Whether you’re new to applied behavior analysis (ABA) services or you’re thinking of acquiring services for the first time, you’ve likely heard the words “autism” and “consistency” used often in the same thought or sentence. It’s science-backed—according to studies, children with an autism diagnosis sleep better, and for lack of better terminology—behave better when there is constant routine and consistency.
In general, all children tend to perform better when there is consistency and routine, but it is profoundly important for those with autism and other developmental disabilities to have a routine they can depend on every day. Not only is this true in all aspects of your child’s life, but it’s also important when it comes to their therapies, particularly ABA. Providing you have a knowledgeable and well-trained ABA clinician, your child’s therapy will be delivered consistently, but it’s often up to the parents to ensure that ABA strategies stay in place even when the clinician is not there. It’s true there are unavoidable moments that can come up week by week, but it’s still possible to maintain your child’s therapeutic consistency and roll with the changes.
Read on to learn more about why consistency is so valuable in those diagnosed with autism and with ABA therapy, how you can help maintain therapeutic routines by becoming more involved, and how to help bridge the gaps when routine may be broken.
Why Is Consistency Important in Autism?
Consistency + autism is something that can’t be overstated. Having a consistent, routine-based schedule for your child, beginning as early as possible, is a concrete building block that helps in many different ways. Those with autism may struggle with a sudden change in routine or may experience anxiety over what to expect next, and having a predictable and even repetitive routine can smooth over transitions and ease anxiety (and ergo, problem behaviors) in a child with autism. The benefits of having a consistent overall routine, including your child’s ABA therapy, can improve your child’s quality of life by adding comfort and stability to it. Outcomes can include:
- Improves motivation and cooperation. Steady routines lead to lower stress levels, which allows your child to be more receptive to practicing current skills or attempting new ones.
- Builds a stronger parent/caregiver-child bond. When a child with autism feels safe, they will build a stronger bond with their caregiver (and ABA clinician)!
- Reduces power struggles and stress. Likely any parent reading this is familiar with meltdowns, and many times the catalyst for meltdowns can be a sudden routine change, no matter how small. When expectations and routines are the same, a child with autism experiences less stress, which can lead to fewer meltdowns and power struggles.
- Builds autonomy. As accomplishments and expectations are met with rewards, a child can feel more satisfaction at reaching a new goal or adopting a new skill. This helps build confidence for learning more goals and skills.
It’s natural to feel a little overwhelmed, not knowing where the starting point is to try to make your child’s day more consistent and routine-based. That’s where ABA parent training and parental involvement in actual ABA sessions can help. Not only are consistent ABA sessions imperative to improve your child’s behavior and quality of life, but your ABA team can also help offer suggestions for a daily roadmap to keep consistency.
Consistency & ABA Therapy
One of the goals of ABA therapy is to reinforce positive behavior and replace unwanted behaviors with more constructive ones. Just like in your day-to-day life, consistent ABA therapy is important. Both home life and ABA routines should meld together so your child always knows what to expect. You’ll be working with both a board-certified behavioral technician (BCBA) and registered behavior technician (RBT), who will try to implement new strategies and redirect unwanted behaviors during sessions, but your ABA team can’t go it alone. Parent involvement is exceedingly important so what’s learned in ABA carries over.
Why won’t it carry over on its own? Simply put, if your child receives in-clinic or in-school ABA, you may only see improvement in behavior at the clinic or at school. Similarly, your child may be a rockstar during in-home ABA, but if consistency shifts after the ABA clinician leaves, you may notice that more constructive behaviors only appear during sessions.
How can you help ensure that ABA is delivered regularly and consistently? Children should attend every session with little to no cancellations. If there’s a change in routine, such as attending another medical appointment, ask your therapist to join you and work on social skills or other behaviors during the outing. What a great chance to generalize new skills in a new setting!
There are other times, such as over the summer and during holiday breaks, when keeping consistency can be an issue. First of all, if your child is offered Extended School Year (ESY) services, make sure they attend if possible. Think of all the areas going to school and ABA help with—these needs don’t “take a break” in summer:
- Consistent hygiene
- Attention to domestic chores and capabilities
- Time management and punctuality
Typically, ESY lasts about five weeks (from July through the first week of August). Children still have an academic program, but ESY is a little looser than the regular school year, with much more structured play. The implementation of ESY is important as it keeps your child familiar with the routine of going to school, and it keeps them in touch with their classmates, teachers, and often, their RBTs and BCBAs. If your child receives ABA in school, this gives your treatment team an opportunity to continue that routine.
Another option for breaks and holidays is summer/holiday camp. If ESY isn’t an option for you, you can help keep routines by ensuring your child still has somewhere to be, every day, at the same time. If possible, your team may be able to attend sessions during summer camp as well.
Your therapy team can also go to your home or other community locations in order to ensure service continuity. Telehealth is also available.
Why Is Consistent ABA So Important?
One of the important reasons for keeping consistent therapy is that children with autism often have more trouble retaining skills than neurotypical children. Because behavior therapy teaches critical life and behavior goals and skills, service interruptions can lead to loss of skills and even regression. Also, learning skills before a situation happens is key. If a child with ASD is unprepared for an abrupt change, there can be meltdowns and anxiety.
As a whole, applied behavior analysis promotes learning and self-improvement. Keeping consistent with therapy for an extended period can help prepare your child for transitioning into adulthood.
Keeping therapy sessions consistent also strengthens your child’s skill generalization across settings. For example, they will be able to apply multiple skill sets in different settings, whether in-clinic, at home, at school, or out in the community. This promotes long-term retention when it comes to a specific skill.
Overall, consistent therapy helps ensure skills do not get lost, and avoids regression in behavior. This can be true for anyone, but it’s particularly important for children in the autism community to ensure basic skills don’t go missing. Basic skills can disappear with a drop in the regular routine and loss of therapy—consistency is again important here.
Regular therapy also helps introduce new skills, which can help augment other ones. Summer, of course, is different, and with it comes new needed skill sets and programming. This helps your child adapt to new situations, whereas a break in therapy can cause a loss of learned skills, so a new skill set introduced over time becomes much more difficult.
One thing you’ll also learn in parent training is that it’s also wise not to take shortcuts through learned skills. Summer can be tiring for everyone in a household, and it’s easy to become quickly frustrated. Perhaps you’re letting your child perform a skill halfway or giving in to avoid a meltdown because of stress, but that only aids your child in reverting to the unwanted behavior. Also, give your little one plenty of time to practice these skills. If you’re rushing off to work or rushing them off to ESY and they don’t have enough time to properly complete a task, this can cause a regression back to unwanted behaviors as well.
If there is an anticipated break in therapy, whether it’s a personal emergency, you’re on vacation, or for some other reason, you can opt for ABA telehealth services. This helps maintain routine and consistency, even though the session may look a little different. However, this avoids a cancellation and allows for learning. In a post-Covid world, many ABA providers also offer telehealth services, especially when needed. Setting up for telehealth services, even if it’s for one session, should be quite simple.
Look for an area of the home that’s free from clutter, such as toys, and is away from the general commotion of the house. A private space is ideal. If your child has a preferred toy or is fond of screen time, make sure these items are put away and out of sight before telehealth begins, as they can be a distraction. The area should also be comfortable—if your child is sitting upright in a chair trying to stay engaged on a computer, they may become restless and uncomfortable after a while. While you don’t want to distract your child with preferred items, you do want them to be as comfortable as possible to maximize their engagement. All you’ll need is a device that has video capabilities (tablet, computer, smartphone) and a reliable internet connection, and ABA telehealth services are ready to go.
What Happens with a Lack of ABA Consistency?
A lack of consistency can lead to what is called intermittent reinforcement. If everyone involved in your child’s life (parents, school, therapy providers) are all on different pages, signals get mixed and ABA can cease to be effective. If you and your team are working on unwanted behavior, as parents, you should sit in on the session, watch the intervention, and practice it. There are several things that can occur if ABA interventions aren’t consistent. First, there may be a “honeymoon period,” where the child is highly motivated by the sudden reward. Too often, parents can mistake this as a child mastering a skill, when in fact, there is much more work to be done, and consistent implementation of the intervention must occur for better behavioral outcomes. Parents may also see a spike in misbehavior following a new intervention; it’s important to stick with the instructions your BCBA has mapped out.
Children can also experience what is known as an extinction burst, particularly after a honeymoon period, which is an increase in maladaptive behavior. For many parents, this may be the “pick your battles” moment, where it’s time to decide whether to continue the intervention or give in. Even though it’s hard, patience and consistency are both important factors in the implementation of ABA therapy. It can be difficult to maintain patience during an extinction burst, but parents should adhere to the intervention as closely as possible. You can also ask your ABA team for advice when it comes to tough situations.
Over time, unwanted behavior can be significantly lessened or eradicated with the two tenets of consistency and patience.
Parent and Caregiver Training
Parents are encouraged to engage in ABA, whether through a course, active participation in parent training, or teaching other household members what someone learned from their BCBA. Within your child’s treatment plan, not only will they have individualized goals, but parents will have goals to achieve as well. This provides parents and caregivers with the opportunity to not only learn about their child’s treatment, but also to participate in it. As every child’s treatment plan is highly individualized, so will the parental goals be—you’ll learn what behavior practices are effective for your child, with the opportunity to implement interventions and practices when the BCBA or RBT aren’t present. Training and parental sessions are designated by the BCBA, however, parents are typically encouraged to participate in as many sessions as possible.
Remember, ABA takes a village to be effective, however, the village needs to have routines and patience in order to function.