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Vancouver
The British Columbia Supreme Court says the province violated the Canadian Charter of Rights and Freedoms and discriminated against children with autism by refusing to pay for a controversial form of behaviour-modification therapy. The ruling came after families with autistic children filed a lawsuit. The province, home to 1300 autistic children, has filed an appeal.
About 150 BC families currently pay up to $60 000 a year for the intensive, 40-hour-per-week therapy developed by Dr. Ivar Lovaas of the University of California. Its supporters claim the Lovaas method is the only effective, long-term treatment for autism; 63 BC psychiatrists endorsed the therapy by signing a petition, which was used to support the lawsuit. The BC government's refusal to fund the treatment led several BC families to move to Alberta, where it is publicly funded.
In her ruling, Justice Marion Allan said early intensive behavioural treatment is medically necessary. She rejected the government's argument that it cannot afford the treatment, arguing that the costs "may well be offset by the saving achieved by assisting autistic children to develop their potential."
Autism, a complex neurological disorder characterized by excesses and deficits in speech, language, cognitive function and socialization skills, causes developmental delay that is evident to specialists by the time a child is 18 to 30 months old. Lovaas therapy is supposed to counter it with intensive training in pre-academic/academic skills, language, socialization and behavioural skills.
Dr. Sabreena Freeman, a sociologist who has an autistic child, says that with the therapy, basic skills are broken down and taught through repetition. In teaching colours to a pre-school-age autistic child, the therapist may place a red block on a table and ask the child to "give me red." If the child doesn't respond, the therapist would place his hand on the block and push it over. This process is repeated continuously.
Deborah Pugh of the Autism Society of BC calls the therapy "highly controversial," since some supporters, desperate for help, started calling the treatment a cure. "For decades families were given very little hope, and [then] Lovaas gave us reason for hope," she explains.
Dr. Ken Bassett of the BC Office of Health Technology Assessment says he is concerned by the lack of detail in the original 1987 study that introduced Lovaas therapy and its 1993 follow-up. "In his program, Lovaas provides a detailed manual, but the extent to which it was actually followed in his own studies is unknown. You can't even tell whether what is going on now is similar to what went on in the original study."
About 10 BC families with autistic children have moved to Alberta, where government-funded Lovaas therapy is available. Scott McDonald's 2 autistic sons now receive 38 hours of Lovaas therapy weekly, and he pays only 3% of the cost. He said autism takes a huge toll on families. "A lot of the people we know [who have autistic children] are now single parents," he said. —
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Copyright 1995-2000, Canadian Medical Association. All rights reserved. ISSN 1488-2329
(e) 0820-3946 (p)
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