A new University of Arkansas program is the only one in the state certifying students in a therapy recommended for the treatment of autism, according to university officials.
Peggy Schaefer Whitby was hired by the University of Arkansas at Fayetteville in 2012 to start a graduate program in applied behavior analysis. The program began in the fall of 2013, and its first students could receive certification this summer.
Applied behavior analysis is a therapy recommended by the American Academy of Pediatrics and the National Research Council as an effective treatment for autism. It uses observation and data to determine behaviors that affect an autistic child's ability to learn, said Elizabeth Lorah, program assistant professor. Analysts then look for the cause of the behavior and tailor plans for each child to modify the behavior.
An article from the Official Journal of the American Academy of Pediatrics in 2007 states that the use of the therapy for autistic children has been documented for five decades.
"Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior," the article states.
Intervention from birth to age 3 can greatly improve a child's development, according to the Centers for Disease Control and Prevention. It says it is important for parents to talk to doctors as soon as they first suspect that their child has autism. However, intervention can be helpful at any age, it states.
Arkansas has 23 board-certified clinicians, according to the national Behavior Analysts Certification Board, the agency that certifies analysts. Northwest Arkansas has six therapy analysts.
"We do have a severe shortage in the state," Whitby said. "There really are not enough certified applied behavior analysts in the population."
One in 65 children in Arkansas has an autism spectrum disorder, according to a report released by the University of Arkansas for Medical Sciences in Little Rock last month.
One in 68 children nationally has autism, according to the CDC. It defines autism spectrum disorder as a developmental disability that can cause social, communication and behavioral challenges.
Various techniques
Lorah said applied behavior analysis techniques vary depending on the child. However, typically certified clinicians target a behavior that is limiting a child's ability to learn. They then seek to determine what is causing the behavior.
For instance, a child may hit a teacher instead of asking for help, Lorah said. It is possible that the child's inability to communicate is the reason the child hits the teacher. She said the child could also cry or throw a tantrum in such situations.
Clinicians teach the child to communicate vocally instead of using other behavior, Lorah said. She said sign language or a visual card system can be used if the child is unable to speak. The child uses the card system to point to an object or hands the card to others to let them know what he needs or wants.
The first step includes prompting the child, Lorah said. The clinician physically moves a child's hand to a card with the image of an apple on it. The child then receives a reward. Eventually the child must point to the card to receive the reward. The reward is specific to whatever the child responds to.
Lorah said once a child learns to communicate, his vocabulary can be increased and other behavior modifications can begin.
The therapy can also help children in environment-specific situations, Lorah said. For instance, some children throw tantrums when in crowded rooms or classrooms. A child exhibiting that behavior will slowly be introduced to small crowds and rewarded, Lorah said. The crowds are increased over time, and the child is rewarded until he can function without throwing a tantrum, Lorah said.
Applied behavior analysis treatment can be implemented at home or in schools, Lorah said. However, a child who throws tantrums when in crowded rooms could have trouble learning behavior modification in the classroom, so that child could be receive treatment elsewhere.
Coverage and providers
Kimberely Parker, owner of Exceptional Advocacy in Bentonville, said the UA program is an asset to the state because it will help produce more clinicians to provide the services in the region. Exceptional Advocacy is an advocacy firm for children with disabilities.
Only a few years ago, some parents would fly board-certified specialists in from places like California to treat their children, Parker said.
"ABA is the gold standard for autism," she said of applied behavior analysis. Using it, "kids can learn and become independent." She said she has had potential workers consider moving to the state, but they would ask about applied behavior analysis. "When I told them it wasn't here, people just didn't come here."
Dianna Varady, Arkansas Policy for Autism Speaks, said there still are many children in the state who do not have access to applied behavior analysis treatment. She said one reason is cost and another is a shortage of providers.
Arkansas has started to see a slow increase in applied behavior analysis services in the wake of state legislation passed in 2011, Varady said. The law requires private insurance companies to cover the therapy.
"When the insurance mandate was passed, that created a demand pretty quickly," Varady said. "All of a sudden the families who needed this treatment had access. We saw some people who already lived here and didn't have the credentials, take the proper course necessary to become credentialed. What we also saw was some board-certified behavior analysts locate to the state."
However, most large companies in the nation and state are self-insured. Those companies are not required to cover the applied behavior analysis services, and most don't, she said. That means that many people still do not have insurance coverage for the service, which can vary in cost, Varady said.
Varady said 30-40 hours of therapy a week are recommended for very young autistic children. She estimated the cost at $50,000 a year. Early intervention typically continues until the child enters school.
"Unfortunately, even if every single child in the state had coverage tomorrow, there is no way we could meet the demand for those children because we don't have enough professionals trained to do it," Varady said.
Varady of Little Rock said her son was 8 years old when the insurance mandate was passed. Her insurance policy began covering the service, and she started treatment for her son at that time.
"He has made significant progress," she said. "He went from basic or below proficient on the state Benchmark scores to advanced in math in one year. He made the A and B honor roll. What we noticed was that all of a sudden he was able to have a conversation with us. He started making friends at school. We had hopes for that. We dreamed for it, but we didn't expect it right away."
Laura Reynolds of Bentonville had trouble finding services for her son. Her insurance started covering applied behavior analysis, but she had trouble finding a service provider in the region.
Northwest Arkansas started seeing the first services by board-certified clinicians in applied behavior analysis in the past year, Reynolds said.
"I was constantly checking the University of Arkansas and UAMS in Little Rock's website because I figured if anyone was going to be cutting edge, it would be them," Reynolds said. "One day I saw they [the University of Arkansas] had hired someone, and I immediately started emailing her and I asked her to help me."
Branching out
Reynolds started contacting Whitby to ask for help. At first, however, Whitby was starting only an academic program. It was decided later to open a clinic with a certified program.
The clinic provides applied behavior analysis services to families in the region at no charge, Whitby said. It also provides clinical training for students in the applied behavior analysis academic program.
Currently, eight children are enrolled in the program, Whitby said. However, she hopes to receive private grant funding that will help expand the program to more children.
Reynolds said the therapy has been life-changing. She said her son, Hunter, now has less fear and anxiety while in public now.
"My husband and I can take Hunter anywhere now, to a restaurant, a store, a play my daughter is in," Reynolds said. "I am 100 percent positive that my son will be a taxpayer someday. That is huge."
Through the program, Hunter, 11, has mastered social greetings, Whitby said.
"Prior to coming to us, Hunter did not respond to people's social greetings, and he did not initiate social greets," Whitby said. "If I went up to him and said 'Hello,' he would say nothing back."
Whitby said the clinic used multiple techniques to teach Hunter. They included modeling the behavior for him and embedding the lessons into play. Eventually, he moved out into the community, Whitby said. He was rewarded by relatives and teachers for using the proper greetings at home or in school.
"It would be reinforced with a small M&M [candy] and initially we did it every time," Whitby said. She said over time the reward would be given less frequently, and now he can respond to social greetings without a reward.
The university offers certification in applied behavior analysis at the graduate level, Whitby said. She said the certification can be infused with master's, specialists or doctoral degrees.
The program also offers a master's degree in applied behavioral analysis. Program graduates will also receive certification. Currently the program has 10 students. Twenty more will be enrolled next year.
Whitby said she also would like to set up satellite centers around the state to offer autism services.
"We live in a rural state, and it is very difficult to reach families in rural America," Whitby said. She said satellite centers could provide services such as training teachers and parents, as well as connecting families with other resources. Whitby said $2 million in annual funding from the state would be needed to run the centers.
Thrive Autism Solutions in Rogers opened in December, and Arkansas Autism Connection opened in Bentonville. Both have certified staffs. NWA Center for Autism & Developmental Disabilities in Fayetteville has been providing applied behavior analysis to the region since 2011. A board-certified analyst does oversee some programs but not all. Multiple employees with the center are getting their certifications, according to officials with the business.
Metro on 05/16/2014