My Blog
The insurance company reduced this child's applied behavior analysis therapy for her autism and the child must wait while the family contests the decision.
WASHINGTONPOST.COM Opinion | Insurance companies aren’t doctors. So why do we keep letting them practice medicine? To get access to health care, you don't just need insurance. You also often need to navigate all the hoops and hurdles of health plans.
One study compared 661 children ages 5-12 years in 5 cohorts over 10 years of which 510 (77%) were admitted for aggressive behavior PRN medication use including sedatives and antipsychotics was significantly less when a behavior modification program was used vs verbal de-escalation. PRNs (As needed medications) were used 163 times with a behavior plan compared to 483 times without one per 1,000 patient-days. Seclusion and physical restraint were also reduced, used 17 times with a behavior plan vs 65 times without one per 1,000 patient-days.
It's a shame that in NY board certified behavior analysts are restricted to autism.
"Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study"
This is another example of why medications are not a safe substitute for applied behavior analysis with supplementary aversives including skin shock if needed. Unfortunately, this recall is for medication dispensed over two months ago, long after people were placed at risk and no one could have predicted this side effect beforehand. The ultimate punishment is death, which can result from a behavior or a side effect of a drug. A 2 second skin shock is the less restrictive intervention by far. We need to be prescribing judiciously, to serve an individual if needed, not to benefit inappropriate placements with insufficient structure, lack of trained staff and useless politically correct behavior plans with no consequences for dangerous behaviors other than chemical prisons.
Ten years ago if you told me one day I would have two dogs in my house, as a psychiatrist, I would have said that you’re delusional. My husband always wanted a dog and I always answered that dogs were filthy animals and I will never let one in the house. I also had a fear of dogs. Then one day at an autism conference, someone spoke on service dogs. I saw how they can help with behaviors and stop my daughter from running away. My husband was surprised when I came home and said I wanted a dog. Once outside, I was holding her hand and I tripped, let go of her hand, and she ran into the street. An SUV stopped within a few inches of hitting her. Seven years ago, after getting a dog, Cecil, I didn’t have to worry about it anymore. Talia learned to walk holding a handle on the dog, rather than someone’s hand, which is stigmatizing and not as secure. She is hooked up to the dog wherever there are cars looming around so I never had to worry about her running into traffic again. Even at school, having Cecil stopped Talia from running away. Other dangerous behaviors also decreased at home.
When Cecil had to retire, I was worried about a replacement. The organization that gave Talia Cecil stopped providing autism service dogs. I was worried about the cost and even if I could get a replacement dog. I have to pay Talia’s school tuition and the NYC Department of Education stopped paying her home applied behavior analysis therapists five months ago. I only work part time because of Talia’s needs, so my income is limited. I found out that BluePath would replace the dog at only a small fee for dog necessities such as preventive medications. We received Tricia in July.
Tricia has been great. Two months ago, while an applied behavior analysis therapist was taking Talia for a walk, she suddenly attacked him and he called me for help. As I ran outside, I knew at least she could not run into the traffic.
Last Saturday, my husband and I took Talia to synagogue and she was being too noisy. We left the main sanctuary and brought her to the preschool group. My husband went back to the sanctuary and I stayed with Talia watching the preschool children do activities and sing songs, while I had to keep redirecting Talia not to put a toy in her mouth. Then something hit me, like a stone being thrown at my heart. Talia is turning 18, will be a legal adult, and she couldn’t do- and most likely never will be able to do- what these preschool children were doing. The teacher was talking to the children about being grateful, and I thought she should tell them to be grateful that they can talk, as Talia only speaks a little bit. Tears started falling and I couldn’t find tissues nearby. I covered my face so no one else would see me and quietly asked another mother to watch Talia for a minute, telling her to make sure Talia doesn’t put the toy in her mouth. I ran to the bathroom and tried to use coping skills I tell my patients to use. I thought this was ironic, as I have tried to comfort countless parents crying in my office and here I was. When I returned, the other mother and Talia were at the door, as Talia was trying to leave the room, but Tricia thankfully stopped her, and for that I am grateful.
Once my older daughter and I were visiting Matty at JRC, I had a flat. The AAA worker when putting the donut on broke two lug nuts. Then next day when I went to buy a new tire the mechanic told me driving with only three of five lug nuts can cause an accident and he would never let me leave with only three lug nuts in a wheel. Instead I would have two wheels with four lug nuts. That night my daughter noticed there was still only three lug nuts in the wheel. I slowly drove to another mechanic, and thankfully without an accident.
Recently, the NYC Office of Pupil Transportation’s actions could have caused an accident. Twice a year soon before routing, I call the Office of Pupil Transportation (OPT) to make sure they do not put another child on the bus who is fearful of or has an allergy to dogs with my daughter Talia with autism who has a licensed service dog. They did it years ago, and despite reassurances when I call, they did it again. It started the last week and a half of summer school when the other child was picked up after and dropped off before my child so I didn’t notice a problem. The parents of the other child wrote a letter to the Committee on Special Education that their child had a fear and an allergy to dogs and OPT reassured me again that would not happen. Well in September, they put the children on the bus together again.
This time the child was picked up before mine and when I put my daughter on the bus with her service dog, the other child started screaming. My daughter is highly noise sensitive and can take off her seat belt, attack people or hurt herself including banging her head if someone else is making a lot of noise. Just like my experience at the tire store, this can cause an accident. The OPT finally put the students on separate buses although twice the afternoon bus did not pick up the other student and the mother had to pay for an Uber for the student and his para. One day after being stranded the bus showed up an hour late. No apologies. Now, clearly to this child having a dog around is aversive. He was exposed to aversives an hour in the morning and a half hour in the afternoon, 90 minutes, 5,400x longer than the two second aversive skin shock GED my brother received, and unlike the GED it surely wasn’t saving his life.
Here is another school district aversive, a public school program recommended for my daughter, whose IEP states she is noise sensitive. In this program students must have their meals either with four classes combined or in the lunch room with the typical high school students. This aversive exposure to loud noises would be 40 minutes a day for lunch for a total of 2,400x the GED application, and unlike the GED application which is on average once a week, these aversives would be five days a week. Unlike the GED which has been shown to stop life-threatening behavior, these aversives might precipitate one.
Well, I am sure the anti-aversive advocates must be outraged about the school district’s aversives, since they care so much about individuals with disabilities. Surely they will put in the same effort they do to ban the two second skin shock to stop the school district from recommending such public school placements to noise sensitive children, and they will make sure the busing is monitored correctly. They will forcefully advocate on local and federal levels to make sure these situations never happen again, just like they do against JRC. Oh, wait, what was I thinking? I must have been dreaming. I guess it’s all those sleepless nights when Talia is screaming, attacking me or herself, or when I’m cleaning up her room after her monthly visitor arrives, looking like what any outside person would assume is a crime scene, or if her home therapists will quit because the NYC Department of Education hasn’t paid them for over four months, or how I ‘m going to pay Talia’s next tuition installment after I rejected the public school placement. By the way, today the school bus never arrived to take Talia home so she got to watch all her classmates leave. So much for alternatives!
PS: Perhaps the anti-aversive activists feel that my daughter who is noise sensitive must endure the aversive of having her lunch in a regular high school cafeteria for a higher power: “inclusion.”
