From the Washington Times

DRISCOLL/O'HANLON: The Pentagon and autism
Wednesday, July 2, 2008

COMMENTARY:
After years of major publicity efforts, Americans are increasingly
aware of the prevalence of autism spectrum disorders in our country.

One in every 150 children, perhaps more, are afflicted by one variant
or another of this disability, which challenges children - and in most
cases, when they grow up, adults - in the areas of language, social
interaction, and life skills needed to survive in this challenging
world. Debates continue about what causes autism, but no one who has
seen the problems in their own children, as we have, doubts its
severity or its consequences.

Tragically, very little is done for most children with autism. That is
mostly because treatment is so expensive, and so infrequently covered
by the nation's health care plans and insurance companies. Less than
10 percent of all affected children get the 25 or more hours per week
of therapy determined to be the minimum standard by the American
Academy of Pediatrics and other national medical policy organizations.

The Defense Department has an opportunity to set a precedent in this
area, and Congress faces a golden moment to provide the legislation
needed. The Pentagon may not seem the natural leader in health care
for special needs children, but given how much are asked of our men
and women in uniform and their families these days, it is only
appropriate that the U.S. Armed Forces do what they can for their own
warriors facing autism in their families.

If done properly, the Department of Defense (DoD) will also provide a
model for other insurers and health plans to emulate. If at a time of
war, the DoD can recognize the importance of funding prescribed autism
treatment, it will send a powerful message for others to follow.

But first, a few words on what this treatment seeks to accomplish. The
core method is Applied Behavior Analysis (ABA)In some ways it
resembles one on one tutoring. But it is specifically attuned to the
behavior issues and needs of children on the autism spectrum. ABA
effectively develops and improves language and communication skills,
social interactions, positive family relationships, daily living
skills, and executive functioning. It teaches skills, step by step,
that most typical children develop automatically by observing and
imitating and interacting with others.

Careful analyses including a recent important Wisconsin study show up
to half of the children receiving intensive ABA services can recover
enough to be mainstreamed into the general education setting.
Virtually no children with autism disorders achieve this outcome
absent such help. With appropriate levels of intervention, they can
often then become productive adults, form friendships, hold jobs and
pay taxes - instead of becoming burdens of the state. Even for the
more severely afflicted, they can learn many self-help skills through
therapy that will greatly improve their quality of life and will
reduce the chances they will need institutionalization later. They can
develop family relationships; they may even be able to develop some
friendships. It is not too much to say that in many ways they can
reclaim the very humanness that autism steals from them.

These treatment methods aren't perfect. As noted, while as many as
half of all kids getting intensive intervention wind up mainstreamed
in school, the other half still do not. Just as with cancer treatments
and so many other wonders of modern medicine, what works for one child
with an autism disorder may not work as well for another.

Additional methodologies for autism therapy such as Floortime and
Relationship Development Intervention, though less well-established,
seek to push the state of the art further. For some children, they may
offer some benefits that ABA does not. Whatever the respective virtues
of the various methods, they are clearly each better than no therapy
at all.

Nonetheless, insurance companies often shamelessly cite the fact that
the autism therapy field is still evolving to deny coverage, claiming
the treatments are experimental. This is not only bogus, but
heartless, and scientifically shameful. Another excuse used by
insurers is that autism therapies are not medical in nature.
Admittedly in some respects they look educational; admittedly they are
often provided by a few (enlightened and well-resourced) school
districts for older children. But autism therapy resembles speech or
occupational therapy - methodologies that generally are covered by
health insurance. And waiting until the school-age years for intensive
therapy is waiting too long in any event.

Back to the Department of Defense. Military children with special
needs face unique circumstances and stresses. The continuum of care
afforded to military children diagnosed with autism is disjointed and
compromised due to the frequent geographic moves and the lack of
effective services available publicly and through the Department's
main health care program known as TRICARE.

Wait lists for state-run programs exist in most states. This
effectively denies care for our military children who wind up bouncing
from the bottom of a wait list to another wait list as they move from
duty station to station.

Effective treatment programs are far beyond the resources and ability
of public schools to deliver (and also beyond the personal means of
most military families). Ongoing relocation makes it extremely
difficult to pursue legal options to compel schools to provide for
effective services. Expecting families to enter legal proceedings at
each duty station to maintain basic care is unrealistic.

Many military families choose to pay for medically prescribed autism
treatment themselves, to the extent possible, and incur significant
debt. This unduly burdens already stressed families, which often have
one parent deployed abroad these days.

Understanding the difficulties military families experience, TRICARE
provides for limited coverage of autism therapy up to $2,500 a month.
That is good, but therapy can easily cost more than $5,000 a month
(one of our children just broke the $10,000 monthly barrier).

Treatment delayed or not provided at the prescribed amount diminishes
effectiveness - and also hurts the warfighter overseas, who should not
have to be distracted by excessive worries about his or her children
and their ability to access desperately needed services.

There is reason for hope. Recently, led by retired U.S. Navy admiral
and Rep. Joe Sestak, Pennsylvania Democrat, the House passed
legislation increasing funding of ABA to $5,000 a month and
establishing procedures to accelerate access to needed therapies for
our military children. The DoD costs would not be trivial, but would
be measured in the tens of millions a year and not the hundreds of
millions or billions. Moreover, the financial impact today is far less
than the long-term consequences to society of not providing for
effective treatment.

Now families are seeking support and assistance from our Senate
leaders to pass similar legislation. It is an excellent moment to help
many of our nation's warriors and their families, and in so doing, to
set a standard that can ultimately help hundreds of thousands of
children with autism throughout our country.

Karen Driscoll is the wife of a U.S. Marine and the mother of three
children. She has been active as a representative and spokeswoman for
Marine families. Michael O'Hanlon is senior fellow at the Brookings
Institution.