What Does ABA Therapy Look Like?

Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.

ABA-based services start with a functional behavior assessment (FBA).  In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior.  The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child.  The completed FBA is then submitted to the funding source for approval.

One-on-one sessions between a behavior technician and your child will start once services are approved.  The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA.  The sessions are used to teach identified skills/behaviors via effective teaching procedures.  Another aspect of ABA-based services in the home-setting is parent training.  Parent training can take many forms depending on what goals have been established during the FBA process.  The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it.   If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.

As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.

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.

How is ABA Therapy Effective?

Applied Behavior Analysis (ABA) is a scientifically backed, highly individualized treatment method which can be effective in many ways. 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 achieve their goals and improve the lives of individuals and their families, there are specific ways in which ABA therapy can be effective.

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.

We hope this post has provided some information on ways in which ABA therapy is effective. Remember – ABA therapy is a scientific, dynamic, and highly individualized approach that can improve a person’s quality of life in many ways!

How to Start ABA therapy

In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare 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 provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.

Once you have identified the ABA provider whom you wish to work with, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

Using Assignment Notebooks to Help Individuals with Autism in Classrooms and Other Settings

An effective organizational strategy for students with Autism Spectrum Disorder, especially those who are older and possess the prerequisite reading, writing, and organizational skills is an assignment notebook. All academic tasks and their due dates are listed in the notebook and the student will take it to school and home every school day. The most effective support would include a sample of how each assignment should look. Ideally, it should also contain examples of completed items (math equations, definitions, filled out problems, etc.) as these would function as visual examples of the correctly completed assignment. Although, simplified assignment books are certainly acceptable and can be effective depending on the particular student. The classroom teacher would need to check the notebook at school to make certain all information and expectations are included. At home, the parents or caregivers monitor the notebook to make sure the student has successfully completed all necessary assignments or activities to the level expected of them. A signature section for each day can provide an additional layer of thoroughness. This can include a signature section for the parent who monitors the assignment book and/or the student who completes the assignments. Essentially, these assignment books function as a visual checklist to help students stay organized and on-task. These are pretty standard in schools, yet it is imperative they are used to help students with ASD succeed.

As with most strategies for students on the spectrum, the specific skills required to effectively use an assignment book will need to be taught or should already be in the student’s repertoire. In addition, motivation needs to be taken into consideration. The teacher or support staff may need to provide additional reinforcement when the naturally occurring contingencies (i.e., assignment completion) are not sufficient. For example, if a student completes all daily assignments within a specified time frame, let’s say, homework that was assigned Monday through Thursday, then on Friday, they may receive access to a special activity or item. Another way to help students “buy-in” to the idea of assignment books is to individualize assignment books so that they include items, characters, colors, or designs that are preferable to the student. Students can customize their assignment books to increase the book’s value and help boost motivation.

We hope that you find the use of assignment books as a helpful organizational tool to promote homework and academic task completion!

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.

Using Time Warnings To Help Students With Autism

Now is the time? Kid and clock: preschool child preparing for the school

Giving students warnings about time remaining in an activity can provide a helpful frame of reference. Time limit warnings should be paired with an auditory or visual cue, such as a bell or card. Towards the end of the work activity, the teacher should verbalize, ‘five minutes left, ‘two minutes left’. For students requiring additional support, the verbal que can be paired with the gestural pointing to the timer and manually signing ‘finished’ using sign language. When preparing students for the end of an activity that has a natural ending point, such as a game or a timed-test, the teacher should alert students that a transition is approaching by making such a statement as, ‘only a few more cards and the game is over’. Finally, time warnings or making transitional cards as part of the student’s routine can also help students with autism develop the capacity to be flexible for change. Additionally, teaching students to put away materials in the completion of an activity can function as a natural queue that one activity is ending, and that another is beginning. For example, the teacher can say, ‘once you finish that problem, you can begin to get ready for recess. All of these simple, yet very effective support strategies are easy to use, and help both students and teachers during everyday classroom activities.

Using Activity Completion Signals to Support Students with Autism in Classroom Settings

An activity completion signal is a tool which can help students identify when an activity is over. Many students with autism have difficulty knowing how long an activity or task will last. These difficulties may also be present when students are asked to switch their focus to another task. Activity completion signals such as “Finish Pockets” or a “Finish Boxes” provide a lot of support for students transitioning between activities. Finish pockets, like other tools, can easily be created—folders or plastic containers can be labeled and placed near students’ visual schedules for students to place completed work into. When the student completes an activity, he or she should remove the icon of the current task or activity, and then also place it in the finish pocket. During this time, the teacher would indicate that the activity is over. For example, “math is over everyone, time for recess” thereby allowing a student to recognize a transition, and recognize what comes next in a visual format rather than only hearing the instructions.

There are various ways you can use activity completion signals such as turning an icon-card around so that it is facing backwards, placing an icon or object near the finish box, crossing off the name of the activity or task on a white board, and of course, the old tried and true timer to indicate the end of a task. The more creative you can be, the more variation you will have, but again, just like with visual schedules, the student’s learning rates and skill levels need to be considered when determining the type of signal you use.

In addition, it is always true that you will need to teach the student with autism how to respond to the signals and that you will need to reward (reinforce) the student’s correct responses to the signals.

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.