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 l 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.

Can Autism Spectrum Disorders Get Worse?

A better way to rephrase this is “can the symptoms that define an autism spectrum disorder (ASD) diagnosis get worse?” Rephrasing the question this way makes us focus more on the specific difficulties that we can develop sound treatment for. Can ASD get worse? The answer is yes, but it also can get better.

For families that are just now starting their ABA-based services at home and/or in a school setting, it is crucial to identify what these symptoms or difficulties are exactly. Upon identifying, assessing, planning and implementing proper treatment programs, these symptoms can be either directly or indirectly addressed by the ABA services. With proper guidance of a BCBA, a sound comprehensive treatment plan may facilitate gains over a targeted amount of time.

That is not to say that once goals are met, “autism is cured.” No. What it means is that the ABA services that addressed the initial or more recent difficulties have been effective as the goals for that period of services have been met. How long that period of services is varies from one child to another. Some children may just need six to 12 months of ABA-based services while some children may need the services for a more extended period of time. Be the services for a short or an extended period of time, a crucial aspect of the services is to guarantee that parents/caregivers are given proper training in order for the family to maintain and continue to generalize their child’s learned skills from the services in the absence of the ABA team. Equally important are the parents’/caregiver’s ability to generalize their own skills when presented with similar situations that their child may face in the near future and again, in the absence of an ABA team.

As with any symptom, left untreated it will get worse. It is important then for families who have not yet received any prior ABA-based services to seek the services in order to get difficulties under some control. Families that previously received ABA-based services who find themselves unable to effectively address their now older child to seek once again ABA services in order for them to address their child’s more current needs.

Can Autism be Treated?

Therapy

This is a common and very good question that we hear “new” families ask during intake or in the very early phases of services; however, before we proceed, something needs to be clarified: treatment is not cure.  Cure implies that we know a definitive cause and we have stopped the cause. Right now, we don’t know a definitive cause of autism. Although some, professionals will claim that autism can be cured based on their studies or personal experience, it is fairly safe to say that for now, there is no cure for autism.

That last statement can be something difficult for some families to take in. From our experience in the applied setting working with families over the years, we have heard that question a handful of times and as professionals, we do feel some responsibility to, in a way, inform new parents early on duirng services so they can focus on what is doable: autism can be treated.

You have probably heard the statement “no two individuals living with autism are the same.” This statement is fairly accurate as what differentiate one person from another are the “symptoms” or difficulties that each live with.

Symptoms. Difficulties. Focusing on these then make addressing the diagnosis of autism doable.  As behavior analysts, it is our responsibility to only administer ABA-based treatment programs that have been proven to be effective given a specific difficulty.  This is called evidence based practices. The specifics of a treatment program will vary of course from one person to another, but the foundations of treatment programs are the same. A foundation derived from sound, empirically proven methods repeatedly implemented in the applied setting over time.

As parents, we will do pretty much anything for our child; however, before doing so, it is highly advised that we inform ourselves about a specific treatment before committing to such treatment especially if it will require additional resources from you (for example, money, time, and effort).

With qualified ABA professionals, proper assessments in the beginning and throughout services, goal-setting, teaching supports to maintain and generalize learned behaviors or skills, and hard work over time, measurable and quality gains can be observed.

The topic of treatment is beyond the scope of this blog; therefore, we do encourage you to communicate with a qualified behavior analyst in your area or you can check out our website at www.leafwingcenter.org for more information on this and other related topics.

Does Research Show that ABA is Successful in Treating Children with Autism?

Yes—research does show that ABA is successful in treating children living with autism. As a matter of fact, since the early 1960s, the effectiveness of ABA based interventions has been very well documented particularly when helping children with developmental disabilities. Over 400 research articles were published between 1964 and 1970 alone and all have concluded that behavior analytic interventions demonstrated the most consistent results with individuals living with developmental disabilities. From the mid ‘80’s to 2010, there were over 500 peer-reviewed, published articles on autism and Applied Behavior Analysis.

Many families of children with autism are or are becoming familiar with the 1987 study published by Lovaas. That 1987 study was the first “group study” looking at children with autism receiving intensive ABA treatment (i.e., 40 hours per week) and children with autism that received 10 hours of ABA treatment or none at all.  In this famous study, Lovaas and his research team implemented many of the basic principles and techniques of behavior analysis into an early intensive intervention program for children with autism. After approximately two years of ABA based interventions, 47% of the children in his study made tremendous gains and were able to enter a typical first grade classroom without any additional assistance and scored in the average range in IQ tests when prior to the intervention these same children scored in the low range in IQ tests. Of the control groups, the children in the study that did not receive ABA interventions but only community supports, only one child was placed in a first-grade placement and scored average IQ.

While this study is over 30 years old, there are recent replications and research studies that indicate similar findings. While it’s beyond the scope of this post to go into all the research studies indicating the effectiveness of ABA programs for children with autism, ABA currently is widely recognized as a safe and effective treatment for autism.  It has been endorsed by a number of state and federal agencies, including the US Surgeon General and the New York State Department of Health. And for that reason, the use of ABA principles and techniques has rapidly expanded in recent years as more studies demonstrate that these principles help individuals with autism live more independent and more productive lives.

How Does Senate Bill 946 Affect Individuals with Autism in California?

Senate Bill 946, passed by the State Assembly and the State Senate on September 9th, 2011 and signed by then Governor Brown and filed with the Secretary of State on October 9th, 2011 is a monumental step for individuals with Autism and Pervasive Developmental Disorder (PDD) in California. The new law took effect on July 1st, 2012.

Previous to this bill signing, individuals with autism could get necessary services in one of three ways. First, families or caregivers could pay out-of-pocket. Only a small segment of the population could afford this as estimated costs for monthly services ranged from $3,000 to $12,000. The second way to get services was to request them from your local school district. This has proven to be very challenging as the school districts have been unfamiliar with the unique service type and more recently are financially challenged. Last was the option of regional centers. There are 21 in the state of California at present and each one has taken a slightly different approach to providing services for Individuals with Autism and Pervasive Developmental Disorder. In addition, the budget crisis in California in the early 2010’s has greatly affected most regional center’s abilities to provide services. Thus, using a regional center then for services for an individual with Autism or PDD depending on where one lived and the policies of that regional center, could also prove challenging.

As a result of SB 946 over the last few years, individuals with Pervasive Developmental Disorders or Autism are entitled to use their medical insurance to obtain services. Specifically, as of July 1, 2012 individuals in the state of California can now use their medical insurance to obtain services Pervasive Developmental Disorders or Autism. This applies to the following medical service providers: Every health care service plan contract that provides hospital, medical, or surgical coverage. It appears that SB 946 does not apply to a medical insurance plan that does not provide behavioral health or mental health services, a health care service plan in the Medi-Cal program, a health care service plan in the Healthy Families Program, or health care benefit plan or contract entered into with the Board of Administration of the Public Employees’ Retirement System.

It is important to note that SB 946 specifically states that there is no intention of the bill to alter the responsibilities that have typically fallen under an Individual Educational Plan (IEP) under the Individuals with Disabilities Education Act (IDEA and its amendments and reauthorizations) or in and Individual Program Plan (IPP) under Title 17. We interpret this to mean that SB 946 does not mean that school systems will no longer have to provide services or will have to alter the services they provide to individuals with Pervasive Developmental Disorders or Autism because the bill now requires that medical insurance will now also cover services. In addition, we feel that the same conclusion can be reached that SB 946 will not eliminate, reduce, or alter regional center’s responsibilities to provide services to Pervasive Developmental Disorders or Autism under Title 17.

What treatments are covered? The following is what SB 946 is referring to when it is talking about services. Specifically, “Behavioral Health Treatment” means professional services and treatment programs, including Applied Behavior Analysis and evidence-based behavior intervention programs. Other than Applied Behavior Analysis, no specific mention of another treatment approach is made.

What is required of the treatment programs? The treatment programs must include all of the following criteria to be eligible for coverage. First, the treatment has to be prescribed by a physician or licensed psychologist. Second, the treatment follows a treatment plan prescribed (developed by) a qualified Autism service provider and administered by a qualified Autism service provider, a qualified autism service professional supervised and employed by the qualified autism service provider, or a qualified autism service paraprofessional supervised and employed by a qualified autism service provider. Third, the plan developed by a qualified Autism service provider has measurable goals that are specified to a timeline and that are unique to the individual being treated. The treatment plan has to be reviewed no less that once every six months, modified when appropriate, and describes the individual with Autism’s impairments that will be treated; develops an intervention plan that specifies the service type (i.e., techniques and methodology), the number of hours required, the level of parent participation to achieve those goals, and the frequency of progress evaluation and progress reporting. Fourth, discontinues intensive intervention services when goals have been achieved or are no longer appropriate. Last, the treatment is not used as a means of or a reimbursement for a respite program, day care, or educational services and cannot be used as a means to reimburse a parent for participating in the program.

What is a qualified Autism service professional? SB 946 specifies the following criteria must be met to be considered a qualified Autism service professional. First, this person provides behavioral health treatment (e.g., treatment for individuals with Autism). Second, if they do not meet the criteria to be a qualified Autism provider, that the person is employed and supervised by a qualified autism service provider (e.g., an agency or clinic). Third, that individual provides treatment that follows a treatment plan developed and approved by the qualified autism service provider. Third, is a behavioral service provider approved as a vendor by a California regional center to provide services as BCBA-D, BCBA, BCaBA, a Behavior Management Assistant, a Behavior Management Consultant, or a Behavior Management Program as defined in Section 54342 of Title 17 of the California Code of Regulations. We interpret this to mean that one of the criteria to be considered a qualified Autism professional is to have met the vendor requirements of a California regional center. Fourth, that the individual has training and experience in providing services for pervasive developmental disorder or autism.

SB 946 also provided for an Autism Advisory Task Force. The purpose of the task force was to submit a report to the Governor and specified members of the Legislature by December 31, 2012. The report developed recommendations regarding behavioral health treatment that is medically necessary for the treatment of individuals with autism or pervasive developmental disorder.