Response Effort Fading to Increase Compliance

Fresh out of the oven journal article manipulated response effort of children asked to comply with instructions to relinquish toy, concludes with suggestions for parents and teachers:

"

"

DSM 5

This editorial by Ozonoff is incredibly useful to understand what is happening to Autism Spectrum Disorder in the new DSM coming out in May. She succinctly reviews empirical evidence considered for the revision and briefly addresses concerns with the exclusion of Asperger's and the creation of a new category that might house those who present significant "social and communication difficulties who do not exhibit the repetitive behaviors of ASD."

Pervasive Developmental Disorders will not longer exist and some of the once considered PDDs are assumed to fit better in one category called Autism Spectrum Disorder (ASD). Two of them are no longer considered PDD or ASD. Rett is out because:

"(...) its molecular basis is known (the DSM focuses on disorders without a molecular or biological test, that must instead be defined behaviorally." (Ozonoff, 2013)

And Asperger Disorder is out because, in gross terms, it should never have been differentiated.

"To the extent that differences between subtypes have been found, they were quantitative (e.g., differing in degree of impairment, severity of symptoms, or level of cognitive function) rather than qualitative (Prior et al., 1998). "

"Multiple studies demonstrated that most children with an Asperger-like clinical presentation actually met DSM-IV criteria for Autistic Disorder (Gilchrist et al., 2001; Williams et al., 2008)."

"The strongest predictor of diagnosis was what site made it, rather than any characteristic of the child. This is a clear sign that the PDD subtypes were just not working."

Be sure to check the virtual issue and the 12 articles Ozonoff chose to discuss the history of the autism diagnosis. 

For those still worried about potential loss of services, here is what TACA emphasizes (below). We do for sure still have to be concerned with potential large numbers of individuals who may never get a diagnosis and go without appropriate supports. But the discussion is much more complex than just blaming the DSM.

Children receiving special education should not be impacted as Asperger’s, PDD-NOS, and childhood disintegrative disorder are not disability categories in IDEA 2004 and these children were already being served based on their individual needs under one of the other 13 categories in IDEA (such as Autism or Other Health Impairment). School districts should not be requiring a medical diagnosis or a re-diagnosis to determine eligibility or services.

Funding ABA for Autism Treatment

Coming to the US from Canada recently, I was pushed into a deep sea of  funding-related new variables. In Canada there is much to do in terms of funding appropriate (ABA) treatment for autism, but our battles are with the Education Department and other Governmental funding sources. We do not have to deal with insurance companies and that has added significant burden on service providers, although of course it has opened up access to appropriate treatment to families who would not otherwise have been able to fund ABA. The fact is that all behavior analysts have to be aware of what is happening and do their best to become and remain informed. 

In the US, as bills are passed in each State, that mandate coverage of autism treatment by Medicare and private insurance companies, a mad rush to figure out who should and can be funded, for what, when, how, etc started. 

We are lucky to count with the advocacy of Autism Speaks* and the tireless work of Lorri Unumb, who plays a major role in advocating for the inclusion of ABA in those laws, and incredibly competent and well-intentioned behavior analysts, who have been working diligently to make sure behavior analysts are at the forefront of the important decisions about what constitutes appropriate treatment and appropriate ABA.

Without the work of these leading behavior analysts, we would not be able to have a chance to establish appropriate guidelines and eventually standards, and to be the ones to determine what appropriate treatment is and who can be a behavior analyst allowed to practice in autism treatment! They are many, they are at every ABAI and ABAI Chapter conference you attend (make sure you do!), and they are speaking for us. We should all be supporting the Behavior Analyst Certification Board (BACB) and the Association of Professional Behavior Analysts (APBA) for their efforts, and following them for information. The BACB, although stating that they do not plan on putting efforts into coming up with similar efforts, recently made available an excellent guide Health Plan Coverage of Applied Behavior Analysis Treatment

for Autism Spectrum Disorder, which for now should be the bible for parents, professionals, and service providers, and insurance companies of course. 

The Autism Special Interest Group is also about to finalize an update to their Consumer Guidelines.


*AS is hosting the first Autism Investment Conference!

Happy Love Celebration Day

In our field we make every day LOVE day. 

At least I go to work with all my heart every day. And the love that I see from moms, dads, siblings, grandparents, aids, to the kids we help develop, grow, and be happy, keeps my heart filled and my technical skills sharp.

Love is King

Empathy, the Brain, and the Therapy

Researchers at Mount Sinai have stated: 

"Our findings provide strong evidence that empathy is mediated in a specific area of the brain." 

 "The findings have implications for a wide range of neuropsychiatric illnesses, such as autism and some forms of dementia, which are characterized by prominent deficits in higher-level social functioning."

The study involved patients with damage to the area of the insular cortex.

The best part is that, according to Science Daily, we can use behavioral therapy to improve empathy. 

This study suggests that behavioral and cognitive therapies can be developed to compensate for deficits in the anterior insular cortex and its related functions such as empathy in patients. 

Would the therapy be the same for non-empathic patients due to brain damage and to those missing this important social skill without brain damage?