How has DSM-5 affected an autism diagnosis?

Many parents and individuals with autism were afraid that DSM-5 might bring major changes to their diagnosis in the sense of services and insurance coverage. The DSM -5 main purpose was to help categorize disorders into “classes” with the intent of grouping similar disorders to help clinicians and researchers when diagnosing individuals with autism.

DMS-5

What is the DSM-5?

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM) to guide healthcare professionals in diagnosing mental health conditions. The manual’s fifth edition – DSM-5 – took effect in May 2013. In the medical profession, it is commonly referred to as ‘the bible of psychiatry.’ The DSM-5 lists the signs and symptoms of autism spectrum disorder and states how many of these must be present to confirm a diagnosis of autism spectrum disorder. Psychiatrists and clinical psychologists alike seek to reference patients against a checklist of behaviors provided in the DSM-5.

The importance of being diagnosed with autism

An official (clinical) diagnosis is deemed necessary for a number of reasons, some of which include:

  • Better access to disabled services by registering with the Department of Work and Pensions (DWP) as disabled.
  • Improved conditions in an educational setting for example the Individual Education Plans (IEPs).
  • Improved employment conditions as diagnosis leads to support/protection under The Autism Act 2009.
  • Improved sense of ‘self’ as the individual seeks to understand his/herself better.

Years later, it’s clear the DSM-5 did not cut services for people already diagnosed with an autism spectrum disorder. A growing body of evidence, however, shows that its criteria do exclude more people with milder traits, girls, and older individuals than the DSM-IV did.

Autism Spectrum Disorder

How does the DSM-5 change the way autism is diagnosed?

The first change with the new edition of the DSM is to combine the formerly separate diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not-otherwise-specified into one group with the name of autism spectrum disorder.
The second change is the combining of the three domains that appeared in DSM-IV

  • Qualitative impairments in social interaction
  • Qualitative impairments in communication
  • Restricted repetitive stereotyped patterns of behavior

The third change is a change in the criteria within the social/communication domain that were merged and streamlined to clarify diagnostic requirements.

Clinicans

What developed based on the change to DSM-5?

The two categories symptoms that evolved were

  • Persistent deficits in social communication/interaction and
  • Restricted, repetitive patterns of behavior

The following rationale was provided:

  1. Deficits in communication and social behaviors are inseparable
  2. Delays in language are neither unique to autism (i.e., they appear in other disorders) nor are they universal (i.e., not all individuals with autism have them)
  3. The changes improved the specificity of the diagnosis while not compromising the sensitivity
  4. Increased sensitivity across severity levels of autism
  5. Secondary analyses of data sets support the combination of categories.

Additional assessment for:

  • Any known genetic causes of autism (e.g. fragile X syndrome, Rett syndrome)
  • Language level
  • Intellectual disability and
  • The presence of autism-associated medical conditions (e.g. seizures, anxiety, gastrointestinal disorders, disrupted sleep)

Creation of a new diagnosis of social communication disorder, for disabilities in social communication without repetitive, restricted behaviors.

Specific changes in diagnostic criteria for autism spectrum disorder (ASD):

  • Eliminates subtypes of ASD including Asperger’s disorder and Pervasive Development Disorder (PDD-NOS) from the scientific lexicon
  • Symptoms reduced to two domains: social interaction/communication and restricted/repetitive behaviors
  • Eliminates language delay as a diagnostic symptom
  • Addition of hyper- or hypo-reactivity to sensory stimuli to list of symptoms of restricted/repetitive behavior
  • Onset of symptoms in early childhood (rather than before age 3 years)

DSM-5 guidelines for persistent deficits in social communication/interaction

Difficulties in social communication

Signs in this area include:

  • rarely using language to communicate with other people
  • not speaking at all
  • rarely responds when spoken to
  • not sharing interests or achievements with parents
  • rarely using or understanding gestures like pointing or waving
  • using only limited facial expressions to communicate
  • not showing an interest in friends or having difficulties making friends
  • rarely engaging in imaginative play

DMS-5 guidelines for restricted, repetitive patterns of behavior

Restricted, repetitive, and sensory behavior or interests

Signs in this area include:

  • lining up toys in a particular way over and over again
  • frequently flicking switches or spinning objects
  • perform repetitive behaviors like hand-flapping, rocking, jumping, or twirling
  • speaking in a repetitive way
  • having very narrow or intense interests
  • needing things to always happen in the same way
  • having trouble with changes to their schedule, or changing from one activity to another
  • showing signs of sensory sensitivities like becoming distressed by everyday sounds like hand dryers, not liking the feel of clothes labels, or licking or sniffing objects

The diagnosis indicates support levels for each area. This means that children might have different support levels for their social communication skills compared to their restricted, repetitive, and/or sensory behaviors. Or they might have the same support level for both.

Remember, non-clinical can assess a person, but a medical professional can diagnose a person.

Levels of support can change over time. This happens as children grow and go through transitions. These transitions include moving from child care to primary school to secondary school, or changes in family life like the birth of siblings.

Minor revisions with DSM-5-TR

The DSM-5-TR version was updated for clarity on the wording of the diagnosis. The first change, it now reads “associated with a neurodevelopmental, mental, or behavioral problem.” The second change is to broaden the idea of specifiers.

The diagnosis may be suspected by developmental screens done at 9 months, 18 months, and 24 months of age. The key is to find out as soon as possible if a child is on the spectrum. That way, you can line up resources to help your child reach their full potential. The sooner that starts, the better. Each child is uniquely different with their own personality and interests. Let Leafwing help you start the support that your child deserves.

Let Leafwing professionals educate you and your child to develop the language skills that will help guide your child to reach their full potential.

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Visual Schedule

How to use Visuals to help Students with Autism

Visual Schedule

When students with autism are in a classroom setting, they often need visuals to help them navigate their daily tasks and learn appropriate behaviors for certain situations. Sometimes they need additional support than just words to complete tasks in a timely manner. A child with autism tends to struggle more with transitioning between tasks and/or settings. See how visuals can support students with autism in the classroom:

  • The benefit of using Visual Schedules to help students with ASD
  • What is a Visual Activity Completion for a student with autism?
  • Learn how Choice Boards help to foster good choice-making decisions
  • Star charts help to achieve a desirable behavioral result

Each of these visuals aids the student with navigating and completing tasks at school to have a better, more productive day and reduce problematic behavior that gets ignited by change and anxiety.

The benefit of using Visual Schedules to help students with ASD

A visual schedule can be helpful in showing a student an overview of their day. It will show activities, tasks, and events and at what times these each occur. Having a visual schedule can make transitioning for students easier and less stressful. Visual schedules allow students to begin practicing the skill of predicting change and being okay with it. Visual schedules also help students with ASD in becoming independent of adult prompts and cues.

Within an overview visual schedule for the day can be multiple mini-visual task organizers. These mini-task organizers help to break down a task or assignment into steps or parts to be completed by the student. These visual steps help to foster independence by a student being able to complete the task on their own. Make sure the student with autism understands the concept of sequencing activities. This will help to eliminate any meltdowns or confusion about the visual schedule that could occur.

The use of a visual schedule and mini-visual task organizer does not happen overnight. Repetition and reminders are the keys to success with these schedules. A visual tap reminder to the portion of the schedule that is current can help remind a student where and what they should be doing. Having a repetitive and consistent day-to-day schedule also increases the odds of a better time through the use of visual schedules.

What is a Visual Activity Completion for a student with autism?

  • A visual or audio signal to a student with autism that a task is complete or almost complete

As stated above, students with autism can have trouble with transitions between activities or events. Therefore, having a signal came to be a great way to make the transition fun and easy for all involved. Some examples of activity completion signals are:

  • Turning over an icon card
  • Checking off a box on a list of activities
  • Turning on a timer
  • Placing the assignment in a folder or box

No matter which option you pick it is still important to teach students with autism how to respond to the signal. It will take some practice for students to respond appropriately to these signals. Additionally, it is vital to continue to reinforce and reward positive and appropriate behavior from the signal.

Learn how Choice Boards help to foster good choice-making decisions

A choice board incorporates choice into a visual schedule. Any students but especially those with autism thrive and can have more positive behavior when a choice is involved. A choice allows a student to feel in control of their learning and the situation they are currently in. Choice does not mean allowing a student to do what they please, rather it lets a student take ownership in completing a required task. No matter the choices are given, both should result in the same desired outcome.

For example, it’s time for recess and the students need to put on coats and gloves, A choice can be which one they want to put on first. Regardless both will be put on for the desired outcome of being ready for recess, but it lets the student take ownership of getting ready.

In order for choice boards to be successful, the choice needs to be discussed aloud and physically pointing to the choices. This helps the student with autism create a connection and be able to quickly make a choice. Making a choice should not be a lengthy process, there should be a limited number of choices so that the student is not overwhelmed. This makes it easier to make a choice in a minute or less and be able to complete the task.

Star chart

Star charts help to achieve a desirable behavioral result

A star chart, also known as a behavior chart, is a visual reward system for students of all ages. It allows the student to see how close they are to receiving a pre-determined reward. Star charts encourage good behavior and allow for student independence as well. Language delays and problematic behaviors such as physical aggression or self-injury can be effectively addressed using star charts. This type of tool provides the much-needed structure and reassurance for a child with autism requires. The Star chart is the motivation the student with autism needs to keep them focused on the task for their reward. The reward needs to be individualized for that particular student otherwise it may have no benefit for the result you are trying to achieve. Teachers do not have to do anything other than make the chart and tell the student to add to it when they receive a token.

Star charts can be created uniquely for each individual student to their interests such as Pokémon, Mario Cart, My Little Pony, Star Wars, etc. A board is made usually for spots to fit 10 tokens with an engaging background. Then characters or objects within the same theme are created as tokens. Velcro helps to hook the tokens to the chart. As a student exhibits desired behaviors throughout the day, then the teacher can let the student know to add a token to their chart.

The reward should be something that is developmentally appropriate and something that interests the student without being a distraction to others. If a student does not earn the reward for the day, a conversation should be had about behavior changes that can be made for the next day. Star charts should reset after each reward is earned and after each day. In order to be successful, the student has to buy in and feel like they are able to earn the reward so having the highest expectations from the beginning may not work. Having small steps to small wins will be great for everyone involved.

The takeaway from using visuals to help students with autism

The versatility of visuals is a training tool to provide cues or reminders for students with autism to engage in a specific task or a reinforcer to deliver the appropriate behavior. The key is identifying your goal and then letting the chart help you achieve it.

Other Related Articles:

Choice Boards And “Wait” Support For Students With Autism In The Classroom
Supporting Students With Autism In The Classroom With An Assignment Notebook
Strategies For Autism In The Classroom

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Motivational words

Choice Boards and “Wait” support for students with autism in the classroom

The benefits of Choice boards and ‘Wait’ support in the classroom may vary depending on the need of the student with autism. Different Choice boards may need to be developed based on the motor and communication skills of the student. As such, it can display the objects, pictures, icons, or words that would represent a menu of activities or reinforcers. It is vital the pictures represent the actual object so the student can connect the picture and the object. These can easily be created with supplies such as poster paper, card stock, whiteboards, or on any surface that you can attach or write on. Choice boards are often placed next to a student’s daily schedule and when a designated time arrives, students simply select a preferred activity from the board. Choice boards with preferred activities can be placed near the free time or break time area of the room, and provide a stimulus for independent selection of activity. Choice boards can implement structure, and provide a routine that becomes familiar to students with autism which aids in decreasing anxiety.


Choice boards for autism in the classroom

What are Choice boards for autism?

A Choice board is a type of visual environmental support that can be beneficial for students, especially students with ASD. Choices should be incorporated into as many activities as possible as choice boards provide students with decision-making opportunities and a sense of responsibility for their behavior and work. A Choice board may or may not have written words describing the image.

When to use a Choice board in the classroom

  • Reinforcers
  • Rewards
  • Activiities or Actions
  • Materials or Supplies

How are Choice boards used?

When introducing a Choice board to a student with autism make sure to show the Choice board and then read the choices aloud and point to the choice that you are reading. You need to make sure to wait for the student to select a choice by either pointing, removing the choice, handing it to you, or verbally choosing.

What are the benefits of using Choice boards within the classroom?

Choice boards are used to encourage communication, provide a visual reminder of what activities are available, and encourage independent decision-making throughout the day within the school setting. Offering a choice before an activity/task begins may increase the likely hood of participation and decrease the possibility of a student with autism to engage in challenging behaviors.


Wait Support for students with autism in the classroom

Why are ‘Wait’ supports important for children with autism?

Similar to Choice boards, ‘Wait’ support is another visual strategy or tool that can be incorporated throughout the school day. As we know, waiting is a difficult skill for many children, with or without disabilities. However, for students with autism, in particular, waiting typically presents problems because time is an abstract concept, not aware of social rules of waiting, or comprehending the reason for waiting.

We also know that if a student is waiting too long or is not engaged in some type of activity, even if it is a simple activity such as putting a backpack away or clearing a desk, then more than likely, unwanted behaviors will occur. Therefore, students with ASD will typically require specific instructions to develop appropriate waiting behaviors.

Guidelines to determine the type of ‘Wait’ support

When developing ‘Wait’ supports, you need to determine if the student has the prerequisite skills that are necessary to engage in waiting behaviors. Students have to wait on many occasions throughout the day.

Examples of wait times at school

  • Wait to access a preferred activity or object
  • Wait for the bus in the morning and afternoon
  • Stand in line to leave the classroom
  • Wait for lunch to be served
  • Wait for everyone to be quiet for circle time

Wait support tools

  • Visual timers
  • Countdown strips
  • Distractors

First, role-play and practice waiting using different instructions and in different settings when you want to identify this skill.

Keep in mind that when you are practicing ‘learning to wait’ with your students, make sure it is authentic and in an actual setting where you would expect the student to use this skill.

Again, be sure to teach waiting skills across a variety of settings to increase the likelihood of generalization. Even using a peer model or a peer buddy during waiting times can offer support for desired behaviors. Additionally, specific ‘physical supports’ such as chairs near the waiting area, setting a timer, or holding a picture representing “wait” can also help a student learn this concept.

As you know for any kind of learning to take place, it is essential for students to have an active involvement with their teachers, peers, and the curriculum. Provide that, students with autism tend to be passive learners, it is necessary to plan activities that require students to become active participants. This can occur by creating opportunities for students to respond. Research supports a functional relationship between academic performance and how often a student is able to respond. Therefore, the more a student participates in an activity, the more off-task and disruptive behaviors will decrease.

Let Leafwing Center help establish some basic Choice boards and ‘Wait’ support methods for your child that simulates the classroom setting. This will aid and decrease anxiety when the student is ready to make the transition to the classroom. Make sure to share the methods with the child’s teacher to help reinforce the foundation that has been established by the ABA therapist for children with autism.

Other Related Articles:

Strategies for autism in the classroom
Supporting students with autism in the classroom with an assignment notebook
Autism communication strategies

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

What not to do with a child with autism

Oftentimes it is suggested what to do with a child with autism. However, equally as important is what not to do. It is necessary to know and understand what not to do in order to be able to provide the best environment for a child with autism.

ABA therapy programs are effective in treating children with autism because they create very structured environments where conditions are optimized for learning. Over time, these very structured environments are systematically changed so that the environment mimics what a child could expect if and when they are placed in other environments.

Let Leafwing professionals educate you and your child on some key components and techniques when raising a child with autism to reach their full potential.

Don'ts of Autism

What not to do with discipling a child with autism

It can be hard to know what to do and not do in terms of discipline with a child with autism. Their development is different from their neurotypical peers so it is vital to make the distinction.

  • Do not punish for typical autistic behaviors. Stimming, meltdowns from overstimulation, and spams are all behavior they cannot control. They are part of a normal every day for a child with autism.
  • Do not be confusing in your reasoning. When explaining to a child with autism a reason for the consequence, use clear logic they can understand. Avoid things like metaphors, hypothetical scenarios, and complex vocabulary.
  • Do not use punishments that are not age/developmentally appropriate. Use consequences to help your child grow and learn. Behavior is a form of communication. Learn what your child is trying to communicate and help them better communicate that next time with positive action.

Your child with autism may not understand the traditional discipline techniques as well as the consequences of their actions. As a parent you might feel frustrated by this, but you need to refrain from any kind of physical or verbal punishment that could have a negative effect on your child. Remember, all children learn from imitation, so try to respond to your child’s behavior clearly and gently. Consistency is the key for all children when it comes to discipline. Do it with a loving heart. When children know you are disciplining them because you love them and want what is best for them then it has a more positive outcome.

What not to do with tasks for a child with autism

What not to do with tasks for a child with autism

Children with autism are able to complete tasks and chores similar to other children. These are necessary to help them become independent and learn essential life skills. Practice tasks with Forward Chaining or Backward Chaining methodology. Use the method that your child feels more comfortable with.

  • Do not have too many expectations. Have a few clear expectations for a child to be able to remember and follow.
  • Do not only have verbal instructions. Many children with autism are visual learners. Therefore, provide both words and pictures. For example, a picture of a toothbrush with toothpaste on it to remind them to brush their teeth.
  • Do not make them do less just because they have autism. Children with autism are just as capable as their peers. They may need a little more help when completing a task but they can still do it. Holding a child back from their full potential will only hurt them in the long run.

Remember at the Leafwing Center your ABA therapist can put together an Acquisition Skill Plan to help hone in on a skill that needs to be refined to help your child progress in basic analysis tasks like getting dressed, brushing teeth, or combing their hair.

 

What not to do when interacting with a child with autism

What not to do when interacting with a child with autism

People can often feel awkwardness or uneasiness when interacting with a child who has autism. However, there are just a few key concepts to remember for the interaction to easily go smoothly.

  • Do not get into their personal space. Many children with autism do not like to be touched especially when it’s unexpected. Give them their space.
  • Do not only see them as a child with autism. Autism is part of their identity but it is not their whole identity. When interacting with a child with autism, treat them like you would treat anyone else with kindness.
  • Do not beat yourself up over making a mistake. As a parent of a child with autism (and just a person in general), you are going to make mistakes. So, give yourself grace, apologize, and move on.

Teaching children with ASD to improve their communication skills is essential for helping them reach their full potential. There are many different approaches, but the best treatment program begins early, during the preschool years, and is tailored to the child’s age and interests. It should address both the child’s behavior and communication skills and offer regular reinforcement of positive actions. Most children with ASD respond well to highly structured, specialized programs. Parents or primary caregivers, as well as other family members, should be involved in the treatment program so that it becomes part of the child’s daily life.

 

Autism Feeding Issues

What not to do during meal time with a child with autism

Meal times can be a stressful time for everyone in a household that has a child with autism. With all the different textures and flavors, it can be intimidating. Children with autism have an increased likelihood of possessing food sensitivities. Both food allergies and food intolerances are common in children with autism. These children are twice as likely to have some type of food sensitivity. Refer to your pediatrician about any food allergies with your child .

  • Do not make choices for them. Allow a child with autism to make choices for themselves within reason. This will give them the confidence and independence to do it on their own next time.
  • Do not yell at them. For any child, this can be overwhelming but for a child with autism, this increase in sound can trigger a meltdown. Additionally, it doesn’t help fix the situation in the end.
  • Do not rush or pressure them. Eating and meal times can be a very difficult time for a child with autism. Allowing them to go at their own pace and providing a safe environment for the child is a necessity.

Leafwing Center can work with you to design a plan for autism feeding issues that you may be facing with your child. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels. ABA therapists are trained to address the behavior. If you are concerned about the health and wellness of your child then you need to contact your physician.

Having a child with autism is a learning process for everyone. You as a parent are going to be constantly learning the new and best way to help your child with autism navigate new experiences with the world around them. There is no one-size-fits-all when it comes to the approach of developing a child, alone a child with autism. Learn from these ‘What Not to Dos’ and adjust your approaches with your child.

Leafwing Center has professional BCBA therapists that can help you and your child navigate through the stages of development as your child grows. Call us today to see how we can help!

Other Related Articles:

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Autism Feeding Issues

Meal times and feeding can be a hurdle in the life of a family with a child who has autism. There can be difficulties with eating due to different textures, smells, sounds, food allergies, aversions, or a lack of interest. However, there are many strategies to help children with autism overcome the hurdle and have an enjoyable meal experience.

Autism Feeding Issues

Autism and Food Sensitivity

Children with autism have an increased likelihood of possessing food sensitivities. Both food allergies and food intolerances are common in children with autism. These children are twice as likely to have some type of food sensitivity. These food sensitivities are common due to immune issues as well as differences in their digestive tracts, especially in regard to carbohydrates.

Children with autism can have food allergies. These are similar to the rest of their peers in that food causes a reaction within the body and can be life-threatening.

Food sensitivities can cause

  • gastrointestinal pain,
  • nausea,
  • gut issues, or
  • hives.

However, not all children with autism can vocalize this discomfort and it may lead to behavioral outbursts. They may become more upset or stressed during meal times, have meltdowns, or attempt to avoid food altogether.

Additionally, children with autism may experience food intolerances. This is not the same as allergies as there is no life-threatening aspect. However, it can still cause the same or similar behavior outburst. Two common food intolerances in children with autism are gluten and casein (a dairy protein).

Food intolerances can cause

  • stomach pain,
  • diarrhea or
  • constipation.

It can be helpful to take a child with autism to an allergy specialist and one that specializes in working with autism. They will be able to determine any food allergies or food intolerances to avoid during meal times. This can make the whole process go smoothly and rule out one possibility of a child avoiding food.

Autism Feeding Issues

What to do if your child with autism won’t eat?

The first step in determining a plan towards diet expansion for your child with autism who won’t eat is to see which problem category they fall into.

Feeding problems or “picky eating”– Some children with autism only eat less than 20 foods and do not include all the food groups. Once they eliminate a food or a group, they will not eat from it again. Determining if your child falls into this category as early as possible is necessary to help them get feeding intervention from a feeding specialist or occupational therapist.

Medical – Sometimes eating can cause a child with autism discomfort or pain. Some possible issues can be reflux, constipation, GI issues, or respiratory involvement. Finding a pediatrician that specializes in working with children with autism is vital in order to get the issues resolved or managed.

Oral motor – Eating involves the coordination of the lips, tongue, jaw, and facial muscles before swallowing. Oftentimes, this process is learned young. However, children with autism can have a breakdown in this learning process due to structural abnormalities. Getting help from a speech-language pathologist can help in strengthening and using these muscles to aid in eating.

How do you teach a child with autism to feed themselves?

Before a child with autism can feed themselves, it is important to establish a routine with the child so they become more comfortable. Try to eat at the same place and same time every day that way it establishes a sense of routine for the child. They know when the family sits down at the table, it is their indicator that eating a meal will be involved as well as the expectations during that time.

  • Begin with the basics. Start off with the child eating foods they already know and love to help them ease into the situation
  • Remove stressors or other sensory aversions before starting meal time. Sometimes smells or unusual sounds can be deterrents to a child with autism at meal time.
  • Support a child’s posture while eating. Oftentimes children with autism have poor trunk and core stability so they may lean or wiggle in their seats. Putting cushions, towels, or a stool can help children sit more comfortably at the table or eating space.
  • Get foods out of the packaging. Sometimes children only think they like a specific brand of food. Taking food out of packages eliminates the questioning if it came from a certain brand. Putting food into clear containers as soon as they are brought home and helping to introduce new brands of similar foods.
  • Avoid focusing on food and your child’s behavior. If during meal time, the family is talking and eating there is less pressure on the child to eat and they can go at their own pace without worrying about being watched or eating quickly.

Leafwing Center can work with you to design a plan for autism feeding issues that you may be facing with your child. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels. ABA therapists are trained to address the behavior. If you are concerned about the health and wellness of your child then you need to contact your physician.

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Strategies to use for the park with your child with autism

There are some simple strategies to use when going to the park with your child with autism. Going to the park can turn into a nightmare quickly if the child with autism starts to feel overwhelmed or surprised. Many parents don’t take the necessary steps to help minimize the meltdowns of children with autism and run into barriers when taking their children out into the community.

Strategies to Help You Go to the Park with Your Child with Autism

Challenges for children with autism at the park

The park is one place where children typically enjoy their freedom and thrive, which can be a nice relief for many parents. Although, for parents of children with autism, this can be a stressful situation for many reasons.

  • Children with autism may not have the social skills to play with other children and they may not interact in ways that are socially appropriate.
  • Some children might have the tendency to run or wander away (elope).
  • Other children may have difficulties with transitions and therefore, leaving the park is always a struggle for the parent of a child with autism, more so than that of a parent of a typically developing child.

Nevertheless, there are some strategies for parents of children with autism to practice to help relieve some of these stressors and make the park a more enjoyable experience for everyone.

How parents can prepare children with autism for the park

The key to going to the park is to plan and prepare ahead of time. Give lots of warnings to help minimize the meltdowns. Predictability allows the child to feel more secure. When they feel uncomfortable and out of control is when the meltdown is triggered.

Tips on how to prepare:

  • Let the child have a say. Ask them what they would like to try first at the park.
  • Share the schedule. Let them know what to expect. If transitions are difficult, let your child know from the time of arrival how much time he or she will have at the park. Have a visual countdown (e.g., boxes that are crossed off every 5 minutes) until it is time to leave. If your child prefers electronics and timers, start a timer on a phone or electronic device instead.
  • Stick to the schedule. Prepare to leave. Have an exit strategy. Provide reminders when time is almost up, so your child is not “surprised” when it is time to transition. When time is up, it helps to have something positive that your child can look forward to after the park (e.g., frozen yogurt, pick up brother, dinner, or treat in the car).
  • Start small. Try not to overload them by having them try everything at the park. Take one thing like the swings and show them how you use the swing.
  • Bring identification. If your child tends to wander or run away you might want to consider having identification. You might tell yourself that you will be close by, but it is always better to be safe than sorry.
  • Facilitate the play. Consider sparking interest in your child for other people, activities, toys, and conversations by pointing these out in his or her environment: “Wow, those kids are going down the slide really fast, that looks fun!” or “That boy has a really cool race car, maybe you can ask to see it?” These are minimally intrusive ways to promote engagement with surrounding people, objects, and activities.
  • Prepare a To-Go bag with calming tools.
    • Sunglasses
    • A wide-brimmed hat
    • Fidget toys
    • Stuffed toy
    • Chewing gum
    • Weighted blanket
    • Bottled water and healthy snacks

With repeated exposure and positive interactions with people and activities at the park, your child’s positive engagement at the park may be reinforced over time. In other words, it may get stronger, and more frequent, and trips to the park can turn into something he looks forward to.

Strategies to Help You Go to the Park with Your Child with Autism

How ABA therapy can help with your park experience

Kids learn through play. ABA therapy can build the skills children need to play by incorporating naturalistic teaching. We want them to experience a park setting in a safe environment and how to use the equipment at their own pace.

ABA therapy can help with:

  • Taking turns
  • Use equipment appropriately
  • Following directions

We hope that these strategies may help relieve some of the stress associated with going to parks and both you and your child can enjoy and have fun!
Don’t stress yourself out if your child does not enjoy being at the park. It is fine. It may not be a good fit. Don’t push the issue. Find something else that your child feels comfortable participating in that offers sensory-friendly activities like museums, theme parks, or movie theaters. Just make sure they are having fun during their playtime.

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Assignment Notebook

Supporting students with autism in the classroom with an assignment notebook

One way of supporting students with autism in the classroom is with an assignment notebook. It will give them the feeling of inclusion especially if all the students have one. While some students with autism are ultra-organized, others need support to find materials, keep their locker and desk areas neat, and remember to bring their assignments home at the end of the day. Present assignment notebooks to the whole classroom for staying organized with assignments from the teacher. This is an effective organizational strategy for students with autism spectrum disorder, especially those who are older and possess the prerequisite reading, writing, and organizational skills in 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. Students on the spectrum tend to be visual learners.

Visual Type Examples:


Supporting students with autism in the classroom

What should the assignment notebook contain to support students with autism?

Ideally, it should contain examples of completed resources (math equations, definitions, filled-out problems, etc.) as these would function as visual examples in order to correctly complete assignments. 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.

Alternatives to classic note-taking to help with assignments

  • Record the lesson
  • Use another student’s notes
  • Use the teacher’s outline and fill in the blanks

Supporting students with autism in the classroom with an assignment notebook
Teachers use assignment notebooks to support students with autism in the classroom

A poor classroom environment for autism can be a grave disadvantage to students with the condition. Most notably, it can cause them difficulty engaging in learning activities and coping with daily life. What’s more, is that these issues can have a lasting impact on them.
This is why, as a teacher, it’s crucial for you to be aware of the educational implications of autism and how to adopt effective autism instructional strategies. By integrating suitable autism learning styles and alleviating any discomfort in the classroom, you will enable autistic children to take part in learning more comfortably and become better prepared for their future.

Additional ways students with autism can be supported in the classroom

  • Have student repeat back directions
  • Provide task analysis for multi-step tasks
  • Break large chunks of work into smaller parts
  • Using graphic/visual organizers (e.g., organizational, attentional issues)
  • Providing notes for lessons in (subject)
  • Providing outlines for lessons in (subject)
  • Using visual cues (PECS, words, charts, cards) to review schedule, expectations
  • Ensuring that student writes homework assignments legibly
  • Ensuring student has homework assignments and materials before departure
  • Providing study carrel or dividers for independent work
  • Providing preferential seating
  • Providing seating away from distractions
  • Providing seating without visual distraction in the visual field (windows, etc.)
  • Structuring for minimal auditory distraction
  • Providing task analysis; breaking down goals into small steps
  • Using manipulative materials to increase participation in the learning experience
  • Providing peer tutoring/paired work assignment

How parents can help with the assignment notebook

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.

The purpose of the assignment notebook for students with autism

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 that 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.

Peer Support

How to encourage the students with ASD to participate in the assignment notebook

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.

Structuring this time daily will give all learners the opportunity to be organized and thoughtful about how they prepare to transition from school to home. Specific skills can even be taught during this time (e.g., creating to-do lists, prioritizing tasks).

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

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Graphic organizers for students with autism

A graphic organizer is a visual support that provides a visual representation of facts and concepts within the organized framework. Graphic organizers arrange key terms to show their relationship to one another, providing abstract or 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 either as an answer organizer or a measure of concept attainment. Graphic organizers also allow processing times for students as they can reflect on the written material at their own pace.

graphic organizer

Why use graphic organizers

A graphic organizer is a great tool that can assist with abstract information and present it 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 keyword 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.

Additional types of graphic organizers

  • Venn Diagrams – shows how different ideas can overlap to show a compare/contract relationship.
  • Concept Maps – good for organizing, brainstorming, visualizing ideas, and planning what you want to write about.
  • Mind Maps – shows hierarchical information that has a central idea with associated topics that branch off.
  • Flow Charts – shows how steps in a process work together.

graphic organizer

How do graphic organizers help students with autism

Graphic organizers have an overall benefit to the education of a student with autism. This tool allows these students to open up and communicate with teachers, teacher aids, and peers without having to verbally communicate because some students with autism can’t or won’t speak. The specific needs of students with ASD may affect their success in inclusive settings in the classroom. First, they will have more challenges than the average student with engagement in the classroom. This may include understanding and effectively working within the classroom environment due to challenges related to filtering unnecessary information, selective attention span or shifts in focus, and difficulty attending to meaningful aspects of the learning environment, especially when it’s not explicitly stated. The graphic organizer can help bridge the the learning gap among students with autism.

A collection of ready-to-use graphic organizers will help children classify ideas and communicate more effectively. By using graphic organizers across all subject areas, this will empower the student with ASD to master subject-matter faster and more efficiently.

Graphic Organizers have been known to help:

  • brainstorm ideas.
  • develop, organize, and communicate ideas.
  • see connections, patterns, and relationships.
  • assess and share prior knowledge.
  • develop vocabulary.
  • highlight important ideas.
  • classify or categorize concepts, ideas, and information.
  • improve social interaction between students, and facilitate group work and collaboration.
  • guide review and study.

The student may neither understand the concept of the main idea, and/or not understand when the teacher is giving cues to students for essential 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, allowing students to follow the lecture, while freeing them from any note-taking,
(2) 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.

Graphic organizers are a means of expanding learning for students with autism

Remember, students with ASD often require visuals to assist with learning and processing information. But, what about assignments other than writing assignments? For example, graphic organizers can aid with math. Story problems are a prime example. Graphic organizers can help narrow down story problem ideas such as important words like “more than”, “difference”, “percent”, or “rate”. Furthermore, graphic organizers can serve as a tool when learning mathematical operations. It will help to organize the student’s thoughts and show their work and clearly identify the answer. The next time you want to teach a student with autism, provide a graphic organizer and see how beneficial it is to their learning. Graphic organizers are useful for any classroom subject and for all ages.

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Grocery shopping with your child with autism

Grocery shopping with your child with autism can be quite stressful for parents. A grocery store is a place that can be a sensory overload for your child who is autistic; the bright lights pulsating overhead, low-grade music, people, kids, and carts milling around, water sprayers misting the vegetables, and the coupon dispensers with their blinking red lights waving coupons at eye level just to name a few. Your approach to the shopping experience can make a world of difference for you and your child with autism. It will require some preparation from you to enhance the shopping experience for your child who is autistic. Some simple Grocery Shopping Preparation tips will help to relieve the stress that comes with shopping with your child with autism. However, depending on how you choose to look at it, this routine life skill can also be a wonderful learning experience if parents take the time to follow a few simple strategies.

Grocery shopping with your child with autism

Preparation before your grocery shopping with your child with autism

Before the shopping experience begins, it may be beneficial to state what is expected from your child. Provide clear rules and expectations for the shopping trip.

Suggestions for teaching three crucial parts of a grocery store visit:

  1. Safe walking to and from the car;
  2. Quiet in the car;
  3. Appropriate conduct in the store.

If this is your child’s first time to the grocery store and they are prone to meltdowns, then start small. Allow your child with autism to bring a small toy for comfort. Set a time of how long it will take.

Make a list of items in the order that you walk through the store, either drawn-out, printed out, or cut out from advertisements that your child can keep track of during the shopping trip. Keep in mind that it is hard to backtrack through the grocery store if you have forgotten an item with a child who is autistic. These can be items they prefer and would be interested in tracking and finding. Ask your child to cross out the items or put the picture in an envelope when you both find the item, signifying one step closer to being done with the shopping experience. Another option would be give your child a shortened list without all the items you need to get on it. A simple trick is to save the last item on your list to correlate to your child’s last item on their list so that they can directly relate that the grocery shopping trip is done when they cross out the last item on the list.

More and more grocery stores are trying out what is called ‘Quiet Hour’ which is a more autism-friendly atmosphere for individuals who need fewer distractions and sensory overload. Check out in your area if there are any participating.

Dad and son at the grocery store

Techniques to use while grocery shopping with your child with autism

Get your child involved in the shopping experience by allowing them to push the cart, select and put the items in the cart, place contents on the conveyor belt, and stay near the cashier until the groceries are bagged. Make the shopping experience fun.

Furthermore, use the experience to teach language skills. Grab a green and a red apple and ask your child to identify which one is red. Grab a big and a small can of tomatoes and ask your child to identify which one is bigger. Ask your child to label items that you grab from the shelves, especially preferable items. Based on how advanced your child’s speech is, tailor what you ask of them to their level.

Don’t forget, it is important to provide continuous positive feedback for when your child is participating in the shopping experience. Try not to draw attention to behavior that is not appropriate at the grocery store. This can be accomplished by providing a reward at the end of the shopping experience. When your child with autism masters the basic skills of shopping, reward them by having one of their favorite food items on the list and allowing them to pick it up. For example, if your child loves Hershey candy bars, then put them as the last item on the list and keep reminding them that good behavior then will allow them to have their favorite item. Keeping their “eyes on the prize” encourages them to stay motivated, attentive, and happy.

Have a backup enjoyable activity that your child can engage in while you are completing the remaining part of the shopping trip that is not on their list. A small coloring book, games on your phone, a squishy toy, or some music through headphones may work to keep them engaged.
Lastly, if your child has difficulties walking through an entire shopping experience, allow your child to catch a ride on the shopping cart only if they have walked and helped for a certain amount of time, or when all of their grocery lists are completed. If you base it on time, be sure to have a visual chart (e.g., have 5 boxes, each representing 2 minutes) or timer for them to know how much time they have left of walking.

Assess the grocery shopping with your child with autism experience

Remember to take your child often to the grocery store. Taking them to the grocery store once or twice each week is now part of their routine and something they expect and even look forward to.

Don’t be discouraged based on one trip to the grocery store with your child on the spectrum. Not all trips to the grocery store end in triumph and when things don’t go so well, tell yourself that success emerges from routine and persistence. Trying again (and again and again) is an important part of the learning process for your child with autism. It is important to learn life skills that they will need to know how to do later in life.

We all have good days and bad days and that holds true to our children. You’ll be pleasantly surprised when you see your child starts to take simple steps toward a positive grocery shopping experience as long as you don’t put limits on your time and expectations of your child with autism.

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?

Autism communication strategies

Autism communication strategies are techniques that help your autistic child develop their language and communication skills. Language impairment in communication is one of the main diagnostic criteria for a child with autism, specifically a delay in or total lack of spoken language. Many children may have difficulties not only expressing themselves but also understanding what other people say. Adults may think that the child is just ignoring them but in reality, the child may not understand what the adult is saying. Imagine going to a foreign country with people speaking a language that you do not understand and having no means of figuring out what the people are saying. If someone says, “Hey you, come here” in their language, would you respond? If you don’t understand what they are saying you probably would not respond. This is how your child might be feeling.

Let Leafwing professionals educate you and your child to develop the language skills that will help guide your child to reach their full potential.

Autism communication strategies

Interventions to improve communication with autistic children

A Speech Therapist or Pathologist is the lead professional in the assessment of an individual’s understanding and use of language and can provide information about you or your child’s level of language development. They can also provide support planning for intervention, and advise of which strategies can be the best use to support the development of communicative skills.

Applied behavioral analysis (ABA) is a type of therapy that can improve social, communication, and learning skills through reinforcement strategies. Many experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder (ASD) or other developmental conditions.

ABA therapy programs are effective in treating children with autism because they create very structured environments where conditions are optimized for learning. Over time, these very structured environments are systematically changed so that the environment mimics what a child could expect if and when they are placed in the classroom.

Autism communication strategies: Visual supports

Visual supports are concrete cues that help communicate and build language skills. This can incorporate the use of symbols, photos, written words, and objects to help children with autism to learn and understand language, process information, and communicate.
We take for granted the different ways we communicate daily which include:

    • Language: The way we represent information – what words mean and how we put them together.
      • Receptive – refers to how your child understands language.
      • Expressive – refers to how your child uses words to express himself/herself.
    • Speech: A verbal means of communicating – using sounds to make words.
    • Non-verbal methods: gesture, facial, expression, eye contact, etc.
    • Pragmatics: The way in which individuals use language in social situations. It includes following the ‘unspoken’ rules of conversations, for example, taking turns.

Many children on the autism spectrum respond well to visual information. Visual information can be processed and referred to over time, whereas spoken communication is instant and disappears quickly.

Visuals can involve communication books or boards that use images and/or words on cards to help the individual learn the word and its meaning. The child can point to the image when they want to communicate. For example, if the child is thirsty, they can point to an image of a glass of water. As the child learns more symbols and words, they can use them to create sentences and to answer questions. Others can also use the images to communicate with the child. This is known as the Picture Exchange Communication System and can be used in the development of intentional and functional communication.

Another autism communication support tool is known as a visual or picture schedule. This helps individuals learn the steps of a routine, like getting ready for bed. A series of pictures show the steps in order and over time they learn each step.

Furthermore, visual schedules can be used to show a person on the spectrum what is happening next or show when there is a change in routine. As people on the spectrum generally don’t like change, this can help them prepare for a change and cope with it more easily. This enables the language surrounding change to be more easily understood and allows individuals to refer back to schedules throughout the task and throughout their day.

Augmentative and alternative communication (AAC)
Autism communication strategies: Augmentative and alternative communication (AAC)

Augmentative and alternative communication (AAC), helps individuals who cannot talk or are very hard to understand. AAC means all of the ways that someone communicates besides talking. People of all ages can use AAC if they have trouble with speech or language skills. This provides another way to help them communicate other than verbally. AAC includes:

  • Sign language
  • Gestures
  • Pictures, photos, objects, or videos
  • Written words
  • Computers, tablets, or other electronic devices

AAC can help children with autism and can even assist with developing spoken communication. A lot of people wonder if using AAC will stop someone from talking or will slow down language development. This is not true—research shows that AAC can actually help with these concerns! People who use AAC can also learn how to read and write.

Speech generation devices either play pre-recorded words via a switch or button or sound out text that is typed into them. Using the previous example, a child who is hungry can press the ‘food’ picture button and the device will say, ‘I want to eat.’
While these tools can be used to replace speech, they can also be used to help a child develop speech. They do this by helping the child to recognize sound patterns and can be used with visual aids to build language skills.

These systems can also help children learn words as they begin to associate the sound and picture with each other. They also help by slowing down communication, giving the child more time to process the information and avoid becoming overloaded.

Autism communication strategies: Guidelines for nonverbal autistic children

No matter where your child falls on the spectrum for autism, they have the ability to communicate in some manner. Here are some simple guidelines to consider when trying to help your child to communicate with you as well as with others.

  • Encourage play and social interaction. All children learn through play, and that includes learning the language. Interactive play provides a delightful chance for you and your child to communicate. Play games that your child enjoys. Incorporate playful activities that promote social interaction. For example singing, reciting nursery rhymes, and gentle roughhousing. During your interactions, crouch down close to your child so your voice and face are closer to them, increasing the chance of them looking at you.
  • Imitate each other. Copying your child’s sounds and play behaviors will encourage more vocalizing and interaction. It also encourages your child to copy you and take turns. Make sure you imitate how your child is playing – so long as it’s a positive behavior. For example, when your child rolls a car across the floor, then you too roll a car across the floor. If they crash the car, you crash your car too. Be sure not to imitate inappropriate behavior like throwing the car!
  • Focus on nonverbal communication. Gestures and eye contact can build a foundation for language. Encourage your child by modeling and responding to these behaviors. Exaggerate your gestures. Use both your body and your voice when communicating – for example, by extending your hand to point when you say “look” and nodding your head when you say “yes.” Use gestures that are easy for your child to copy. Examples include clapping, opening hands, reaching out arms, etc. Respond to your child’s gestures: When they look at or point to a toy, hand it to them or take the cue for you to play with it. Similarly, point to a toy you want before picking it up.
  • Give time for your child to talk. It’s natural for us to want to fill in the missing words when a child doesn’t quickly respond. It is important to give your child lots of opportunities to communicate, even if they are not talking. When you ask a question or see that your child wants something, pause for several seconds while looking at them enthusiastically. Watch for any sound or body movement and respond promptly. The promptness of your response helps your child feel the power of communication.
  • Simplify your language. Be literal and obvious in your choice of language. Say exactly what you mean. Speak in short phrases, such as “roll ball” or “throw ball.” You can increase the number of words in a phrase one your child’s vocabulary increases.
  • Follow your child’s interests. Rather than interrupting your child’s focus, follow along with words. Use simple words about what your child is doing. By talking about what engages your child, you’ll help them learn the associated vocabulary.
  • Consider assistive devices and visual supports. Assistive technologies and visual supports can do more than take the place of speech. They can foster its development. Examples include devices and apps with pictures that your child touches to produce words. On a simpler level, visual supports can include pictures and groups of pictures that your child can use to indicate requests and thoughts.

Remember, the more concise and simpler the instruction, the more successful the child will be. It is important to note that the simplicity or complexity of language used should be based on the child’s language repertoire at that particular time. Over time, and with success, simple and concise instructions will be elaborated and more language will be part of their communication.

Autism puzzle
Autism communication strategies: how ABA therapy can help

ABA therapy is effective 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.

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 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.

Listen to:

The Advantages of Applied Behavior Analysis (Podcast Episode)

 

Frequently asked questions about ABA therapy

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 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 are 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 us at [email protected].

Who Can Benefit From 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.

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.

How do I 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 with whom you wish to work, 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?