Investing in intensive behavioral intervention reduces future burden


Mental health does not receive adequate funding to provide sufficient care for kids with autism. It is vital the state and providers recognize that the costs and risks of not investing in intensive Applied Behavior Analysis (ABA) services for children with Autism Spectrum Disorder (ASD) are significantly higher.

Assuring access and adequacy of ABA-based therapy for children with ASD could save Michigan almost $20 billion in preventable educational and social services expenses over the lifetime of the 9,000-plus children born in Michigan between 2013 and 2017 who have ASD and will be entering the school system; and an additional $2.2 billion for each birth year cohort after that.

In 2016, there were approximately 114,000 births in Michigan. As ASD generally can’t be reliably diagnosed until between 18 and 24 months of age, using recent data from the Centers for Disease Control and Prevention, it is likely that during 2018, there were anywhere from 2,000-2,500 new toddlers in Michigan who demonstrated behaviors and deficits in communication and social interaction that met diagnostic criteria for ASD.

The lifetime per person incremental societal cost of autism has been estimated between $2.4 million and $3.2 million; children with ASD cost between $200,000-$300,000 more in educational services and supports between kindergarten and age 18, and millions more in social, economic and housing supports between 18 and 65 years of age.

However, there is substantial evidence as to the power of intensive behavioral intervention with ABA to improve the lives of children with ASD and their families and reduce the social and economic burden of ASD on society.

ABA is a “dose-dependent” therapy; higher doses result in greater treatment effect. Expert guidance recommends a minimum of 25 hours per week 12 months a year for comprehensive interventions. Studies comparing the costs associated with 18 years of special education to the costs associated with the implementation of an average of three years of ABA-based Early Intensive Behavioral Intervention (EIBI) revealed savings of approximately $200,000 per child across 18 years of education after three years of EIBI. Such an investment would save Michigan a total of more than $400 million in special education costs just for the 2016 birth cohort. 

Untreated or undertreated, ASD seriously impedes potential for employment and the capacity to live independently; the parents of children with ASD are more likely to be unemployed. The investment in intensive ABA can reduce the cost of social services, housing and vocational support services, special payments and health care costs associated with persistent ASD-related disabilities by $656,000-$1,082,000 between 18 and 55 years of age, as well as reduce the risk that parents of children with ASD will stop working. Investing in intensive ABA as soon as possible after diagnosis could additionally save the Michigan social services systems as much as $1.8 billion until age 65, for each annual birth cohort.

The implications for taxpayers, lawmakers, policymakers and regulators are clear: Investing in at least three years of intensive behavioral intervention for every child will significantly reduce the social and economic burden of ASD-related disabilities on children, families and the community.

Steven Merahn, M.D., is the chief medical officer for Centria Healthcare, which has a location in Walker.

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