This is about limiting access to ABA. ABA was started by the same guy that started gay conversion therapy. It’s not good. United Healthcare sucks, though. https://nsadvocate.org/2018/07/11/treating-autism-as-a-problem-the-connection-between-gay-conversion-therapy-and-aba/ #actuallyautistic #autism

minor but critical error here: ABA doesn't help autistic kids, it just makes them more docile and agreeable as reported by their parents and teaches teachers, at great cost to the kids. This is consensus in the autistic community. Reporting on ABA as a thing to be valued and protected is wrong and damaging.

I cannot speak to the controversy, as I just don’t have enough data to evaluate the efficacy or ethics of the modality. My daughter is autistic, but declined ABA when offered. Because I have always stood firm that she had full autonomy the moment she drew breath, I did not force it.

I have read a fair number of white papers which suggest the modality is both efficacious and ethical when dealing with profoundly autistic children, but the studies on functional disorders is scattered and I would suggest that the datasets are too small for anything but conjecture, but again, I’ve barely scratched the surface at pubmed.

All of that aside, in the case in the article, it was helping that child, and the insurance denial had nothing to do with ethics, and everything to do with profit. And that’s the bigger picture, they are eliminating any treatment options that aren’t quick fix, 4 appt CBT.

It's wonderful that you respect your daughter's autonomy. Too few parents do that, especially for their autistic children. It's what I've always tried to do with mine.

I'm not sure that ABA is helping Benji. I feel really bad for him after reading that article. He's ten and his mother still doesn't know what triggers his meltdowns&treats them like they're aggressive tantrums. He doesn't have his basic needs met and they're trying to make him work longer than a full-time job.

Benji desperately needs someone who understands what it's like to be autistic in his life to work with him and find what's needed to bring him peace. Speech is obviously not easy for him and he should be taught how to use an AAC device to communicate more easily.

The problem with ABA is that it's not focused on what the person being treated needs or wants at all but on what other people want to make them do. That's very evident in that article.

I was reprocessing this article a few minutes ago as we autistics are wont to do, and I realized in addition to being demanded to do something he can't, he's also probably frustrated they're treating him like he isn't very intelligent, because studies say that most nonspeaking autistics are of normal intelligence, they just can't speak.

I've been digging into ABA, from the provider perspective; i.e. people who administer or oversee the treatment modality, from the research perspective, i.e., what is it *supposed* to, or purportedly does for the autistic person, and from the perspective of autistic people who have experienced the treatment.

I will grant that my perspective may have been colored by stories people have shared with me, but as a bioethicist, I'm not sure how this became the *gold standard* of treatment, and I am suspicious that profit was more of a driver than efficacy.

That said; #UHC wouldn't cover any therapy for my kid when she refused ABA. They wouldn't cover a neuropyschologist to evaluate and recommend a different kind of therapist for her.

So, they won't pay for ABA. They won't pay for *not* ABA.
Ergo, I think we can safely conclude that they're just not going to pay to help autistic people.

I'm sorry to hear that. I feel like therapy really did help one of my children be more comfortable around neurotypicals, but it's impossible to know if that would have happened anyway. Thinking about my own life and that of my kids I think the most important things are to let autistic kids know that there's a reason they feel like they're different from the other kids (and that's ok!) and to treat them like they are human beings capable of making their own decisions.

I’ve just engaged an occupational therapist with a specialty in executive function. It’s not “autism” therapy, but it is skills she lacks. I want her to have the skills and habits she needs to survive when I’m gone. (I’m not going anywhere soon, Bob willing.) 💃
Of course it’s not covered by insurance, that would be ridiculous. I mean, just cause we give them 25k a year, why would they cover anything?

I think that's great! Executive functioning is second only to social interactions in things I've struggled with in life.

It might be worthwhile to get your kid assessed for ADHD if executive functioning is an issue. Two thirds of us have it and until fairly recently they weren't supposed to diagnose us with both. That said, autism by itself is certainly enough to cause executive functioning issues.

Yeah adhd is also a diagnosis. She find that the meds have helped a lot with that aspect of life management, which…yay!

I really can't put into words how wonderful it was when I finally got ADHD meds that worked. But that makes it really ridiculous that they won't pay for executive function therapy because that's a major part of ADHD.

it’s that there are no occupational therapists in network. There are almost zero therapists of any flavor in network. By design. ProPublica’s been on top of this, and had a story a week or two before The Adjuster reconfigured the c-suite at #UHC on how all insurance works overtime to get rid of therapists in network. I posted a link to it, but it’s probably easier to find on their site searching for therapists+insurance.
Wait, here: https://projects.propublica.org/why-i-left-the-network/

And this follow-up : https://www.propublica.org/article/unitedhealth-mental-health-care-denied-illegal-algorithm
Which is uhc specific.

Oh, that's terrible. I always pick the plan with the biggest network that my employer offers, but I know not everyone has that privilege.

We're not with UCH any more, but as propublica points out, it's all insurance companies doing their best to force therapists out. It's getting so that now therapists have to join group practices just to manage the insurance part of the business. And just like insurance companies bought up all the public and private hospitals, and many many private practices, they have turned their voracious appetites towards mental health practices.

Everyone my family goes to has been bought up by one of the two megaconglomerates in the area in the last two years.

yeah. I've never hesitated to pay too much in premiums to ensure I could get the care I needed (since one terrible experience with HMO, anyway), and even paying way too much up front isn't enough anymore.

Yeah, we have a "cadillac" HSA plan, and even with our high premiums, we still have a 3k per person, 12k per family deductible before any benefits other than negotiated rates kick in, and the provider pool is narrowing to the practices that the insurance company owns. The whole system is just beyond fubar, and a prime example of why capitalism should not be allowed to run amok without regulation.

We’re on Kaiser Permanente, which has its ups and downs. Not the UHC level of bullshit though.

I'm beginning to think UHC operated on an entirely previously undiscovered level of evil. Which is saying something in a universe that once held a Kissinger and a Cheney in the same room and didn't spontaneously combust from the sulfuric fumes of demonic celebration.