A child participates in an applied behavior analysis session. (Francine Orr/Los Angeles Times/TNS)
For the first time in a decade, there are new guidelines for the most widely used autism treatment.
The Council of Autism Service Providers, or CASP, a nonprofit trade group representing hundreds of autism service providers, recently released the third edition of the Applied Behavior Analysis (ABA) Practice Guidelines for the Treatment of Autism Spectrum Disorder. The document aims to provide ABA standards of care for insurers, regulators, consumers, professionals and other interested parties.
“ABA is a very effective treatment for autism. But it has to be implemented correctly and with the highest quality,” said Lorri Unumb, executive director of CASP. “These guidelines are key to achieving this.”
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The latest edition reflects a lot of changes in the industry since the second edition was published in 2014, according to Unumb. That includes widespread use of state licensing for behavior analysts, establishment of medical billing codes for ABA, and expansion of ABA insurance coverage mandates.
The updated guidelines address everything from training and certification for ABA professionals to staffing and delivery models, treatment implementation, outcome measures, and relevant state and federal policies. Additions in the new version include defining “medical necessity” in the context of ABA, addressing the use of telehealth, greater details on collaboration, care coordination, transition, and discharge planning.
Unumb said regulators often rely on the guidelines and insurers use them to understand what ABA should be like when authorizing services. Additionally, people with autism and their families can use the information to identify quality providers, she said.
At the same time, the guidelines help ABA providers across the country ensure consistency in their offerings.
“Just as a cardiac catheterization should not look different in North Dakota than it does in New York, ABA should not look different from state to state, at least not based on geographic differences,” Unumb said, although he highlighted the inherent differences . A challenge in this given that ABA is meant to be highly individualized.
ABA can be provided at various levels of intensity depending on medical need, the guidelines state. The duration of treatment can range from months to years or throughout life, and services may be provided in clinics, homes, community settings, or other settings.
The 88-page document is the culmination of a three-year process to incorporate the latest scientific evidence and clinical opinion, CASP officials said.
“We gathered input from more than 60 behavior analysts, exhaustively reviewed the latest research since version 2.0, and carefully deliberated every word,” said Dr. Jane Howard, who chaired the steering committee and is co-founder of Therapeutic Pathways, a treatment for autism. center with multiple locations in California.
This is the first time CASP has published the guidelines. They were first published by the Behavior Analyst Certification Board in 2012 and revised in 2014 before being transferred to the trade group in 2020.
The use of ABA has been controversial in recent years, with some self-advocates reporting negative experiences and expressing concerns that the treatment teaches people to hide their autism traits. But advocates of the approach say it can help reduce challenging behaviors and improve quality of life.
“These guidelines do not change our fundamental concerns about the philosophy behind ABA, the evidence base for ABA, how it is practiced, and its effect on autistic people,” said Zoe Gross, advocacy director for the Autistic Self Advocacy Network, which opposes ABA.
Unumb said the clinical practice guidelines are not intended to address those issues, but noted that “the third edition places a strong emphasis on shared decision-making and collaboration with consumers and caregivers.”
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