If your child has been diagnosed with autism, you may be considering an applied behavior analysis (ABA) clinician or agency. You may hear recommendations from your child’s school, your pediatrician, or other parents, as ABA therapy is an important piece of the needs of children with autism. Overall, it may be a comprehensive piece of several therapies, including occupational therapy (OT), physical therapy (PT), and speech therapy. Understandably you want the best ABA provider possible for your child. Your child is unique and you need a provider that can adapt to their needs.
Applied behavior analysis is based on the science of behavior and learning. Using ABA therapy, trained professionals can gain a better understanding of how learning occurs, how the environment affects behavior, and how behavior “works” overall. Compared with other therapies, the field of ABA is relatively new; for this reason, your choice of an ABA provider that invests heavily in training and support is critical. Your clinician(s) should offer your child individualized treatment plans designed for the needs of each child and come from an ABA provider that is attentive and professional at all times. Not only should your child’s plan incorporate goals such as gaining social skills, but parent training and involvement is a huge part of ABA also.
While there are many factors you should be looking at when selecting an ABA provider, there are some things to consider well before you schedule an intake or appointment. Before you begin to search for providers, there are several things to know:
- Make sure you and the provider are on the same page when it comes to what they mean by “ABA therapy.” There are providers out there that may say they perform ABA therapy, but you want to know for sure. Look for a company that takes a naturalistic approach to ABA, which helps children and adolescents acquire the behavioral skills necessary to function as high as possible. Your provider should coordinate with schools, other service providers, and primary care providers to ensure treatment efficacy.
- A board-certified behavioral analyst (BCBA) must be on staff or licensed behavior analyst / behavior specialist. The person takes a supervisory role in your child’s therapy. The clinician holds a master’s or Ph.D. in behavior analysis or a related field and is highly trained.
- Ask about background checks. You always want to feel as if your child is in safe hands. Most reputable ABA companies will run background checks for all of their employees before hiring, but it’s wise to ask and always make sure.
- Have a list ready of goals or skills you’d like your child to acquire. This may include fostering better social skills, minimizing aggressive behavior, or enhancing communication. Be wary of an ABA provider that makes grand promises. While intensive applied behavior analysis isn’t meant to be for a lifetime, it may take some time to see a marked improvement.
There are also many other things to consider when selecting an ABA provider.
Who Provides ABA?
There are different types of staff at any ABA provider, including BCBAs, registered behavior technicians (RBTs), and behavior technicians (BTs). The route to becoming a BCBA or RBT takes a lot of dedication, hard, work, and effort. At the bare minimum, a board-certified behavior analyst must first possess an undergraduate degree from an accredited university (often in Psychology). From there, to become a BCBA, one must:
- Have a graduate degree in a related field
- Take relevant courses during time at school
- Complete supervised experience out in the field before becoming certified
- Pass the BCBA exam and become certified in the state of practice
RBT training is slightly different. To become an RBT, a high school diploma is required, and the future RBT must pass a background check, must take 40 hours’ worth of coursework, and pass the RBT certification exam. BCBAs work very closely with the RBTs they supervise, and much is learned in the field.
Individualized Treatment Plans
Individualized treatment plans are a prime focus of ABA therapy. Because autism is a spectrum, every child is different, with different needs and goals to achieve. The supervisor will evaluate your child during an initial session, perhaps with the registered behavior technician (RBT). While this session won’t give a total comprehensive look into every aspect of your child’s needs, it’s a start with the ABA provider to ensure everyone involved is a good fit for your child’s needs. Staff is assigned based on the unique needs and fit of the child.
During this initial session, the supervisor will likely perform a Functional Behavioral Assessment (FBA) to determine your child’s needs for an individualized treatment plan. Other assessments may also be conducted, and may take one or more follow-up sessions.
Be prepared for the assessor (typically the supervisor) to ask questions about your child’s behavior as well as their strengths and abilities. You may also fill out a questionnaire. Second, the assessor will interact with your child getting to know their strengths and areas of skill deficit through play.
Using the FBA, the clinician can formulate the beginning treatment plan. They may ask questions about:
- Medical history
- Behavior concerns, including things that happen immediately before or after a behavior is observed
- Who lives in the home (family structure)
- History of prior ABA services
- Mental health concerns
- Medications (if applicable)
- School placement (public school, private school, outplacement)
- Major life events (e.g., trauma or moving far away, divorce, etc.)
- Academic placement and abilities
- Other services, such as physical therapy (PT), speech therapy, or occupational therapy (OT)
The treatment plan will have target dates for when goals should be mastered. Graphs are often included to help foster parents’ understanding of ABA and its overall goals. Assessments will be ongoing, particularly as your child progresses and masters goals and treatment plans are revised as needed. A behavior support plan (BSP) will be part of the course of treatment, following the standards of ABA. The best ABA providers individualize treatment and ensure skills are learned in multiple settings.
ABA Services Across Settings
While a provider’s main goal is to provide applied behavior analysis services, you may want to opt for a company that does work with other therapists, educators, and medical professionals in your child’s life so all providers are on the same page when it comes to treatment.
RBTs and their supervisors are well-trained in the field when it comes to providing ABA services across different settings. While in-clinic and in-home goals can be wonderfully accomplished, your child’s life doesn’t stop there. Look for a provider that can assist your child out in the community, in a medical setting (such as inpatient), in the school setting, and with your other providers (OT, PT, and speech, among others).
Children and adolescents with autism spectrum disorder may have trouble transitioning from one activity to another. This is where a solid ABA provider can assist and put transitioning as a goal in the treatment plan. Having your child’s ABA therapist help guide you in many different settings can make your child (and yourself!) feel more comfortable. When a new skill is acquired, generalizing the skill across different settings is important.
What Does ABA Therapy Teach?
At its core, ABA therapy teaches functional, social, and communicative skills so your child can succeed. Everyone, both children and adults, need to learn and practice functional and social skills to thrive. However, children with autism spectrum disorder often struggle when it comes to picking up these skills naturally.
If you’re confused about what social and functional skills actually mean, your supervisor will explain everything you need to know in-depth, but overall, functional skills refer to tasks that are practical, useful, and helpful. For example, learning everyday hygiene and functional life skills is paramount. However, sometimes those with autism, especially younger children, can struggle to learn these skills.
Functional skill goals must be highly specialized for each child. There’s no template to draw what will work—cookie-cutter interventions don’t work well with ABA therapy. Everything is individualized to the child for the best possible outcome. It’s also important to remember that functional skills may look different for each child. For example, a child has two choices when brushing their teeth: they learn it themselves or someone does it for them. Functional goals can be taught.
An ABA company should also work across settings with your child’s providers and educators, as well as others who are important in your child’s life. When honing and teaching functional skills, particularly new ones, things must be consistent throughout services. Perhaps a parent is struggling to get their child to use utensils at mealtime, but the child uses utensils in school with different prompts. However, the parent doesn’t know. A good provider ensures your child gets consistency across the board, which is necessary to keep autism routines safe and help generalize new skills across settings.
Social skills are also an integral part of ABA therapy. Autism is described in part in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as, “persistent deficits in social communication and social interaction across contexts.” Applied behavior analysis therapy can improve these social deficits in individuals with autism, which overall improves the quality of life.
All children socially learn through modeling, observation, and imitating behaviors, such as emotional reactions, attitudes, and behaviors. In a child with autism, sometimes social learning is not so easily learned or imitated. Social skills are closely linked to communication. Nonverbal children often communicate and communicate well through other avenues, such as American Sign Language (ASL) and an AAC device or program, such as Proloquo2Go. As a part of the individualized treatment plans, social skills must be completely individual and comprehensive for each child.
Your supervisor will likely add social skills as part of the treatment plan. These goals can change and adapt over the years—remember, ABA therapy can continue into adulthood. Once social deficits are identified and your BCBA has done some observation and data analysis, ABA therapy can begin to pinpoint these deficits but in a gentle, play-based way that doesn’t upset the child and teaches vital skills.
Parent Coaching and Support
Parent coaching, training, and support should be a key part of the ABA company you choose. The staff should work with parents, guardians, and caregivers to coach ABA techniques. It can take a village to ensure treatment is generalized across settings, and keeping all service providers and family members on the same page is imperative.
Being a parent of an individual with autism can be difficult, and it happens very often that parents may feel ostracized, frustrated, or just not sure what to do. As you’re selecting an ABA provider, ask yourself the question, “when difficult situations arise, how do I deal with them?”
Your provider should meet children where they’re at, but that same goal should be a facet of ABA therapy for you as parents also. Center-based therapy is usually not the most effective environment for ABA, unless there are significant reasons to require such a restrictive setting. Some families may be very familiar with ABA services, while others may just have received a new diagnosis and are unsure about a lot of things. Similar to an individualized treatment plan for the child, you should select a provider with individualized parent coaching also. Knowing the ropes a little helps parents out exponentially when their RBT is not around and a hard situation comes up. The best ABA providers also individualize training for parents.
Parents should also be involved in their child’s therapy, treatment plan, and goals. ABA has an end time each day, but the same ABA practices should be modeled at home as well. It’s also important to know some of the basics of ABA (such as the ABCs: antecedent, behavior, consequence). Everything is a behavior, and a consequence is not always a bad thing; it’s simply a result. Knowing a little bit about ABA programming can help you better understand how to apply the same principles when your RBT and BCBA aren’t there.
Your provider may also provide support for parents in the community. These events occur so autism families (and children, of course!) can get to know other parents who may be experiencing some of the same issues and roadblocks that occur in children with ASD. Bringing your child along to an event is also a continuation of honing their social skills. You will have the support of your ABA care team with you at these events, so we can all work on some of the “hard stuff” that inevitably must be a focus.
Overall, it’s wise to look for a provider that has individualized goals for both you and your child so that you can both thrive and have a higher quality of life.