the prefiling to build consensus among the interested stakeholders of families, insurance providers and small businesses.


Related
MO Governor, Lawmakers Introduce Legislation Again Mandating Autism Insurance Coverage Marshall Griffin, 
St. Louis Public Radio (2009-12-03)

Gov. Nixon, legislative sponsors announce legislation to require coverage of autism diagnosis, treatment
Missouri Governor Jay Nixon's News Release
December 3, 2009
Pre-filed bill would require coverage of Applied Behavioral Analysis, protect families from slashed coverage because of autism diagnosis

Autism Votes Missouri page (not yet updated 12/4/09)

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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: 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,

NEWS: Blue Cross Blue Shield of Michigan Forced to Pay for Behavioral Therapy for Autism In Landmark Case

Release issued by Mantese and Rossman, P.C., on June 19, 2009

Detroit, Michigan. The family of an autistic child filed a motion in federal court today to confirm settlement of a class action against Blue Cross Blue Shield of Michigan. The family alleged in the suit that the insurer wrongfully refused to cover behavioral therapy for children with autism spectrum disorder (ASD), on the baseless ground that the care was"experimental. "

Under the terms of the settlement reached at a court-ordered conference on Wednesday, June 17, 2009, Blue Cross [of Michigan] has agreed to reimburse all families who paid for behavioral therapy for their children after May 1, 2003, and who were covered under a Blue Cross Blue Shield of Michigan insurance policy. Blue Cross had earlier filed a motion seeking dismissal of virtually the entire case on legal grounds, but the Honorable Stephen J. Murphy III permitted the case to go forward and scheduled the matter for further proceedings, including a settlement conference before Magistrate Michael Hluchaniuk.

The settlement was reached in the case of Christopher Johns v. Blue Cross Blue Shield of Michigan, 08-cv-12272, filed in Detroit. In the suit, the plaintiff alleged that Blue Cross' pattern and practice of characterizing the scientifically established Applied Behavioral Therapy as "experimental, " and thus as excluded under its insurance policies, was arbitrary, capricious, illegal and contradicted by many years of scientific validation.

Under the settlement, Blue Cross [of Michigan] will pay for behavioral therapy rendered to over 100 children in the last six years. Plaintiff's counsel, Gerard Mantese and John J. Conway, were pleased with the settlement.

Mr. Mantese and Mr. Conway issued a joint statement emphasizing:

"No insurer should ever take this approach to needed care for children. Applied Behavioral Analysis therapy is supported by science and is not 'experimental. ' Delays by insurers in authorizing this treatment, when it is covered by insurance policies, should not be tolerated. Research shows that children with autism spectrum disorder need this therapy early on in life and delaying treatment can irreversibly prevent them from achieving their full potential."

Mr. Mantese emphasized that the settlement includes even families who never submitted a claim to Blue Cross, but who obtained this care for their children and were covered by a Blue Cross policy. Mr. Conway believes that this is the first such settlement addressing Applied Behavioral Analysis (ABA) in the country.

ABA therapy is administered under the supervision of licensed psychologists and other professionals. ABA applies one hundred year old concepts of changing behavior through positive and negative reinforcements. The federal suit in which this settlement was achieved centered upon the ABA treatment provided by prestigious Beaumont Hospital and its HOPE Center, including Dr. Ruth Anan and Dr. Lori Warner.

The case settled shortly after Plaintiff's counsel obtained a court order requiring Blue Cross to produce file documents which validated the effectiveness of ABA therapy for treating children with autism spectrum disorder.

Among the documents in the Blue Cross files obtained by Plaintiff's counsel was a draft of a Blue Cross Blue Shield Medical Policy for 2005, which acknowledged the following:

Applied behavioral analysis (ABA) is currently the most thoroughly researched treatment modality for early intervention approaches to autism spectrum disorders and is the standard of care recommended by the American Academy of Pediatrics, National Academy of Sciences Committee and the Association for Science in Autism Treatment, among others.

Blue Cross' own documents further acknowledged that:

The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions.

Mr. Mantese stated,

"After we compelled Blue Cross through motion practice to produce all materials supporting its position that this care was allegedly experimental, we received numerous file documents which actually established that ABA therapy works and is highly effective in increasing the functioning of these children."

Mr. Conway emphasized, "We are pleased that we were able to obtain a result which will require Blue Cross to pay for this important care and will alleviate some of the financial strain imposed on over a hundred families by having to pay for this care when it was covered under their insurance policies."

Contact information for the families' attorneys follows:
Gerard Mantese, Esq.
Mantese and Rossman, P.C.
1361 E. Big Beaver Road
Troy, Michigan 48083
248-457-9200 Office
248-515-6419 Cell

John J. Conway, Esq.
John J. Conway, P.C.
645 Griswold St, Ste 3600
Detroit, MI 48226
313-961-6525 Office
313-574-2148 Cell

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Previous newsstories on the case:

Blue Cross Reverses Position on Autism After Federal Court Litigation Intensifies
Monday 11th of May 2009 13:19

Blue Cross ordered to defend stance on autism therapy coverage
Detroit News | March 9, 2009

Judge Considers Suit Against Blue Cross Over Autism Treatment
By Shaun Heasley
DisabilityScoop, February 26, 2009

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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,

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Practitioner Issues in Behavior Analysis SIG
-----------
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,