Report Details DoD’s Misuse of Science to Make Case

The Department of Defense (DoD) is bending science to justify cutting critical, medically necessary services for military children with autism to save money, according to a report released today by the National Coalition for Access to Autism Services (NCAAS).

The report was written by Dr. Ira Cohen, who is one of the world’s foremost scientific and medical authorities on autism and is the author/co-author of more than 100 peer-reviewed scientific and medical papers on autism.

“The DoD has been playing fast and loose with science to discredit a highly effective autism therapy and, apparently, substitute a cheaper and less effective treatment,” said David Fuscus, National Coalition for Access to Autism Services spokesperson. “The DoD’s campaign is based on the seemingly intentional misuse of a highly regarded scientific and medical tool to evaluate progress in children with autism.”

Since 2018, DoD has been systematically building a false case to Congress that a common and trusted treatment does not work, saying repeatedly in quarterly and annual reports that Applied Behavior Analysis (ABA) is ineffective, which couldn’t be further from the truth. ABA is considered an evidence-based best practice treatment by the U.S. Surgeon General, all 50 states require commercial insurance coverage, including Medicaid beneficiaries and children participating in the federal Children’s Health Insurance Program (CHIPS) in all 50 states have access to it.

Further, numerous studies show that children who have access to ABA are less likely to need support and services and are more likely to become independent as adults. Yet, the DoD continues to wrongly evaluate children with autism in order to disprove ABA’s nationwide-accepted efficacy.

Dr. Cohen, who created the leading autism assessment and analysis tool that the DoD has been using to evaluate military children with autism receiving ABA, recently wrote a paper citing that the DoD’s misapplication and misinterpretation of the tool produced dismal and erroneous conclusions. “I can only conclude that the persons responsible for scoring the tests didn’t read the instruction manual which biased TRICARE’s analysis and made the results meaningless,” wrote Dr. Cohen.

Dr. Cohen also analyzed numerous flaws in the DoD’s data, and wrote that the “most glaring is the total lack of understanding as to how the [behavior survey] is scored and interpreted and the obvious failure to read the manual. This led to the elimination of vast numbers of cases… because of the incorrect assumption that a score of “0” means that the item was ‘missing’. Instead, it means that the behavior was not seen.” As an example, in 2018, the DoD discarded 90% of 14,700 assessments in its original test sample, only drawing conclusions from 1,577 children because of the assumed missing data.

“Even a first semester statistics student knows that if you throw out 90% of the people in a study, something is terribly wrong,” continued Fuscus. “Nearly 17,000 military children with autism receive Applied Behavior Analysis as their primary treatment, and the DoD continues to use a flawed study with bad data just so they can stop covering it under military health insurance.” ABA is currently covered by the Department of Defense Autism Care Demonstration that is schedule to expire on December 31, 2023.

“If the Department of Defense is successful in killing coverage for ABA, military families would be the only population without access to ABA,” continued Fuscus. “TRICARE is alone in the wilderness with their antiquated view of this vital treatment for autism. All 50 states require commercial insurance to cover ABA, Medicaid beneficiaries have access to ABA and even all other forms of federal health insurance, including from the Veterans Administration, cover ABA because it is an effective and established treatment. The Congress has never asked DoD to provide a cost-effective evaluation, so DoD must have some purpose for focusing on cost,” said Fuscus.

And the DoD is getting aggressive about destroying funding. Even though Congress never directed that program costs be evaluated, DoD has made money a key metric to evaluate the program. It recently wrote to Congress that leading up to 2023, DoD will be “analyzing, evaluating, and comparing the quality, efficiency, convenience and cost effectiveness” of the ABA program.

“The tone and language of these reports and the focus on program costs make it clear that DoD is trying to abolish this pediatric autism program and deprive military families of a gold standard treatment that is widely accessible to civilians,” concluded Fuscus. “The Department of Defense and TRICARE clearly want to substitute something less effective, and less expensive, than Applied Behavior Analysis.”

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