Association for Behavior Analysis International

Autism Spectrum Disorder (ASD) is a developmental condition characterized by challenges in social interaction, communication, and repetitive behaviors. Applied Behavior Analysis (ABA) services are a recognized and effective intervention for individuals with autism. In the U.S., Medicaid plays a crucial role in providing access to ABA services for many families, ensuring that children with autism receive necessary support regardless of their financial situation. However, there remains a lack of research on client demographics and service delivery patterns for ASD. Our study sought to address this gap by analyzing data on Indiana Medicaid members to better understand ASD service delivery patterns. Demographic data from 2019-2020 were analyzed using sample size proportions for race, gender, and age. We then examined the percentage under each category across four selected ABA services (assessment, individual therapy, group therapy, and family guidance). Our results indicated that individuals with different demographic characteristics were consistently billed across all service models. However, certain services, such as group therapy, were underutilized despite their potential positive outcomes, possibly due to lower reimbursement rates. These findings highlight the potential for significant improvement in the delivery of ABA services through policy-level changes.

Toilet training is a common challenge for caregivers, particularly for caregivers of children with Autism Spectrum Disorder (ASD). Incontinence can negatively impact the hygiene, physical comfort, independence, and quality of life for children with ASD. Encopresis, or incontinent bowel movements, is typically caused by constipation for most children. Children with ASD are 3.8 times more likely to have constipation than their typically developing peers. Recurring bouts of incontinence and constipation can also negatively impact caregivers in the child’s life. We conducted a randomized clinical trial with a treatment as usual group and one intervention group, receiving the Multidisciplinary Intervention for Encopresis (MIE) which involved both medical and behavioral approaches for treating encopresis without the use of laxatives, enemas, and punishment procedures. In addition to these treatments, we conducted the Treatment Acceptability Rating Form-Revised with caregivers to assess the acceptability of the treatment recommendations. Results indicate that the MIE resulted in statistically significant changes in independent continence with a for participants completing the MIE with high acceptability scores from caregivers. Additionally, participants in the MIE group continued to improve post-treatment in follow up. The presentation discusses practical significance and impact for children, caregivers, and practitioners in the treatment of encopresis.

Families may face long waitlists for behavior analytic services due to high demands and limited resources. Referrals for therapeutic services also vary in intensity and severity, where some families may greatly benefit learning about validated parenting strategies as they wait for their first appointment. To help caregivers begin to address behavioral concerns at home, a parenting website was developed by a team of behavior analysts and psychologists at Kennedy Krieger Institute. Waitlist families (independent users) who were initially offered access to the website showed low engagement with content on the site. As a result, a contingency program was implemented to evaluate the effects between engagement time and frequency of challenging behavior. Thirteen waitlist families were recruited and offered the opportunity to bypass the waitlist contingent on providing daily data, reviewing tutorials on the website, and attending weekly check-ins for a month. Results showed higher engagement for caregivers in the program compared to independent users. Additionally, all caregivers who completed the program reported a substantial decrease in their child’s challenging behavior.