Behavior Functions of ABA Therapy

What are the 4 Behavior Functions of ABA Therapy?

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Behavior Functions of ABA Therapy
There are four categories of Behavior Functions: Sensory, Escape, Attention, and Tangible, commonly referred to as S.E.A.T.

When going to an ABA Therapist, they will evaluate a child and put their different behaviors into one of four behavior functions or behavior categories. They are as follows:

This helps the therapist to identify a behavior and a reason the behavior may occur, and then make a plan to either redirect the behavior when it occurs or use other tools within ABA therapy to replace the behavior with a more desired one. Therapists will work with both the parents/guardians as well as observe the child to determine behavior.

By singling out instances of a behavior they can determine where a behavior may occur in a category. For example, if a child asks for a cookie and they are given one, they are likely to ask for one again. An ABA therapist would place this scenario into ‘Access to Tangibles’ as the child is getting the physical cookie to have when asked.

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Sensory Integration

# 1 Behavior Functions of ABA Therapy: Sensory Stimulation

This is when a child desires sensory input to help their muscular-skeletal and nervous systems to receive feedback easier. Children with autism have either under-sensitive or over-sensitive bodily awareness to normal input. For example, an itchy sweater can be annoying to an average person and they might get used it to by wearing it more often or ignoring it. However, for someone with autism that itchy sweater disrupts how they feel entirely and their body cannot process the feeling normally so it typically can cause an outburst or it can be the only thing they can think about all day.

For sensory stimulation, children with autism typically do something with repetitive movement. This helps their body receive sensory input feedback easier.

Some examples are:

  • hand flapping
  • rocking
  • touching objects or people
  • making loud noises and vocalizations
  • pen tapping
  • popping a toy in and out
  • twirling an object back and forth

Typically, Sensory Stimulation is fine to occur unless it harms the child or those around them. If that’s the case then the ABA therapist would work to redirect the harmful sensory stimulation to something safer.

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# 2 Behavior Functions of ABA Therapy: Escape

Escape behaviors occur when a child with autism is trying to avoid a task or get away from too much sensory input at once. They may actively ignore something by turning their head away or hiding their eyes. They also may leave the environment altogether by walking or running. This can pose the possibility of danger to the child or to those around them. Therefore, it is important to have a designated spot or room that a child can go to that is safe for them when they do need to escape. Many schools have a sensory room that students can escape to that aids them in re-regulating with padded walls, a swing, and other manipulatives for sensory.

In order to reduce the occurrence of escape behaviors, ABA therapy encourages positive reinforcement strategies. By providing a child with rewards and verbal praise, the therapist can encourage them to stay and complete their tasks.

Additionally, prompts and cues can be used to remind a child what they need to do or that they are supposed to stay in one place. If a child is overwhelmed by sensory input, ABA therapy can also work to reduce the intensity of such input by providing more calming activities or a quieter environment.

ABA therapists will also use prompting and fading techniques to help a child learn and retain new skills while reducing their reliance on prompts or cues from the therapist. Prompting is a commonly used ABA strategy that is often paired with fading. These two techniques work together to promote correct responses from the child. Prompting involves employing strategies to encourage accurate responses while fading involves gradually reducing the prompt as the child becomes more familiar with providing the correct response.

Finally, extinction methods are often used in ABA therapy when behavior is particularly difficult to extinguish. Such as when a child does not receive candy when throwing a tantrum, the child gradually decreases the frequency of tantrums until they cease entirely. The learned behavior of throwing tantrums has become extinct.

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Boy screaming

# 3 Behavior Functions of ABA Therapy: Access to Attention

This is when a child with autism wants attention from others. This can be especially difficult for children with autism who are non-verbal. Just with their regular peers, attention-getting behaviors can be good or not so good.

Positive attention-seeking behavior:

  • by saying “Excuse me”
  • politely tapping the individual

Negative attention-seeking behavior:

  • crying
  • screaming
  • throwing objects
  • hitting
  • biting

An ABA therapist will work to help those not-so-good attention-seeking behaviors. For children with autism who are non-verbal, it may be beneficial to introduce an iPad or other such electronic device that acts as their words where they can ask questions, request what they want, and be able to appropriately and safely interact with those around them. Children with autism who can speak may still benefit from sheets with different visuals that can aid them in identifying what they want.

The four main behaviors that an ABA therapist might focus on with regard to attention-seeking behaviors are:

  1. Teach the child appropriate ways to request attention through modeling. ABA therapists will model expected behaviors and help the child learn and imitate those behaviors. This can be done through verbal and/or visual cues, depending on the child’s abilities.
  2. Replace inappropriate attention-seeking behavior with positive reinforcement such as verbal praise or rewards like a toy or a sticker when they do something right.
  3. Teach the child to recognize when they are being too demanding for attention and give them strategies to control their behavior.
  4. Encourage the child to participate in activities that promote social interaction and provide positive feedback for appropriate behaviors. This could include activities such as

#4 Behavior Functions of ABA Therapy: Access to Tangibles

This is when a child with autism wants access to preferred reinforcers which can also be known as rewards. Rewards can come in many different shapes and forms:

  • Toys such as blocks, cards, cars
  • Food items such as chips or sweets
  • Electronics such as TV, iPad, music

Just like how people may eat a sweet as a reward for a good game or completing a task, the same works for those with autism. Access to tangibles can work really well as rewards but it can also backfire and cause undesirable behavior to occur if not done properly.

When a child completes a necessary task then access to tangible things can be a great reward. For example, a child completes their morning routine of getting dressed and brushing their teeth. The parent can say “Good job! You did it all by yourself and for that, you get 15 minutes of access to watch your favorite YouTube show before breakfast.” A blend of positive statements and tangibles can help shape behaviors and motivate them to complete tasks that are requested of them.

Next time you hear an ABA therapist talk about the acronym SEAT you now know about Sensory Stimulation, Escape, Access to Attention, and Access to Tangibles. Although an ABA Therapist will interview you to learn more about your child and their behaviors. You can help identify your child’s behaviors into one of these four categories to help out. Such as knowing which sensory stimulations or tangibles your child prefers can help therapists already start to build a plan of what they can redirect when an undesirable behavior occurs.

ABA therapists help individuals with developmental disabilities, like autism, learn new skills and behaviors using evidence-based techniques. They also support families and caregivers in understanding and managing behaviors.

Unlock your child’s full potential with the help of Leafwing Center! Our team of highly trained Behavior Analysts, Assistant Behavior Analysts, and Technicians are here to provide the resources, time, and expertise needed for your child with autism to succeed in life. Together, we’ll create an individualized plan tailored to their unique needs, ensuring they thrive in any environment they encounter. Let us be your partner on this incredible journey!

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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 info@leafwingcenter.org.

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 Friendly Jobs

Autism-Friendly Jobs

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Autism-Friendly Auticon
Important Note: LeafWing Center Does Not Hire for Jobs

LeafWing Center is not an employer and does not hire people for jobs. This blog post is for informational purposes only. Our goal is to provide helpful resources and guidance to assist autistic individuals in finding workplaces that support their strengths.

When is it a good time to start thinking about an autism-friendly job for your autistic child? Part of becoming an adult is entering the workforce to put your skills to good use and make an income. Many people around the age of 16 begin to take entry-level jobs over the summers to start exploring what their skills and strengths may be for future careers. Getting a job for a person with autism can be difficult as they might not know what their skills are or have trouble maintaining a job with needs that are different from other typical employees. Doing some research can be helpful for those with autism to find a job that best fits them. Looking for autism-friendly employers, and autism-friendly jobs, knowing about the different groups helping those with autism find jobs.

We are always thinking about our children in their current state, but our children will become adults. Then what? Let Leafwing be a resource when developing your child with autism for the next phase of their life – adulthood.

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Autism Friendly Jobs

How to find an autism-friendly job

It’s also important to consider what kind of job may fit an individual’s needs and abilities best when looking for an autism-friendly job. Jobs that are repetitive and require minimal communication may be ideal for those who need structure and routines in order to succeed at work. There are many different types of jobs available, so it’s important to explore all options before settling on one position.

Steps:

  1. Individuals should identify their strengths and skills that can be beneficial in the workplace. These can include computer skills, problem-solving abilities, or creative thinking. Knowing what qualities to showcase when interviewing for a job can help individuals with autism stand out from the crowd.
  2. It is important to connect with organizations or groups dedicated to helping those on the autism spectrum find employment. These types of organizations have resources and services tailored specifically for those with autism such as job placement programs and training opportunities. They also provide support during the process of finding and applying for jobs.
  3. It is essential to research companies that are known for their efforts in hiring people with autism. These companies often have programs in place to ensure that people on the spectrum are given equal opportunities as others. Websites such as Autism Speaks offer a list of potential employers who are known for providing jobs for individuals on the spectrum.

By taking these steps, those with autism can increase their chances of obtaining an autism-friendly job and having success in the workplace!

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Autism-Friendly Employers

Autism-Friendly Employers

One way to find autism-friendly employers is to research companies that have been noted for their efforts in hiring people with autism. These companies often have programs in place to ensure that people with autism are given the same opportunities as others. Additionally, websites such as Autism Speaks offer a list of potential employers who are known for providing jobs for people on the spectrum.

List of autism-friendly employers:

  • AMC Theaters: works with the FOCUS program which gives the same opportunities to autistic people to earn a wage and benefits alongside other typical associates.
  • Chevron: works with PathPoint which helps to place those with autism into jobs that match well with their skills.
  • CVS: works with people with autism to get job training and get a job coach to help them find a job that meets their skills.
  • Ford: developed FordInclusiveWorks to help those with autism get jobs in the company and combat issues that people with autism face in keeping jobs.
  • Google: the website states that they accept, thrive, and benefit from the skills that people with autism bring to the workforce. They also allow for accommodations during the interview and training processes.
  • Grocery Stores (Kroger, Giant Eagle, etc.): many grocery stores will hire people with autism of all ages from teens, to young adults, and adults to do entry-level jobs such as bagging, cart return, and stocking.
  • Home Depot: Both CVS and Home Depot work with the same group to help those with autism get job training and match their skills to jobs. To date, 1,000 people with autism have gotten matched with jobs at Home Depot.
  • JP Morgan Chase: launched the Autism at Work program to hire those with autism and allow them access to needed accommodations in the workforce.
  • Lowe’s: won many awards for their inclusive workplace. They offer many opportunities once hired such as scholarships, tuition reimbursement, job coaching, and skill training.
  • Walgreens: works with the group “retail employees with disabilities” and has a special evaluation process for those with disabilities to make sure that they are placed in a job that promotes and uses their strengths.
  • Walmart: scored a 100% on the Disability Equality Index (which measures how well a company is doing with hiring, training, and keeping employees with disabilities). As stated on the website people with disabilities including autism should not feel intimidated to apply for any job on the website.
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Autism-Friendly Jobs

Based on the number of companies that will hire a person with autism, it is safe to say that any job could be autism-friendly as long as the person meets the skills required for the job. So, a person with autism should not limit themselves to only certain jobs or only entry-level jobs. A person with autism should first determine what interests them and what their skills and strengths are to determine what kind of job would be suitable for them. They can use a group that provides mentors and training for them to be ready for the workforce as well as use the company they apply for to gain access to the needed resources for them to be successful.

Samples of autism-friendly jobs

Finding employment for individuals with autism can be a challenge, but there are some jobs that are particularly suited to those on the spectrum. Autism-friendly jobs typically have certain qualities, such as being predictable, requiring minimal social interaction, and providing sensory input. These types of jobs may offer great opportunities for individuals with autism to reach their fullest potential.

Here is a list of some potential job opportunities for those on the autism spectrum:

Let Leafwing Center help with the daily routine for your autistic child, so you can have a successful bedtime routine. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels.

  1. Computer Programmer – Computer programming is an excellent job for individuals with autism because it is logical and predictable and offers plenty of solitary work time.
  2. Pharmacy Technician – Pharmacy technicians often work in a quiet environment behind the counter in a pharmacy, filling prescriptions and managing inventory. This type of job requires attention to detail, which many autistic individuals excel at.
  3. Web Designer – Autistic people have the inherent ability to process large amounts of information quickly and accurately, making web design an ideal job opportunity for them. Web design involves designing websites or graphics using software tools; this type of job allows autistic people to utilize their skills without having to interact with others too much outside their comfort zone.
  4. Data Entry Clerk – A data entry clerk typically works alone in a quiet office environment entering data into computer databases or spreadsheets; this kind of job requires accuracy and focus which are traits often seen in autistic people.
  5. Dog Groomer – Dog groomers need to be patient and gentle when dealing with animals, which makes it an ideal career choice for someone on the autism spectrum who enjoys working with animals or has experience working in animal care settings such as kennels or veterinary clinics. Additionally, grooming dogs also involves very little face-to-face contact with clients making it easy for someone who might otherwise feel uncomfortable interacting socially.
  6. Accounting Clerk – Accounting clerks often work independently preparing financial documents such as invoices or accounts receivable/payable records; they also handle routine accounting tasks like recording transactions or reconciling accounts—all tasks that require precision and attention to detail—traits many autistic individuals possess!

In addition to providing employment opportunities for individuals with autism, companies that offer these types of positions can benefit from their employees’ unique skill sets and strengths. For instance, those on the spectrum may have an aptitude for highly structured tasks or an ability to focus intently for long periods of time.

Ultimately, finding a job that suits an individual’s skill set can be a great way to empower individuals with autism. With the right job and support from employers and coworkers, those on the spectrum can reach their fullest potential in the workplace.

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Groups that help those with autism find jobs

It may be beneficial to work with organizations or groups dedicated to helping individuals with autism find employment. These organizations often provide job placement resources and services that can be tailored specifically for those with autism. For example, the Autism Society of America has a job placement program that helps connect employers with qualified candidates on the spectrum.

List of groups that partner with individuals with autism to find jobs:

  • Autism at Work: created by JP Morgan Chase to allow those with autism to get the tools they need to succeed. Anything from training, career advice, mentors, and lunch buddies
  • FOCUS Program: stands for Furthering Opportunities, Cultivating Untapped Strengths. The program works with people across all states to employ people at AMC theaters.
  • Ken’s Krew: created by a group of parents who had children with autism as they were worried about them finding satisfactory employment. Their mission is to recruit students with autism in schools, evaluate them for their strengths and skills, provide training, find and help them apply for employment, and support them through employment and beyond.
  • PathPoint: a non-profit that helps people with autism pursue their hopes and dreams through strengthening workplace abilities, building life skills, and developing meaningful relationships.
  • REDI: stands for Retail Employee with Disabilities Initiative. This group helps people with autism gain valuable career skills that give candidates the tools to be successful in any retail setting.

Those with autism have the ability much like anyone else to obtain and maintain a job out in the real world. It just takes a few simple steps to identify the strengths and skills the person has, work with a group supporting those with autism in the workplace, and connect and work with employers who are autism-friendly to be successful. Getting a job can create even more opportunities and offer a chance to gain additional skills for those with autism.

Finally, it’s important to remember that anyone can succeed in any job if they have the right support and guidance from their employer. It’s essential that employers understand how individuals with autism think and act differently than others in order to create an environment where everyone feels comfortable and capable of doing their best work. With some extra patience, understanding, and support from employers, individuals with autism can achieve great success in the workplace!

Leafwing can be a valuable resource for developing individuals with autism for their transition into adulthood, as it is important to consider their future beyond the current state of childhood.

Call Us at (888) 436-2532

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 info@leafwingcenter.org.

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 to do before and after telling your child with autism “No”

What to do before and after telling your child with autism ‘No’

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What should happen before and after telling a child with autism ‘no’? Telling a child ‘no’ can be a difficult task for any parent or caregiver. The child may still be in the process of learning the concept of ‘no’. It’s possible that it hasn’t been enforced consistently in the past, resulting in a lack of understanding on the child’s part. Additionally, the child may believe that ‘No’ means they will never have access to the object or activity again, rather than realizing that it simply means they can’t have access at that particular moment. Children don’t always have a full understanding about why they are being denied what they want even if it is a harm to their safety. This can also seem like a monumental task for a parent of a child with autism. Children with autism can have a hard time processing big emotions and being told ‘no’ can produce multiple emotions of anger, sadness, and frustration.

Furthermore, during a typical school day, some objects or activities may not be available to the child, such as restricted computer use or not having access to a preferred toy while working. This can lead to challenges for the child in accepting the situation and potentially exhibiting negative behaviors.

Both parents and teachers face the obstacles of teaching a child how to cope when hearing the word ‘no’. So, what should you do before and after telling your child with autism ‘No’:

Before:

After:

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What to do before and after telling your child with autism “No”

Think of an alternate saying before you tell a child with autism no

Before saying ‘no’ to your child, it’s important to avoid using that exact word. Simply saying ‘no’ can lead to negative behaviors. Instead, find a different way to explain why the answer is no.

For instance, if your child wants something at the grocery store:

Instead of saying: “No, you cannot have that!”
Say: “That’s not on our list today”.

This helps your child understand that the no is not a punishment and may happen at another point. You may even want to explain your reasoning through a social story to help the child understand why they cannot have access to a desired object or activity at a specific time. It’s especially helpful for children with autism. Remember to positively reinforce when the child stays calm and accepts ‘No.’

Consider the various meanings that can be conveyed by the word ‘No’:

  • You can’t have that right now.
  • You are not allowed to do that.
  • We are not going there today.
  • Danger.
  • Stop.
  • Don’t touch that.
  • Maybe.
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What to do before and after telling your child with autism “No”

Give a Visual before telling a child with autism no

Children with autism do very well with visuals in all aspects of their lives, being told no is no exception to this. Visuals can be used in a first/then method. This works when you want to say no for right now. So maybe they want to play a game or do something fun but they need to finish homework. You’re not saying no to something fun forever but you need them to finish a task that is important beforehand. This is similar to what their typical peers’ parents go through as well. So, using a first/then chart is helpful to show a child with autism that they can have what they want after they have completed the assigned task.

Another way a visual could be used is through a Social Story. Social stories are a great way to teach a no that might put a child in danger such as not touching a hot stove or not running across the street while there is traffic. A social story could be used to show pushing the button to cross and then waiting for the light to tell them to cross. This shows a child that one action will always be a no (running across the street when it is not safe) and give them an alternate action to take to avoid the no (waiting for the walk symbol).

Allow time for a child with autism to process after telling them no

As with any child being told ‘no’ or ‘not right now’ can create a difficult emotion that they have to process through. It’s a fact of life that we cannot always have or do what we want when we want. However, it takes time to learn the skill of getting a no and moving on without causing a major undesirable behavior. Allowing time for children to process being angry and upset will teach them to deal with the emotion easier the next time. Just like any skill it can take time to practice, it will get easier the more the child understands a no and knows what they can do after.

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Giving alternates after telling a child with autism no

A good way to help a child process being told no is to give them an alternative. For example, say a child wants a snack of chips, but it is close to dinner. Instead of saying no and being final, you could say chips aren’t an option right now, but you can have grapes or carrot sticks. This gives a child a choice of an alternate option to something they want while you’re still saying no to their original request. Giving an alternate option is a great way to help a child process through the ‘no’ quicker because now they have a choice to make and it seems to them that they are still getting something that they like.

Points to consider when telling a child with autism to accept the words ‘No’ or ‘Stop’

They have a:

  • strong drive toward favorite objects/activities
  • limited understanding of the concept of ‘No.’
  • difficulty in following verbal instructions
  • lack of understanding of why access is denied

Remember, telling a child with autism ‘no’ can seem like an obstacle to a task. However, knowing what to do before and after can make the process easier on everyone involved and the child learns that sometimes a no happens and it’s nothing to be overly upset about as there could be alternate options for their request or their request could be fulfilled at a different time. It is important to provide positive feedback when a child remains calm and accepts the response of ‘No.’

The Leafwing Center offers services to teach children the skill of accepting the word no, which can be reinforced at home. ABA therapists will create personalized plans based on the child’s ability level and are trained to address the behavior that comes with teaching the skill of accepting the word no.

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Glossary Terms

How to teach your child with autism to wait

How to teach your child with autism to wait

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Parents often ask how to teach their child with autism to wait, as waiting is a part of everyday life. Waiting in lines, for food, or at stop lights is natural. However, waiting can be difficult for the average child, who may feel like waiting equals not getting what they want. For a child with autism, waiting can be even more challenging as they may struggle with understanding what it means to wait and how long it may take. However, there are a few ways to teach a child with autism how to wait, these are:

  • Practicing Waiting
  • Visuals
  • Social Stories
  • Distinguish between waiting and unavailable

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How to teach your child with autism to wait

How do you practice the skill of waiting?

One of the first things in teaching your child with autism to wait is to practice waiting. Being able to practice waiting in low-stakes situations can help a child build up the stamina for waiting. Do not let a child’s first experience be out in public or in an unfamiliar place as they will need to process their emotions when it comes to waiting and it can be a stressful situation for everyone. Practice waiting at home so a child with autism can have a safe space to process the frustration or anger that can come with the activity of waiting. When they ask for their favorite treat, ask them to wait for two minutes the first time and explain why we have to wait. Continue to build up the time to practice them waiting and increase their stamina for waiting.

Also, it is important to create a trusting and safe environment for your child with autism as this can help with waiting. Make sure to reward them for their patience and explain the consequences when they do not wait. Give them choices between two activities or items that can help them understand why one has to wait, such as allowing them to choose which toy they get first and the other one after they’ve waited.

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How to teach your child with autism to wait

Wait Visuals for autism

Visual aids can be helpful for children with autism to learn and process new tasks. These aids may include timers or wait symbols to indicate waiting periods. The timer helps the child understand that the wait will end and they will receive what they want. If there are other children present, a wait sign acknowledges the child with autism’s needs and communicates that attention will be given as soon as possible. This reassures the child that they have not been forgotten.

It’s also important to remember that for a child with autism, it might take longer for them to process the instructions of having to wait. So, it’s best to give them enough time and repeated reminders if necessary. The goal is to teach your child the ability to pause and think before responding rather than impulsively reacting.

You can practice this by:

  • role-playing scenarios with them
  • using visual cues
  • rewards

When teaching your child with autism to wait, it’s important to remain consistent, patient, and understanding. It can be helpful to provide visual cues like a timer or picture that shows how long the wait time is going to be.

Use verbal reminders:

  • Count down from 10
  • Repeat instructions in smaller chunks

Additionally, positive reinforcement such as praising your child and offering rewards for successful waiting can help encourage desired behavior. For example, if your child is able to wait a certain amount of time before asking for something, you can reward them with extra playtime or a special treat. It’s also important to stay calm and provide positive reinforcement during times when the waiting process gets difficult. Being consistent, understanding, and reinforcing good behavior teaches your child with autism to wait can be difficult, but the end result is a reward that they desire.

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Wait Social Stories for autism

Social stories are a way to teach children with autism to wait. They use visuals and characters to depict real-life experiences. For instance, waiting in the grocery store can be addressed with a social story. The story can feature a child with the same name as the real-life child waiting in line for check out at a specific grocery store, even including the name of a cashier.

A good social story would include:

  • The who
  • The what
  • The where
  • The why
  • Should be written in a positive manner (what should happen instead of what not to do)
  • Include real-life feelings the child could face in that situation

The story should be written in the first person and should include visuals of the child waiting in line, interacting with the cashier, and getting their food. It can also include a few sentences about how long it took for the checkout process to finish. The social story should end with a positive outcome that reinforces to the child that waiting is an important skill to have and something they can do.

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Distinguish between “wait” and “unavailable”

When teaching your child with autism to wait, it is important to help them distinguish between “wait” and “unavailable.” Waiting can be a difficult concept for someone with autism to understand, but it is essential for their development. To make the distinction clear, explain that waiting means that something will happen soon and that they should remain patient until it does, whereas unavailable means that it won’t happen at all or not for a long time.

Unavailable:

For example, let’s say your child wants cereal for breakfast but you are out of their favorite cereal. You would not want to teach the wait skill here because they are not going to be getting their cereal. Therefore you must show them that unfortunately, they are going to have to pick something else because their cereal is currently not available in the house. You can do this by showing an empty container to show that the cereal is all gone.

Waiting:

Teaching the skill of waiting only works when there is something for the child to receive at the end of the waiting whether tangible or not. This could be the item they wanted to eat or buy or going to the park or leaving the grocery store for home.

Teaching the skill of waiting can be very beneficial to everyone involved. It can prevent meltdowns and undesirable behavior from occurring. Additionally, waiting is a skill that everyone has to learn and put to use in everyday life. Similarly, to their peers, children with autism can struggle at first with the skill of waiting. Therefore, teaching a child with autism to wait through practice, visuals, and social stories can improve their waiting endurance.

The Leafwing Center offers services to teach children the skill of waiting, which can be reinforced at home. Two common difficulties that we encounter when working with families over the years are regarding waiting and when a child is told no.  These two scenarios can be overwhelming as they are often accompanied by the most intense challenging behaviors. ABA therapists will create personalized plans based on the child’s ability level and are trained to address the behavior that comes with teaching the skill of waiting.

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Other Related Article

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 info@leafwingcenter.org.

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?

IS ABA therapy covered by my insurance

Applied Behavior Analysis

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ABA therapy

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.

A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences, and family situation.

The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too. There may be parent training involved to be consistent in the child’s progress.

A branch of psychology concerned with employing evidence-supported interventions or instruction forms the basis of Applied Behavior Analysis (ABA). Examples of ABA-centered interventions encompass but are not limited to, Discrete Trial Teaching, Casual Teaching, Central Response Training, and Functional Communication Coaching.

The philosophy behind ABA therapy is:

  • To teach a child how to do something (e.g., prepare for school, behave better, play with others, or do things for himself or herself)
  • To provide interventions to those who may deal with pervasive developmental disorders such as autism spectrum disorders
  • To break a new skill down into very small steps
  • To provide a reward to a child for each step they do, even if they need help
  • Child friendly, and rewards a child with things or activities they like
  • To personalize the therapy to the level of the ability of the child
  • To measure the child’s skills regularly in order to adjust the teaching level

Some ABA teaching programs include:

Generally, children start receiving ABA treatment between the ages of two and six. If a child is two when beginning treatments, they can use ABA to cultivate superior communication abilities and teach them to obey simple instructions – all in preparation for preschool. For older children, ABA is often used as part of the child’s education, to teach social skills, and daily living skills or to help change problem behaviors.

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Additional Articles:

What is ABA therapy?
ABA Therapy Examples
Individualization in the Treatment of Children with Autism

How has DSM-5 affected an autism diagnosis?

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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.

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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.

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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.

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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.

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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.

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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 info@leafwingcenter.org.

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

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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.

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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.

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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.

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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.

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Additional Articles:

Foods To Avoid With Autism
Grocery Shopping With Your Child With Autism

Glossary Term:

Bio-Medical Approach

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 info@leafwingcenter.org.

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 and Communication Difficulties

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Autism and communication difficulties go hand in hand. A failure to develop language is one of the earliest signs of autism. The ability to identify the distinct signature of this deficit in very young children has become increasingly important, given that the presence of speech before five years of age is the strongest predictor for better outcomes in 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 the classroom.

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

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Autism and Communication Difficulties

Signs of autism and communication difficulties

For the child with ASD, these developmental processes appear to be hijacked taking the form of impaired or delayed language abilities at a very early age.

Some language skills including articulation, vocabulary, and grammar appear to be relatively preserved. In contrast, the difficulties that appear as robotic and abstract use of language are clearly evident. Language impairment varies with age and developmental level. The child with ASD typically uses words to regulate his or her environment to demand or protest. They’re less likely to communicate for social reasons, like sharing information.

Ways Autistic Children Communicate:

  • mimic or repeat other people’s words or phrases, or words they’ve heard on TV, YouTube or videos. They repeat these words without meaning or in an unusual tone of voice.
  • use made-up words
  • say the same word over and over
  • confuse pronouns, referring to themselves as ‘you’ and the person they’re talking to as ‘I’.

They also often have difficulty knowing when and how to communicate with people in socially appropriate ways. For example, they might not make eye contact or let another person take a turn in a conversation.

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Ways ABA programs help autistic children with their communication difficulties

Most ABA programs will teach a child using simple and concise language at the beginning stages of the program. For example, if the goal is to teach a child to imitate a ‘clap’ the teacher would simply say, “Do this” or “Copy me” while demonstrating the action. The instruction would be limited to as few words as possible (in this example, two words and then a demonstration of the action). The teacher would refrain from using a longer instruction that contains more words such as, “okay, now I’m going to do something and I want you to watch me and then copy me after I’m done. Are you ready?” For a child who has difficulty understanding language, this instruction is laden with words that are unnecessary to complete the instruction and probably will include many words that the child does not presently know.

Approaches used by ABA programs:

  1. Create a reason to use language
  2. Through play
  3. Model the language
  4. Build the child’s language skill
  5. Reward the child for language use

Techniques used with autism and communication difficulties:

  • Use short sentences – for example, ‘Shirt on. Hat on’.
  • Use less mature language – for example, ‘Playdough is yucky in your mouth’. Point to your mouth.
  • Exaggerate tone of voice – for example, ‘Ouch, that water is VERY hot.’
  • Encourage and prompt the child to fill the gap when it’s the child’s turn in a conversation – for example, ‘Look at that dog. What color is the dog?’
  • Ask questions that need a reply from the child – for example, ‘Do you want a sausage?’ If you know the child’s answer is yes, you can teach the child to nod their head in reply by modeling this for the child.
  • Give the child enough time to understand and respond to questions.
  • Practice communicating with the child on topics or things they’re interested in.

Over time, many autistic children can build on these beginnings and learn to use language in more typical ways.

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Autism learner

How are language difficulties in autistic children treated?

When working with an ABA program they will have a speech-language specialist perform a comprehensive evaluation on the child. The speech-language pathologist is a health professional trained to treat individuals with voice, speech, and language disorders. Furthermore, they address social, play, cognitive skills, and feeding and swallowing challenges as well. The speech-language pathologist will design an appropriate treatment program to prevent further developmental delays. In addition, the speech-language pathologist might make a referral for a hearing test to make sure the child’s hearing is normal.

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.

Speech therapy might include:

  • interacting through talking and playing, and using books, pictures other objects as part of language intervention to help stimulate language development
  • modeling correct sounds and syllables for a child during age-appropriate play to teach the child how to make certain sounds
  • providing strategies and homework for the child and parent on how to do speech therapy at home

Autism and communication difficulties: other means of communication

Augmentative and alternative communication (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 can include sign language, gestures, pictures, computer tablets, and other electronic devices.

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.

Main key points to autism and communication difficulties

In the initial stages of an ABA program, 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 the time of assessment. Over time, and with success, simple and concise instructions will be elaborated and more language will be incorporated into the instruction.

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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 info@leafwingcenter.org.

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?

7-dimensions-aba

Some current dimensions of ABA

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7-dimensions-aba

Some current dimensions of ABA ultimate goal are to bring about meaningful change to their children and families and for that change to occur in situations with school and family members. In the first Journal of Applied Behavior Analysis article in 1968, Baer and colleagues described seven dimensions of behavior analysis. To facilitate your understanding of this seminal article, we suggest that you substitute the word “characteristic” for the word “dimension.” We will do so for you in the following description.

 

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The 7 dimensions of ABA

The 7 dimensions make up the framework of proper Applied Behavior Analytic interventions and they support techniques used during therapy sessions. The seven characteristics are;

  1. Applied: The therapy should bring changes in social behavior of the receiver and his/her surroundings. It is apparent that society values the use of applied behavior analysis to teach individuals with autism to communicate or to reduce self-injurious behavior for example. A behavior change is applied when it enhances and improves the everyday life of a learner, and those who are closest to a learner (e.g., parents, siblings, peers), by improving a socially significant behavior. The goals are personalized to the individual needs to easily, and successfully, function within their environment. The same applies to intervention. So, application in socially significant ways is the first dimension of ABA.
  2. Behavioral: Behavior must be observable and measurable in order for it to be changed. ABA is concerned with direct measures of actual behavior. Behavior, of course, is composed of physical, observable events. In other words, ABA is concerned with facts and actual occurrences of behavior, things that can be observed and measured. It’s pragmatic in that it is guided by practical experience and observation rather than theory. With intervention programs for individuals with autism, teams are focused on observing behavior—teaching behavior and not so much with what individuals inferred thoughts are.
  3. Analytical: Being analytical means looking at the data to make data-based decisions, which means data must be collected on interventions. In order for results of any experiment to be credible, a researcher or the person actually conducting the experiment has to show that somehow the variables used or manipulated in the study actually controlled the behavior that they were looking at to the greatest extent possible. In other words, the experimenters must show that by changing one or more aspects in a person’s environment a change in behavior occurred, and by returning those variables back to what they were before the experiment, you can stop the behavior from happening (this is sometimes referred to as experimental control or is referred to as the process of establishing a functional relationship). In an intervention program for children with autism, Analytical would refer to the fact that the individual performs behaviors when asked to do so (e.g., “touch the blue card” and the individual touches the blue card) and that the function of behaviors is analyzed (Baer does not explicitly state this in the article and this article pre-dates the concept of the behavioral function, but he is describing the foundations of the concept of behavioral function intentionally or not when he says ….”a believable demonstration of the events that can be responsible for the occurrence or non-occurrence of that behavior (p 94)”). So applied behavior analysis is Analytical.
  4. Technological: This simply means that the procedures used in ABA have to be thoroughly identified and written down in clear and concise terms so that someone who has no familiarity with the procedures can read the description and know exactly what behavior to look for and how to implement the techniques needed. Think of this dimension like a recipe – all steps are written in detail to get the desired result. You would not be able to follow a recipe if it did not list the specific ingredients and measurements. It is the same with the intervention outlined. If it is difficult to understand or not clearly written; the chances that everyone on the treatment team is implementing treatment in the same way is low.
  5. Conceptually Systematic: Whatever interventions are made should be consistent with the studied instructions. It is important that practitioners continue to use research-based techniques, and avoid using any shortcuts in our teaching methods. An important question to ask: “Is this intervention consistent with principals that have determined to be effective as defined in the research?”
  6. Effective: All interventions are monitored and tracked to evaluate changes in behavior and effectiveness of therapy. If the application of behavioral techniques does not produce large enough effects for practical value, then the application has failed (Baer, Wolf, Risley, 1968). An intervention is effective when it changes the behavior it seeks to change. The therapist is frequently monitoring progress of data collected and observing the interventions being utilized.
  7. Generality: Behavior can be changed beyond a short period of time. In other words, a behavior demonstrates generality when the taught behavior carries over into other contexts than just the training environment. We want these taught behaviors to be used in multiple settings, across multiple people, and to continue to be used in the future. A treatment is not considered effective or successful until generality is achieved.

The reason why these seven dimensions identified almost 40 years ago still pertain to this day has to do with their importance in the effectiveness of an ABA program when it comes to the treatment of children with autism. However, ABA was a relatively new applied science and setting the foundations was very important.

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Example of some current dimensions of ABA

For example, if a child is engaging in tantrum behaviors because they are not able to effectively communicate their wants and needs, what would be a meaningful behavior to target? Teaching the child how to effectively communicate their wants and needs would be a socially valid goal. It would immediately affect the client’s everyday life, as well as the lives of those who interact with the child on a daily basis (family members, teachers, friends). When considering treatment interventions, the team must always consider how immediately important the targeted behavior change will be to the client.
This notion of effectiveness means that the changes that were brought about by the ABA techniques must be significant enough to be of practical value and seen as helpful or significant to the people being helped (a conceptual precursor to social validity and the introduction of the concept of effect size in ABA). In addition, the change in behavior must be large enough to make a difference in an individual’s life (e.g., increasing attendance to the classroom teacher during instruction time from 1-2 seconds to 3-5 minutes rather than increasing attendance to the classroom teacher from 1-2 seconds to 4-5 seconds). The qualification of social importance can be determined by the child, the parents, the student, the teacher, and so on (and all should have a say in determining this). If the changing behavior isn’t seen as significant (i.e., meaningful) to the people you are trying to help, then all your efforts are wasted.

In 1987 Baer, Wolf, and Risley revisited the dimensions of ABA and found them still very relevant. Some of the dimensions were refined in terms of tactics, but still represent ABA. Now while all these dimensions were highlighted back in 1968 and 1987, all of these dimensions are still directly related with what experts believe as being effective characteristics of treatment programs for children with autism today.

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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 info@leafwingcenter.org.

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 and bedtime routine

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Design a bedtime routine that can be a win-win situation for your autistic child and yourself. Bedtime can be one of those nightly events which many parents love or hate or both! It means that peace and quiet are soon ahead, but it also can mean that a huge struggle is about to proceed. Many children with autism have difficulties either transitioning to bed, falling asleep, or even staying asleep all night long. Any of these difficulties can increase stress and tension in your home. Keep in mind that no single suggestion will be for all children but getting the right amount of sleep will allow your child to perform better academically, encourage the development of motor skills, and allow them to maintain a better mindset. Not to mention, it’ll help you get a fuller night of rest, too!

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a child sleeping

Bedtime routine for children with autism

The first step to a healthy sleep starts with the daily routine. Be consistent. By creating a visual schedule, it helps to remind your child what they should be doing and what is to come. Take pictures of all events (e.g., dinner time at the table, bath time, reading books, and the child in bed), laminate the pictures and a piece of construction paper, and Velcro each picture either horizontally or vertically on the paper. When each event is completed, you can guide your child to take off the picture and point to the next event which helps them to actively check off their tasks.

Praise your child for successfully completing steps in their bedtime routine. Descriptive praise is when you tell your child exactly what it is that you like. For example, ‘I like the way you’ve found a spot for everything in your room’. This helps your child understand exactly what it is that they’ve done well. It’s also more genuine than non-specific praise like ‘You’re a good boy’. For younger children, you could use a reward chart.

A typical daily routine for better sleep

It is important for the daily routine to be consistent with time and order. Make sure your child wakes up every morning at the same time. They eat breakfast at the same time. Whatever the routine, keep it consistent so the child learns what to expect. A routine helps signal the body.

Morning routine

  • Wake up at 7 am
  • Brush teeth
  • Take a shower
  • Get dressed
  • Brush hair
  • Make bed
  • Eat breakfast

Afternoon routine

  • Eat lunch at 12 pm
  • Exercise for 1 hour
  • Plan activity

Evening routine

  • Eat dinner at 6 pm
  • Watch TV
  • Play a board game with the family
  • Read a few books to quiet down

Bedtime routine

  • Put on pajamas
  • Brush teeth
  • Go to the bathroom
  • Dim the lights
  • Put on the white noise machine
  • Give a massage
  • Go to bed

Remember there are triggers that might enhance alertness during bedtime like caffeine. Caffeine can stay active in our body for up to 12 hours. Monitor caffeine intake as well sugar consumption in foods. Watching TV, videos, or playing on the computer, especially if the shows or games are scary or violent, can lead to kids with autism having more trouble sleeping.

Problems sleeping happen more often in autistic children who have restricted and repetitive behaviors (lining up toys, rocking, hand-flapping), anxiety, or sensory problems and can lead to having trouble paying attention, feeling restless, getting angry, and throwing tantrums.

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girl-sleeping

Autism and the successful bedtime routine

It can’t be stressed enough, to stick to a routine. Make bedtime routine no more than 20 to 30 minutes. The bedtime routine should be calming like reading a book, singing a song, or a massage. You know your child best. What is calming for one child may be stimulating for another. Design an area that encourages sleep. Make sure to only use your child’s bed for sleep. Keep the temperature in the room less than 75 degrees Fahrenheit. Don’t leave lamps or overhead lights on overnight. Nightlights can be used to provide some light. Using a white noise machine will help your child from being disturbed by noise around them.

If your child has a hard time falling asleep, or wakes up in the middle of the night, first consider if they take naps during the day. You may want to reduce these naps so your child is more tired at night time. If your child wakes up in the middle of the night, be sure to keep the sleeping environment calm and do not allow him or her to play games or leave their room. This may take many sleepless nights by the parents but it will pay off in the end. It is important that your child learn the skill of falling asleep without a parent present. All children and adults wake briefly during the night but quickly put themselves back to sleep by reestablishing associations used at bedtime. So if your child needs a parent present to fall asleep at bedtime, he might need a parent to help him fall back asleep during the normal awakenings.

The time you invest in putting a sleep routine for your autistic child now will save you many, many hours in the long run and you won’t have to do it forever. Once patterns are established, you will be able to reclaim a large part of your evening for yourself.

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Autism and bedtime routines: other considerations

It is important to address medical or psychiatric issues that potentially interfere with sleep. Your child’s medications might need adjustment if they affect his sleep. If your child suffers from a sleep disorder such as sleep apnea, sleep walking, sleep terrors, restless legs syndrome, they may need a referral to a sleep specialist. Some children with persistent insomnia will need further behavioral or pharmacological treatment to improve their sleep.

Children and Adults with autism tend to have signs of insomnia: It takes them an average of 11-15 minutes longer than most people to fall asleep. Many wake up frequently during the night. Some adults and children with autism have sleep apnea as well, a condition that could potentially cause them to stop breathing several times during the night.

Let Leafwing Center help with the daily routine for your autistic child, so you can have a successful bedtime routine. Our ABA therapists are trained in creating personalized plans that match your child’s ability levels.

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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 info@leafwingcenter.org.

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?