Applied Behavior Analysis (ABA) is probably the best-known and best-researched therapy for autism. Its purpose, in essence, is to teach children with autism to act, speak and engage as typically as possible. In theory (and often in fact), when children with autism can engage with the world like other people, they are also able to take part in typical classes, make friends with typical children, and generally become a part of the world at large.

Given that ABA is not a panacea, and that it works better for some people than for others, it is still considered the gold standard for autism treatment.

The problem: when ABA is provided as prescribed (up to 40 hours per week of 1:1 therapy), it can cost as much as $70,000 per year. As a result, insurance companies are balking at the cost. An article in the LA Times describes a mutiny on the part of California health insurer who refuse to cover the treatment.

The argument made by the health insurers is that ABA therapy is not medical, but rather educational.

Of course, ABA does much more than teach academic content - and parents feel strongly that a therapy intended to build functionality should be considered medical. But it's understandable that medical insurers would make the "educational" argument to save money, and expect to be heard by the courts. Here's why:

• ABA is often provided by school districts. In fact, many kids with autism are placed in "ABA classrooms."
• ABA is often used to teach academic, social and life skills - none of which are, strictly speaking, medical concerns.
• ABA does not directly treat medical symptoms sometimes associated with autism, such as motor issues or mood disorders.

What's your feeling? Is ABA a medical treatment or an educational tool? Should it be covered by health insurers, or offered by and through schools? Or - should it be considered just one of many autism treatment options that parents can choose for their child and pay for on their own?

Physical awkwardness, low motor tone and other gross motor issues have always been among the symptoms of autism spectrum disorders. Up until now, though, there's been little research conducted to figure out why this is the case. Now, an intriguing study conducted by the Kennedy Krieger Institute and Johns Hopkins sheds some light on the subject:

The findings suggest that children with autism appear to learn new actions differently than do typically developing children. As compared to their typically developing peers, children with autism relied much more on their own internal sense of body position (proprioception), rather than visual information coming from the external world to learn new patterns of movement. Furthermore, researchers found that the greater the reliance on proprioception, the greater the child’s impairment in social skills, motor skills and imitation.

Based on findings in this study, researchers plan a follow-up study:

Potential next steps include the use of neuroimaging to investigate whether or not proprioceptive versus visual feedback is actually associated with abnormal patterns of structural and functional connectivity in the brain of children with autism. Additionally, researchers may study if patterns of motor learning can be altered to increase visual connections in specific regions of the brain. Through interventions such as cortical stimulation, biofeedback and behavioral approaches, researchers are looking to investigate if there is an improvement in children with autism’s ability to rely on visual input to guide how they learn a range of behavioral skills.

This is one of the few recent findings I've read of which seem to actually suggest directions for useful treatment of challenging symptoms. In essence, it may be possible to put these findings to work as a tool for rebuilding connections in the brain, thus improving physical, emotional and behavioral skills.

Sounds good to me!

There seems to be no end in sight to the debate over whether vaccines, in one way or another, actually cause children to become autistic. In fact, over the past three years, the debate has actually intensified, with believers on both sides lining up on opposite sides of "town," virtual pitchforks and torches in hand.

Throughout, I've found myself pummeled by both sides, as I attempt to take the position of a "vaccine moderate."

What does this mean?

On the one hand, I acknowledge readily that the vast preponderance of science-based evidence makes it highly unlikely that there is a consistent, large-scale direct connection between vaccines and autism. No, I don't think that kids who begin developing autistic symptoms six months after a vaccination are likely to be vaccine damaged. No, I don't think that an intolerance to wheat or dairy proves anything relative to vaccines (though of course I think it's a great idea to take a child with food intolerances off the offending food!). What's more, I am certain that any risk to the general population from vaccines is less than the risk from a resurgence of diseases like polio and diphtheria.

On the other hand... knowing that there are risks and benefits related all medical treatments, and knowing that there are children who are badly injured by vaccines overall, I believe that a very small number of autism-related claims of vaccine injury are probably for real. I suspect it is possible to create safer vaccines, to revisit the vaccine schedule with potential injuries in mind, and to discuss vaccinations intelligently with concerned parents. I can't understand what stands in the way of a well-conceived study that (at least in theory) shows that unvaccinated children are diagnosed with autism at the same rate as vaccinated children. I'd love to see some research into possible vulnerabilities that could lead to vaccine injuries. And I am baffled by the apparent unwillingness of the medical mainstream to seriously investigate credible anecdotal evidence of vaccine-related regression.

In short, I see reason on all sides of the issue -- though I stand squarely in neither camp.

As I've stated these perspectives over time, I've found surprisingly little support. I'm not sure whether that's because "vaccine moderates" tend not to write much about their moderate views (compared to those with stronger opinions) or whether I'm really in the minority.

What's your perspective? Is it possible to be a vaccine-autism moderate?

It's so tempting to read those blaring headlines and leap onto those gleaming bandwagons.

Today's headline on the BBC reads Problem pregnancy 'autism risk' -- suggesting to the offhand reader that a difficult pregnancy somehow causes autism.

Dig just slightly deeper -- to the blurb -- and you read something a bit different: "Complications during pregnancy and giving birth later in life may increase the risk of having a child with autism, a review of dozens of studies suggests." What this says is that someone reviewed existing research and found that we already have some information about correlations between certain prenatal issues and autism. Most significantly, we know (and have known for a long time) that there is a correlation between older parents and autism. We don't know, however, whether these correlations can be interpreted as cause and effect.

Dig a bit deeper -- into the article itself -- and you learn that:

The cause of the condition [autism] is unclear, and the review team from the Harvard School of Public Health said there was "insufficient evidence" to point to any one prenatal factor as being significant.

In other words, there are apparent connections between certain prenatal factors and autism -- but we don't know whether these apparent connections are causal or not. In fact, we don't even know whether these factors are significant or not.

Given the limpness of these findings, perhaps the headline should read "Review of Studies Shows We Still Don't Know What Causes Autism (Though It's Best to Have Babies Younger and to Stay Healthy During Pregnancy)."

But lack of evidence doesn't stop authors, bloggers and product salesmen from offering you advice on "how to prevent autism during pregnancy." Google the term, and you'll find plenty of information about how changing your diet during pregnancy and avoiding exposure to everything from pesticides to antibiotics will prevent autism. Of course, you can't possibly hurt your unborn child (and you could improve his overall health) by eating healthy foods or avoiding toxins. Avoiding treatment for maternal disorders, though, could cause far more problems than it prevents.