The longer a child receives a popular autism treatment, the greater her gains in language, daily living, and other skills. The number of hours spent on the therapy each week is also important to its success.
ABA therapy breaks skills and behaviors into discrete steps, rewarding success at each step. But it is expensive and may require up to 40 hours per week. The new work is the first to tease apart the effects of the duration of ABA and its intensity; both aspects together compose the therapy’s ‘dose.’
The findings could help clinicians maximize the therapy’s effectiveness and limit its costs.
“It’s really difficult to nail down how much is exactly enough: What is the actual dose that a kid needs in treatment, and what are the trade-offs?” says study leader Dennis Dixon, director of analytics at the Center for Autism and Related Disorders (CARD) in Woodland Hills, California.
The study also shows that certain types of skills routinely take children longer to master than other skills. For example, reliably remembering to turn in homework requires sustained practice over time, whereas language skills may develop more quickly with intense drilling.
“That’s a much more fine-grained or nuanced look at this than other people have done,” says Tristram Smith, professor of pediatrics at the University of Rochester in New York, who was not involved in the work.
More is more:
The researchers analyzed data from 1,468 children in eight U.S. states who were receiving ABA treatment that followed the CARD model. The children were between the ages of 18 months and 12 years, received at least 20 hours of ABA therapy each month and had been receiving the treatment for at least one month.
The team tracked the number of skills the children mastered in each of eight skill domains over 36 months. The domains range from academic skills, such as matching objects by color, to social skills, such as responding appropriately to greetings.
For every domain, the children who spend either more hours per week or more months in therapy learn more skills than those who do less in either dimension, the researchers found. Duration has a bigger effect than intensity. For example, children master 0.78 of a motor skill, on average, per additional hour of treatment per week. But they learn 2.01 motor skills per additional month of treatment. The precise relationships vary from one domain to the next.
Because the two components of dose are measured on different time scales, however, it is difficult to directly compare them, Dixon says. In short, both components matter.
Still, the importance of duration came as a surprise, he says. Most studies have focused on the role of the therapy’s intensity. And most, but not all, have found that more hours per week translates to greater benefit. The new work appeared 19 September in Translational Psychiatry.
The researchers also assessed the relative importance of intensity and duration for learning different skill sets.
When working on adaptive skills, such as brushing teeth and getting dressed, or on executive function skills — attention, memory, and self-control — most children tend to make slow, steady progress. More hours per week leads to greater gains, but the effect is small relative to that of extending treatment length.
By contrast, dialing up either intensity or duration both greatly improve children’s mastery of language skills.
The results are difficult to compare with those of other studies, however, because they are based on data from CARD rather than on standardized measures, says Zachary Warren, director of the Treatment and Research Institute for Autism Spectrum Disorders at Vanderbilt University in Nashville, Tennessee. Warren was not involved in the work.
If the results hold up, they could help clinicians plan the parameters of the therapy to offer a child, Dixon says. For example, clinicians might choose to work on executive function in a child for only a few hours a week and continue to practice it for many months. And they might re-evaluate the treatment if the child’s language skills don’t progress rapidly despite spending many hours each week on them.
One of the study’s investigators, whose 8-year-old receives ABA therapy, found the results personally reassuring.
“I took comfort in the fact that empirically we can see that both intensity and duration are creating value,” says Erik Linstead, assistant professor of mathematics and computer science at Chapman University in Orange, California. “My child is spending hours and hours a week in therapy. This made me feel like, okay, I’m glad that we’re doing this.”
Nearly all children with autism are dealing with at least one other condition — and often several — ranging from anxiety to attention deficit hyperactivity disorder, sleep, behavioral and gastrointestinal issues, a new study suggests.
In an analysis of records on almost 1,900 kids on the spectrum, researchers found that over 95 percent presented with at least one issue in addition to autism.
The findings come from a study published online this month in the Journal of Autism and Developmental Disorders led by researchers at the U.S. Centers for Disease Control and Prevention.
Researchers looked for evidence of the 18 most common co-occurring conditions or symptoms in the children with autism, including cognitive issues, regression, behavior problems, congenital or genetic conditions and language disorders.
On average, they found that each child had 4.9 of these secondary conditions, with a higher prevalence among 8-year-olds compared to 4-year-olds.
Moreover, the study found that kids with autism who had co-occurring conditions were more likely to be diagnosed with the developmental disorder at younger ages.
“While the reasons behind this high prevalence are still unclear, their presence contributes to the ASD phenotype heterogeneity, which is a potential barrier to a timely diagnosis of ASD and a challenge for studying ASD etiology because of difficulties in defining a single early ASD behavioral marker,” the study authors concluded.
The researchers said their findings support the need for a “comprehensive system of care” for those with autism and greater consideration of co-occurring conditions in order to enhance early detection of the developmental disorder.
COLUMBUS, Ohio — An Indianapolis company is bringing two autism therapy centers to central Ohio as part of a plan to ultimately open 20 sites and provide about 1,000 jobs across the state.
The Hopebridge centers, slated to open in late April in Dublin and Westerville, are among 10 the company plans to have to operate within a year, said chief executive Dennis May.
Four have already opened: three in the Cincinnati area and one outside Dayton. Other centers are planned for Akron, Cleveland, and Toledo. They join a network of 17 Hopebridge clinics across Indiana and Kentucky.
The expansion comes after an Ohio law went into effect last April requiring individual and group insurance plans to cover kids 14 and younger for autism-spectrum screening, diagnosis, and treatment. Advocates say a key element of the law is its inclusion of applied behavior analysis, or ABA, which uses techniques based on human-behavior principles, such as prompting a child to imitate and repeat the desired behavior several times, offering rewards each time it is performed correctly.
Similar law changes have happened in 45 other states, leading to spikes in service providers, particularly those offering ABA, which has proven effective but has long been denied by insurance companies, said Lorri Unumb, vice president of state government affairs for Autism Speaks.
“It’s such a wonderful thing,” Unumb said. “This not only expands access or creates access for children with autism and will change the trajectory of their lives forever, but it also spawns new business.”
Hopebridge, which offers ABA, factored the law change into its decision to expand into Ohio, May said. Access to care also was a consideration.
“There’s really a shortage of the number of providers for the number of children, the size of the state and the need in the state,” May said. “We’re excited to support those families that have needs.”
Marla Root of the Ohio Autism Insurance Coalition said the group works to introduce providers to Ohio.
“We definitely have already seen some providers from other states looking to come into Ohio, absolutely, and we’re hoping that’s the case,” she said. “We have a lot of need and, especially, we have a lot of underserved areas.”
Some providers, however, continue to hang back as Ohio works to include ABA as a Medicaid benefit, Root said.
The change in law also has led to an increase in demand, exacerbating the need for more providers, said Melissa Bacon of the Ohio Center for Autism and Low Incidence. There have been new providers, she said, but it takes time to obtain needed certifications and approvals.
“It’s not like you can just turn a switch on and have that happen,” said Bacon, who directs policy, strategic initiatives and stakeholder engagement.
The federal Centers for Disease Control and Prevention reports that 1 in 68 children has been identified as having autism spectrum disorder, a developmental disability that can cause social, communication and behavioral challenges.
May said the Hopebridge clinic-based model is different from other providers that offer in-home treatment because it gives kids the space needed for therapy as well as social interaction with other children. The centers also offer comprehensive, collaborative care, with one-stop access to speech, occupational and physical therapies as well as ABA, he said.
Speech, occupational and physical therapies were generally covered before law changes, Unumb said, but it is significant that ABA has been added.
She said Ohio is a bit different from other states because, since 2013, ABA coverage was required for individual and small-group plans provided under the federal Affordable Care Act, also known as Obamacare.
A child with severe impairment could require 20 to 40 hours of ABA therapy each week, services that could cost as much as $70,000 a year, Unumb said. The new laws open the therapy up to children from non-wealthy families.
“It’s absolutely life-changing,” she said. “We see all over the country children who had no access to ABA therapy before making remarkable gains.”
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