DESCRIPTION
Applied behavioral analysis (ABA) is the design, implementation, and evaluation of environmental modifications to produce socially significant improvement in human behavior. ABA has been investigated as a treatment modality for individuals with developmental disabilities. ABA involves a systematic analysis of behavior, utilizing careful observation to identify those behaviors that are triggered by environmental factors and are interfering with socialization and learning. An individualized treatment plan is designed using positive reinforcement and rewards designed to change behavior. ABA focuses on explaining behaviors in terms of environmental events that can be manipulated and modified rather than biological forces that are beyond the individual’s control.
ABA is based on the work of Dr. Ivar Lovaas and may be offered as a home-based program. Discrete trial teaching (DTT), a common intervention in ABA , is a behavioral based instruction where appropriate skills are demonstrated, prompts or cues are employed to encourage the desired behaviors, and rewards are offered to motivate correct responses. This cycle of learning is repeated several times in succession for days, weeks or longer until the skill is mastered. Often behavioral goals must be broken down into many individual skills which are then scaffolded in a step-wise manner for successful skill-building in multiple functional areas for the individual including academics, communications, imagination play, and social and motor skills.
ABA may also be referred to as intensive behavioral intervention (IBI) therapy, Lovaas therapy, or early intensive behavioral intervention (EIBI).
POLICY
Applied behavioral analysis for the treatment of any condition/disease is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
This medical policy does not apply to TennCare.
ADDITIONAL INFORMATION
No controlled studies were found in the published literature that validate the application of applied behavioral analysis for the treatment of any condition/disease or provide comparisons to other therapies.
The literature on efficacy of behavioral interventions lacks controlled trials. It is still to be determined which subset of individuals benefit most from behavioral interventions, which components are integral to positive outcomes, and whether any functional benefits are long term.
SOURCES
Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Journal of Developmental and Behavioral Pediatrics, 27 (2, Suppl.), S145-S155. (Level 4 - Independent study)
Council on Children with Disabilities, Section on Development Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118 (1), 405-420.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010) Randomized control trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125 (1), e17- e 23.
ECRI Institute. Health Technology Information Service. Evidence Reports. (2009, August). Comprehensive educational and behavioral interventions for the treatment of autism spectrum disorders (ASD). Retrieved Novemebr 21, 2011 from ECRI Institute. (166 articles and/or guidelines reviewed)
Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Dawson, G., et al. (2003). Practice parameter: Screening and diagnosis of autism: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55 (4), 468-479.
Hayes. Medical Technology Directory. (2011, April). Intensive behavioral intervention therapy for autism. Retrieved November 22, 2011 from www.Hayesinc.com/subscribers. (74 articles and/or guidelines reviewed)
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55 (1), 3-9.
Lovaas, O. I. (1993). The development of a treatment-research project for developmentally disabled and autistic children. Journal of Applied Behavior Analysis, 26 (4), 617-630.
Myers, S. M., Johnson, C. P., & the Council on Children with Disabilities. (2007). Management of children with autism spectrum disorders. Pediatrics, 120 (5), 1162-1182.
Ospina, M. B., Selda, J. K., Clark, B., Karkhaneh, M., Hartling, L., Tjosvold, L., et al. (2008). Behavioural and developmental interventions for autism spectrum disorder: A clinical systematic review. PLoS One, 3 (11), 1-32.e3755. (Level 1 - Independent study)
Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. Journal of Autism and Developmental Disorders, 39 (1), 23-41. (Level 1 Evidence - Independent study)
Sallows, G. O., & Graupner, T. D. (2005) Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110 (6), 417-438. (Level 2 - Independent study)
Scottish Intercollegiate Guidelines Network (SIGN). (2007). Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders. Retrieved November 22, 2011 from http://www.guidelines.gov.
Spreckley, M., & Boyd, R. (2009). Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: A systematic review and meta-analysis. The Journal of Pediatrics, 154 (3), 338-344. (level 1 Evidence – Independent study)
Technology Evaluation Center. (2009, February). Special report: Early intensive behavioral intervention based on applied behavior analysis among children with autism spectrum disorder. (Vol. 23, No. 9). Chicago: BlueCross BlueShield Association. (58 articles and/or guidelines reviewed)
Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 23 Mandated Insurer or Plan Options: 56-7-2367. Autism spectrum disorders. Retrieved November 21, 2011 from http://www.lexisnexis.com/hottopics/tncode/.
ORIGINAL EFFECTIVE DATE: 4/1/2002
MOST RECENT REVIEW DATE: 1/12/2012
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