Acclaim Autism developed a mini-documentary. Listen to the experiences of some of the families we serve. Parents tell their stories about their kids getting diagnosed, how they learned about ABA therapy, what they experienced throughout the journey, and how it helped. If you’re early on in this journey, start by watching this video.

Information About ABA & Autism

According to the National Autism Association it’s estimated that, as of 2022, autism spectrum disorder (ASD) affects 1 in 44 children, with boys four times more likely to receive a diagnosis than girls. It’s important to understand that no two people with an autism diagnosis exhibit the same behaviors or symptoms. Roughly 40 percent of children with autism are non-verbal, and over half have a comorbid intellectual disability (ID). Autism can be comorbid with other disorders, such as attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, Fragile X syndrome, epilepsy, and gastrointestinal disorders. 

Autism is considered a “spectrum” disorder because every child and adult with autism is different. It is often said that “if you’ve met one person with autism, you’ve met one person with autism.” No two people are alike, meaning each child needs individualized care to help meet their needs and help them thrive. 

Applied behavior analysis (ABA) therapy is considered the gold standard when treating individuals with autism. It is often mistaken for simply behavior modification, however, it can help in many areas, including communication and social skills. It also aids in learning and academics. ABA has grown and improved from its earlier days and has become more of a play-based therapy, which allows a child to have fun and play while receiving treatment.

Read on to learn more about ABA, what it is, and how it can be part of your child’s care plan. 

What Is ABA, Exactly?

The American Psychological Association (APA) considers ABA to be an evidence-based practice. In other words, ABA treatments have undergone a thorough research and review process, supporting that ABA can be a very successful treatment for those with autism. ABA 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. When considering a therapy to reduce the symptoms of autism, ensure the therapy is evidence-based.

ABA is not only used to treat individuals with autism, but other disorders as well, such as substance use disorder (SUD), eating disorders, and borderline personality disorder (BPD). Because it has been highly studied and tested, it is a successful treatment for many conditions, particularly in autism spectrum disorder (ASD). Because everyone with autism is different, ABA must be individualized for each person to help target problem areas and improve behavior and learning.

Before therapy can begin, a person must be evaluated and assessed. This looks not only at modifying unwanted behaviors but also at your child’s abilities and strengths. Comprehensively, this can create a treatment plan to help your child thrive and reach their goals. 

The Importance of Early Intervention

According to the U.S. Department of Health and Human Services and the National Institutes of Health (NIH), early intervention for autism spectrum disorder is key. Studies have shown that children who receive early intervention services are more likely to “have major long-term positive effects on symptoms and skills.” 

Because autism has been so widely studied, trained professionals can now detect and diagnose ASD in children as young as 2 years of age and sometimes even younger. During this period of time, the brain has a higher level of plasticity, as the brain is still developing and forming. If early intervention services are provided at this young age, such as speech therapy, occupational therapy (OT), physical therapy (PT), and ABA, a child with autism has a higher chance of reaping long-term benefits. Modern studies suggest beginning early intervention therapies (including ABA) as soon as a child is diagnosed or autism spectrum disorder is suspected. Including ABA, overall early intervention skills work to offer your child:

• Emotional skills
• Communication skills
• Thinking skills
• Physical skills
• Social skills

Generally, these skills come naturally to a neurotypical child, but for the child with ASD, individuals often need some assistance understanding and honing these skills. Applied behavior analysis, often combined with other services, can help your child improve these skills and give them a better long-term outlook when it comes to reaching goals and making progress. 

ASD Markers and Targeted Goals

The Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-V), is very specific when it comes to describing the “symptoms” or markers of autism. This helps trained psychologists better understand and diagnose ASD. A child with autism spectrum disorder may exhibit one or more of the following:

• Repetitive behaviors and extremely targeted interests.
• Behaviors or actions that interfere with daily life functioning (such as with work and school, among others).
• Social problems and difficulty with communication.

Individualized applied behavior analysis treatment plans can help improve behaviors that affect daily life skills and target social and communication difficulties. 

How to Begin ABA Therapy

Evaluation (Diagnosis)

Beginning ABA therapy is a process that typically begins with an evaluation, which produces a diagnosis. Then your child’s developmental pediatrician, child psychologist or other provider may give you a referral to a specific provider, or you can reach out yourself to find a provider you’re comfortable with and you feel will help meet your child’s needs and goals. 

Assessment

Before a treatment plan can be initialized, your child must first be assessed in what is called a Functional Behavior Assessment (FBA), and/or another assessment that’s specific to their needs, as chosen by a clinical supervisor. The assessment is not intrusive at all and has two sections. First, the assessor will ask your 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. 

ABA therapy, including the assessment, can take place either in a clinic, home, school, or a location in the community. The FBA is play-based, meaning that the therapist will spend time interacting with your child in a “fun” way. However, these are highly trained professionals that will be making observations during the assessment regarding your child’s social and communication level, behaviors, and other skills. For a comprehensive assessment, the therapist may also visit your child’s school to observe the same things. Behavior can vary widely from school to home, so it’s wise to get an overall picture of your child’s needs for the best treatment outcomes. 

Treatment Plan

After the FBA is complete, the supervisor will create a treatment plan, which you will look over together and have input to; this is the document that outlines behavior goals, so you should partner with the supervisor on developing goals for your child. 

Services

Once the assessment and treatment plans have been created, the next step is usually providing services. This is where one or more therapists will come in. This can involve someone spending numerous hours per week with your child. Before that can happen, your insurance company may take some time to review the assessment and treatment plan before authorizing services to begin.

Who Provides ABA Services?

FBAs and other assessments are typically performed by a board-certified behavior analyst (BCBA), licensed behavior specialist (LBS), or behavior analyst (BA), who we call clinical supervisors. A BCBA is highly trained and must hold a master’s degree or Ph.D. in behavior analysis or psychology, be licensed by the state (a lot of states have their own individual requirements), and pass a national certification exam. 

When ABA therapy begins, your supervisor will meet with your child again, accompanied by a registered behavior technician (RBT), behavior technician (BT), or  behavioral health technician (BHT), who we refer to as the therapist. Therapists work most closely with your child, under the regular supervision of the clinical supervisor. 

In addition to professional training, all direct services staff must possess certain skills to effectively work with a child that has autism or other disorder. These are taught in the classroom but should also be somewhat intrinsic. These can include:

• Critical thinking skills: staff must understand that every child is different and they must adjust accordingly. Staff must be able to act quickly if behaviors are unsafe.
• Empathy: the child must feel understood and staff must remain empathetic in all situations. 
• Communication: many children with ASD are non-verbal, so therapists must have a handle on all types of communication and respond appropriately to both verbal and non-verbal communication, and have an understanding of both. Therapists must also be able to effectively communicate with parents, teachers, etc. in an effective way 
• Close attention to detail: children will have both strides and setbacks as they work through therapy, and therapists must be highly tuned in to notice even minor details. 
• Patience: some undesired behaviors can be difficult to work through, and both supervisors and therapists must have a high level of patience to help the child work through tougher moments. 

What Does ABA Therapy Look Like?

Often, parents have trepidation about beginning ABA therapy based on things or myths they’ve heard. The effectiveness of ABA therapy has been long-studied and is efficacious, no matter where your child falls on the spectrum. While ABA is play-based, it is intensive and it is recommended that children receive 10 to 40 hours of ABA therapy per week, which often looks like two to eight hours of ABA therapy per day. ABA is also appropriate for adolescents, and even adults.

One of the hallmarks of ABA is the ABCs, which stands for antecedent-behavior-consequence. When it comes to understanding behavior, this means:

• Antecedent: what provokes a certain behavior.
• Behavior: the behavior provoked by the antecedent.
• Consequence: the response to the behavior.

Every individualized plan is different, however, in ABA therapy, the “C” (consequence) is marked by positive reinforcement. For example, if screen time has expired, a parent asks for an iPad back, and the child hands over the iPad, they are positively reinforced through praise or another reward. If giving back the iPad is a regular struggle, your ABA team can work toward a goal of giving the iPad back seamlessly. 

There are also specific types of interventions that may be used depending on your child’s needs as not every type of ABA intervention looks the same. Your child’s individualized plan may include one of the following:

• Early intensive behavioral intervention (EIBI): this type of ABA focuses on early intervention techniques and is typically implemented for children age 5 and under. At its fundamentals, EIBI is meant to hone adaptive, functional, social interaction, and communication skills. Because early intervention is so imperative if your child is age 5 or under, EIBI can be of great help. 
• Pivotal response training: this type is presented as a learning activity, where the child takes the “lead” over the therapist, although the therapist may help guide the child through specific skills for reinforcement.
• Discrete trial training: these are structured tasks that the child completes. Upon completion, positive reinforcement and a reward are offered. 
• Verbal behavior intervention: while your child may have separate speech services, ABA therapy can help with language as well. These types of interventions are meant to improve communication and/or verbal skills. 
• Early Start Denver Model (ESDM): this is play-based ABA therapy that is enjoyable for the child but behind the intervention, there are specific goals put in place by the therapist. 
• Modeling: using this technique, the therapist displays a behavior, and the child is gently instructed to model the behavior. Over time, imitation can help promote healthier behaviors.
• Picture Exchange Communication System (PECS): this is a system that is most often used with children who are non-verbal or demonstrate limited functional communication. It helps improve communication using small picture cards. For example, if a child is hungry for an apple, they can show the therapist a card with a picture of an apple to indicate they are hungry. Similar techniques can also be used with augmentative and alternative communication (AAC) devices. These are often tablets or laptops with special programs. In addition to an electronic picture exchange, AAC devices are equipped with verbal sounds so the child can also hear the word as they select the picture. 

It’s also important to note that parents or caregivers are an important piece in any type of ABA therapy. Parent coaching and teaching can help maintain and generalize ABA principles when therapists are not present. It is highly recommended that parents participate in sessions, whether they are conducted in a clinic, in the home, school or out in the community. Often, ABA sessions can take place in the community, where children can interact with real-world situations. 

What Are the Benefits of ABA Therapy?

As previously mentioned, ABA therapy is the gold standard for autism treatment and is considered the most efficacious of all ASD treatments. Every child with autism will eventually become a teenager and an adult with autism, and one of the end goals of ABA therapy is to help a person with autism maintain independent life skills. The earlier the treatment begins, the more successful it may be. Some of the benefits of ABA therapy include:

• Social skills improvement: children with autism often have trouble interacting with peers because of differences in social skills. Over time, ABA can help improve these skills. ABA therapy can also be performed in a group setting with several children as well.
• Improved parenting interactions: parents are strongly encouraged to be involved in ABA sessions, and supervisors can also advise parents separately as to how to handle difficult situations. Because an ABA therapist cannot be present 24 hours a day, this helps parents reinforce skills learned during ABA sessions. Parenting a child with autism can often be challenging and difficult, and with ABA therapy, parents can better recognize their child’s abilities and strengths rather than focusing on negative behaviors. Also, BCBAs can help guide parents so that every situation becomes a learning experience instead of a difficult situation.
• Generalizing & retaining skills: individualized ABA treatment plans have a plan to generalize newly learned skills across settings, with retention in mind. Regular sessions over time help children with autism to retain skills, giving individuals the opportunity to use coping and other skills when presented with difficult or new situations. 
• Independent living skills: keep in mind that ABA is not solely focused on behavior modification and under its umbrella, many skills are taught. ABA therapy can help individuals with autism learn basic life skills, such as using the bathroom independently, brushing teeth, sleeping through the night, and living independently as they transition into adulthood.
• Creating and maintaining friendships: social and communication skills are important in real-world situations; applied behavior analysis can help children with autism create and maintain friendships, which helps individuals to thrive. Social skills groups provide a structured curriculum to help develop social skills with individuals of a similar age and ability.
• Overall life satisfaction: over time and therapy, ABA promotes overall life satisfaction as it works on improving those three markers listed in the DSM-V so that a person can thrive.
• Teaches important skills for when parents are gone: unfortunately, parents will not be present forever to help guide their children to live independently. ABA teaches life skills to individuals that will prepare them as adults to live and work in the community without parental support, as independently as possible.

Ongoing Evaluation and Assessment 

Your child’s treatment plan will evolve and change over time, particularly as your child masters their goals. New goals will be added as old ones are mastered, and if new difficulties occur, they can always be added to the treatment plan. Your supervisor will review progress and new treatment plans as they evolve. 

Get in touch to discuss your child for individual ABA support or a social skills group program.

References

Helt, M., et al. Can children with autism recover? If so, how? (2008). Neuropsychology Review,      18(4):339-66. 10.1007/s11065-008-9075-9 

Lollar, D.J, et al. Management of children with autism spectrum disorder. (2007). Pediatrics, 120(5):1162-1182. 10.1542/peds.2007-2362

US Department of Health and Human Services: National Institutes of Health. (2021). Early Intervention for Autism. Retrieved from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/early-intervention#.