By Casey Moore, Board Certified Applied Behavioral Analyst
The month of April can represent a time of change. During most years, as long as Michigan weather cooperates, April is when we start to see plenty of sunshine and rainstorms, which combine to help wash away the winter doldrums.
As many know, April is also designated Autism Awareness Month in the United States. Many businesses and public locations around our communities will “light it up blue” to demonstrate their commitment to autism awareness, inclusiveness, and support for the different needs that many folks on the autism spectrum may have.
It’s also a great time for us here at BRAINS to talk about one of the methods we offer to help support those needs – Applied Behavior Analysis (ABA) therapies.
Your Questions, Answered by Our ABA Specialists
The ABA team here at BRAINS is fortunate enough to have been serving folks on the spectrum for nearly a decade. We’ve had the opportunity to speak to many parents, extended families, and educators of individuals on the spectrum, as well as those individuals themselves, about what ABA is and how it might become a way for them to support a happy, healthy lifestyle and build up key skills to maximize success and self-sufficiency.
Given that ABA is commonly recommended for folks with Autism Spectrum Disorder (ASD), we wanted to take the opportunity to review some frequently asked questions that we receive about ABA here at BRAINS.
What would ABA services look like? What would be worked on, and what are the expectations for both my child and me as a parent/guardian?
ABA Expectations for Children
ABA is a one-on-one therapy service that is completely individualized to the person receiving care. Both in-home and clinic-based ABA service models are available. In-home services (like those offered here at BRAINS) involve a professional who works directly with the person with ASD, known as a behavior technician, coming out to the home. Note, however, that other community locations are usually a part of ABA services, and services may also occur in locations such as daycares, community parks, or after-school events. The service is designed to be implemented at the locations where support and assistance is needed. Clinic-based services differ in that they involve the person with ASD going to a particular service location to receive the service.
The targets for ABA are practical and functional, and the focus is on areas of life that are relevant to daily functioning and independence. The types of skills that ABA can help with may include but aren’t necessarily limited to:
- Increase alternative behavior to reduce challenging behavior
- Social skills
- Independent living
- Communication
- Play skills
- Self-help
- Vocational skills, when appropriate
All ABA goals are developed and implemented in coordination with the person receiving the service and/or their caretakers. At the onset of services, the clinical team completes an initial ABA assessment, during which targets and goals are identified and shared with the client and family for feedback and modification, as needed. Services start following the completion of this assessment and when authorization for payment has been received from the client’s insurance provider.
The amount and duration of services are also individualized for each person receiving care and can range from a few hours per week (for a person who only wants/needs to work on one skill area) to up to 25-30 or more hours per week for a person who needs more comprehensive support on many different skill areas (such as a young child who is developing communication, social skills, and would benefit from support with some challenging behavior concerns). This amount of time is initially determined based on clinical need and may be modified to meet the capacity and physical availability of family members and the person being served.
ABA Expectations for Parents/Guardians
Parents/Guardians are encouraged to be active participants during in-home sessions. Often, the presence of a parent, sibling, or other family member can set the stage for naturalistic skill practice. The level of parental presence is up to each individual family unit, though parent participation and follow-through are considered vital to the ultimate success of most ABA goals. For this reason, direct parent training sessions are also always included in approved services and are vital to long-term behavior change. It’s true that the child or individual receiving the services is not the only “client” but rather includes the whole family/caretaker unit. These people can represent the most important part of any person’s environment!
Importantly, ABA therapy relies entirely on reinforcement. This means that our goal is to help encourage and teach the people we work with what to do, as opposed to solely giving consequences or redirection for inappropriate behavior.
We want the session to be fun! Play, laughter, games, and expressions of joy truly are the hallmarks of a great ABA session. After all, if the people we work with don’t want us around, we won’t be very helpful to them.
My child has a complicated history. Will ABA be sensitive to my/my child’s background and particular needs?
In short, yes, definitely. As ABA is completely individualized, all the goals, intervention strategies, and expectations for growth are unique and created with the feedback and ongoing involvement of the client and caretakers. At the time of assessment, it will be the goal of the ABA team to identify these sensitive areas and design the ABA program to accommodate them, which might mean avoiding certain types of activities or contexts or even spending more/less time on particular skill areas.
I’m interested in ABA, but is it better for me to have ABA in my own home, or should we go to an in-clinic provider?
Though we wish there was a hard and fast answer, the truth is both formats have strengths and benefits, so this decision really is an individual one.
Home-based services offer fantastic opportunities for “generalization,” the expression of target skills outside of when ABA team members are present. This is a great strength of in-home services and is largely why BRAINS’ own ABA model focuses on it. The ABA programs are implemented in natural locations, using items and activities that the person is already accustomed to, which can greatly facilitate the speed of skill gains.
However, clinic-based services can offer much benefit as well. Moving to a novel location for services often allows the goals to be implemented with a high degree of precision and control, which can sometimes be difficult when someone is in their “comfortable” place at home. New items, different people, and unique, fun settings can offer a lot of opportunities for learning and growth that might not be as easy to get at home.
My child is already in school for 6 hours a day. Wouldn’t adding ABA services be exhausting?
It’s true that ABA is considered an “intensive” service. The number of hours recommended for it can, at first, feel daunting. However, we always strive to remind families about the ABA commitment to reinforcement as the tool for our success. This means the session should be enjoyable!
In many cases, our clients spend a fair amount of time during an after-school ABA session engaged in activities they would naturally be doing anyway, including having dinner with family, engaging in extracurriculars, completing life skills tasks, and preferred leisure time. It’s not intended to be a “go, go, go!” service that exhausts the person being served, but something that is balanced within their natural schedule to fit with the rhythms of an existing after-school routine.
How long will it take for me/my child to improve with ABA?
Unfortunately, when asked this question, we always mourn that no one has access to a crystal ball to see the future. The truth is that the rate of skill acquisition and progress in ABA varies greatly from person to person. Some individuals can make progress on their goals within 6 months to 1 year of ABA, while it is also not uncommon for young children to have ABA sessions scheduled during their week for up to 3 or 4 years before transitioning out of care.
If someone starts ABA with fewer areas of concern, we tend to see quicker movement out of the service and longer durations of service for people with many areas of concern. For a child of 3-4 years old who starts ABA with goals in multiple areas, we would likely expect a multi-year duration of ABA before goals are met.
What ABA does isn’t magic or a miracle; it’s just hard work that takes blood, sweat, and tears to pay off. In general, we like to say that consistency + time = effective ABA.
If I start ABA, I’m apprehensive that the providers will expect me or my child to change who they are to conform to expectations I don’t share.
There exists, at times, a sentiment that ABA may induce drastic, rapid change in the people who experience it and that this change comes from a great deal of pressure, control, or influence that ABA providers exert over the recipient of the service. We want to emphasize that ABA works to make adjustments to the environment around the individual, not the individual themselves. Along these lines, ABA focuses on using reinforcement to make proactive rather than reactive changes.
To present an example, a common issue a child with ASD may experience is frequent tantrums and highly emotional outbursts when asked to change activities. ABA programs would focus on understanding the source and cause of these tantrums and proactively provide the child with the means to self-express their wants/needs and gently move them towards tolerance of activity change, as opposed to simply preventing a tantrum from stopping an activity change until the child “gives up” and no longer tantrums.
Remember, our focus is on teaching what ‘to do’ as opposed to what ‘not to do.’
So, the goal of in-home ABA isn’t to completely change a client’s daily routine but to gradually build helpful skills by practicing alternative behaviors, reducing reliance on short-term coping strategies that may be harmful in the long run.
Finally, the individualized nature of the program remains sensitive not only to traumas but also to personal goals, interests, and tastes. At no point is the goal of an ABA program to take a person diagnosed with ASD and convert them into a person without ASD by changing what they like and how they act. This would be unethical, at the very least, not to mention almost certainly impossible to accomplish. Cultural sensitivity and focus on individualized family/client-directed outcomes are top priorities for quality ABA programs.
I want to help my child grow, but should I start ABA, Speech, OT, or something else entirely? It’s so overwhelming!
There are so many options available, and all may have their own valuable contributions to offer. What is lucky is that many insurance plans support payment for all of these types of services simultaneously, so the easy answer we can provide is – if you have time and opportunity, go for all of them and see how it goes!
ABA services, in particular, are focused on collaboration. As our goal is the adjustment of the individual’s environment, we are accustomed to working together with other providers hand in hand. After all, those providers are another key element of each client’s environment!
It is commonplace for our clinicians to work alongside speech-language pathologists (SLPs), occupational therapists (OTs), talk therapists, and educators as part of our “whole family” approach to services.
ABA does tend to involve a more extended time commitment than other services. Still, an advantage may be that some recommendations and resources made available to our clients from those other services may be utilized and practiced with the client during ABA sessions if they align with the identified ABA goals and practices (which SLP goals in particular frequently do).
BRAINS Will Support You Every Step of the Way
We hope that the response to these frequently asked questions proves helpful to those of you who may be weighing your options for autism services.
Our ABA providers at BRAINS are happy to discuss your individual needs and concerns before scheduling any type of assessment. We recommend having these conversations openly and directly with any ABA program you are exploring, working with, and moving forward with once you feel comfortable.
We hope you all have a great, sunny April and have many enjoyable opportunities to share your experiences with ASD with others.
Best wishes to all who are seeking access to services that are a great fit for you or your family!