When the Centers for Disease Control and Prevention announced in March that one in 88 children today have autism, many were dismayed. In the media firestorm that ensued, many disputed the findings. Some questioned the legitimacy of the disease or the CDC’s definition of it. Dr. Doreen Granpeesheh was not surprised. She has been at the forefront of the disorder for 32 years, watching genetic and environmental factors coalesce to produce those mind boggling statistics and treating its young victims. Using applied behavior analysis (ABA), she has helped thousands of children, trained hundreds of therapists, and has built what is probably among the nation’s top three businesses around ABA. Her Tarzana-based Center for Autism and Related Disorders (C.A.R.D.) booked $36 million in revenues last year, funds that came primarily from contracts with school districts and in recent years, insurance companies. With 20 centers across the country and 1,200 employees, the business is growing 15 to 20 percent a year, according to C.A.R.D. Chief Financial Officer Mark Keller. Affiliate programs are launching in South Africa and Colombia, where the therapy is reimbursed. The company also is getting deeper into developing electronic games, assessments and online screening tools, as well as online training programs targeted at school districts looking to train their own counselors in ABA. Now, as last year’s legislation mandating insurance companies to cover the therapy goes into effect across California, the center is poised for even greater growth, although Dr. Granpeesheh perhaps downplays the potential impact. Before the legislation produces new revenue for C.A.R.D., she said, there is, for the moment, only chaos. “Right now in California, there aren’t even codes for the billing,” she said. “There’s massive chaos.” ‘Life-changing’ therapy? But the treatment pioneered by Ivar Lovaas, Dr. Granpeesheh’s mentor at UCLA, is not without skepticism. ABA is an intense one-on-one therapy that relies on rewards to teach children appropriate behavior and language skills. And though most agree that ABA helps children improve, some published reports say Lovaas’ seminal 1987 study showing that children can make a full recovery has yet to be reproduced using the highest scientific research methods, including a control group. At 40 hours a week, ABA is also incredibly costly — costing as much as $40,000 a year. Dr. Granpeesheh is unfazed by the critics. She firmly believes that children can and do recover. She has seen it again and again, she said, starting back at UCLA, where she worked under Lovaas as a graduate student and then went on to become the supervisor of his center, the Clinic for the Behavior Treatment of Children. In fact, she said, it’s what inspired her to remain and continue in the field. “We started recovering kids,” she said. “And that was like, ‘Wow, this is really life-changing. How could I do anything else?’” Parents who come to C.A.R.D. say the same thing: ABA is life-changing. Pattie Lofton remembers the very moment she realized there was something wrong with her daughter, Amaya Lofton, 5. Amaya was 13 months old and there were early signs. She was colicky and could never sleep through the night, and she didn’t make eye contact. Then one day Lofton watched in dismay as Amaya picked up a block and started to spin it repetitiously for 15 minutes. “I felt the blood drain from my face,” Lofton recalled. “I was devastated. I cried for an entire weekend. Then I picked myself up and figured I needed to fix her.” Amaya had a few false starts but now is in the hands of a C.A.R.D. analyst who accompanies her 30 hours a week to pre-school and home. With intense, hard work, Amaya is learning to respond to people, laugh, read and using an iPad app, communicate despite her condition, which makes speech challenging. “I said to myself I would do whatever it takes,” Lofton said. Indeed, Lofton has made sacrifices to give her daughter the best possible care. Her house is in foreclosure, but Amaya is getting therapy her mother hopes will ensure a future. “This has been life-changing,” she said. Building a practice For Dr. Granpeesheh few things are as gratifying as hearing those words. It makes her long, exhausting days worthwhile. But for the Iranian immigrant and mother of four, building C.A.R.D. has not been without its challenges either. After UCLA, she set out on her own in 1990, starting with a small practice of 30 children in Encino. Within a few years, she had an office in New York. Her first breakthrough came when a parent called her from San Jose, Calif. There was a group of 20 parents who needed help for their children, and the parents wanted her to open a practice, she said. “I told them I need it to be financially feasible and I would need at least 25 families to commit to a certain number of hours,” Dr. Granpeesheh said. “They got it together and we opened.” Then came a defining moment: The same father from San Jose, who approached her with the idea of forming a practice, sent a list serve message to parents with autistic children, telling them that C.A.R.D would set up an office in their community if 25 families could commit their children to therapy. Within weeks, Dr. Granpeesheh was inundated with requests from across the country. “It was crazy after that,” she said. “People were calling from all over the country; they wanted me to speak. They were desperate. It was the only marketing I ever did.” Dr. Granpeesheh also has spent hours testifying in court to compel school districts to pay for the therapy. That, too, has been a form of marketing. And over the years, with advocacy groups pushing for it, school districts and the California Department of Developmental Services have come to pay in excess of $200 million a year for ABA, according to the Los Angeles Times. Fighting spirit Last fall, Gov. Jerry Brown signed the law that mandates insurance companies to pay for treatment, making California the 28th state to require it. It was a hard-fought battle, and insurance companies claimed it would cost upwards of $850 million a year. Advocates said it would cost only $99 million a year. Dr. Granpeesheh would not strike anyone as a tough political fighter. She says her best moments are the ones she shares with children in one of the center’s therapy rooms with pictures of Curious George on the wall. But she is no stranger to political conflict. Her own father was the advisor to the ministry of finance before the Shah of Iran was overthrown by the Ayatollah Khomeini in 1979. Her mother was a major in the Shah’s army. Fearing for their daughter’s life, they sent Dr. Granpeesheh to safety in California in 1978 when she was just 15. A precocious child, she enrolled at UCLA a year later. Her parents spent the following three years in hiding before they made the escape. Bruising battles with school districts and insurance companies, however, have just been part of what she’s endured building her company. She alleges the person who opened her New York office embezzled $150,000 from her business by charging personal expenses to the company credit card. She’s had therapists who have disappointed her, leaving her company and starting competing business. One time, a group of five up and left her Torrance office, and opened a competing business. But she’s made her peace with that, she said. Having trained thousands of therapists over the years, she now realizes that the more people who leave C.A.R.D. to start their own business, the better off patients are. “It’s funny,” she said, “I’ve trained most of my competitors. “It used to make me upset but now I realize it’s awesome. It’s increasing our reach.” Center for Autism and Related Disorders FOUNDED: 1990, HEADQUARTERS: Tarzana CORE OF BUSINESS: Behavioral treatment for autism and related disorders Number of Employees 2012: 1,200; Revenues in 2011: $36 million
Behavior therapy
