The Kossor Scale for Treatment Outcome Measurement

If you combine knowledge about neurological development with understanding of how Behavioral Health Rehabilitation Services (BHRS, still referred to in PA as “wraparound” services) are available as a treatment modality to children from birth to the age of 21 in Pennsylvania (and 32 other States) regardless of family income, you realize that the very early treatment (intensive, individualized practice) that children with ASD need (to change the direction and intensity of “neurological pruning” and connection-making described in the WSJ 10/5/17 article summarized below) can be funded 100% by BHRS through the EPSDT program of Medicaid.  The youngest child I’ve treated with BHRS so far was a 16 month old, who responded so well that we were able to discontinue treatment in one year (not claiming “cure” here but the child no longer needed BHRS).  Of course, the insurance company functionary (who challenged the child’s need for treatment by saying “all children that age cry,” to whom I replied “but almost all children by the age of 16 months do much more than cry, wouldn’t you say?”) had to be thwarted in order to get and keep the treatment funding.  I’ve just summarized the treatment outcome data collection system I developed that thwarted him and made the funding possible.  It’s available on Amazon for $15; search Kossor Treatment Funding to find it.  Best wishes always.



New Tools Detect Autism Disorders Earlier in Lives

Aside from genetics, any parental contribution to the disorders is probably nil

By Susan Pinker

The Wall Street Journal           Oct. 5, 2017 10:56 a.m. ET

When a child is diagnosed with an autistic-spectrum disorder, a parent’s emotions can swing from disbelief to worry to despair, and many ask themselves the understandable question: Why did this happen?

Genes are the answer, though which combinations are responsible remains a mystery.

The mounting evidence for a heritable cause hasn’t stopped some people from trying to pin the disorder on parents, fueling parental guilt and damaging families that are already struggling with a child’s diagnosis. Now a new study shows that the roots of autistic disorders are detectable so early in life that, other than genes, any parental contribution to the disorder is probably nil.

There is a long and bitter history of baseless finger-pointing around autism. In one of 20th-century psychology’s most shameful mistakes, supposed experts blamed the childhood disorder on “refrigerator mothers,” who were said to cause autism by being emotionally distant. Ultimately, studies showed that a crucial clue to the disorder’s origin was the babies’ inability to respond to their mother’s nurturing—not the other way around. Fifty years later, activists tied autism to childhood vaccines. This false idea led to fewer immunized children and a resurgence of dangerous infectious childhood diseases.

In this new study, John Lewis, the lead author and a neuroscientist at the Montreal Neurological Institute, analyzed data from the MRIs of 260 babies to chart the trajectory of their developing brains. (It was published this summer in Biological Psychiatry.) His previous work had revealed that toddlers with a strong family history of autistic spectrum disorders show sluggish neural pathways in areas critical to language and social development. Such pathways, composed of nerve fibers, transmit information from the body’s five senses and allow regions of the brain to communicate with each other. Dr. Lewis wanted to see how early these neural inefficiencies appeared.

Using MRI-based data, Dr. Lewis and his team charted—at six months of age and again at 12 months—the length and strength of fibers connecting different regions of the babies’ brains. Shorter and stronger connections are more efficient.

As children grow, their brains typically streamline such connections by “pruning”—a form of neural housekeeping whereby unnecessary or unused connections between distant brain regions are weeded out.

His research team the tracked neural pathways of two groups of infants. One group had a sibling on the autistic spectrum—which meant the baby was at high risk of developing the disorder. The control group had no family history of autistic spectrum disorders.

A comparison of the two groups revealed that, when analyzed as a group, the brains of 6-month-olds with an autistic sibling showed inefficiencies in the right auditory cortex, an area that processes speech sounds. By 12 months of age, certain neural areas critical for language, touch and self-awareness were also less efficient than those of the control group. “If your brain starts off not processing the sensory inputs efficiently, then it can’t do the proper pruning. It’s just passing on noise,” said Dr. Lewis.

The study was launched seven years ago, and by the time it was complete, the researchers knew which of the high-risk infants ended up with an autism spectrum diagnosis. (Almost 17% of the high-risk group received an autism diagnosis, compared with 1.3% of the control group.) Yet they found that the biological markers of their disorder were evident at 6 months of age.

A computer analysis of the high-risk group’s MRIs could retroactively identify which babies would ultimately show behavioral signs of autism spectrum diagnosis years later—and which babies would be unaffected. What’s more, the degree of neural inefficiency predicted how severe that child’s symptoms would be.

This research suggests that very early diagnosis—and early intervention—is on our doorstep. It also means that parents can’t be blamed.

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The “coarsening” of America continues… what can we do?

I’ve been watching the “coarsening” of America for the past forty years (grammar school kids assigned to read books with bloody horrific content including a wolf pack’s attacking and eating a deer — “held down by the nose and steaming out the rear” while being eaten alive is actually a line in the award-winning children’s book — is just one example) and there can only be one outcome for the pervasive immersion in themes of violence and wanton loss of life that videogaming has brought to hundreds of thousands of youngsters for decades, not to mention the influence of premature sexualization and the union of sexuality and aggression in media far and wide. Our election of a reality show personality to the office of the Presidency is only another symptom of how far we’ve fallen. The bottom is coming up fast, I’m afraid, despite all of the hard work that good people are doing as we are plummeting. 

My conclusion is that the best we can do is try to give wings to as many children as we can on the way down, so that they’ll have a chance to slow their descent and avert a hard landing.


Advice to students seeking a career in psychology

A student from a local University interviewed me today and asked “What advice would you give to students seeking a career in psychology?”  These words came to mind:  Never listen to anybody who tells you about future who isn’t creating it.


In defense of kind, compassionate behavioral treatment professionals…

I sincerely wish that every child with Autism symptoms could receive the biological treatments that could heal them, without any delay, and that they all would respond as quickly as we all wish they would, without side-effects and lingering disabilities. For those who can’t achieve these wonderful goals as fast as we all wish they would, behavioral treatment delivered by kind, compassionate professionals can mean the difference between life and death for children who behave dangerously.  Those treatment providers can enhance the life of every child they encounter and more parents should know how to identify and seek them.  I wish there were more of them, and fewer of the “others” who don’t warrant a friendly embrace. 

To indiscriminately run away from behavioral treatment providers, as some ersatz “Autism Advocates” have been recommending lately, is a tragic mistake.  More information about what it takes to be a kind, compassionate behavioral treatment professional is available at

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Update from National Geographic – they rejected my “Chasing Genius” entry because….

I included the logo for the Institute for Behavior Change in the video. Got to read the fine print….

In any case, I received a great deal of encouragement from a wide range of people for the model I created to deliver community-based mental health treatment to lots of children.  It’s a really good idea that will have to wait a little longer for it to be appreciated more widely, unfortunately.  Please let others know about it by sharing my blog post (below) about the National Geographic “Chasing Genius” program.

Best wishes always.


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My entry in the National Geographic “Chasing Genius” contest

National Geographic announced a search for innovative solutions to three global problems (including global health problems).  The application said “Tell us about the problem you are inspired to solve.”  Here’s what I said:

Children with mental illness symptoms need practice using new, mature problem-solving strategies and tactics.  Seeing a counselor once or twice a week in their office will never be enough practice for the vast majority of children!  Parents and teachers don’t have the skill, patience, time or ability to deliver all of the practice opportunities that children with disabilities (Autism, ADHD) require to learn new skills successfully.  Professionals who are trained and supervised can do this.

Then, they said “Provide a clear sense of how your idea will solve the problem identified.”  Here’s what I said:

A single licensed mental health professional can train and closely supervise 10 or more Masters-level mental health professionals who in turn each train and supervise 9 or more Bachelors-level professionals who deliver behavioral support and therapeutic guidance (opportunities to practice new skills) in the child’s own home, school and community.  No trips to an office, ever.  The services are entirely “evidence based” treatment procedures with decades of success behind them.  And they’re free.

Finally, they said “Share what inspired you to create your idea.”  Here’s what I said:

I’m a licensed psychologist and a certified school psychologist in Pennsylvania with 40 years of experience.  I have been delivering treatment to children using the model I created and described above, with funding for 10, 20, 30 or more hours of intensive, individualized treatment weekly per child.

They wanted a one minute video with the application.  Here’s a link to that:

I hope they think this is a worthwhile idea.  The staff of the Institute for Behavior Change and I have been perfecting the model I created in 1981 for the past 35 years.  Our treatment model has been examined by independent researchers from four different educational institutions since 2007.  They all agreed that the results are remarkable and worthy of publication.  With well over 1,000 treatment plans studied, they reported that the probability of the positive changes in the lives of all of the children treated had occurred due to chance was less than one in ten thousand.  That’s called a powerful and “statistically significant” finding in the professional literature, but not everybody respects findings like that, so I continue to call attention to the good work we’re doing.

We’ll see what National Geographic does with my entry.  In the mean-time, I’ll be publishing the results of some more treatment outcome research in conjunction with a book about the treatment outcome measurement system that I developed over the past 20 years that has been so successful in obtaining and retaining treatment funding via the EPSDT mandate of the Medicaid Act.  It’s called The Kossor Scale.  It will be released on Amazon (and to my friends upon request) in August.

Best wishes always for future success and happiness.


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Let’s tell the truth: PH95 is not a “loophole.”

Medical Assistance (Medicaid) Category PH95 was created by an act of the PA legislature in the late 1980s. Just like the legislatures in 32 other states, Pennsylvania’s elected representatives decided that the 14th Amendment (the one that established the right to “equal protection under the law”) applies to children with disabilities, regardless of their parents’ incomes. That some self-proclaimed advocates, especially those touting “decades” of experience, would call for the elimination of the PH95 category of Medical Assistance in Pennsylvania is not surprising. The same group came out to support Act 62 (requiring a license from the Board of Medicine for some supervisors of Autism treatment) which has crippled the ability of most providers of BHRS (“Behavioral Health Rehabilitation Services”) to deliver quality, essential treatment to children with Autism Spectrum Disorders.  The sponsors of Act 62 misguidedly confused “credentials” with “competence” (as if the acquisition of a paper certificate would somehow bestow competence on practitioners, or that the lack of that magical piece of paper could somehow revoke the competence that providers had been demonstrating for months – if not years – prior to the stillbirth of Act 62). The State Medicaid Agency backed Act 62 in Pennsylvania, just like the State Medicaid Agencies did in 30 other States, because it would drive kids with Autism Spectrum Disorders off the Medicaid roles.  Employees of the State Medicaid Agency in Pennsylvania and their fellow “advocates” have been calling for the “repeal” of PH95 for decades, referring to it (in official, written documents no less) as a “loophole” — as if that is an appropriate term for an act of the Pennsylvania legislature.

I have decades of experience too, and all of it supports the sensibility, humanitarian necessity, and fiscal responsibility of allowing people who have incomes “above the Federal Poverty Level” to receive Medical Assistance benefits if they are under the age of 21 and disabled. By giving those kids access to treatment, the State and Federal government are making a bet that treatment early in life will result in a lower need for treatment in the remainder of life. That’s a terrific bet, and explains why the legislature in 33 states, including Pennsylvania, decided to make that bet, despite the pleadings of others who didn’t do the math and think that this fiscally responsible and humanitarian gesture somehow entitles thousands of people to get what they don’t deserve.

The fact is, most affluent people don’t get Medical Assistance benefits because they don’t need it. Most “poor” people don’t need it, either. Children with disabilities desperately need it and it’s morally and fiscally misguided, at least, to think that taking away Medical Assistance eligibility from the few who qualify under PH95 will have more than a superficial impact on Medicaid in Pennsylvania. How about looking at the hundreds of millions of dollars that have been swallowed up by schools in Pennsylvania (over $150 million last year alone) without the slightest oversight by the Managed Care Organizations or other apparent controls. If saving Medicaid money is your big concern, take it from the schools — there’s SO much more available there. Over $50 Billion nationwide in the last decade alone.  But that’s unthinkable.

It should be just as unthinkable to take Medicaid money from your neighbors whose family income rises above the Federal Poverty Level (hint: it’s less than $2,500 monthly for a family of four). Sure, there are a few families with high incomes who are taking advantage of the system, but their children are no less impaired than their poorer neighbors’ kids. The altruism of PH95 is a virtue that we should be able to afford, no matter how much or how little we make individually and we surrender it for no good reason.

You can learn the truth about PH95, Medicaid, the EPSDT benefit as a Civil Right for children enrolled in Medicaid, Autism, ADHD treatment and much more at the website of The Institute for Behavior Change – an organization I founded in 1997 to recruit, train, deploy and monitor the performance of new professionals treating children with mental illness symptoms in their homes, schools and communities:


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