Autism treatment field, largely unregulated, finally gets a license

A long awaited action by the legislature has afforded parents of children with autism a level of consumer protection they never had before, and has granted to the behavior specialists in the field a degree a professionalism and responsibility that they have been crying out for since the 1990s.

Starting this month, anyone seeking to practice behavior analysis — long considered the leading approach to helping people with autism learn new skills — must be licensed by the state. And in another important signal that the field has evolved into a proven profession, licensed behavior analysts will from now on be designated as mandated reporters of suspected child abuse or neglect.

“The primary benefit of licensure is consumer protection,” said James Carr, CEO of the Behavior Analysis Certification Board in Littleton, Colo. “Parents and caregivers are going to know that they are getting someone with a defined background in the profession.”

It has been a long time in coming.

Even as the prevalence of autism exploded and state after state began to license treatment specialists, Connecticut sat back and allowed the practice of behavior to remain largely unregulated.

In fact, a review by The Courant found that out of a group of 60 providers of behavioral services who have been accepted to do work for the state Department of Developmental Services, 17 had no license in any professional field, not behavior analysis, not social work, not special education, not psychology.

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Under review

Department officials told The Courant Friday that the agency is reviewing the qualifications of those who are doing behavior analysis work. Those without credentials will be required to work under the supervision of a licensed behavior analyst. Failing that, the person receiving the service will be transferred to someone who is licensed.

While there is, and has been since 1998, a group of board certified, master’s- and doctorate-level practitioners in the state, they have been stretched thin, and the side doors to the profession were always left open.

That allowed people with far less professional training to slip in and find work in family homes and even in schools, particularly during the first decade of the 2000s, as parents with children who were newly diagnosed with autism became desperate for qualified analysts.

A person with a good rap and an affinity for working with children could earn a lot of money, at rates approaching $400 an hour — and they could keep working for months or even years, unless or until a parent or school district recognized that the impostor was skirting the requirements for studied observation, precise assessments of behaviors, careful data collection, an individualized treatment plan, and follow-up.

‘Cowboys’

“I called them cowboys — maybe they got a list of programs, maybe they attended a workshop, or they spent time working with someone who was qualified,” said Suzane Letso, the mother of son with autism and a pioneer in the field in Connecticut.

Several years ago, Letso helped win title protection for the real practitioners. It became a felony for someone without board certification to call him or herself a behavior analyst.

However, that didn’t stop people with no credentials from offering their services. They just avoided the title, Letso said.

“Of course it can do harm,” Julie Swanson, mother of a son with autism and a special-education consultant, said of the work of unqualified behaviorists. “If the intervention doesn’t work, behavior problems can linger into adulthood, and they can become magnified in adulthood. If the assessment is wrong, then the treatment plan is going to be wrong.”