Push on for insurers to share autism costs - The Boston Globe
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Monday, October 20, 2008
Sunday, October 19, 2008
Hippotherapy (Horse Therapy) for Autism
Horseback program focuses on autistic riders CHAMBERSBURG, PA.
Holly Bortfeld has watched her autistic son benefit greatly from therapeutic horseback riding over the last decade, but waited several years for a slot to open at the riding center for her 15-year-old daughter, who has Asperger’s syndrome.
While Greta does not communicate verbally much, her mother said the girl’s actions offer the best feedback about the new program at the Franklin County 4-H Therapeutic Riding Center.
“Every Friday, she’s dressed and ready to go,” Holly Bortfeld said.
Summit Endowment established the therapeutic riding center’s new program dedicated to autistic riders. Using contributions from Summit Health, which owns Chambersburg and Waynesboro, Pa., hospitals, the Summit Endowment distributed more than $400,000 in grants to nonprofit organizations this year.
“They’re going to be looking at how the program improves the lives of children with autism,” said Ann Spottswood, Summit Endowment manager.
Shaping and Chaining
Shaping and Chaining
Shaping and Chaining is a method of discrete trial training where the teacher does not wait for the child to actually complete the whole desired behavior. If the child partially completes the behavior or makes a move or effort towards the desired behavior, the child is rewarded. Chaining is putting the small subparts together to obtain the desired behavior. Shaping and chaining is often used with severely autistic children.
While DTT is based upon principles of learning theory and has been demonstrated to be an effective intervention methodology, it represents only one of dozens of teaching strategies within the field of ABA. ABA methods of teaching can be used with PECS (Picture Exchange Communication System), photo activity schedules, naturalistic learning, pivotal response, chaining and shaping, graduated guidance, and functional communication training.
Excerpted from Dave Sherman's book, Autism: Asserting Your Child's Rights to a Special Education
Shaping and Chaining is a method of discrete trial training where the teacher does not wait for the child to actually complete the whole desired behavior. If the child partially completes the behavior or makes a move or effort towards the desired behavior, the child is rewarded. Chaining is putting the small subparts together to obtain the desired behavior. Shaping and chaining is often used with severely autistic children.
While DTT is based upon principles of learning theory and has been demonstrated to be an effective intervention methodology, it represents only one of dozens of teaching strategies within the field of ABA. ABA methods of teaching can be used with PECS (Picture Exchange Communication System), photo activity schedules, naturalistic learning, pivotal response, chaining and shaping, graduated guidance, and functional communication training.
Excerpted from Dave Sherman's book, Autism: Asserting Your Child's Rights to a Special Education
Parents push for state laws on autism treatment coverage
Parents press states for autism insurance laws
By CARLA K. JOHNSON – 2 hours ago
CHICAGO (AP) — In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana's lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren't working directly with Autism Speaks.
"This is the hottest trend in mandates we've seen in a long time," said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. "It is hard to fight them."
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they've tried. In two states, bills got nicknames like "Steven's Law" and "Ryan's Law," so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said "bubba" for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to "buy" privileges like going for a car ride.
Shayan's improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
"I pulled over to the side of the road," she said. "I had to call the police to drive behind me so I could drive safely home."
The Foroughs have health insurance, but it doesn't cover Shayan's therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state's insurance commissioner to issue a bulletin spelling out what was expected of insurers.
"It's no longer acceptable that blatant discrimination against people with autism occur," Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
[FULL STORY]
By CARLA K. JOHNSON – 2 hours ago
CHICAGO (AP) — In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana's lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren't working directly with Autism Speaks.
"This is the hottest trend in mandates we've seen in a long time," said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. "It is hard to fight them."
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they've tried. In two states, bills got nicknames like "Steven's Law" and "Ryan's Law," so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said "bubba" for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to "buy" privileges like going for a car ride.
Shayan's improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
"I pulled over to the side of the road," she said. "I had to call the police to drive behind me so I could drive safely home."
The Foroughs have health insurance, but it doesn't cover Shayan's therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state's insurance commissioner to issue a bulletin spelling out what was expected of insurers.
"It's no longer acceptable that blatant discrimination against people with autism occur," Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
[FULL STORY]
Saturday, October 18, 2008
Autism Animal Assisted Therapy: Therapy Dog Video
In study after study, animal-assisted therapy has proven to be a valid tool in helping children with autism and other developmental disabilities build a new sense of self-confidence. Animal-assisted therapy has been shown to counteract isolation and facilitate socialization. In this 20-minute video, split up in 5 parts, one little boy builds a relationship with a therapy dog and learns about purpose and compassion.
Animal Assisted Therapy: Video 1 of 5
Animal Assisted Therapy: Video 2 of 5
Animal Assisted Therapy: Video 3 of 5
Animal Assisted Therapy: Video 4 of 5
Animal Assisted Therapy: Video 5 of 5
Animal Assisted Therapy: Video 1 of 5
Animal Assisted Therapy: Video 2 of 5
Animal Assisted Therapy: Video 3 of 5
Animal Assisted Therapy: Video 4 of 5
Animal Assisted Therapy: Video 5 of 5
Friday, October 17, 2008
HBOT Miracle, Junk Science, Both?
From CBS 4 in Denver. Report on the benefits of HBOT for autistic children.
Miracle or Junk Science? http://www.sciencebasedmedicine.org/?p=249
Miracle or Junk Science? http://www.sciencebasedmedicine.org/?p=249
All signs point to a guy named Dan Rossignol. Dr. Rossignol is apparently into every form of autism crankery, including mercury poisoning, mitochondrial dysfunction, and oxidative stress (although I can’t imagine that increased PaO2 is an effective treatment for “oxidative stress”). After spending a few minutes looking through his web-based material, I’m starting to think that this guy can give the Geier’s a run for their money.
True to form, Rossignol is a “pioneer” and a “maverick”. He goes where legitimate clinicians haven’t dared. Based on an implausible hypothesis, he (apparently) subjects autistic children to potentially dangerous hyperbaric oxygen therapy. He has published his ideas in the crank-magnet “Medical Hypotheses”, and in BMC Pediatrics, a journal devoted to rapid, “flexible” publication.
Even if his data were to support his nonsensical hypothesis (again, increased O2 to treat oxidative stress??), should we believe it?
Well, someone does, and that someone apparently sells hyperbaric therapy, and not just for autism. They also treat Lyme disease, multiple sclerosis, and cerebral palsy—and anything else you can spell. The site does, however, have a very small Quack Miranda Warning on the left sidebar.
Discrete Trial Training (DTT)
Discrete Trial Training (DTT)
Discrete Trial Training is a form of ABA. It is a short, instructional training that breaks down an activity into three distinct components: (1) an instruction by the teacher or therapist (2) a response or behavior of the child and a (3) a consequence. (The consequence is what happens to the child following a behavior.)
Many discrete trial programs rely heavily on directions or commands as the signal to begin the discrete trial. In the beginning, an edible treat, affection, praise or another reward is often given the child as the consequence. DTT programs sometimes used aversives (punishment) in the past. In general, if an aversive is used today, it will be very minor such as saying "No!"
In Discrete Trial Training (DTT), the beginning lessons center around basic functions. Children learn to attend, to control tantrums and other maladaptive behaviors. At the same time, they are taught positive behaviors, such as "Look at my eyes."
After an instruction, if the child responds appropriately, he may be given an favorite edible. As the program progresses, the rewards can be changed to social reinforcers such as hugs or praise. DTT is a methodology that is teacher directed, with the child following the lead of the instructor. Often DTT programs can be up to forty hours a week of one-on-one training. As the program progresses, simple lessons are combined to teach more complex tasks and social behavior.
Excerpted from Dave Sherman's book, Autism: Asserting Your Child's Rights to a Special Education
Natural Language Paradigm (NLP)
Natural Language Paradigm (NLP) is built upon arranging the environment to increase the children's opportunities to use language. One of the goals of NLP is to achieve a more naturalistic approach of enhancing the language and communication development of children with autism. It differs from strategies that often lean heavily on teacher choice, manual prompts, strict shaping, and edible reinforcement. NLP is related to approaches that include caregiver-child interaction. Children are encouraged to initiate the interaction. It includes the following:
Koegel, R. L., Koegel, L. K., & Parks, D. R. (1995). "Teach the individual" model of generalization: Autonomy through self-management. In R. L. Koegel & L. K. Koegel (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities (pp. 67-77). Baltimore, MD: Paul H. Brookes Publishing Company.
Source URL: http://www.educ.ttu.edu/edsp/burkhartproject/ModuleTwo/Strategies/NLP.htm
- Stimulus items are chosen by the child, varied every few trials, age-appropriate and found in the child's natural environment.
- Prompting occurs by repeating the item.
- Teacher and child both play with the stimulus item (stimulus item is functional within interaction).
- A loose shaping contingency is used so that attempts to respond verbally (except for self-stimulation) are also reinforced.
- Levels of disruptive and off-task behavior during language instruction are often significantly reduced.
- Activities should be outcome-based. Data should be collected systematically on IEP objectives. Decisions regarding instructional strategies should be data-based.
Koegel, R. L., Koegel, L. K., & Parks, D. R. (1995). "Teach the individual" model of generalization: Autonomy through self-management. In R. L. Koegel & L. K. Koegel (Eds.), Teaching children with autism: Strategies for initiating positive interactions and improving learning opportunities (pp. 67-77). Baltimore, MD: Paul H. Brookes Publishing Company.
Source URL: http://www.educ.ttu.edu/edsp/burkhartproject/ModuleTwo/Strategies/NLP.htm
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