A man reaches out to his son, who has autism, in Portland, Oregon. Photograph: Stephen Voss / Alamy/Alamy
Jack, a nine-year old boy in a bright blue shirt, runs into the kitchen for his after-school snack. In between bites of an apple, he jumps up and down. David, his behavior interventionist, follows behind, preparing a form for recording data on his clipboard. After break time, he will conduct a two-hour session of applied behavior analysis (ABA) therapy, a widely used treatment program for autism.
Today, David will work with Jack to reduce some of his challenging behaviors, teaching him appropriate communication, as well as social and self-help skills, with the intention of closing the developmental gap between him and his typically developing peers.
Please go get the map and spread it out on the floor, prompts David. Jack follows this two-step instruction, meeting one of the goals identified by his family and behavior team. Great job! says David, making a tick mark on his data sheet.
David asks Jack if he would rather eat ice cream or pizza. I dont want to talk about pizza, says Jack. David prompts him to try his response again. I dont like pizza. David lightly praises Jack for clarifying his response and asks him why he doesnt like pizza. I dont want to talk about pizza. Jack says. David prompts him once more. I dont like pizza because I dont like the way it smells, says Jack. Good! Thank you for answering my question. Since they started using the ABA methodology to teach social skills, Jack has been initiating more conversations at school with his peers.
You can earn stars when we go outside if you dont do, what? continues David. Walk on my tiptoes, says Jack (toe walking is characteristic of some people with autism). A token economy is a system used in ABA for providing positivereinforcement to a child so as to motivate him to engage in desired behaviors and to decrease inappropriate behaviors. When Jack earns all his tokens, he receives a reward. After practicing gross motor skills such as 10 reps of push-ups, jumping jacks and jump rope outside, Jack is rewarded with free time to scoot around in his blue wagon. This is my train, he says with a smile.
This is a small snapshot of a single provider of ABA therapy for one child, among thousands of children diagnosed with an Autism Spectrum Disorder (ASD). The experience, however, varies widely for families and providers around the country.
The demand for providers of ABA therapy has skyrocketed over the past five years, as 38 states and the District of Columbia have passed laws mandating private insurance companies to offer more coverage for the rapidly growing population of people with an autism diagnosis.
According to a 2014 report released by the Centers for Disease Control and Prevention, one in 68 children were identified with ASD in a study conducted in 2010. This new estimate is roughly 30% higher than the estimate for 2008 (one in 88), 60% higher than the estimate for 2006 (one in 110), and 120% higher than the estimates for 2000 and 2002 (one in 150).
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Autism: does ABA therapy open society's doors to children, or impose conformity?