Wednesday, February 4, 2009

Why Does Autism Intervention Have to be so Expensive?

We understand the negative reactions being voiced over CNN’s reported cost of $20,000 for RES-Q (Autism 911), but there is more to the story. In fact, the cost is $2500 per day and is usually completed in five days (which was the length of time for Marissa's intervention).

RES-Q is actually a very tiny part of the work we do. Out of more than 300 children we see yearly, an average of only 5 will need the intensive in-home intervention. The families who have participated in RES-Q have been able to obtain funding for the intervention through a variety of means. One of the reasons why funding agencies recognize the value of and need for this intervention is that it often means the difference between continuing to live at home vs. requiring residential placement.

We work diligently to keep costs as low as possible, but we are not willing to sacrifice the quality of services. To develop staff with the level of expertise and training that Rick has is costly. Although it might seem as simple as sending a therapist out for a few hours, there is extensive support and time behind the scenes to ensure a successful outcome for treatment. The intervention is a team effort which includes psychologists with more than 30 years of experience working with children, adolescents and adults with ASD.

Those of us who founded Autism Partnership and all of our staff members did not enter this field out of a desire to get rich. If that was the goal, we would have chosen other fields. We take seriously our commitment to helping parents and their children. We provide a variety of services including direct intervention, parent support, and consultations in schools to help teachers and school districts provide effective education. We work collaboratively with funding agencies so that parents get financial support and can afford the intervention that is so vital to their child. We also conduct low fee and free workshops, as well as writing books to help families.

Our goal in participating in the CNN report was for parents to see that there is hope, that children can change. As Marissa’s mom said, she didn’t realize that Marissa could be capable of accomplishing so much. We are thrilled that Autism Partnership was able to help Marissa and her family. It is gratifying that they are able to enjoy life in ways they thought were not possible. Children with Autism have amazing potential. Our job is showing parents and teachers how to help them achieve the high quality of life they deserve.


Friday, January 2, 2009

ABA: Neanderthal or Evolved?

Ron Leaf’s recent experience with a panel of experts discussing autism treatment brought up again the problem of people having a far outdated view of ABA. We have often taken up the cause of myth busting about ABA. It is viewed as rigid, mechanistic, superficial and short-lived in its effects. The fact is that ABA is a tool that can be used in many ways, some good, some bad, some artful and some uninspired. And it is being used much more skillfully in 2009 than it was in the 1970's because we have learned better ways to impact behavior as well as what behaviors make the biggest difference. Imagine someone making judgements about automobiles based on the models from 30 years ago? They guzzled gas, required constant tuning, spewed pollution, did not have seat belts, and, can you imagine, you hand to crank the window open by hand!

We have posted a video clip of ABA therapy that is taken from a documentary about the UCLA Young Autism Project nearly 30 years ago. We have shown this clip to workshop participants and invariably the reaction approaches horror. We do not use this clip to denigrate the work that was done in the early days of autism therapy. In fact we trained the therapist and he implemented the therapy exactly as we intended him to do it. It represented state of the art at the time. Even as crude as the approach may seem today, it still was more effective than anything else that has come along in the last 30 years.

When you watch this clip you will probably be struck with how harsh the therapist was, the use of food reinforcement and how strongly controlling the therapist was. This is how many people think ABA looks today. What people fail to appreciate is the use of prompts and fading, differential reinforcement, controlling random variables to maximize discrimination of the concept, and genuine praise for making good behavioral choices.

The essence of ABA is its structure, and its intensity, designed to maximize learning gains and close the developmental gap in a short period of time, along with its constant reliance on evaluating outcomes and revising interventions to achieve the best results. But this can be done in a fun, motivating and engaging manner, respecting the child’s preferences when possible, and using natural language and natural environments. We have posted a second clip which illustrates how you can be natural and fun, while still maintaining the integrity and discipline of systematic teaching.

If your idea of ABA is what you saw in the first clip, please remember, ABA has evolved over the past 30 years. -JM