Cost-Benefit Analysis: Early Intensive Behavioral Intervention for Children with Autism

Applied Behavior Analysis Early Behavioral Intervention is typically provided to children with autism for 2-3 years beginning at 2-4 years of age, costing an average of $50,000 per year for a total of $100-150,000. A lifetime cost analysis incurred by individuals with autism conducted by Michael Ganz of th
e Harvard School of Public health indicated “the total annual societal per capita cost of caring for and treating a person with autism in the United States was estimated to be $3.2 million….,” of which direct medical costs totaled $305,956. (Ganz, ML (2007) The Lifetime Distribution of the Incremental Societal Costs of Autism. Arch Pediatr. Adolesc Med. 161).

Numerous studies indicate that approximately half of children with autism who receive Early Intensive Behavioral Intervention for 2+ years function in the typical range by 6-7 years of age and are able to participate in regular education, community and family life. Those individuals do not require on-going intensive medical treatment or the additional costs associated with home health care or group home/residential care typically covered by Medicare, private insurance supplemented by family out-of-pocket expenditures,
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are obviated.

This suggests medical and indirect care costs incurred by individuals with autism who have received EIBI should be reduced by half (i.e. $1.6 million over lifetime per individual), assuming their health care costs should approximate those of a typically developing child (i.e. $11,000 from birth to 18 years of age). This substantial savings can be realized by providing the best scientifically validated, evidence-based treatment available, i.e. Early Intensive Behavioral Intervention. These estimates do not include reduced costs of caring for half of individuals with autism who experience significant, but less dramatic improvements as a result of EIBI.

The health and economic consequences of lack of appropriate early treatment are serious and can be severe and life-altering

According to the National institute of Neurological Disorders and Stroke, “Autism varies a great deal in severity. The most severe cases are marked by extremely repet
itive, unusual, self-injurious, and aggressive behavior. This behavior may persist over time and prove very difficult to change, posing a tremendous challenge to those who must live with, treat, and teach these individuals…. Adolescence may worsen behavior problems in some children with autism, who may become depressed or increasingly unmanageable.” NINDS Autism Fact Sheet, 2010; May 4, 2010

Prior to the late 1980s when autism early behavioral intervention was first introduced, many individuals with autism exhibited downwardly worsening severe behavior problems (aggression, self-injury, property destruction), combined with lack of communication and social skills, that led to institutional or specialized residential placement in settings for people with developmental disabilities, often for the rest of their lives. These
services are funded by Medicaid with cost in state public institutional costs ranging from $100-$200,000 (mean= $134, 619) per year per resident. The average annual cost of care in private community residential facilities is $52,585. (Braddock, D., Hemp, R and Rizzolo, MC (2004) State of the States in Developmental Disabilities. Mental Retardation. 42: 356-70). [David Braddock shown in embedded photo.]

Not only do we value the lives of the children with autism with whom we work, it makes economic sense as well. This does not imply that every child with an ASD medically requires 40 hours per week of EIBI for four years, but it makes a strong case for individualization of EIBI services for children with autism matching their profiles of characteristics.