ABA Therapy for Autism

Applied Behavior Analysis (ABA) is a scientifically backed, highly individualized treatment method which can be effective in many ways especially for individuals living with autism spectrum disorder (ASD). The ways in which ABA can be effective depend on several factors including but not limited to the individual needs of the learner, frequency of treatment, specific interventions, and the environment in which services are implemented. While it can be said that one of the ultimate goals of ABA is to help individuals living with ASD and their families achieve their goals; thus, improving their quality of life in general.

One of the ways in which ABA therapy is effective is through the identification and treatment of challenging behaviors. Effective ABA programs will identify challenging and undesirable behaviors at the onset of services. The function, or purpose of the challenging behavior(s) will be identified and a comprehensive behavior intervention plan will be established. An effective behavior intervention plan should include researched backed principles to reduce the unwanted behavior and should also include replacement behaviors. Replacement behaviors are behaviors that achieve the same result as the challenging behavior but are considered to be socially appropriate, easy to engage in, and generally speaking, more desirable than the challenging behavior. For example, if it is determined that a learner engages in aggressive behaviors to escape a difficult task, replacement behaviors which will be taught may include requesting a break, or asking for help. Hence, one of the ways in which ABA therapy is effective is through the assessment and treatment of undesirable behaviors.

Another way in which ABA therapy is effective is through the identification and targeting of skill development goals. ABA therapy will typically address skill deficits across several domains. These domains will vary and depend on the individual needs of the learner. For example, skill development goals may be targeted to address deficits in communication, self-help skills, motor skills, social skills, or play skills. Again, the specific skill development goals that are chosen by the family and ABA team will vary based on the current clinical needs of the learner. Ultimately, the goal of skill development programs is to improve the learner’s quality of life and promote more independence.

It is important to note that ABA therapy does not start and end with the learner. High quality ABA programs will involve family members, caregivers, and other stakeholders in the child’s environment. One of the goals of ABA programs is to transfer knowledge of the techniques and strategies that are used in the program to other individuals in the child’s life. This is usually achieved through parent and caregiver training sessions. In these training sessions, a Behavior Analyst or qualified Supervisor will instruct the parent or caregiver on various techniques that are shown to be effective in the ABA program. This is usually accomplished through verbal instruction, role play, modeling, and demonstrations of the techniques by the parent/caregiver while feedback is provided. Hence, the transfer of knowledge from the ABA provider to caregivers in the child’s life is another way in which ABA therapy is effective.

Where to get ABA Therapy?

While this depends on geographic location, in most cases and particularly when an Autism diagnosis is involved, ABA therapy is provided through private organizations such as ABA agencies. In other cases, families may opt to work with private practitioners, school districts, or non-profit organizations to secure ABA services. At this time, most ABA services are provided by private ABA agencies. It is common for properly credentialed and reputable ABA agencies to be contracted with most major medical insurance carriers. Therefore, it is typical for members’ medical insurance carriers to offer lists of local ABA providers to their members after an Autism diagnosis is received. Similarly, many pediatric psychologists and psychiatrists will have a network of ABA agencies with whom they work with and they are typically always prepared to provide referrals. Therefore, it is encouraged for families to request a list of local ABA providers from their medical insurance carrier or diagnosing physician.

Depending on the ABA therapy program that is selected as well as the individual needs of the child, ABA services can be provided in the home, school, clinic, or community settings. Sometimes, and depending on clinical needs, a combination of these locations may be used. ABA agencies are responsible for employing individuals who are properly screened and credentialed (Behavior Technicians, Registered Behavior Technicians, Board Certified Behavior Analysts, etc.) Additionally, ABA agencies are responsible for hiring, training, and placing staff members on a child’s ABA team. Initial and ongoing assessment, modification of treatment goals, and the delivery of ABA services are the responsibility of the ABA agency. It is important for families that are seeking ABA services to have a discussion with the ABA agency they are interested in working with and develop a plan.

For your reference, the following are some questions to ask ABA providers which may help in choosing the agency that best matches your loved one’s needs. Please note this list is not exhaustive: “Are there Board Certified Behavior Analysts on staff and will we have access to one?”, “Does this agency provide ABA services in our area?”, “What can we expect from the initial assessment process?”, “Who will provide services to my child and what are the staff’s qualifications?”, “Are you in-network with my medical insurance carrier?”, “How does the scheduling of my child’s services work?”, “Can sessions take place during community outings or playdates?”, “Who Supervises the staff on my child’s ABA team and how often will we meet with the Supervisor?”, “Does your program include a parent training component?”

We hope this post has provided you with some useful information about where to get ABA therapy and some questions to ask potential ABA providers.

What Insurance Covers ABA Therapy?

As of right now, all 50 states have mandates that require some level of insurance coverage for the treatment of Autism. The U.S. Surgeon general and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorder. Therefore, ABA therapy is typically funded by most insurances when there is a medical necessity. The criteria for medical necessity may vary from insurance to insurance, so it is best to check with your carrier, however the criteria typically (though not always) include an Autism diagnosis.

With respect to Medi-Cal and Medicare, these insurances cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance carrier to determine the specifics of the coverage (copays, coinsurance, deductibles, maximums) and to ensure that ABA is in fact, a covered benefit.

As most of us already know, the landscape of insurance is ever-changing, with information constantly being updated. Overall, insurance coverage of ABA therapy continues to move in a desirable direction, with more and more affected individuals having access to covered ABA services. However, it is always recommended to speak to your individual insurance carrier to get the most up-to-date and accurate information about ABA coverage.

Here are a few questions that may help with gaining more information about ABA coverage from your medical insurance carrier: “Is ABA a covered benefit for my child?”, “What criteria needs to be met for ABA services to be covered (e.g. Autism diagnosis)?”, “What is my co-pay and coinsurance?”, “What is my individual and/or family deductible?”, “Is there a benefit maximum (e.g. some insurances may only fund up to a certain amount for a particular treatment)?”, “Which providers or ABA agencies are in-network?”

Please note, the questions above are meant to serve as examples and are not a comprehensive list. We hope this post has provided you more information about insurance funding for ABA therapy!

Where do ABA Therapists Work?

This depends on the needs of the learner, family preference, and the approach used by an ABA agency or individual provider. However, generally speaking, ABA therapists work in the places where services are needed. These typically include four different environments: home, school, clinic, and community. The home setting is one of the most common places where ABA therapists work. This is where a child and his family spend much of their time and is typically the child’s natural environment. Many of the toys, instructional tools, household items, familiar people, and preferred activities are within immediate access in the home setting. This can be beneficial to learning. For example, let’s say we are teaching a child to wash his hands. In the early stages, teaching a child to wash his hands in his own bathroom sink can promote effective learning – the sink is familiar, it is accessible, and the environment can be modified easily to make the task easier (stepping stool, moving soap/towels around, etc.) However, it is also imperative that once the child learns to wash his hands in his own sink, that he acquires the ability to generalize that skill to other settings and people. This is referred to as generalization across stimuli, environments, and people. We will explore the topic of generalization in depth in a separate post.

The school setting is another very common place where ABA therapists work. Typically, the ABA therapist is part of the child’s IEP team and plays an integral role in facilitating the child’s behavioral, social, communication, and play goals (among others). Sometimes these staff members are referred to as 1:1 aides or IEP assistants.

Some ABA providers will offer ABA services in the clinic setting. These are structured environments that have access to a variety of instructional and play materials where various skills can be targeted. Not all ABA agencies provide in-clinic sessions, so it is recommended to check with the providers with whom you are seeking services.

The community setting is also a very important place for ABA therapists to provide their services. These can include trips to the grocery store, mall, park, play dates, ice cream shops, etc. Community outings are a great way to facilitate generalization (skills the child has learned in home or school sessions that can be applied out in the community) and to work on novel goals that cannot be targeted in the home or school setting. Community goals may include creating a short list of needed items and helping a parent retrieve them at a store or initiating play or a conversation with a peer at a park. One of the great things about ABA is that each program is highly individualized to meet the needs of the learner, therefore ABA therapists can work where the services are needed the most.

ABA Therapy Jobs

Although there may be various job titles or positions in an ABA company, needless to say the variety and number of these titles that grow exponentially once we consider all the companies that provide the services, at a minimum, a company will have two main jobs necessary to provide ABA-based services: a supervisor and a direct service provider (a.k.a. 1:1, shadow, behavior therapist, behavior technician, to name a few)

A supervisor is a Board Certified Behavior Analyst (a.k.a., BCBA) or a Board Certified Associate Behavior Analyst (a.k.a., BCaBA) or an individual working towards their certification.  The last two can function as a supervisor but only under the guidance of a BCBA or a BCBA-D. The supervisor is responsible for developing the treatment plan that may include a behavior intervention plan to address challenging behavioral excesses or deficits, the “curriculum” that comprises goals for skills across several pertinent areas that will be taught to the learner, and parent training goals. The supervisor will also be responsible for making sure that his or her team will be trained to make sure that the learner can learn from the services. Also, the supervisor will be responsible in making sure the parents/family/caregivers will learn pertinent skills in parent training.

A direct service provider is the person that provides the actual direct service.  Other labels used to name this job category are “1 on 1,” “shadow,” ‘behavior therapist,” “or “behavior technician” just to name a few.  These individuals work under the supervision of the BCBA and are responsible for the regular implementation of the treatment plan which also includes implementation of the behavior plans during scheduled “sessions.”  The treatment plan is implemented across settings in which it was prescribed to be used such as home, school, and the community.  To establish a standard and accountability among those providing direct services, the Behavior Analyst Certification Board has introduced a new class certification: Registered Behavior Technician (a.k.a., RBT).  Registered Behavior Technicians go through standardized training, examination, and documented on-going supervision to receive and maintain their certification.  RBT’s function as direct service providers.

As mentioned earlier, each ABA provider may be structured differently with various jobs or positions or titles like “Assistant Supervisor,” or “Lead/Senior Therapist,” or “Consultant” to name a few and that these titles may entail different sets of responsibilities within any ABA company; however, the basic jobs can be categorized in just two: a supervisor and a direct service provider.

ABA Therapy Examples

The science of Behavior Analysis is comprised of three branches: Behaviorism, Experimental Analysis of Behavior, and of course, Applied Behavior Analysis (ABA) with the last more focused on applying researched concepts to promote socially-significant behavior.  From ABA comes the multitude of research-based therapies or interventions which include Discrete Trial Training, Pivotal Response Training, Natural Environment Training, and Incidental Teaching to name a few.

Developed by Ivar Lovass at the University of California in Los Angeles, Discrete Trial Training (DTT) is perhaps the most widely-known ABA-based therapy for individuals living with ASD.  DTT, as the name suggests, simplifies a teaching step into three parts: the instruction, the response specified by the instruction, and the consequence that depends on whether the learner performed the specified response or not.  Not only does DTT break down learning into this short, clear three-part instruction, but it also builds in the repetition/intensity at which these trials are given to teach one concept, for example, responding to the instruction, “What is your name?”  DTT is very useful when it comes to teaching factual information (e.g., learning the alphabet, someone’s address, names, lyrics to a song, et cetera); however, it may be limited when it comes to teaching more abstract concepts (e.g., mathematical operations) or comprehension (e.g., understanding a paragraph the learner just read).

Developed by Robert Koegel and Lynn Koegel at the University of California in Santa Barbara, Pivotal Response Training (PRT) is another ABA-based therapy for individuals living with ASD.   PRT focuses on tapping into a learner’s motivation, teaching the learner to respond to multiple cues, encouraging learner- initiated behaviors, self-management, and empathy development.  In contrast with DTT which may appear very contrived and unnatural, PRT takes place in a learner’s natural environment which includes the participation of the learner’s family or caregivers with treatment coordinated across all of the learner’s environment (e.g., home, school, community).  As mentioned, the key element in a PRT program is the learner’s naturally occurring motivation which significantly increases social validity of the teaching instructions and skills learned as the consequences corresponds with the behavior learned via PRT.

Natural Environment Teaching (NET) is an ABA-based therapy wherein a target behavior to be taught is identified, a learner’s preferred items or activities are identified, the antecedent for the behavior to be taught is contrived, and the proper consequence delivered contingent on whether the learner performed the target behavior or not. In a way, it can be similar to PRT as both do implement the teaching opportunities in the natural environment; however, that’s where the similarities end as PRT is more comprehensive. Not to say NET is the weaker of the two—choosing between the two depends on what goal is to be achieved by the learner.

Incidental Teaching (IT) is an ABA-based therapy similar to Natural Environment Teaching (NET); however, the biggest difference is teaching opportunities are not contrived or intentionally triggered by the instructor.  These naturally occurring situations that includes the learner’s motivation to get or accomplish something makes it a potent teaching technique as, like PRT, the consequence or the “reward” for performing a behavior is directly tied-in with the reward for doing the behavior. For example, after walking a couple of blocks, the learner naturally feels thirst.  The learner grabs for the water bottle held by the instructor at which time, the instructor provides the learner prompts to communicate “water please.” Upon performing the action, the learner gets the water bottle.

As you may have noticed, there is a difference between DTT and PRT/NET/IT as DTT appears to be very limited in scope albeit the teaching technique being intense in delivery whereas PRT/NET/IT appear to be more in-tune with teaching socially significant behaviors taught in a more natural setting.  True.  However, it is very rare for an ABA-based service or program to be solely based on a single ABA-based intervention. Depending on the goals of the ABA-program for your child, the ABA professional may use two or all of the four examples we have gone over or perhaps even more not covered by this blog (e.g., FCT, TA, shaping, et cetera).

For more information regarding this topic, we do encourage you to speak with your ABA provider or email us at [email protected]

What is ABA Therapy Used For?

ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with other pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community.  In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors area observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to as at [email protected]

Who needs ABA therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

How will Autism Affect my Child?

Autism affects everyone differently and while cases of Autism may be similar, no two cases are ever the same. Some individuals with Autism may be mildly or moderately impacted while others may be profoundly impacted. Autism may affect several areas of development including: communication, socialization, daily living skills, motor skills, executive functions, among others. Challenging behaviors such as tantrums and difficulty communicating wants and needs may be present as well. Generally speaking, an Autism diagnosis can impact attention span, eye contact, socialization abilities, play abilities, motor skills, academic performance, emotional regulation, self-care skills, communication skills, among other areas.

In addition to the diagnosis itself, many factors affect the ways in which a child is impacted by Autism. These factors include but are not limited to: accessibility of effective treatment, timing of treatment (earlier vs. later), developmental areas affected (motor, play, communication, etc.), as well as a child’s environment (school placement, access to resources, etc.). As mentioned earlier, some children who are diagnosed with Autism may only have mild to moderate skill deficits and challenging behaviors. Others may present with more profound deficits such as limited speech or communication skills and aggressive behaviors. Additionally, many children diagnosed with Autism also present with sleeping, feeding, and toileting difficulties. It is a clinical and ethical requirement for all Applied Behavior Analysis (ABA) programs to be individualized to fit the needs of the individual. Therefore, behavior and skill development goals must be custom tailored and specifically designed to match the clinical needs of the learner. When applicable, strong ABA programs will place an emphasis on the development of communication skills as this is an integral component of many aspects of development. In fact, many challenging behaviors occur when there is a lack of communication skills present. In other words, if a child does not know how to communicate, either through vocal language, sign language, PECS (picture exchange communication system), or another communication device, the more likely he or she will be to engage in challenging behaviors to gain access to wants and needs.

Despite the degree to which a child is impacted by Autism, ABA therapy can help. Through the use of research backed strategies and principles, ABA programs can be utilized to facilitate positive and desirable changes in behavior. For more information on how ABA programs are effective, please see our previous post titled: “How is ABA Therapy Effective?”

Using Graphic Organizers to Help Individuals Living with ASD in Classrooms and Other Settings

A graphic organizer is a visual support that provides visual representation of facts and concepts within the organized framework. Graphic organizers arrange key terms to show their relationship to one another, providing abstract of implicit information in a concrete, visual manner. They are particularly useful with content area material that occurs in K – 12 curricula. Graphic organizers are effective for a variety of reasons: they can be used before, during, or after students read a selection wither as an answer organizer of a measure of concept attainment. Graphic organizers also allow processing times for students as they can reflect on the written material at his or her own pace.

Additionally, abstract information is presented in a visual, concrete manner that is often more easily understood than a verbal presentation of the material alone.  One type of graphic organizer is a “thematic map.”  The focal point of the thematic map is the key word or concept enclosed in a geometric figure such as a circle or a square and if necessary, in a pictorial representation of the word or concepts. Lines and arrows connect this shape to the other shapes and words or information related to the central concepts are written on the connecting lines or in other shapes. As the map expands, the words become more specific and detailed.

The student may neither understand the concept of main idea, and/or not understand when the teacher is giving cues to students for salient information. For example, when the teacher repeats an item or changes voice tone, the information is important and typical students naturally pick this up. As with other areas, some students in the ASD spectrum do not pick up on these cues naturally and therefore need guidance. The teacher can assist the students by providing the following: (1) a complete outline that contains the main points in the lecture, (2) allowing students to follow the lecture, (3) while freeing them from any note-taking, (4) or the teacher may provide a skeletal outline that contains only the main point. Students may use this format to fill in pertinent details delivered through the direct verbal cues.  Verbal cues such as “this is the first main point” or “be sure to include…” assist the students in identifying which points are important. Subtle verbal cues also provide cues regarding importance such as “during the 1900’s…” “did you include that in your outline?” Or “make sure to remember the names.” The note-taking level of students on the spectrum then must be considered when selecting the appropriate type of assistance to be provided to the student.