ABA Benefits for Autism: Association for Science in Autism Treatment (ASAT) Educates LA Times Alan Zarembo

The attached letter was written by ASAT Board member Sabrina Freeman Ph. D., and Secretary Florence DiGennaro Reed, Ph. D., BCBA-D to the LA Times Alan Zarembo who did such a poor job (in my humble opinion) reporting on autism issues in a recent LA Times series.  In the letter Freeman and Reed attempt to educate Zarembo about the scientific, evidence based benefits that ABA has been demonstrated to bring to autistic children.  

I don't know if a superficial mainstream media reporter is capable of  understanding the information presented in the letter or if he would make the effort to understand.  I applaud ASAT for trying to break through Zarembo's self constructed brick wall of ignorance and educate him about the evidence basis behind ABA, an intervention that has helped so many autistic children. 

ASAT Responds to LA Times Story “Families Cling to Hope of Autism Recovery”

Monday, January 30, 2012

Dear Mr. Zarembo:

We are writing to you regarding your article entitled, “Families Cling to Hope of Autism Recovery” (the Los Angeles Times, December 15, 2011). We appreciate your time and effort in highlighting the work of Dr. Lovaas and the larger field of applied behavior analysis. We especially appreciate your advocacy of science as the means to evaluate the effectiveness of any treatment.

While you acknowledge some positive benefits of applied behavior analytic treatment, your emphasis ignores a large body of research indicating that children who receive Early Intensive Behavioral Intervention (EIBI) benefit significantly relative to those children who do not receive EIBI. We ourselves acknowledge that there are gaps in the science of autism treatment, including EIBI; however, we respectfully disagree with your presentation of the outcomes. We are unaware of other treatment protocols that have been studied and replicated to the same degree as EIBI. Unfortunately, many other treatments are marketed as “cures” without evidence of benefit. As such, EIBI represents best practices for people with autism. While you rely on the AHRQ report in your article, we wish you had also highlighted that treatments based on the principles of applied behavior analysis have been endorsed by the U.S. Surgeon General,1 National Institutes of Health,2 the National Research Council,3 the National Standards Report4 published by the National Autism Center, and others. 5Although we agree that additional research is needed to develop and refine EIBI and other science-based approaches, your article leads readers to conclude that the high cost and burden of a forty hour-a-week requirement to replicate the positive outcomes from the scientific literature is too high a cost for society. We advocate for research funding to identify aspects of treatment that are most important for improving function. Until that time, though, children with autism deserve access to high quality treatments based on our current understanding of science.

The science of applied behavior analysis and its application to autism treatment are often portrayed inaccurately in the media. Unfortunately, we believe your story contributes to further misunderstanding and misconception. The potential risk is that caregivers will delay pursuing empirically-supported, effective treatment. We suggest that rather than advocate denial of effective autism treatment, we should acknowledge the true state of science in autism intervention and advocate for access to effective treatment by families. It is important for parents and caregivers to access accurate information regarding autism treatments so that they may make wise decisions for their children. For more information, please visit http://www.asatonline.org/resources/autismtreatments.htm.

Sabrina Freeman, Ph.D.
Board Member, Association for Science in Autism Treatment


Florence D. DiGennaro Reed, Ph.D., BCBA-D
Secretary, Association for Science in Autism Treatment


References 
¹U.S. Department of Health and Human Services (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
²Strock, M. (2004). Autism spectrum disorders (pervasive developmental disorders). NIH Publication No. NIH-04-5511. National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, 40 pp. http://www.nimh.nih.gov/publicat/autism.cfm
³National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press.
⁴National Autism Center (2009). National Standards Report. Randolph, MA: National Autism Center.
⁵New York State Department of Health (1999). Clinical practice guideline: Report of the recommendations. Autism/pervasive developmental disorders, assessment and intervention for young children (age 0-3 years). Albany, NY: NYS Early Intervention Program.

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Autism Rising: LA Times Gets It Wrong

The LA Times has written an  ill informed, one sided, article on autism increases which misleads the public into believing that the evidence has clearly established that the entire increase in autism diagnoses over the past two decades is attributable to the 1994 DSM diagnostic manual changes, diagnostic substitution, and the hunt for government funded autism services. The article, Discovering Autism Unraveling an epidemic, can be summarized in the following paragraph from the article:


"Two decades into the boom, however, the balance of evidence suggests that it is more a surge in diagnosis than in disease."

The truth is the LA Times article publishes no reference to studies that confirm that conclusion about the alleged balance of evidence.  The LAT does refer dismissively to Dr. Irva Hertz-Piccioto who has conducted research on possible environmental causes of autism disorders.  It also offers selective quotes from a variety of other autism sources, in addition to Roy Richard Grinker, the anthropologist and father of a high functioning child with Aspergers, who has sought out all the allegedly autistic Korean children who function very well in Korean society.

What the article does not mention is the emerging consensus that autism arises not just from genetic factors, which would support the biased perspective the LAT offers, but from the interaction of genetic and environmental factors.  Nor, in dismissing Dr. Hertz-Picciotto's work, does it mention that genetic autism research has been overwhelmingly funded at the expense of environmental autism research.  Better to present positively the opinions of a biased anthropologist with an agenda then an actual autism researcher.

Dr. Bearman, a sociologist, is also quoted but not in any meaningful way. He was interviewed more fully, or quoted more fully, in an article on the National Institute of Mental Health website reporting a discussion Dr. Bearman had with Dr. Tom Insel of the IACC:

Dr. Insel: From what you know now when you add all of those together how much of the increase can you explain?


Dr. Bearman: Well that’s a complicated question, but I think we can pretty uniquely associate about a quarter of the increase from the birth cohorts from 1992 to 2001 which is a lot, to diagnostic change on the border between diagnosis and mental retardation in autism. I think we can associate about 16 percent of the increase on the other border between autism and other neurodevelopmental disorders on the spectrum: Asperger’s, PPDNOS etc. And those are largely non over-lapping components of increase, so that’s about 40 percent. I think the spacial clustering itself adds another few percent. I would say I am confident that 40 percent of the increase I think I know what caused that. That leaves a lot of increase left, 50 percent is a lot to look for still.


Dr. Insel: Any ideas about what’s driving that other 50 percent?


Dr. Bearman: Well, some is genetic. I think that the increased parental age accounts were 11 percent of the increase over this period and that’s a lot and the mechanism by which increased parental ages expressing itself I think likely largely genetic. I think the tricky part is going to recognize that it would be harder now to find that 50 percent. It would look like it should be some toxicological environment that’s shared because of the spacial clustering. Because there’s a very strong process of amplification of the understanding of autism that leads to increased diagnosis as parents learn how to recognize symptoms a very, very, small event that would transform the environment five years ago, ten years ago, even you could imagine, 40 years or 50 years ago, when the moms of children with autism now were in utero as eggs- a very small event could cascade into a larger epidemic now."

The LA Times could have checked out the web site of the IACC, the Interagency Autism Coordinating Committee which states:

"As with many complex disorders, [autism] causation is generally thought to involve some forms of genetic risk interacting with some forms of non-genetic environmental exposure. ... In addition, a number of other environmental factors are being explored through research because they are known or suspected to influence early development of the brain and nervous system. Recent studies suggest factors such as parental age, exposure to infections, toxins, and other biological agents may confer environmental risk. ... Progress in identifying environmental factors which increase autism risk has been made recently (Eskenazi et al., 2007; Palmer et al., 2006; Palmer, Blanchard,; Wood, 2009; Rauh et al., 2006; Roberts et al., 2007; Windham et al., 2006), although this area of research has received less scientific attention and far fewer research dollars than genetic risk factors" [Underlining added - HLD]


- United States IACC (Interagency Autism Coordinating Committee)

No one disputes the obvious fact that the 1994 DSM changes increased the number of autism diagnoses.  The LAT implies though that the "science" indicates that the increase in autism diagnoses is simply a matter of diagnostic change and substitution and that environment plays no significant role in causing autism disorders. That position amounts to a confession of ignorance and/or bias by the LAT ... and a lack of concern over whether the number of autism diagnoses could be decreased if the research dollars were distributed more evenly towards research of environmental causes and triggers of autism disorders. 

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LA Times Gets It Right: ABA Is An Autism Treatment Worth Funding

I am a frequent critic of the mainstream media's tendency to misrepresent autism disorders. The mainstream media routinely presents feel good stories of autistic accomplishments, painting autism as merely a different way of thinking and speculating that many of histories great geniuses were probably autistic.  Discussion of autism treatments ranges from riding horses in Mongolia to swimming with dolphins.  More serious mainstream media treatments of autism treatments will acknowledge that early intervention is important for successful outcomes without mentioning ABA, applied behavior analysis, the most solidly evidence backed treatment shown for many years to result in a number of intellectual, language and behavior gains in autistic children who receive early intensive ABA intervention.

I have criticized all aspects of mainstream media misrepresentation of autism including the tendency to hide the evidence based effectiveness of ABA known for many years and confirmed by authorities from the US Surgeon General to the American Academy of Pediatrics.  It is only right that I acknowledge, with gratitude, when a mainstream media institution gets it right as the LA Times has done with its clear, straight to the point,  statement about the importance of ABA as a treatment for autism disorders:

"An autism treatment worth funding


Editorial


A California bill would require insurance companies to cover the cost of applied behavioral analysis for the autistic. It's good policy.


September 30, 2011


State law requires insurers to include coverage for autism in comprehensive healthcare policies. Now, lawmakers want to go a step further, requiring coverage of a particular autism treatment: applied behavioral analysis. Insurers are resisting. They don't question the effectiveness of the therapy; they just say it doesn't fit the definition of "medical" treatment. Their position reflects how crucial parts of the healthcare system are wedded to the status quo, regardless of what's best for patients. State lawmakers have passed a bill to overcome the insurers' resistance, and Gov. Jerry Brown should sign it."

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