EBD Blog

In the Virginia (US) legislature (which I sometimes call the “House of Burgess” for fun), efforts to mandate coverage of intensive behavioral therapy (AKA “ABA,” “discrete-trial training,” etc.) by insurance policies gained a little momentum 16 February when Senate Bill 464 passed by a nearly 2-to-1, bi-partisan margin. Earlier this legislative session, one similar bill (HB 303) was rejected by a narrow vote (4-to-4) in the committee on Commerce and Labor of the Virginia House but another (HB 34) may still be alive (I’m too uniformed about legislative processes to know).

The summary of the just-passed Senate bill, whose chief patron is Senator Janet D. Howell of Reston (VA, US), is as follows:

Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the diagnosis of autism spectrum disorder (ASD) and for treatment of ASD in individuals from age two to six, subject to an annual maximum benefit of $35,000. This requirement does not apply to individual or small group policies, contracts, or plans, and will not apply to the state employees’ health insurance plan until July 1, 2015. This measure will not apply to an insurer, corporation, or health maintenance organization if the costs associated with coverage exceed one percent of premiums charged over the experience period.

Virginians who are concerned about helping young children with Autism to succeed should contant their representatives to urge passage of this legislation. It is not a perfect solution (for example, the coverage is limited to young children only), but this is a situation in which the perfect should not be the enemy of the good.

Senator Howell’s bill has co-patrons, including R. Creigh Deeds, Mark R. Herring, David W. Marsden, J. Chapman Petersen, Richard H. Stuart, Patricia S. Ticer, Jill Holtzman Vogel, and Mary Margaret Whipple. Way to go to them and to every Virginia Senator who voted for the bill: Blevins, Colgan, Deeds, Edwards, Herring, Houck, Howell, Locke, Lucas, Marsden, Marsh, McEachin, Miller (Y.B.), Norment, Northam, Petersen, Puckett, Puller, Quayle, Reynolds, Saslaw, Stosch, Stuart, Ticer, Vogel, Wampler, and Whipple. Thanks.

• HB 34 Health insurance; mandated coverage for autism spectrum disorder.
• SB 464 Health insurance; mandated coverage for autism spectrum disorder.
• HB 303 Health insurance; mandated coverage for autism spectrum

The state legislature voted nearly 2:1 to reject similar legislation in 2009 (HB 1588 Autism spectrum disorder; mandated health insurance coverage).

During the 40 weeks after receiving a brief course of ω-3 (“omega three”) polyunsaturated fatty acids, adolescents at risk for psychotic disorders were less likely to progress to psychotic status than similar peers who did not receive the supplement. In the study by G. Paul Amminger and colleagues, the youths in the treated group also had fewer positive, negative, and general symptoms of psychosis and improved overall functioning than those in the control group.

The youths in the treated group received a supplement of two fish-oil capsules twice a day for 12 weeks, and the controls received a placebo of coconut-oil capsules. The researchers then monitored their status and symptoms for the following 40 weeks.
Continue reading ‘Fish oil and adolescent psychosis’

Buie et al.’s “Take-Away Messages”

In Pediatrics Dr. Timothy Buie and colleagues published a paper providing evidence-based recommendations for pediatricians who evaluate and treat gastrointestinal problems in patients with Autism. The authors, who represent many important scientific groups concerned with allergies, gastrointestinal disorders, nutrition, and similar problems, concluded that children with Autism and related disorders should be assessed and, as approriate, given medical care just as would individuals without Autism. The team encouraged pediatricians to develop and employ “evidence-based algorithms for the assessment of abdominal pain, constipation, chronic diarrhea, and gastroesophageal reflux disease (GERD).”
Continue reading ‘Science, gastro-intestinal problems, diets, and Autism’

Right here in my home commonwealth of Virginia last week, Mira Signe, Vicki Hardy-Murrell, John Morgan, and Margaret Nimmo Crowe explained why it is important that government and private organizations attend to and address issues in children’s mental health. By explaining that Virginia has inadequate services and that one in every five children or youths experience mental health problems at some time during their lives, they made the point that that there is a tremendous need for public focus on these issues. This was the kick-off event for the Campaign for Children’s Mental Health.

The Campaign for Children’s Mental Health is a 3-year sustained effort to make mental health services more available and accessible to Virginia children in need. It will strongly endorse Governor-elect McDonnell’s call for system improvements; urge the General Assembly and state and local government to work collaboratively with the administration to address system deficiencies; and conduct a high-profile three-year advocacy and education drive to build public and political support for improved mental health services for children.

Only about one in 20 of Virginia’s children have access to the key services listed in the accompanying box. So, four out of five children who need these services do not have access to them.

No, Virginia, this is not an acceptable way to treat our children. Let’s do better.

• Down load the press release (source of the excerpt quoted here).
• Read coverage in these newspapers:
  • Lynchburg News and Advance—Coalition pushes mental-health care for children
  • Washington Examiner&mdash:Advocates start bid to expand children’s mental health services under bleak budget;
  • Richmond Times Dispatch— Coalition advocate mental-health care for children
  • Washington Post (blog)—New coalition has AG’s support for mental health reforms
• Visit (and support) the Web site of the Campaign for Children’s Mental Health.
• Download pdfs of “Survey of Community Services Board Child and Adolescent Services” and “Review of Community Services Board Child and Adolescent Services“; these are report by James W. Stewart, Inspector General for Virginia’s Mental Health, Mental Retardation & Substance Abuse Services (now called Behavioral Health and Development Services). The list of key services comes from these reports;
• Visit the < href="http://www.facebook.com/pages/The-Campaign-for-Childrens-Mental-Health/183467424796?v=wall" target="_blank">Facebook page;
• Listen to a brief (3+ min) interview with Ms. Crowe from WMRA: Pushing for Children’s Mental Health Reform.

In “Autism: A journey of recovery” on the “American Morning” section of the Web site of CNN, reporter Kiran Chetry relates the story of Jake Exkorn and his family. Jake’s remarkable story is one of great losses in competence as a toddler, followed by persistent, intensive therapy during his childhood and substantial progress.

Review the transcript for this Autism story here.

Hill Walker and colleagues reported that the First Step to Success program benefitted young children at risk for developing emotional or behavioral disorders. In a longitudinal study of the three-year program conducted in Albuquerque (NM, US), the researchers found substantial reductions in disruptive behavior and improvements in social functioning.

In a press release, Professor Walker said, “Albuquerque was the first opportunity we had to mount a large-scale study of the program using a randomized control group, the gold standard for research. First Step has been implemented widely, but not [studied] in this way.”
Continue reading ‘First Step takes off’

Trine Tsouderos and Patricia Callahan, the Chicago Tribune reporters who have provided exemplary examinations of unsupported therapies for Autism, continued their series of stories on the topic with a piece entitled “Autism: Kids Put At Risk” in the Los Angeles Times. In this briefer (though still well-researched) article they devote most of the coverage to examining the physicians who prescribe chelation, hyperbaric oxygen therapy, anti-testorsterone drugs, mega-doses of vitamins, and many other unproven regimens and other doctors who have serious doubts about the consequences, including the safety, of such therapies.

Read “Autism: Kids Put At Risk.” See the related articles “On shaky ground with alternative treatments to autism,” “Four autism treatments that worry physicians,” “Chelation based on faulty premise,” and “Autism therapies can get undeserved credit.” Also, see related EBD Blog posts about the investigative journalism of these writers: Dangerous therapy and Baseless, risky therapies for Autism

Council for Children with Behavioral Disorders (CCBD; a division of the Council for Exceptional Children) will hold it’s 2010 International Forum 11-12 February in New Orleans (LA, US). The theme for the conference is “Research Into Practice: Achieving Academic and Social Competence with Challenging Students.” Registration is limited. Learn the full program and other details from the Web page describing the conference.

File this one in “things that work.”

In a smallish-but-well-done study, Geraldine Dawson and colleagues reported in Pediatrics that the Early Start Denver Model (ESDM)—a variant of the behavioral methods that have often been found to be effective—produced salutary benefits for young children with Autism. The children who received the ESDM intervention had significantly greater gains in IQ than those in a community treatment control and their social behavior kept pace with the standards for their non-disabled peers while the social behavior of the community controls declined relative to the standards.

OBJECTIVE To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).
Continue reading ‘ESDM benefits toddlers’

Michael Aman and co-authors (and there are at least 25 of them) reported that a combination of medication and parent training in behavior management was more effective than medication alone in reducing behavior problems. They assigned families randomly assigned to receive either risperidone as well as parent management training or risperidone alone. After 24 weeks, they assessed the children’s behavior with parent-report measures. The parents who learned to use behavior management strategies reported lower levels of non-compliant behavior and irritability.
Continue reading ‘Meds plus behavior management for Autism’

The second installment of Chicago Tribune reporters Trine Tsouderos’ and Patricia Callahan’s investigation of alternative treatments for Autism is available. Liz Ditz cited it in her comment on my earlier post about the first installment of this exemplary piece of journalism, but I am repeating the link here so that it will be readily apparent to readers. For even more on the coverage of questionable alternative therapies by Ms Tsouderos and Ms. Callahan, see the post entitled “The Unethical Treatments that ‘Autism is Vaccine Injury’ (And Other False Premises) Give Rise To” on Liz Ditz’s blog.

Writing in the Chicago (IL, US) Tribune under the headline “Autism treatments: Risky alternative therapies have little basis in science” Trine Tsouderos and Patricia Callahan reported about the background and myriad problems with many treatments used as therapy for children with Autism. They expose the lack of evidentiary support for therapies ranging from mega-doses of vitamins to chelation and show the relationships between practitioners of these therapies and a couple of organizations well-known among those who follow Autism.

The Tribune found children undergoing daylong infusions of a blood product that carries the risk of kidney failure and anaphylactic shock. Researchers in the field emphatically warn that the therapy should not be used to treat autism.

Children are repeatedly encased in pressurized oxygen chambers normally used after scuba diving accidents, at a cost of thousands of dollars. This unproven therapy is meant to reduce inflammation that experts say is little understood and may even be beneficial.

Children undergo rounds of chelation therapy to leach heavy metals from the body, though most toxicologists say the test commonly used to measure the metals is meaningless and the treatment potentially harmful.

Reporters Tsouderos and Callahan conducted interviews with an impressive array of advocates for the therapies (including representatives of Autism One, Autism Research Institute, and Defeat Autism Now) and doubters (mostly serious scientists). They combed through the weak and barely related research that many of the advocates use as well as the evidence showing limited or no benefits of the therapies.

All in all, these reporters deserve kudos for the unflinching thoroughness of their reporting. I encourage readers to read, reread, and disseminate the article. Here’s a link to “Autism treatments: Risky alternative therapies have little basis in science.” Flash of the electrons to Liz Ditz, whose Twitter post about this article alerted me to it.