Two weeks ago, I got to have my favorite type of conversation with one of my client’s parents. I scheduled them for a parent meeting and got to tell them, “Your son doesn’t need us anymore.” When I get a kid, I know my job is to work myself out of a job and every time I tell a parent it is time to part ways, it is such a bittersweet moment. I sat there, watched the parents cry tears that they said come from a place of happiness, and listened to their statements about how they never imagined this moment two years ago when their son started services with us and was labeled as “non-verbal”. It’s times like these that make me astonished when I come across articles, like the one posted on the Stars and Stripes website entitled “Tricare seeking right mix of therapies for kids with autism,” that claim, “the effectiveness of applied behavioral techniques remain unproven…”
“When I get a kid, I know my job is to work myself out of a job…”
I was forwarded the article by a friend of mine who, like the family mentioned, had a journey with ABA that started with a nonverbal son who now talks (too much if you ask his mom) and is now getting vocational training. Throughout the article, there are statements quoted that assert that ABA does not meet Tricare’s standards for being an “evidenced-based coverage” even going as far as saying that parents “believe” that ABA helps their children as if it some fad treatment that has not been tested and assessed for decades. When I come across these types of statements, all I can do is do what the ABA field has drilled into me: look at the data, look at the research. As a professional in the field, and a human being who has seen ABA make remarkable changes in her own family member diagnosed with autism, I know the research identifying ABA as an effective, evidenced based treatment is robust. The literature dates back more than 50 years. Whether we are talking about the famous Lovaas study in 1987 or the more recent research done within the last decade, the findings indicate that the groups that receive intensive ABA therapy have a significantly higher percentage of participants that are able to achieve average cognitive functioning and participate in a general education classroom setting with minimal supports than control groups that did not receive ABA.
Simmer, the individual interviewed in the Stars and Stripes article, also references a survey given to 28,000 parents via an online support group in 2012. He states that the results of this survey said that only 15% of parents said that ABA worked best for their child (coming in 3rdplace behind occupational therapy and speech therapy). I am not familiar with this survey, but as other factors are not reported (i.e. which of the participants have insurance that cover ABA services, and which have accessed what services) this survey MUST be taken with a grain of salt. The authors of this survey state that the participant data reported was only from about 8,000 individuals and that the results were not part of “rigorous science” and it ”is not meant to be comprehensive research.” In short, if any individual is questioning the effectiveness of any evidence-based treatment, then they should only bring to light any research that has gone through some scientific process and/or peer review to combat its effectiveness.
There is a plus side. Before pulling the plug on ABA coverage altogether, something that the article states is “unlikely”, Tricare seems to be doing its due diligence by conducting a 7 million dollar study to find evidence for how many ABA sessions are effective and “what factors predict which mode of treatment is more effective”. Also, I love the fact that the article touches on the fact that a comprehensive plan is best for children. A comprehensive plan may also include Speech and Occupational therapy services, which definitely have their place in the remediation of certain deficits that a child may have due to their Autism diagnosis or some other comorbid diagnosis. Simmer states that he wants to make sure “all providers are working together as a team.” As a BCBA delivering services to our clients, it is our ethical obligation to ensure that we are making contact and collaborating with all stakeholders involved in the care of our clients.
In summary, when articles like this are put out to be seen by the general public, it is very concerning to me. In a time where the research is increasingly showing that the gains of ABA are best during early intervention years, an article like this can unnecessarily persuade a family not to contact ABA services by referencing studies that haven’t undergone a drop of scientific process and stating opinions which are not backed up by facts. My main point is always this: As the parent of a child with autism, or any disability, you are their biggest advocate. No one wants better for your child than you do. No matter what therapies or treatments are suggested to you, it is always a good idea to do your own research and get information from trusted, reputable sources.