Sunday, February 24, 2008

Through the Looking Glass: ABA in Wonderland

A diagnosis of autism in a child can be horrible news for the family. Of course, after the diagnosis the physician or psychologist discusses the services the child will need to overcome autism and hopefully mainstream in the school system. According to the CDC and other government heath care agencies, as well as and most health care professionals now realize that Applied Behavior Analysis (ABA) is the treatment of choice. ABA will teach the child with autism to follow directions, not tantrum or be aggressive, and make it easier for speech, OT, teachers, and other professionals to work with these children. After getting a diagnosis of autism and information on services the real fun begins for parents. Usually, finding someone competent to do ABA with their child and how to pay becomes an issue. (Usually insurance companies say that ABA is experimental and will not pay.) ABA providers range from Psychologists with Ph.D's who are licensed Health Care Providers (HSP) to someone who has been to a few workshops. Board Certified Behavior Analyst (BCBA) hold Master's degrees and have specified graduate courses in ABA, a long supervised internship, and must pass a comprehensive national exam. In my view BCBA's hold the minimum qualifications. Of course there are not enough Psychologist and BCBA's around and the ones that are around are booked up and have long waiting lists. So many parents find themselves looking for ABA because it is the single most effective treatment for autism and wondering why it is not more widely available.

Thursday, February 07, 2008

Clinic Notes: Prognosis for a Child with Autism

Every parent wants to know what the future holds for his or her child. And this is especially true for a child with a disability such as autism. What is the prognosis for a child with autism? Well years ago I remember reading articles asking what happens to children with autism when they become adults? Back then children with autism just seemed to disappear--absorbed into society in one-way or another. The stats were 1 in 2500, later 1 in 500. But now with 1 in 150 children with an autism diagnosis how will the picture look like when these kids are grown?
Last week one parent told me that a speech-language pathologist told her that her child had severe autism and would never amount to anything. This seemed to me a very cruel thing to say to a mother, but setting that aside how accurate was this prediction? I remember reading that 50% of children with autism also had mental retardation and 10% were savant. But I wonder about the accuracy of this statement because I know a lot of children with autism have performance deficits. In other words, they know the correct answer to a question, but choose to not give the correct answer for one reason or another. If 50% of children behave as if they have mental retardation what programs will be available for them after they leave the school system? (Group homes and sheltered workshops now have long waiting lists.) I have not seen this problem addressed by any candidate running for any office. Maybe children with autism will just be absorbed into society when they grow up like they were in the past. But I doubt it.