Thursday, December 15, 2005

Autism Spectrum Disorder & ABA

By CYNTHIA McCORMICKSTAFF WRITERTeresa Manzi of Falmouth had little time to brood over the unfairness of life when her daughter Tessa Vacchino was diagnosed with autism at age 2.
Falmouth resident Teresa Manzi and her 4-year-old autistic daughter, Tessa Vacchino, sit down every day to practice routine tasks that are broken down into small steps and taught through repetition. (Staff photo by Ron Schloerb)
There were so many therapies to coordinate: speech, occupational and physical.
And there was the specialized behavioral therapy Tessa received at home from Children Making Strides, an educational and counseling organization in Pocasset for families of children with autism.
All told, the toddler received about 15 hours worth of one-on-one therapy a week. The applied behavioral analysis was particularly helpful for Tessa, now 4, her mother says.
''They told me she would never talk, and she's talking,'' Manzi said. ''My daughter is so loving now. She loves hugs and kisses. You notice such a big difference.''
Many experts agree that intensive early intervention is a key tool in combating autism, a brain development disorder that affects a person's ability to communicate, learn and pay attention and can cause repetitive and obsessive behavior.
Up until a child diagnosed with autism turns 3, the state Department of Public Health, will pay for intensive interventions such as applied behavioral analysis from Children Making Strides in Pocasset or the May Institute in Chatham.
But few children are actually diagnosed with autism before their second birthdays. And that doesn't leave much time for intensive therapies to work.
Autism on the rise
Nobody knows for sure what causes autism, but the national Centers for Disease Control and Prevention in Atlanta says the number of diagnosed cases has increased tenfold from the 1980s. The CDC estimates that one in 166 children has autism.
What is autism?
Autism is a developmental disability that typically appears during the first three years of life. It is the result of a neurological disorder that affects functioning of the brain in the areas of social interaction and communication skills.
More than 500,000 people in the United States have some form of autism.
Autism‘s prevalence rate now places it as the third most common developmental disability - more common than Down syndrome.
Occurs in 1 in 166 births
Four times more prevalent in boys than girls
Fastest-growing developmental disability with 10- to 17-percent annual growth
Growth rate comparison during the 1990s:
- U.S. population increase: 13 percent
- Disabilities increase: 16 percent
- Autism increase: 172 percent
Income, lifestyle and education are not predictive factors for autism
Source: Autism Society of America
Teachers of applied behavioral analysis don‘t leave anything to chance. They say children with autism don‘t pick up on things like other children, so tasks must be broken into small steps, repeated often, and constantly reinforced.
For instance, children with autism must be taught to greet a parent or to look up when someone calls their name.
Teachers and parents get children to identify items by placing their hands over the object.
Every family is equipped with a little black binder with laminated pictures of objects such as the bathtub or food attached inside with Velcro.
Teachers often rely on pictures. They make it easier for the language-delayed child to communicate - and avoid tantrums.
Good ABA instructors are nothing if not peppy. They ignore bad behavior and cheer effort with a variety of rewards - a turn at blowing bubbles or even the opportunity to hit the ring tone on a phone.
Statewide there were 5,706 students age 3 to 22 with autism as of December 2004 - an increase of 900 students over the year before, according to Gretchen Kirby, an autism education specialist with the state Department of Education.
The number of Bay State children with autism receiving early intervention services has climbed 14.7 percent, from 775 to 909 children since 2004, said Tracy Osbahr, director of the Office of Specialty Services at the state Department of Public Health.
During fiscal year 2006, the department will pay $8.3 million to provide therapies to autistic children under the age of 3.
Spending money on early intervention saves the state money in the long run, said Pat Antonellis, program director of Children Making Strides in Pocasset, which received about $380,000 in DPH money last year.
She said children who get early intensive services are less likely to need special education classrooms or require a full-time teacher's aide.
Schools are seeing a decline in the number of pre-teen and teenaged children who go on to expensive residential placements of $100,000 to $250,000 a year, said Barbara Prindle-Eaton, early intervention director at Cape Cod Child Development. The agency runs the early intervention program on the Cape and islands.
''Early is better. You can have a greater impact on brain development earlier,'' she said.
'A very tiny window'
Cape Cod Child Development has 10 to 15 young clients with autism, Prindle-Eaton said.
She knows this doesn't include all the preschoolers on the Cape with autism, since many aren't diagnosed until they are 3 or older, when they no longer qualify for free home-based early intervention services.
''You're talking about a very tiny window of time between diagnosing and enrolling in early intervention,'' she said. ''The vast majority will be over 2 when they are diagnosed. We have them for a very short period of time.''
It can take a long time to get an autism diagnosis, required for intensive therapies, said Antonellis. Many Cape physicians don't feel comfortable making the diagnosis and advise parents to consult specialists in Boston, where the wait for an appointment can take months, she said.
The state Department of Mental Retardation is launching a Pediatrician Awareness Program to encourage doctors to screen children early for autism and other developmental delays.
Meanwhile, Children Making Strides has arranged to have doctors and nurses from Massachusetts General Hospital - specialists in pediatric neurology - come to their offices in Pocasset once a month to screen children..
Trained in techniques
At age 3, children with special needs become the responsibility of the public school system and typically start pre-school.
Parents who can afford it often end up paying privately for intensive services after their children ''age out'' of early intervention.
Manzi, who supplements her family's income with a cleaning job at Falmouth Academy, paid $3,000 to be trained in applied behavioral analysis techniques by an organization based in California.
Manzi hopes Tessa will become a productive member of society, have friends and be able to hold a job.
So when Tessa gets home from preschool, mother and daughter sit down for an hour and go over applied behavioral analysis strategies, sometimes with mixed results.
The other day, Manzi was teaching Tessa the first name of her father, Jay Vacchino. The next morning the little girl greeted him by saying, ''Hello, Jay.''
The money and the time spent on Tessa are worth it, said Manzi, who has another daughter, Nicole Vacchino, 10.
''Would you rather have your daughter lying on the floor, staring at the ceiling for 24 hours a day? Or spinning circles?,'' Manzi said.
''My regular pediatrician said to just enjoy my daughter, but I said there has to be something else I could do.''