Monday, November 30, 2009
December 4, 2009
Dear Ms. Falco,
On behalf of the Association for Science in Autism Treatment, I am writing about the article, "Study: Early Autism Intervention is Effective" (November 30, 2009). I am pleased that CNN is spotlighting research that examines the effectiveness of treatment for autism. With so many unexamined treatments available for children with autism, it is extremely important that we continue to promote treatments which are science based; thank you for doing this in your article. We are writing today to provide feedback and hopefully some clarification of a few statements that could lead to misunderstandings which may have unfortunate consequences.
QUOTE: Half of the children were given community-based interventions or therapies.
ASAT: According to the article in Pediatrics, those in the control group were referred to community-based interventions, but whether they accepted them is unclear. Furthermore, the mean hours of "intervention" received by that group was nine hours of individual therapy — nine hours of what they received is unclear.
QUOTE: This is in contrast to traditional Applied Behavioral Analysis, which is delivered at a desk, next to the teacher or therapist who breaks down complex tasks into small components and then gives tangible reinforcements.
ASAT: "Traditional ABA" has become a very ambiguous term, and seems to be inaccurately equated with rigid table-top therapy that creates robotic responses. Even thirty years ago, ABA-based treatments were not exclusively table-top work. Current ABA-based interventions deliver instruction in many settings, not just at a desk. The framing of this comparison of "traditional ABA" vs. Early Start Denver Model (ESDM) is analogous to one in which Chevy might suggest that their 2009 Camaro is much better than the "traditional Ford" and describe the features of a 1978 Ford car. Rather, a more accurate picture would describe the evolution of ABA, thanks to continued scientific research.
The most problematic part of this quote is that ESDM describes itself as a developmental model based in applied behavior analytic principles, while this quote implies that the study is comparing two different things, ESDM vs. ABA. In reality it is comparing a developmental ABA-based approach (ESDM) with an unspecified community service, according to the authors of the article.
QUOTE: Rogers says that parents can pick up the ESDM therapy methods quite easily... "They can learn this within six hours of working with therapists."
ASAT: This too is misleading — in the study, they had graduate level supervisors and baccalaureate therapists with at least two months of training and weekly supervision by a lead therapist. The therapy was delivered for 20 hours weekly (two 2-hour sessions daily for 5 days per week).
In addition to this therapy, the parents were provided semi-monthly trainings and asked to utilize ESDM throughout — and reported another 16 hours of parent-provided therapy. So – either the children were receiving 36 hours of therapy per week – or the parents could not be easily trained, and therefore those hours should not count.
QUOTE: “It’s a very pleasing kind of therapy, kids are happy. It is play, and it can happen everywhere,” Rogers explains. Dawson adds that this type of intervention builds on a fun, positive relationship with the therapist. This is a contrast to traditional Applied Behavioral Analysis (ABA), which is delivered at a desk, with the child sitting next to the teacher or therapist, who breaks down complex tasks into small components and then gives tangible reinforcements.
ASAT: It is a mischaracterization to imply that ABA-based interventions are not positive, fun or relationship oriented. In fact, behavior analysts incorporate child choice, motivating social activities and "fun" into their sessions. One of the primary goals of ABA-based intervention is to find out how the child learns best and then to utilize a range of motivating fun activities (including social interaction) to facilitate learning. Intervention goals are directed toward improving a wide range of social skills, including the development of joint attention and peer relationships.
In conclusion, this is an exciting study, and ASAT is thrilled to see the progress in the examination of interventions for autism; however, we are concerned about misrepresentation in the media, especially since most people do not necessarily have access to the journal, Pediatrics, for first-hand information.
This is especially important with so many parents fighting for funding for treatment. According to the above-mentioned quotes, insurance companies now have a source that says that in six hours, parents can learn an effective treatment. Insurance carriers could utilize this piece to deny requests for needed intensive therapy, either outright, or only allowing for reimbursement up to 15 hours per week. Either response would be a sad outcome from this exciting research.
Joshua K. Pritchard, M.S., BCBA
Board Member, Association for Science in Autism Treatment
Read More at http://www.cnn.com/.../index.html