Monterey Bay Forum

written by Cameorn S. Jackson, Ph.D., J.D., Licensed Psychologist
DrCameronJackson@gmail.com

There are two strands of therapy for young autistic children — the prickly rigor of Applied Behavioral Analysis (ABA) and the softer therapies such as FloorTime and P.L.A.Y. which focus on relationship building. ABA does a great job of jump starting language when there is none. However, ABA can be abrasive and often the parent is largely left out of the loop with the focus on the therapist-child relationship. As a psychologist I have always favored relationship building and having spontaneous fun with a child. Spontaneous, creative interactions between parent-child are so vital and important.

Now for interventions for young autistic children, researchers have combined the two approaches. Successfully!

The method — known as the Early Start Denver Model — can be used with children as young as 12 months. This is REAL progress in the therapy world for autistic children.

See the article below.

Study Finds Early Intervention For Toddlers With Autism Highly Effective
30 Nov 2009 “A novel early intervention program for very young children with autism – some as young as 18 months – is effective for improving IQ, language ability, and social interaction, a comprehensive new study has found.

“This is the first controlled study of an intensive early intervention that is appropriate for children with autism who are less than 2½ years of age. Given that the American Academy of Pediatrics recommends that all 18- and 24-month-old children be screened for autism, it is crucial that we can offer parents effective therapies for children in this age range,” said Geraldine Dawson, Ph.D., chief science officer of Autism Speaks and the study’s lead author. “By starting as soon as the toddler is diagnosed, we hope to maximize the positive impact of the intervention.”

“The study, published online in the journal Pediatrics, examined an intervention called the Early Start Denver Model, which combines applied behavioral analysis (ABA) teaching methods with developmental ‘relationship-based’ approaches. This approach was novel because it blended the rigor of ABA with play-based routines that focused on building a relationship with the child.

While the youngest children in the study were 18 months old, the intervention is designed to be appropriate for children with autism as young as 12 months of age. Although previous studies have found that early intervention can be helpful for preschool-aged children, interventions for children who are toddlers are just now being tested. Autism is a lifelong neurodevelopmental disorder characterized by repetitive behaviors and impairment in verbal communication and social interaction. It is reported to affect one in 100 children in the United States.

“Infant brains are quite malleable so with this therapy we’re trying to capitalize on the potential of learning that an infant brain has in order to limit autism’s deleterious effects, to help children lead better lives,” said Sally Rogers, a professor of psychiatry and behavioral sciences, a study co-author and a researcher at the UC Davis MIND Institute in Sacramento, Calif. Rogers and Dawson developed the intervention.

“The five-year study took place at the University of Washington (UW) in Seattle and was led by Dawson, then a professor of psychology and director of the university’s Autism Center, in partnership with Rogers. It involved therapy for 48 diverse, 18- to 30-month-old children with autism and no other health problems. Milani Smith, who oversees the UW Autism Center’s clinical programs, provided day-to-day oversight.

The children were separated into two groups, one that received 20 hours a week of the intervention – two two-hour sessions five days a week – from UW specialists. They also received five hours a week of parent-delivered therapy. Children in the second group were referred to community-based programs for therapy. Both groups’ progress was monitored by UW researchers. At the beginning of the study there was no substantial difference in functioning between the two groups.
At the conclusion of the study, the IQs of the children in the intervention group had improved by an average of approximately 18 points, compared to a little more than four points in the comparison group. The intervention group also had a nearly 18-point improvement in receptive language (listening and understanding) compared to approximately 10 points in the comparison group. Seven of the children in the intervention group had enough improvement in overall skills to warrant a change in diagnosis from autism to the milder condition known as ‘pervasive developmental disorder not otherwise specified,’ or PDD-NOS. Only one child in the community-based intervention group had an improved diagnosis.

“We believe that the ESDM group made much more progress because it involved carefully structured teaching and a relationship-based approach to learning with many, many learning opportunities embedded in the play,” Rogers said.

“Parental involvement and use of these strategies at home during routine and daily activities are likely important ingredients of the success of the outcomes and their child’s progress. The study strongly affirms the positive outcomes of early intervention and the need for the earliest possible start,” Dawson said.

In this study, the intervention was provided in a toddler’s natural environment (their home) and delivered by trained therapists and parents who received instruction and training as part of the model.

“Parents and therapists both carried out the intervention toward individualized goals for each child, and worked collaboratively to improve how the children were responding socially, playing with toys, and communicating,” said Milani Smith, associate director of the UW Autism Center and a study co-author. “Parents are taught strategies for capturing their children’s attention and promoting communication. By using these strategies throughout the day, the children were offered many opportunities to learn to interact with others.”

Other study authors include Jeffrey Munson, Jamie Winter, Jessica Greenson, and Jennifer Varley, all of UW Autism Center or the department of psychiatry and behavioral sciences, and Amy Donaldson of the department of speech and hearing science, Portland State University, Portland, Ore.

The study was funded by a grant from the National Institute of Mental Health (NIMH). NIMH has also funded a multi-site trial of the Early Start Denver Model which is currently being conducted at the University of Washington, the UC Davis MIND Institute and the University of Michigan.

Source: Jane E. Rubinstein
Autism Speaks

Michigan Class Action Settlement on Autism Treatment Hailed as Landmark Case
The article below discusses a recent class action case in Michigan wherein insurance co has agreed to pay for ABA treatment for autism. Hopefully, other methods such as P.L.A.Y. and FloorTime – softer approaches than ABA — will also be covered. Contact Easter Seals for P.L.A.Y. in Santa Cruz and Monterey Counties. If you are interested in Floor Time — a way to spontaneously interact with children there are a several therapists available in the Santa Cruz and Monterey area.

In my opinion as a psychologist it is crucial that parents be in the driver’s seat and make decisions they think in the best interest of their child. Too often parents defer to others (this therapist, that therapist) and are slow to voice their concerns. There are many treatments for autism and autistic spectrum disorders. Parents need to decide what is best for THEIR child.

Emial cameronjacks@gmail for more information. Dr. Cameron Jackson, licensed psychologist in CA PSY14762

June 23, 2009
In what plaintiffs lawyers are calling a landmark autism case, a Michigan insurance company has agreed to reimburse at least 100 families for costs involving treatments for their autistic children.

The $1 million class action settlement from Blue Cross Blue Shield of Michigan comes amid a legislative wave in which a growing number of a states are passing laws that require insurance companies to pay for autism treatments and screenings. To date, 13 states have such laws, the most recent being Connecticut, Colorado and Nevada. New Jersey is currently considering an autism bill, and Pennsylvania’s law goes into effect July 1.

The June 17 Michigan settlement, meanwhile, has autism advocates hopeful that insurance companies will stop claiming that behavioral therapy for autistic children is experimental, and start paying for it.

“It is a significant victory for the families, obviously, and it marks a trend, hopefully, that insurance companies will start to look at autism treatment differently,” said Areva Martin, an attorney at Los Angeles-based Martin & Martin who is currently handling about 30 autism cases. She believes the labeling of autism treatments as experimental is “absurd.”

“It’s a neurological condition similar to a patient that has a stroke,” Martin said.

In the case, Johns v. Blue Cross Blue Shield of Michigan, filed in the Eastern District of Michigan, the family of an autistic child sued Blue Cross for allegedly failing to acknowledge that a treatment known as applied behavioral analysis is scientifically valid. ABA therapy attempts to change behavior through positive and negative reinforcements.

In the suit, the plaintiffs alleged that Blue Cross’ pattern and practice of characterizing ABA as “experimental” was arbitrary, capricious, illegal and contradicted by many years of scientific validation.

Blue Cross sought dismissal of the case, but a judge permitted it to go forward.

The case settled shortly after plaintiffs counsel obtained a court order requiring Blue Cross to produce documents that validated the effectiveness of ABA. Among the documents obtained was a draft of a 2005 Blue Cross Blue Shield medical policy, which stated: “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’ documents also stated: “The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions.”

“I think we had ‘em. Their files were so damming,” said Gerard V. Mantese, of Troy, Mich.’s Mantese & Rossman, one of two lawyers who represented the plaintiffs. “We kept hearing from Blue Cross that this is experimental, we’ve researched it. So when we sent our discovery requests saying, ‘Show us what you have,’ their file looked almost like my file. It had paper after paper supporting ABA therapy.”

Under the settlement, Blue Cross will pay for behavioral therapy rendered to more than 100 children in the past six years. Mantese believes this is the first such lawsuit settlement where an insurance company has agreed to pay for autism treatment.

“We’ve searched across the country for similar cases. This is the first one that we’re aware of,” said Mantese, who is getting calls from numerous attorneys handling similar cases. “I’m getting calls from all across the country. They’re encouraged. They’re pleased with the settlement, and they’re motivated to fight for these families and these children.”

Jeffrey Rumley, vice president and general counsel for Blue Cross Blue Shield of Michigan, issued this statement: “We knew we could resolve this matter to the benefit of the families involved, and are pleased to be able to conclude this matter in a manner that puts the families first who received services from the early intervention program,” Rumley stated.

Separate from the lawsuit, Blue Cross Blue Shield of Michigan announced on May 11 that it will offer its customer groups the ability to purchase coverage for autism treatment programs that provide intensive early intervention. The new benefit option involves coverage for children aged two to five years old who use ABA, although the insurance carrier said that it still considers ABA an investigational and experimental treatment.

The coverage will begin on July 1.

“We saw a need in the community and moved to find a way to address it,” said Thomas Simmer, M.D., Blues Cross Blue Shield of Michigan senior vice president and chief medical officer, when announcing the new coverage last month. “We developed this coverage option as part of our commitment to improving the health and wellness of all Michigan children and families.”

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