Federal Ruling Ensures that Insurers Must Cover ABA Therapy

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GavelFederal Judge Michael H. Simon in Oregon ruled last week that insurance providers cannot deny coverage of Applied Behavior Analysis (ABA) therapy for children diagnosed on the autism spectrum. The ruling was in response to a lawsuit against Providence Health Plan, an insurance provider that denied coverage of ABA therapy for children diagnosed with autism, while simultaneously granting coverage for children without a diagnosis. ABA therapy, which can cost over $50,000 a year, involves a behavioral interventionist working with a child in the family’s home or in his school to address behavioral deficits for up to forty hours a week.

Oregon State Governor John Kitzhaber also agreed with this ruling and will adjust state health plans to reflect Judge Simon’s decision. The discrepancy between insurance policies and what providers actually cover arises because the medical community views ABA as “a medically necessary treatment of autism,”1 whereas some insurance providers accept it as an educational service that is provided in schools. Since autism is also classified as a “developmental disability,” instead of a mental health disorder, insurers exclude ABA coverage for those with autism, which is also a violation of mental health parity laws.

In some states like California, several warnings have been issued to insurance companies after several denials of ABA coverage had been overturned on appeal. Regional centers now fund ABA therapy by service providers, as well as insurance companies. With President Obama’s signing of Autism CARES last week, the federal ruling will hopefully set a precedent for insurance companies across the country to allow coverage of ABA therapy for families of children diagnosed with autism. ABA therapy is the most influential and widely cited form of therapy for autism, showing the most promise and efficacy in the treatment of autism.

1 https://exm.nr/1oJvnxa

Pick of the Week: Prepositions StoryCards—Learn basic prepositions & sequencing through storytelling!

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Learn and practice using basic prepositions with creative storytelling with story cards and finger-puppets! You can also save 15%* this week on Prepositions StoryCards by using our promo code PREPOS2 at checkout. This set of 48 beautifully illustrated cards is designed to develop children’s understanding of basic prepositions such as in, on, under, above, below, and around.

With only illustrations and no words, Prepositions StoryCards promotes expressive language in storytelling form, and each story is flexible to your student’s standards. An accompanying booklet includes suggested stories for each of the 4 sets of story cards, as well as approaches for building and reinforcing preliminary concepts, developing verbal comprehension, improving attention and listening skills, expanding expressive language and vocabulary, and sequencing.

Four felt finger-puppets depicting the main character in each story are also included as an interactive and playful tool for reinforcing preliminary concepts.

Don’t forget to take 15%* off your set of Prepositions StoryCards when you order it online or by phone with promo code PREPOS2 at checkout!

 

*Offer is valid until 11:59pm EDT on August 26th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Obama Signs Autism CARES to Renew Funding for Support

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Late last Friday, August 8th, President Obama signed the Autism Collaboration, Accountability, Research, Education and Support Act (Autism CARES), a reauthorization of the U.S.’s primary autism legislation, which includes over a billion dollars in federal funding for autism research, services, and support.

Autism CARES is a renewal of what was previously called the Combating Autism Act, which was first enacted in 2006. The renewal calls for $260 million in funding per year through 2019 for autism research, prevalence tracking, screening, professional training, and other initiatives. It will also ensure a new point person in the U.S. Department of Health and Human Services to oversee research and support services and activities related to autism. Amendments will also be made to the Interagency Autism Coordinating Committee, mandating that a new report be conducted on the needs of young adults and youth during transition.

“The Autism CARES Act will allow us to continue to build on these efforts. It will increase understanding of the barriers that youth and young adults with an autism spectrum disorder or other developmental disability face as they transition from school-based services to those available during adulthood by charging federal agencies with assessing the particular needs of this population,” said Taryn Mackenzie Williams, Associate Director of the White House Office of Public Engagement.

To find out more about how the Department of Health and Human Services is supporting autism, visit their website here.

Tip of the Week: How to Implement a Successful Behavioral Intervention

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Creating a successful behavior intervention is more challenging than it first appears. Below, I’ve listed four essential parts for changing maladaptive behaviors and increasing desired behaviors. Most of the time, when a behavior intervention is not working, one or more of these steps has been neglected.

1.  Find a BCBA or ABA provider who can guide you through the process. Getting help from someone with experience in addressing challenging behaviors is an essential first step. They should be a wealth of information about each of the following steps, provide check-ins and troubleshooting during the intervention process, and maintain data on the behavior to insure the intervention is working.

2.  Identify the function of the behavior. There are four reasons that any of us behave: attention, escape/avoidance, access to a tangible (such as chips or a toy train), and automatic reinforcement (meaning physical sensations that are not related to social interactions, including sound, taste, touch, or a response to movement). A BCBA can be especially useful in helping to identify the function of the behavior. They may utilize an ABC chart to determine the function, which means they observe the behavior and note it’s antecedent, what the behavior looks like, and the immediate consequence. If the ABC chart is not helpful, they may perform a more formal Functional Analysis. Before any intervention is put in place, all parties interacting with the child should understand the function (or reason) for the problematic behavior.

3.  Provide a replacement behavior. As a part of the intervention, a replacement behavior should be provided. A BCBA or ABA provider should be able to help you find appropriate replacement behaviors for the problematic behavior. For example, with one student who was chewing his shirt, we introduced a replacement behavior of chewing gum. With another student who was throwing his iPad, we used tape to put an “X” on his desk and taught him to place it on the “X.” The idea is to provide an appropriate behavior that is incompatible with the problematic behavior. But that’s not always possible. For example, one of my former students was banging her head on the table during instruction. We taught her to request a break by touching a picture of a stop sign. Realistically, she was able to bang her head while simultaneously touching the stop sign, but once she learned that she got to escape the activity by touching the stop sign, she stopped banging her head in order to escape. It’s important to note that using the stop sign wouldn’t work for all head-banging behavior, but we had identified the function of the behavior and were able to introduce a replacement behavior that served the same function while meeting the skill level and needs of that individual student.

4.  Provide reinforcement for appropriate behavior. A specific plan for providing reinforcement for use of a replacement behavior and any other desired behaviors is essential. The reinforcement for the appropriate replacement behavior should serve the same function as the problematic behavior. This can sometimes be difficult to achieve, but without this aspect of intervention, you may see slow success, or no success at all.

Again, creating a multi-pronged intervention can be a challenge. It’s important to seek out help, and to take a look at research related to the problem behavior you are trying to address. It is possible to create a strong intervention that has a huge impact on your learner, but it must include the aspects listed above to have the highest potential for success.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Pick of the Week: NEW! Caterpillar Token Board – Reinforce and monitor behavioral success

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Reinforce and monitor behavioral success with our brand new Caterpillar Token Board, a versatile chart that’s perfect for focusing on a specific task, behavior, or goal. This week, you can save 15%* on your Caterpillar Token Board by entering or mentioning promo code CATERP1 online or over the phone during check-out.

With a cute, furry friend, kids will be motivated to work and stay on task both at home and in school. Use the Caterpillar Token Board for a short-term goal, such as helping your child sit still at the dinner table, or getting their homework done without complaining, as well as tracking long-term goals. This token board serves as a portable reward system to encourage positive behavior and reduce anxiety. The Caterpillar Token Board comes with 8 reusable reward stars, a magnetic strip on the back for easy display, and a Suggestion Guide. Measures approximately 9 x 5 inches.

Don’t forget to take 15% off* your order of the new Caterpillar Token Board by applying CATERP1 at check-out!

*Offer is valid until 11:59pm EDT on August 19, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Modified Instructions for Parachute Play

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We’re excited to bring you the sixth installment of our series of Modified Instructions, created by Sam Blanco, BCBA. In this installment, we’re introducing Sam’s Modified Instructions for Parachute Play. Our bright and colorful parachutes are perfect for motivating young learners during the summer holidays.

   6ft-Parachute 12ft-Parachute

Continue reading →

Pick of the Week: Teaching Hands Clock—Take the Guess Work Out of Telling Time

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This innovative wall clock takes the guess work out of telling time by highlighting both the correct hour and minute numerals. This week only, take 15% off* the Teaching Hands Clock by entering in promo code THCLOCK6 at check-out.

The shaped hands of the clock are sure to attract your students’ attention and help them learn to tell time quickly. Think of the hands as training wheels for an analog clock. The shapes at the end of each hand help train the student’s eye to look at the correct hour and minute.

Remember, you can take 15% off* your own Teaching Hands Clock this week only by using code THCLOCK6 when you check out online or over the phone with us, and help your student learn to tell time with ease with this handy clock!

*Offer is valid until 11:59pm EDT on August 12, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

 

Tip of the Week: Minimize Tantrums with High and Low-Quality Attention

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Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn’t have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

  • When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn’t allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
  • Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents.
  • The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn’t getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

Pick of the Week: Sensible Pencil

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Save 15%* this week on Sensible Pencil, an easy-to-use handwriting program for both parents and professionals to use with their learners. Children learn to print upper- and lowercase letters and numbers, using eleven basic lines. Use our promo code PENCIL3 this week only to redeem your savings on the Sensible Pencil handwriting workbook.

Designed to help new writers achieve success quickly, this carefully structured program contains sequential worksheets that move ahead in short easy to achieve steps. The child can start with simple horizontal and vertical lines that are presented as fun, and then moves on to the other basic lines needed for handwriting skills. Sensible Pencil includes 200 worksheets, a progress chart, and a manual. Worksheets can also be copied so children can master the tasks at their own pace.

Don’t forget to apply our promo code PENCIL3 at checkout to save 15%* on your copy of Sensible Pencil this week only!

*Offer is valid until 11:59pm EDT on August 5, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Simplifying the Science: Are You Giving Your Student Enough Freedom?

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One of my favorite research papers was published in the Journal of Applied Behavior Analysis in 1990 by Diane J. Bannerman, Jan B. Sheldon, James A. Sherman, and Alan E. Harchik. The title is Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap. It’s an in-depth look at the level of control practitioners can exert over the individuals they serve, and the implications of that control.

It’s important to consider the ethical implications of requiring the individuals we work with to complete specified exercises at scheduled times, eat a healthy diet for all meals, and limit TV. I have seen situations in which the practitioner is holding the individual with developmental disabilities to a higher standard than they hold themselves! Most of you reading this can probably quickly rattle off the name of the last TV show you “binge-watched” or the delicious ice cream you enjoyed too much of.

So how do we teach making appropriate choices to individuals with developmental disabilities without denying the personal freedoms we all value?

One quote from the paper states, “Not only do people strive for freedom in a broad sense they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking time off from work, or taking a nap before dinner.” In an effort to teach our learners independent skills, we often neglect to teach meaningful decision-making that reflects the types of decisions neurotypical adults make every day. Since the paper was originally published, there has been more work done on promoting decision-making skills for learners with developmental disabilities, but the issues described in the paper are still relevant today.

Here are a few key considerations described:

  • We need to consider client preference when creating daily schedules, goals, and access to preferred activities.
  • A client’s refusal to participate in an activity may not be a failure to teach appropriately but an expression of preference.
  • It is important for practitioners to teach choice-making. The paper states, “Many people require teaching to help them discover their own preferences and learn to make responsible choices.” We should consider this as an essential step towards promoting independence in our clients.
  • Inflexible schedules for clients can sometimes be obstacles to opportunities for choice-making.

The paper goes on to cite multiple research articles and laws for both sides of the argument about the right to choice for those with developmental disabilities. You can read the full text here.  Overall, I consider this article to be essential reading for anyone working with clients with disabilities. It provides a lot of information to support its final conclusion that “all people have the right to eat too many doughnuts and take a nap” and we have the responsibility to teach clients how to exercise such freedoms.

WRITTEN BY SAM BLANCO, msed, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.