If your child has recently received a diagnosis of autism, you may be getting recommendations from your pediatrician, evaluator(s), and even friends and family on what the next steps are to help your child thrive. Many therapies don’t require a significant time investment; for example, if you pursue outside occupational therapy (OT), physical therapy (PT), or speech therapy, you’ll quickly find these sessions often range from 30 minutes to 1 hour per week.
Applied behavior analysis (ABA) therapy is likely to also be recommended. However, ABA therapy requires more of a time commitment, and many insurances allow up to 40 hours per week of therapy, depending on the unique needs of the child. But, every child with autism is different, and so is their treatment plan. The amount of ABA hours your child needs highly depends on their level of autism and what behaviors need to be managed. Those with more severe autism may require more time, while those that fall on the other end of the spectrum may require less time.
How Many ABA Hours Per Day?
Before the number of ABA hours can be determined, your child must first be assessed by the service provider you’ve selected. Every state’s rules and regulations are slightly different, and Pennsylvania’s requirements will be discussed later on. However, hours are determined by the outcome of the assessment from the ABA clinical supervisor.
The typical ABA medical necessity recommendation for hours per week or month ranges a great deal. You may see ABA hours begin at more per day (or per week/month), but as goals are met, often those hours decrease.
A benefit of having more hours per day (three hours plus) is that it can be easier on the family’s schedule overall, particularly if your child is receiving other services and has other appointments and commitments to attend. Having three plus hours a day can help meet your child’s weekly recommendation without receiving services every day. However, it’s also important not to take too much time between sessions so programming can be therapeutic.
How Many ABA Hours Per Week?
The number of recommended ABA hours per week is the factor that can daunt some parents. Having 40 hours of therapy a week may seem like a lot, but keep in mind, that may not be the recommendation for your child. Just as with ABA hours per day, there is a certain range that programming falls under, and because every child and their needs are different, this recommendation varies widely as well.
Generally, an ABA recommendation falls between 10 and 40 hours per week. When goals are met, the number of sessions and hours per week can decrease, provided there isn’t a regression in behavior.
Check with your ABA provider to see if they have a minimum amount of hours that must be met. Your child will have individualized staffing, and some companies have a set minimum number of hours per session, which can vary. This may not work for some parents and families, so doing some research beforehand will save you time on assessments and interviews with companies you’re unable to work with.
Some providers will require the recommended hours to be met in order to continue services. This is to ensure the hours are therapeutic in order to help your child.
ABA Hours & Fitting in the Time
One of the biggest ABA challenges parents may experience is the number of hours. While the range of hours varies from 10 to 40, many children fall between the recommendation of 20 to 30 hours, which can be difficult to fit into a schedule. Many ABA clinics offer in-home and school services, which can cut down on travel time, and in many cases, you can mix both in-school and in-home work to meet the hours across settings.
It’s imperative to remember that ABA is an important part of your child’s treatment. Sometimes it just isn’t possible to accommodate a high number of hours, but do your best when it comes to scheduling ABA. As your child meets goals, hours can decrease, leaving you with a little more breathing room. ABA is often used as part of early intervention services, so getting the maximum amount of hours deemed medically necessary early on is vital to your child’s learning, development, and behavior. You may see higher amounts of hours suggested for children that are 3 and under.
Don’t be surprised if you see an increase in negative or maladaptive behaviors at the beginning of ABA therapy—there can certainly be some resistance at the outset. Don’t fear that therapy isn’t working or decide it’s not a good fit for your child based on the first month (however, a good rapport with the ABA therapy team is essential). After the first month, you may see behaviors decreasing and goals being met, which can eventually lead to a drop in ABA hours.
The difference in recommended ABA hours also is related to the type of treatment plan the team has designed.
What Are the Different Types of ABA Treatment Plans?
There are generally two types of ABA treatment plans, and they correspond directly with the number of recommended ABA hours. The two types are:
- Focused. Here, you will see fewer ABA medically necessary hours, and recommendations typically fall between 10 to 25 hours per week. This type of plan focuses on one-on-one direct therapy with only a few behavior targets, but it can also include in-clinic social skills therapy. It may also be used as a way to fade out from a more comprehensive plan that has more hours (listed below). This plan is most appropriate when there are a few primary behavior concerns to target rather than global deficits across multiple domains.
- Comprehensive. This type of plan will recommend between 26 and 40 hours per week and is more intensive. You’ll see this type of plan “prescribed” for children with more severe autism but also for early intervention therapy (such as for a child under 3). Instead of only addressing several behavior targets, this type of plan tries to develop a more comprehensive level of skill sets, such as self-care, coping skills, and social skills, and may include ABA hours out in the community so your child is more familiar with real-world situations. If your child has behaviors such as aggression or severe noncompliance, this type of treatment plan may also be recommended.
The Council of Autism Service Providers had this to say about both types of treatment plans: “[ABA therapy] is not restricted by age, cognitive level, or co-occurring conditions.” It is solely dependent on the severity of autism and your provider’s recommendations based on an evaluation.
How Do ABA Hours Work in Pennsylvania?
Every state is different when it comes to ABA therapy. In Pennsylvania, Intensive Behavioral Health Services (IBHS) is overseen by the state, and ABA hours and therapy fall under that umbrella. In order to receive ABA services in PA, a written order must be issued by licensed personnel. This is essentially a prescription for ABA, deeming it medically necessary for your child. However, this written order typically doesn’t come from your ABA provider but from a different licensed professional.
To complete a written order, the person completing the order must have a face-to-face interview of some sort with the child. This may be required to be in person or you may have a virtual option. Since prescribers often aren’t not the direct ABA provider, the original written order may have too many hours or too few hours.
If the written order has recommended an exorbitant amount of hours, the assessment performed by your supervisor can help manage that number. If the supervisor determines fewer hours are needed, the order is flexible enough to deliver fewer hours. However, if the supervisor decides the child needs more hours than what appears on the written order, they will have to contact the prescriber to have it rewritten to include more hours. It’s important to remember that the written order is written for the maximum number of hours that can be provided each month. Your individualized treatment plan (and the number of hours) is determined by the supervisor conducting the assessment.
The order must be written up to 12 months before services begin, and it should be reevaluated once per year. Any addendum or change to the written order must be adapted by the original prescriber. The order also notates what type of behavioral services the child should receive, including:
- Behavior analytic services
- Behavior consultation
- Assistant behavior consultation
- BHT-ABA services (BHT stands for Behavioral Health Technician)
If there’s any part of the written order process you don’t understand, ask your prescriber or supervisor if you have any questions. Just remember, it is simply a state requirement and starting point for ABA services to be implemented, and it lists the maximum number of hours, likely not the amount your child will be receiving.