1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
The decision I'm facing is determining when Applied Behavior Analysis (ABA) is appropriate for individuals with autism, both children and adults. I'm particularly interested in understanding if there is developmental gain in adults from ABA and at what point the risks of side effects of ABA outweigh the benefits. This decision is critical because there is significant variability in the intensity and delivery of ABA across the country. ABA treatment usually demands a major commitment from families, patients and others involved.
I'm concerned about regions where high levels of ABA treatment do not seem productive while in other areas children may wait months or even years to access treatment due to a shortage of providers. This delay could result in missed opportunities for effective intervention, further straining the healthcare system. Additionally, I have reservations about a tread in Texas where some children are being diverted and removed from school to receive ABA in clinics, potentially compromising their education, treatment options and general future. Given these issues I believe that there is a critical need for unbiased information to guide the appropriate use of ABA.
2. Why are you struggling with this issue?
I am struggling with this issue due to significant uncertainties about the benefits and risks associated with ABA particularly when its overused or inappropriately applied. While ABA can be highly beneficial for children between the ages of 2 and 5, many of these children remain on waitlists, unable to access treatment during a critical developmental window. At the same time, there are cases where individuals continue to receive intensive ABA for 10's of years, often with questionable outcomes. This raises concerns about the potential overuse of ABA and whether some individuals are receiving treatment that may not be effective, which in turn exacerbates the shortage of available provider for those who might benefit the most.
I struggle with the identification of the side effects of ABA and dependency it creates when inappropriately delivered. I am concerned in how it conceals the identification and evaluation process and management.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
I want to see a system where early and comprehensive ABA is readily accessible for children between the ages of 2 and 5 with all barriers removed to ensure timely intervention during this critical period. This includes fostering a collaborative approach that fully supports these children and their families, with clear guidance and resources for parents.
To achieve this, I believe ABA recommendations should be made following a comprehensive evaluation that involves input from all relevant providers and treatment planners. Ongoing, collaborative monitoring should ensure that the treatment is aligned with realistic expectation and tailored to the individual needs of each child. I will know that my concerns are being addressed when there is a seamless process for early access to ABA, supported by a robust framework that integrates comprehensive evaluation, collaboration among professionals and clear realistic goals for treatment outcomes.
4. When do you need the evidence report?
Sun, 08/24/2025
5. What will you do with the evidence report?
I will use the evidence report to guide the management of care within both commercial health care organization and Medicaid management of ABA services. Additionally, I plan to leverage the report in Texas to shape the education and adoption of evidence based ABA delivery ensuring that practices align with the best available data. I am eager to contribute to this process in any way I can. I want to help promote informed decision and improve outcomes for those receiving ABA therapy.
Optional Information About You
What is your role or perspective? Physician consultant (Medicaid) and Medical Director (commercial)
If you are you making a suggestion on behalf of an organization, please state the name of the organization PENNSYLVANIA OMHSAS
May we contact you if we have questions about your nomination? Yes
