AAT Case Management Guide

Applied Behavioural Analysis (ABA)

OFFICIAL For Internal Use Only

Field	Content	Reference Documents
Title	Applied Behavioural Analysis (ABA)	-
Purpose	This document is part of a suite of guidance documents for case managers to use in formulating their approach to managing individual cases before the Administrative Appeals Tribunal (AAT).	-
Scope	ABA therapy refers to a non-pharmacological behavioural intervention to help children diagnosed with Autism Spectrum Disorder (ASD), intellectual disability or developmental delay to develop skills in communication, self-care and social interaction, and/or reduce behaviours that are barriers to learning and participation. ABA is one of a number of different evidence-based approaches to support children with ASD. It is characterised by intensive interventions, delivered by trained personnel in a clinical or childcare environment.	[Applied Behavioural Analysis (ABA) Therapy
Escalation to Hearing Oversight Committee (HOC)	If a matter is within the parameters of this document, the AAT CM Branch Manager may approve proceeding to hearing. Where there is substantial risk or the matter is outside the parameters of this document, the matter should be referred to HOC.	-
Current National Disability Insurance Agency (NDIA) policy on the subject	The NDIA will fund ABA therapy if the NDIA is satisfied it is a reasonable and necessary support. Where ABA therapy is to be funded as an early intervention support, the NDIA must also be satisfied that it is likely to reduce a participant’s need for future disability supports. Supports for children with ASD should be evidence-based and delivered using a family-centred approach that incorporates individual planning. ABA therapy is likely to NOT be delivered with a family centred approach and more likely to be delivered in an allied health clinic or childcare/school environment.	Section 34(1) of the National Disability Insurance Scheme Act 2013, Rules 3.2 and 3.3 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013, Operational Guideline – Applying to the NDIS, Operational Guideline – Early childhood approach

AAT Case Management Guide

Applied Behavioural Analysis (ABA)

OFFICIAL For Internal Use Only

NDIA Posture in relation to this subject	The NDIA is likely to fund up to 20 hours per week of ABA therapy where it is considered likely to be effective and beneficial.
Evidence from a meta-analysis of clinical studies indicates that it is unlikely that more than 15 hours per week of ABA will be effective and beneficial.
Where more than 20 hours of ABA is requested, the NDIA is most likely to run the matter to hearing. The matter will turn on the question of the participant’s age, and their own capacity as well as their family’s capacity to meet the time obligations of ABA therapy.
Where a participant has commenced school and requests more than 10 hours of ABA per week, the NDIA must consider the capacity of the participant and their family to sustain both full-time schooling and intensive therapy.

| | ECIA National Guidelines – Best Practice in Early Childhood Intervention Council of Australian Governments (COAG) – Principles to determine responsibilities of the NDIS and other service systems Operational Guideline – Creating your plan CXZS v National Disability Insurance Agency [2021] AATA 511 Intervention Recommendations for Children with Autism in Light of a Changing Evidence Base | Report, Dr M Sandbank et al (generalised findings, specific to older children) Autism CRC early intervention report | NDIS The Department of Defence (USA) | Comprehensive Autism Care Demonstration Annual Report 2021 A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism - ScienceDirect |

AAT Case Management Guide

Applied Behavioural Analysis (ABA)

OFFICIAL For Internal Use Only

Evidence recommended to inform NDIA position in a specific matter before the Administrative Appeals Tribunal (AAT)	Other considerations
To consider funding for ABA therapy, the NDIA requires evidence of a relevant diagnosis from a paediatrician, psychiatrist, psychologist or a specialist multi-disciplinary team. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is the NDIA’s preferred diagnostic standard.

Clinical evidence that ABA therapy satisfies the criteria in section 34(1) is also required to be provided by a psychologist, occupational therapist, paediatrician or, where a participant has received ABA therapy previously - an ABA therapist.

Clinical evidence must address the link between ABA therapy and a participant’s goals and specify how the requested number of hours of ABA therapy will be effective in assisting the participant to achieve those goals.

Evidence from a behavioural paediatrician who has assessed the participant in person is recommended. Professor Einfeld or Dr McDowell are recommended. | The NDIA must also be satisfied that ABA therapy meets the National Disability Insurance Scheme (NDIS) funding criteria – in particular, that it:

• is unlikely to cause harm to a participant or pose a risk to others;
• is not duplicated by other funded supports.

Consider the context and circumstances of the family and their capacity to support the delivery of 15–20 hours of intervention in the learning environment of the child (usually the home or school). Also consider:

• children with greater baseline cognitive skills and higher adaptive behaviour scores at baseline have better outcomes from early intensive ABA therapy; and |

Australia’s First National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders | Autism CRC List A: Conditions that are likely to meet the disability requirements | NDIS Section 34(1) of the National Disability Insurance Scheme Act 2013 Rules 3.2 and 3.3 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 Persons Giving Expert and Opinion Evidence Guideline | Administrative Appeals Tribunal Rule 5.1 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 How we work out if a support meets the funding criteria | NDIS Autism CRC early intervention report | NDIS Section 3 of the National Disability Insurance Scheme Act 2013

AAT Case Management Guide

Applied Behavioural Analysis (ABA)

OFFICIAL For Internal Use Only

• younger children have better outcomes from ABA therapy.

The NDIA must also have regard to a participant’s choice and control in the pursuit of their goals and the planning and delivery of their supports.

The AAT will not consider whether ABA therapy is an effective early behavioural intervention strategy for children diagnosed with ASD, but whether ABA therapy satisfies the criteria in section 34(1), which will be determined on the facts of each case.

Previous matters that may advise the NDIA position

When considering funding for ABA therapy, the NDIA must also consider the promotion of an applicant’s choice and control in the pursuit of their goals and the planning and delivery of their supports. It is the responsibility of the NDIA to show that ABA therapy can be substituted with other mainstream therapies and achieve the same outcomes for the applicant.

FRCT v National Disability Insurance Agency [2019] AATA 1478 WKZQ v National Disability Insurance Agency [2019] AATA 1480 CXZS v National Disability Insurance Agency [2021] AATA 511

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Document admin Quality, Strategy and Training

Approved Matthew Swainson, General Counsel

Endorsed Hearing Oversight Committee

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