NCAAS Reports Important Step Forward for ABA Therapy in U.S. National Defense Authorization Act 2022


National Coalition for Access To Autism Services

“Military families already experience far greater challenges in accessing benefits for ASD than their civilian counterparts,” said NCAAS Chair Mike Moran. “The involvement of the NAS in evaluating TRICARE’s Autism Demonstration is a positive step toward… accessing treatment…”

The National Coalition for Access to Autism Services (NCAAS), the voice of the nation’s premier autism treatment providers, today welcomed language in the National Defense Authorization Act that seeks to improve the analysis of data collected from active duty and retired military families whose children participate in the Department of Defense’s Autism Care Demonstration (ACD), which provides access to medically necessary services for individuals with autism spectrum disorder (ASD). The FY 2022 National Defense Authorization Act was signed into law by President Biden on Monday, December 27, 2021.

“Military families already experience far greater challenges in accessing benefits for ASD than their civilian counterparts,” said NCAAS Chair Mike Moran. “We applaud everyone for their support and advocacy of our military families with children who have autism. The involvement of the National Academies of Sciences in evaluating TRICARE’s Autism Demonstration is a positive step toward ensuring families are accessing top-quality treatment and that data collected from their child’s treatment is used appropriately.”

Since 2019, NCAAS has raised concerns directly with the Department of Defense and with the House and Senate Armed Services Committees about the improper use of data collected from DoD patients utilizing the PDD Behavior Inventory (PDDBI), an internationally recognized and utilized behavior assessment tool, but which the DoD has improperly assessed and thus asserted unsupportable conclusions about the effectiveness of applied behavior analysis (ABA) used to treat ASD. Moreover, the DoD’s improper analysis has been the foundation of troubling assertions in quarterly and annual supports submitted by the DoD to Congress. In February 2020, Ira Cohen, Ph.D., the co-creator of the PDDBI met with the DoD to convey his concerns about the DoD’s improper use of the PDDBI data and the inaccurate conclusions asserted by DoD based on its flawed use of that data. Despite Dr. Cohen’s efforts, subsequent DoD reports to Congress continued to misuse the data and asserted conclusions that Dr. Cohen had clearly asserted were unsupportable.

“I met with the Department of Defense to point out the errors in their application of the PDDBI, and the resulting errors in their conclusions based on the PDDBI. I found it extremely frustrating to see that the Department simply continued to send an additional three quarterly reports and an annual report to Congress with the same erroneous information,” said Dr. Cohen. “The conclusions that the Department has made in its reports to Congress about the effectiveness of its Autism Care Demonstration based on its application and analysis of the PDDBI are simply unsupportable,” Dr. Cohen concluded.

With the Autism Care Demonstration expiring at the end of 2023, thousands of military families are relying on an accurate assessment of the effectiveness of a treatment of ABA, the gold standard in the treatment of developmental delays and interfering behaviors commonly present in children who are diagnosed with ASD. ABA is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree and to demonstrate the interventions employed are responsible for the improvement in behavior.

In light of numerous reports to Congress making erroneous conclusions about ABA’s effectiveness, legislators included language in the NDAA that requires DoD to contract with the National Academies of Sciences to conduct an independent analysis to determine whether data from the PDDBI are being interpreted properly and to complete other analyses to measure the effectiveness of the program.

“Frankly, I am relieved to know that the National Academies of Sciences will ensure qualified experts are scrutinizing the data that comes from the PDDBI,” said Dr. Cohen.

NCAAS members serve tens of thousands of families throughout the United States and more than 16,000 military families affected by autism spectrum disorder (ASD). NCAAS and its members are committed to serving military families and remain committed to working with the DoD and the National Academies of Sciences in its evaluation of the ACD.

NCAAS recognizes and applauds Senators Kirsten Gillibrand (D-NY), Thom Tillis (R-NC) and Jeanne Shaheen (D-NH), and Representatives Jackie Speier (D-CA) and Mike Gallagher (R-WI) who championed the issue in the Senate and House Armed Services Committees for supporting the language in the National Defense Authorization Act for 2022.

Now that President Biden has signed NDAA into law, the DoD will have the help of experts from the National Academies of Sciences to ensure greater accuracy in the analysis of treatment outcomes, as well as future reports to Congress.

TRICARE is the only major insurer in the United States which does not include ABA as part of its regular benefit. All 50 states require commercial insurance to cover ABA, and Medicaid, the federal Children’s Health Insurance Program (CHIP) and Department of Veterans Affairs beneficiaries in all 50 states have access to ABA. Military families deserve access to the same evidence-based, medically necessary services for ASD as their civilian counterparts. Numerous studies show children who have access to ABA are less likely to need additional support and services and are more likely to become independent, thriving contributors to society.

ABA is an evidence-based ASD treatment recognized by experts:

  • The U.S. Surgeon General considers ABA to be an evidence-based best practice treatment.
  • The CDC has called ABA a “notable treatment approach” that is widely accepted among professionals in many treatment settings.
  • The American Psychological Association has found ABA is “well-grounded in psychological science and evidence-based practice.”
  • The American Academy of Pediatrics has noted: “most evidence-based treatment models are based on the principles of ABA.”

According to the Defense Health Agency (DHA), more than 16,000 children of military families receive Applied Behavior Analysis (ABA) therapy, the primary treatment of ASD, through the ACD.

About National Coalition for Access to Autism Services (NCAAS)

The NCAAS is a nonprofit organization representing autism treatment providers and the hundreds of thousands of children and families they serve in every state who are diagnosed with autism spectrum disorder. NCAAS providers contract with TRICARE, public schools, Medicaid, CHIP, and commercial insurers to provide essential medically necessary treatment to patients of all ages.

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https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X120-doc

https://www.cdc.gov/ncbddd/autism/treatment.html.

https://www.apa.org/about/policy/applied-behavior-analysis

https://publications.aap.org/pediatrics/article/145/1/e20193447/36917/Identification-Evaluation-and-Management-of

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