Association for Behavior Analysis International

Many experts consider Applied Behavior Analysis (ABA) to be the gold-standard treatment for children with autism spectrum disorder (ASD). Treatment intensity (sometimes referred to as dosage) typically comprises both the number of hours of direct ABA treatment per week and the total duration of treatment. Recommendations regarding the specific intensity of treatment should be based on the?medical necessity?of the treatment for each individual patient (BACB 2019), and it is the professional behavior analyst that determines the treatment intensity or dosage that is medically necessary. However, there is currently no standard method for making medical necessity determinations for ABA services and there is no data available on how behavior analysts individualize dosage for children who present with varied skills, needs, ages, and family contexts (Pellecchia et al., 2019). Indeed, researchers can only speculate as to the reasoning that each clinician uses in making treatment intensity recommendations, given that there is a high degree of variability reported in the number of treatment hours patients receive in clinical practice—an important limitation in large-scale outcomes research (Linstead et al., 2017). Medical necessity determinations are part of the careful construction and individualization of behavior analytic treatment and are an essential element of ABA practice that is not well understood. In this symposium, we will discuss considerations for determining medical necessity and calibrating recommendations based on the best available information, and the potential for greater standardization.

Behavior analysts within their first 5 years of practice, practitioners, supervisors, and senior leaders.

Most published outcome research on Applied Behavior Analysis (ABA) treatment seems to suggest that high intensity yields the best outcomes for patients with autism spectrum disorder (ASD). Yet little is known about what impacts the medical necessity determinations made by behavior analysts to inform treatment intensity recommendations. We conducted a cross-sectional survey of behavior analysts with experience developing and overseeing behavior analytic programming for individuals with ASD (N = 559). We asked participants to report how 36 patient, familial, and logistical factors impact their recommendations using a 7-point Likert Scale (Significantly Decrease, Moderately Decrease, Somewhat Decrease, No Impact, Somewhat Increase, Moderately Increase, Significantly Increase). Results indicated variation in the factors that impact recommendations as well as the direction of impact. A majority agreed on the direction of impact among 9 of 10 factors related to patient diagnosis and skills (e.g., Level 3 DSM-5 Classification), 4 of 10 factors related to patient medical history (e.g., presence of seizure disorder), 3 of 5 additional patient-specific factors (e.g., age at treatment onset), and 3 of 11 familial and logistical factors (e.g., limited family availability). Implications will be discussed specifically as they relate to clinical practice when working with managed care organizations.