Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder

Area of Science:

• Pediatric Health
• Behavioral Science
• Health Services Research

Background:

• Applied Behavior Analysis (ABA) is a common therapy for Autism Spectrum Disorder (ASD).
• Integrated healthcare systems and state autism mandates aim to improve access to ABA services.
• Understanding service receipt patterns and patient outcomes is crucial for optimizing care.

Purpose of the Study:

• To examine patterns of ABA service receipt for children with ASD.
• To evaluate patient outcomes, specifically time in ABA and adaptive behavior, in an integrated healthcare system.
• To assess the impact of a state autism mandate on ABA utilization and outcomes.

Main Methods:

• Retrospective, observational study of 334 children (3-17 yrs) with ASD referred for ABA.
• Data extracted from clinical reports over 24 months within a Southern California integrated healthcare system.
• Primary outcomes: time in ABA and child adaptive behavior.

Main Results:

• 13% of referred children never started ABA.
• 66% initiated ABA and stayed for 12 months; 46% for 24 months.
• Lower functioning children showed significant adaptive behavior gains (p=0.02), despite low ABA dosing (28% received full dose).
• Special education history correlated with longer ABA duration; single-parent status correlated with discontinuation.

Conclusions:

• High rates of ABA discontinuation and low dosing were observed in this health system.
• These service delivery challenges may reduce the potential benefits of ABA for children with ASD.
• Mandated insurance coverage alone may not overcome systemic barriers to consistent ABA therapy.