There are strong concerns from families and providers of autism therapy that the Holcomb administration is considering a substantial funding cut for Medicaid reimbursement of ABA therapy. ABA therapy is the most scientifically backed therapy for autism. There are concerns that Indiana regulators may call into question the efficacy of Applied Behavioral Analysis (ABA) therapy to justify potential cuts.
Not only does this upset the families in our coalition who have seen transformational benefits from ABA therapy for their children, but it ignores forty years of scientific evidence.
One collection of seven peer-reviewed scientific studies from 1987 to 2013 and an article summarizing another 27 peer-reviewed studies published after 2010 showed that ABA therapy is effective in improving language, cognitive abilities, IQ scores, adaptive behavior, social skills, and reducing anxiety and aggression in children with autism.
That is a mountain of evidence on its own, but there is a lot more:
- A scientific review published in the Journal of Clinical Child & Adolescent Psychology of all available peer-reviewed studies of ABA therapy from 2008 to 2015 concluded they were “predominately favorable” and that ABA therapy is “well-established” as effective in a wide range of community settings. A 2010 meta-analysis of studies published in Clinical Psychology Review agreed, stating that since the mid-1980s, scientific evidence “has accumulated steadily” to show that ABA therapy “is beneficial to the intellectual, verbal, and social functioning of children with autism and autism spectrum disorders”.
- Several recent controlled studies published in the peer-reviewed journal Behavior Modification bolstered the evidence around how effective ABA therapy for children can be in school-based or community settings. One 2007 study on children with autism in mainstream public kindergarten and elementary school settings found that ABA therapy given to children with autism at a mean age of 5.5 brought larger increases in IQ and adaptive functioning, and fewer aberrant behaviors and social problems by the mean age of 8, compared to children with autism who did not receive ABA therapy. Another published in January 2020 added more evidence that effective ABA therapy for children with autism is sustainable in community settings starting at varying early ages, and provides significantly more improvement on standardized tests of IQ, nonverbal IQ, adaptive behavior, and academic achievement than usual special needs services.
- A 2013 controlled study in the scientific journal Autism supported the conclusions in the Behavior Modification studies, finding that children with autism receiving early and intensive behavioral intervention like ABA therapy exhibited significantly steeper developmental trajectories than children in the control group, in both intelligence and adaptive behaviors.
- A 2009 review and meta-analysis in the Journal of Clinical Child & Adolescent Psychology of 34 peer-reviewed studies concluded that early intensive behavioral intervention like ABA therapy “should be an intervention of choice for children with autism.” This conclusion supported a 2008 review in the Journal of Autism and Developmental Disorders of 10 comprehensive intervention programs for young children with autism that found early and intensive interventions like ABA therapy are effective.
- Extensive recent scientific evidence demonstrates that while ABA therapy provides enormous benefits to children with autism, its results are heightened even more based on the qualifications of the provider. A 2016 study published in Behavior Analysis in Practice found that a highly qualified ABA therapy supervisor leads to much better outcomes for children in terms of mastering learning objectives, with Board Certified Behavior Analyst (BCBA) supervision leading to significantly more learning objectives being mastered by children with autism.
- A 2017 review found that families that can’t afford quality ABA therapy in the home must rely on autism centers. The review of 44 studies of center-based autism therapy on its own and in combination with other settings such as in-home and parent-led, concluded that center-based therapy was the only realistic service option for families who were facing multiple economic or social stresses or are in an underserved area (urban or rural). The peer-reviewed article stated that in any of these situations, to force the home-based service delivery model on vulnerable families may reduce the effectiveness of ABA therapy because it will be too compromised.
More than 20 years ago, the evidence was already clear. An article in the scientific journal Behavior Modification noted that “ABA has emerged with widespread recognition” beyond academics and scientists and was “recognized by the U.S. Surgeon General as the treatment of choice for autism.”
“Thirty years of research demonstrated the efficacy of applied behavioral methods” for children with autism, said Surgeon General David Satcher in his mental health report for children in 1999.
This wealth of scientific evidence clearly supports the fact that ABA therapy is effective and important to give children with autism the chance to enjoy happy, productive lives while minimizing their dependence on expensive state-funded adult services. High quality ABA therapy is a lifeline for children and provides the greatest value for the taxpayer. The most economically challenged families – who are most likely to depend on Medicaid – need access to quality care at autism centers, from qualified providers. The above studies prove this.
Now is not the time to cut Medicaid reimbursement rates for quality ABA therapy in Indiana, and the Holcomb administration needs to closely review and consider the scientific evidence about its proven effectiveness.