Wisconsin autism activists felt years of effort pay off last year when Gov. Jim Doyle issued an emergency rule requiring insurance coverage of autism spectrum disorders.
The emergency rule, which went into effect Nov. 1, mandates autism coverage for health insurance policies issued by an insurer. The rule does not apply to employers with self-funded health plans. The rule lasts for a year while the Office of the Commissioner of Insurance comes up with a permanent rule.
The law requires a minimum of $50,000 a year for intensive evidence-based treatment, and $25,000 annually for non-intensive services.
As autism diagnoses grew in the 1990s and first decade of this century, so did the variety of treatments, everything from diet change to psycho-educational interventions. But “evidence-based treatment” at the moment refers to Applied Behavioral Analysis, an intensive intervention method developed by clinical psychologist Dr. O. Ivar Lovaas.
Lovaas, his staff and students trained in his method worked one-on-one with autistic children aged two to four. The work – 40 hours a week of structured training – was conducted in the children’s homes, with parents participating so they could continue the behavioral training on their own.
After studying three groups of children through age 7 – the experimental group receiving the Lovaas Technique, a control group that received some behavioral training and other treatments, and a third group that received no behavioral treatment – Lovaas published his results in 1987 and reported that 47% of the children in the group that received intensive behavioral therapy were functioning normally.
His results caused a stir in the then relatively small autism community, especially when other studies were unable to replicate Lovaas’ results.
“People were starting to say about Lovaas’ treatment, ‘It can’t be true. He’s faking his data.’ That caused a war in literature between camps for years,” said Dr. Glen Sallows, president and co-founder of the Wisconsin Early Autism Project, a program and clinic with treatment based on Lovaas’ work.
“Lovaas’ study came out in ’87 and he updated it in ’93, but no was ever been able to replicate it,” Sallows said. “There were several attempts to replicate it. In my mind, there were good reasons why those didn’t work as well. They didn’t have enough hours. By and large they were at universities and didn’t have access to much money so they didn’t have the hours. They didn’t do it long enough to bring about the changes. And I don’t think people understood how much supervision and training you have to give your line staff.”
Sallows, originally from Los Angeles, had Lovaas as an instructor when he was an undergraduate at UCLA in the 1960s. He went on to the behavior-oriented graduate school at the University of Oregon. Upon graduation, Sallows’ first job was as a psychologist for a children’s mental health clinic in New Jersey. In 1979 he joined the staff at the Mendota Mental Health Institute in Madison, and in 1981 led the autism unit there.
Sallows had read about …