Early Intensive Behavior Intervention - Cost of Care

Cost of Care

A concern that parents have brought up regarding Lovaas is the cost, which in April 2002 amounted to about US$4,200 per month ($50,000 annually per child). In addition, the 20–40 hours per week intensity of the program, often conducted at home, may place additional stress on already challenged families.

Another study estimated the expenses of a three-year period of DTT to total a conservative cost of $20,000 and the extreme cost of $60,000, with a yearly average of $40,000. These costs were based on a sliding scale model that would be adjusted accordingly to socio-economic status and parental involvement. Yearly expenditures were predicted to drop to an average of $22,500 a year when parents and family became involved in the process. Additional family involvement would subsequently alleviate case manager and paraprofessional hours by assuming their roles in the process. The upfront costs of DTT for the state of Texas would initially amount to $67,500 for three years compared to the currently state budgeted $33,000 for Special Education. The difference is predicted to be recovered within five years of the initial implementation of the program. Texas would experience a 72% reduction in expenses in the 15 year offset following the conclusion of DTT, amounting to a total savings of $84,300 per child.

However, the federal law called the Individuals with Disabilities Education Act (IDEA) requires school districts to provide a Free and Appropriate Public Education (FAPE) to all children over the age of three. Many Due Process and court decisions have found 35–40 hours per week of ABA to be FAPE. Parents may wish to consider hiring and attorney or advocate if their school district denies ABA treatment.

Thomas et al. (2007) conducted a survey study that involved 383 families with children diagnosed with autistic spectrum disorder from North Carolina. Three quarters of these families reported using a major treatment plan. Of these, college or graduate degree holding parents were two to four times more likely to use a neurologist and/or PECS. Annual incomes of $50,000 or more had higher rates of using developmental pediatricians and speech/language therapists. Racial and ethnic minorities were half as likely to see a case manager. These families also had a quarter of the odds of seeing a psychologist, developmental pediatrician, or implementing sensory integration. This supports several other national studies that concluded racial and ethnic families, parents with a low degree of education, and those not residing in a metropolitan area were more likely to receive limited care, utilize a less diverse range of services and less likely to follow a major treatment plan. Both the national studies and the North Carolinian study yielded a correlation between high stress levels and amount of services sought.

Families that did not identify with a major treatment approach had one fifth to one half the odds of using support of friends and family in providing care. Therapeutic support services (PECS, parent support classes, sensory integration, casein- and gluten-free diets) were also one fifth to one half as likely to be used compared to families identifying with major treatment plans.

Insurance coverage is another major determinant in the amount of support services received. Recipients of Medicaid or other forms of public health insurance have 2-11 times the odds of using services that are considered medically necessary. Utilization of respite, PECS, case managers, speech or language therapists also increases markedly in this bracket compared to families with private insurance.

Rising costs in education and the provision of adequate care for developmentally disabled individuals have been a continuing concern for state policy makers and tax payers alike. A study was conducted on cost comparison of 18 years of traditional Special Education on Early Intensive Behavioral Intervention (EIBI) for autistic children. The Texas state budget for the year 2002 allotted $11,000 per child for Special Education. The study suggested the state would save an average of $208,500 per child over an 18 year period by implementing DTT in early childhood, effectively curbing or eliminating future special needs costs by preparing the child academically for mainstreaming. This amounted to a potential total savings of $2.9 billion over an 18 year period for a cohort consisting of 10,000 autistic children.