What is ABA Therapy Used For?

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

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ABA therapy and initial assessments of children with autism

teacher and student

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.

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Parent training a part of ABA therapy for the treatment of children with autism

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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.

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ABA therapy is individualised to best meet the needs of your child with autism

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.

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?

Where to get ABA Therapy?

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

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

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

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

What Insurance Covers ABA Therapy?

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

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

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

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

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

Where do ABA Therapists Work?

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

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

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

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

ABA Therapy Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How to teach your child with autism to wait

How to teach your child to wait and what you could do before and after telling your child “no”

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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.  We will go over these on this this post.

First off, the skill of requesting appropriately must be well-established already.  If this skill is not yet in your child’s repertoire then it must be taught first. If the skill is already there, but it’s not as fluent as we’d need it to be, then work on that first.

Let’s say your child can already ask for a cookie—this is great, but what can you do if for some reason, you child has to be told to wait?   If your first thought given that question you just read is along the lines of “oh…” then do consider the following.  There is this passage of time that happens between being asked to wait for something and finally getting that something.  The key here is working on that gap.  Depending on how your child “understands” that concept—time—you may have to be more hands-on when helping out your child go through it.   Instead of simply saying “wait,”  try giving your child something that he likes to “kill time.” This is not something out of the ordinary. Case in point: look at long lines of people at a grocery store, a theme park ride, at a bank, et cetera.  It is very rare to see a long line of people, waiting, just starting blankly at the back of the head of the person in front of them (unless you’re in the military or something similar) and just “wait” for their turn.  Perhaps you’ll notice a handful dealing with waiting in not-so-positive ways but for the most part, people will do something to pass time.  From being on their phones, talking to someone whom they are with, looking around, reading a book—we, again, most of us, can handle waiting because we fill that gap with something else.  And that is something that you can try out—offer your child something that they will not mind doing while they wait.  The more reinforcing that activity the better. When starting to teach your child to wait while engaged in something, make sure to keep the wait-time very short. How short?  It depends on each child really, but a good rule of thumb is to end the wait when your child is still behaving well (i.e., before your child starts that path to a full-blown tantrum). Let’s say that time is around one minute—great. Keep it around that time limit and systematically increase the time just a bit and stay on that higher limit (e.g., from one minute to about two minutes) until your child gets used to it.  From there, you can once again increase the limit to say three minutes.  This does not happen without any difficulty—the key here is you being consistent.  Also, avoid a situation wherein the wait time had been too long that your child “forgets” about whatever it is he or she is waiting for.  You need your child’s motivation for whatever it is he or she is waiting for for the learning process to “click.”  Once that motivation goes away, the teachable opportunity is lost so it is best to be realistic on how long you really want your child to wait.

Again, teach waiting only if they can truly have that cookie, but at a later time (or after a number of activities).  If they cannot have that cookie, then don’t say wait (after which they do) then tell them no in the end. Hence, the next topic: what can you do when you are about to tell your child no (i.e., denial).

True: a no is a no and that is something our children must learn; however, before we get to that lesson, let’s take a few steps back.  If you know that your child cannot have that cookie, give your child’s behaviors a chance to not escalate.  Offer your child something she likes instead of whatever that is she wants at the moment.  The key here is you offering an alternative that she truly wants—whatever that is given that moment.  If your child accepts the alternative—great!  If your child does not like your attempts to compromise—and if your child is capable—ask her to choose her own alternative item/food/activity.  Be prepared to honor her choice.  If your child accepts that scenario—great!   If not, time to roll up your sleeves—it’s time to teach your child that no means no.  There is no going around this.  You have offered her alternatives. You have also given her a chance to choose her own alternative.  If those fail, you have done your job but despite your efforts to teach alternatives, the tantrums will happen. As those behaviors are happening, the worst thing that you can do is give in—no.  Don’t give in as that will only reinforce all those not-so-nice behaviors.  It will be difficult, but a no is a no.

When your child’s behaviors start to de-escalate, it is still possible to offer her alternative and/or giving her a chance to select her own, but never give in.

If your child already engages in the most extreme challenging behaviors such as self-injurious behaviors or property destruction or any other behaviors that compromise the safety of others during times when he or she is denied access to something, we highly recommend that you immediately seek assistance from a trained professional.

What approach should caregivers take with challenging behaviors?

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Challenging BehaviorsManaging challenging behaviors can be quite stressful.  Most of the time, parents just do what they can to get through the situation with as little fuss and fighting as possible.  Unfortunately, this often times involves strategies that may be counterproductive, increasing the chance of these behaviors occurring in the future.  If the goal is to decrease these behaviors in the long run, there are specific strategies to use based on why the behavior is occurring.  Not all behaviors should be treated the same.  These strategies that we will discuss below and in future posts may not always be the first strategy a parent would think of, we do recommend consultation with a behavior analyst who can provide a treatment plan and provide support for you and your family along the way.

In general, it is important to plan for a) alternative behaviors to teach your child to engage in instead of the behaviors they currently engage in during specific situations, as well as b) how to handle behaviors in the moment when they are occurring.  When planning for these strategies, it is crucial to always think about why your child is exhibiting the particular challenging behavior.  There are four reasons that people engage in maladaptive behaviors, to get something they want, to get attention from someone, to get out of a situation, and to get sensory feedback from the behavior itself.  We will briefly review these four reasons in this post.

Children often engage in maladaptive behaviors to get something they want.  For example, a child may want a cookie out of reach in the kitchen, so he screams in the kitchen, hitting his head until someone comes in the kitchen and offers what they can until he or she gets what they want.  The child learned that screaming and hitting his head is an effective way to get a cookie.

Children also engage in maladaptive behaviors to get attention from others.  Have you ever been talking with your partner and your child starts screaming or engaging in other bad behaviors?  This may be because he or she wants your attention, for you to pay attention.

A very common reason why children engage in challenging behaviors is to get out of things.  Imagine a child eating dinner and he starts throwing his food and hitting their caregiver.  The caregiver says, “okay, okay, all done,” and allows the child to leave.  The child learned that throwing and hitting is an effective way to get out of eating.

Lastly, children diagnosed with autism engage in challenging behaviors sometimes because they like how the challenging behavior feels.  Screaming, pinching their bodies, pulling their hair, banging their heads on hard surfaces are all behaviors that may serve some sensory need.  It is important to distinguish this from any of the other reasons previously discussed before determining how to react and what to teach instead.

Take some time to think about your child’s challenging behaviors and why he or she may be engaging in them.  Stay posted for future posts outlining strategies for how to react to these behaviors and what to teach your child instead, based on why they are engaging in the behavior.

What have been your specific challenges?

When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

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ABA programThe following are things that you should expect as a parent when you begin treatment for your child with Autism.

You and your child have a right to a therapeutic environment.  This means that the teaching environment set up to help your child is one in which socially significant learning occurs.  As a client, your child also has the right to services from an agency in which their number one goal is the personal welfare of your child (e.g., safety, treatment efficacy, advocacy). This means that all energy put into the program is to help your child become more independent and lead a better life.

It is also your child’s right to have a treatment program supervised by a competent behavior analyst. Unfortunately, as the rates of autism have increased, so have the number of treatment programs allegedly providing assistance to children with autism.  Furthermore, in many locations, the demand presently outweighs the supply for trained, experienced behavior analysts. It is imperative that the credentials and qualifications of your service provider be credible.

Your child has a right to be provided with a program that teaches functional skills. Functional skills are skills that a child can use in their everyday life and that furthers their independence (tying shoes, initiating conversation, engaging in cooperative play, etc.). There is little benefit in taking the time and dedication to teach a child something that cannot be incorporated or used in their everyday life.

Assessment and ongoing evaluation are crucial components of any ABA program, and should be expected.  This includes setting up a program based on the individual needs of a child and continuing a program based on the ongoing needs of a child. These needs will continually change, therefore ongoing assessments and modifications are imperative, necessary, and a right.

Parent and caregiver trainings should be included in the ABA program. These typically include meetings between parents or caregivers and their service provider in which valuable ABA strategies are discussed, demonstrated, and implemented. The focus of these meetings is to educate parents about various but individualized ABA based techniques they can implement with their child to address challenging behaviors, reinforce desirable behaviors, and promote generalization of progress.

Lastly, and perhaps most importantly, a child with autism has the right to the most effective treatment procedures available. In this case – scientifically validated treatment programs which today have only been shown to be based on ABA principles and techniques.