SIOUX CITY -- At age 2, Clara Sachau wasn't talking.
Her parents took her to a specialist who diagnosed her with autism, a pervasive neurodevelopmental disorder that affects an individual's ability to communicate and interact with others. In 2014, the CDC estimated that about 1 in 59 U.S. children had a diagnosis of autism spectrum disorder by age 8, up 15 percent from 2012.
Sam and Luke Sachau, of Dakota Dunes, were urged to enroll their daughter in Applied Behavior Analysis (ABA), a type of therapy that doesn't cure autism, but encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The couple found a long waiting list at the Pier Center for Autism, one of just a couple ABA providers in Sioux City. As the Sachaus, who both work in the medical field, waited for an opening, they learned their health insurance wouldn't cover services at the Pier Center because it was outside their provider network.
The other option, driving three hours to Des Moines multiple times a week to see an in-network provider, wasn't feasible. The couple even thought about moving from South Dakota to Iowa to try to obtain Medicaid coverage for their daughter and avoid the coverage difficulties associated with crossing state lines for services.
"You get a diagnosis and you just kind of wait, because there's such a need for ABA therapy and there's not enough of it," Sam Sachau said. "The roadblocks are the insurance and access to care. It's really sad."
The Sachaus found out about Briar Cliff University's pro bono ABA Clinic from another parent; and, last October, started bringing Clara, now 4, to therapy sessions, which are led by Mike Harman, assistant professor of psychology, and staffed by trained student clinicians. In a year's time, Clara, who also attends speech therapy and preschool, has made significant strides.
"The amount Clara has learned within one year with all these services has been amazing. Last year, she had difficulty making eye contact with you when you would call her name and she couldn't even say her name when we started. This year, she can spell her name. She can write her name," Sam Sachau said. "Clara's ability to sustain on one task has improved drastically."
The ABA Clinic, which was founded in the fall of 2016, currently serves three clients full-time, meaning each client receives between five and 15 hours of therapy a week. Harman said one of the biggest challenges facing the clinic is meeting the high demand for services.
"We have a wait list now that is really indefinite. We just don't have the resources to meet that demand," he said. "Seeing how we can change the lives of just a few people is very rewarding, but it also presents a challenge -- the scope with which we can practice is limited."
On the cusp
While seated in a tiny rainbow-colored chair between Harman and student clinician Nhi Pham, Clara was shown two cards -- one printed with white clouds and the other, brown rocks.
"What's white and fluffy?"
Clara pointed to the clouds and received resounding praise in return and a paper coin, which she later used to redeem a piece of candy. The Sachaus watched the session unfold on a TV screen in an adjoining room in the clinic, which is located in Heelan Hall on Briar Cliff's campus.
"I'd definitely say she likes coming here," Luke Sachau said of Clara, who doesn't hesitate when Harman says it's time to get to work. Harman gives her high-fives and jumping breaks on the trampoline.
While the majority of the clients who receive and have received services at the ABA Clinic have been diagnosed with autism, Harman said the therapy has been used in a variety of realms, including mental health, substance abuse and sports performance.
"Anywhere there's a problem, applied behavioral analysis could really step in," said Harman, who said clinic staff work to manipulate the environment to best suit each individual learner. "Any problem someone might have, whether it's not being able to speak, not being able to tie your shoes or not being able to get to class on time, Applied Behavior Analysis offers solutions. We operate under the assumption that we are environmental creatures."
Harman said the first step is working with parents, grandparents, teachers and therapists to set goals for a child, who may be displaying too much behavior -- engaging in aggression, self-injury or tantrums -- or not enough behavior -- using limited language skills or not being toilet trained. Student clinicians work for many weeks building rapport with clients, learning their interests and determining what they find reinforcing. Rewards could be a candy bar, a hug or a smile.
Summer Williams, a junior psychology and behavior analysis major from Kansas City, Missouri, said the bonds she forms with clients are memorable. She recalled a client who didn't want to work with her at first.
"Now, she wants to work with me. Whenever she sees me, we're going to play, we're going to get stuff done," she said. "Then, sometimes, when Mike comes in, she's like, 'We're done. I don't want to do it anymore.'"
Maisie Hurd, a senior psychology and art major from Bridgewater, South Dakota, will never forget the first time a client responded to her own name.
"For weeks there was no response to her name. Then, one day, she just started responding to both of us saying her name," she said. "It was such an exciting moment, because you could physically see that we were helping her."
Harman said the behaviors and skills that Clara is learning at the clinic are more complex than other clients are currently learning. Besides learning the difference between fluffy and rough, and fruits and vegetables, Clara is being taught how to determine when she has to go to the bathroom and when it's appropriate to jump up and down or yell really loud.
"If she can identify a fruit and vegetable, that's terrific news, but it's serving as what we call a cusp," Harman said. "She's right at one of those cusps, where if we can teach a few examples of how to best categorize, then the floodgates are open and concepts like same and different, or abstract principles, like small, medium and large, are now in reach. That is definitely something above a developmental milestone of a typical 3- or 4-year-old."