Association for Behavior Analysis International

Receiving reimbursement for ABA therapy from insurance funding can be a hellish experience, both for ABA providers as well as insurance companies. Health insurance continues to gain prominence as the major source of funding for ABA therapy in the United States. There are currently forty three states that mandate insurance companies fund autism treatment. One hot topic behavior analysts would do well to understand is medical necessity and its impact on both the assessment and treatment of autism. For instance, the VB-MAPP is a common assessment tool used by behavior analysts. However, its categorization of skill acquisition as well as its suggestions for IEP curriculum development can lead to tension between what is medically necessary and what is educational. Such tension may ultimately result in a denial of coverage, on the basis that the service should be provided by the Department of Education. This paper will focus not only on differences in language used by medical and behavioral professionals, but also on how these differences impact treatment objectives. Finally, this paper will identify a potential resolution that allows proper funding of ABA therapy upon which both behavior analysts and health insurance providers can agree.

Polypharmacy is defined as the concurrent use of multiple medications by a consumer and has been increasing for individuals diagnosed with Autism Spectrum Disorder. Polypharmacy has been predicted for individuals by a variety of factors such as psychiatric support, group home residence, and history of aggressive behavior. Unfortunately, there has been little research conducted examining combined drug effects on metabolic or behavioral factors in individuals diagnosed with Autism Spectrum Disorder. This has serious implications because it is assumed that each drug will impact the consumer individually while in actuality, there may be summative effects that may impact influence behavioral interventions. This paper will present an overview of current studies that have examined combined drug effects, predictors for polypharmacy, and potential effects of summative drug administration from a behavior analytic perspective. In addition, the paper will also discuss ethical considerations for consulting practitioners in relation to responsibility and the conflict of evidence-based treatment recommendation between behavioral and medical interventions.