Intro: This podcast is brought to you by the LeafWing Center. Helping children and families since 1999. Brought to you by the Clinical Treatment team at the LeafWing Center, this is the Autism Treatment Professional Podcast.
Sevan Celikian: Hi everyone. Welcome to the LeafWing Center Podcast here. We’d like to discuss anything and everything related to ABA and autism. My name is Sevan Celikian, I’m a Board Certified Behavior Analyst at the LeafWing Center and with me today are my amazing colleagues.
Rei Reyes: My name is Rei Reyes. I’m a BCBA at the LeafWing Center.
Manjit Sidhu: My name is Manjit Sidhu and I’m also a BCBA at the LeafWing Center.
John Lubbers: Greetings everybody. I’m John Lubbers and I’m a Behavior Analyst as well.
Sevan Celikian: Fantastic everyone. So for today we want to do a Q & A or Question and Answer of the most commonly searched ABA keywords. So we’re pulling this off search engines. We’re pulling this off the most commonly searched keywords and questions that the public, you are asking out there. So we’ll go through as many of these as we can folks and there are quite a few and keep in mind please that some of the wording on these questions they might sound a little bit grammatically different. Some of them might be in a statement format, some might be shorter questions, others longer and we’ll cover as much ground as we can today and if we missed anything, folks as always, please feel free to reach out to us anytime with your questions and we’ll answer those for you. We’ll leave some contact information towards the end of the episode and with that shall we start with our first question guys.
John Lubbers: Let’s do it.
Sevan Celikian: Fantastic. Rei, this was yours.
Rei Reyes: All right let’s do this.
Sevan Celikian: First question, can ABA therapy cure autism?
Rei Reyes: That is an excellent question, Sevan. To say care, it implies that we know the cause right now, although there are multiple possible explanations as to how ASD comes about, there really is no single cause identified. With that being said, with research based interventions such as ABA, it’s been shown to at least improve upon those deficits or areas in which individuals are having difficulties with in a way, you know, facilitate improving their lives over time basically. So no there is, it is not a cure.
John Lubbers: Yeah. Since we don’t know the cause of it specifically, we cannot really say there is a cure for it and we can say that it can address all of the symptoms and alleviate those or remediate those. But cure is a little bit of a stretch for us.
Sevan Celikian: Thank you guys. And let’s move on to the next question. This one might be something that parents, caregivers might be curious about regarding the qualifications or the screenings for ABA therapists. So the next question is do ABA therapists get drug tested?
Rei Reyes: Another good question. We won’t speak for all the ABA agencies in regards to this topic. You know, as each ABA company and you know that number has grown over the years. So each company may have their own approach or policy when it comes to drug testing. All right. As a pre-employment requirement or implemented as a periodic random drug testing. But whoever, at least for us for LeafWing Center, we expect our staff to be professionals, show up for work 100% productive and safe you know when working with others and most especially when working with our kiddos. And with that in mind though, will a staff member get drug tested? With ample reason, the answer is yes. You know, and it is a requirement if something, you know, someone got reported for being offish, you know, and if we suspect that it may be involved that we will, we will require that staff member to go through such testing.
John Lubbers: Yes. This is a complicated topic as well, Rei, as you kind of talked about with the legalization of marijuana. Exactly. More and more States, most people probably would describe marijuana as a drug end quotes. And then also if you consider that sometimes people are prescribed medication, you know, by their physicians so they have equal and valid prescription. So it’s really complicated. And then to add to that, some of our contractual and agency companies have contractual relationships with insurances or school districts or regional centers. Some of those contractual relationships might also require or strongly suggest that there are zero drug tolerance policies and or random testing as required of the agencies providing the service. Like you said, Ray, I think most agencies nowadays are really moving towards a zero-tolerance policy if they don’t already have it and they do have either random, if it’s permitted legally in their state, or some form of drug testing and discouragement for any professional to be either under the influence or partaking in that so that it affects their job performance.
Sevan Celikian: Thank you guys for exploring that question with us. The next question, does ABA therapy work?
Rei Reyes: Research over the years have shown that ABA therapy can work, however, it is an applied science. The science itself, the science of ABA is valid, but it still boils down to having competent individuals, you know, doing the work, implementing these ABA principles, you know, on a daily basis when they work with clients. Children. Or in a different school setting or home setting or what-not. Does it work by definition? It does. It does work. But like I said, we still need to have capable individuals doing the work.
Sevan Celikian: Thank you Rei for pointing on the next question, which kind of ties in a little bit to the one I just asked, does ABA therapy help with speech?
Rei Reyes: I don’t see any reason why not. And one way to look at ABA is to look at it as a means to effectively teach. That’s something I always tell people. What is ABA all about? You know, for me as a behavior analyst, I want folks to get it right away. It is all about effective teaching, how to teach something as effective as possible. And if you’re looking at it that way, then why not? Yes, the principles of ABA can be used to teach someone like in a speech therapy. I’m assuming, you know, with this key word out there on the internet, for example, you want to teach a child to say help. So in the beginning what we want to do is strengthen approximations to the word help. For example, you know that word. So to say, the ABA therapists will say, can you say help? The child will say, you know, and the child will get a consequence in the form of positive reinforcer to make the “huh” stronger in the future.
Rei Reyes: Now let’s say from that point the child is starting to say, “hew,” so from there you know the child gets positive reinforcement for saying something that is more than the last approximation that they’re able to say. So just for that example, can ABA help speech? Yes it can definitely.
Sevan Celikian: Thanks for breaking that down rain. I agree with you 100% and I think another thing to add to that, and one of the great things about ABA is we like to factor in motivation speech all about capturing and creating that motivation for speech to occur. So like that example that you pointed out with help, we might even capture or create a situation in which the child needs help opening a toy container for example. So when that motivation is there, it is even easier for us to evoke that vocalization or or an approximation is not unique to ABA, but it’s definitely something important we want to factor in motivating operations ever. We target speech and functional communication, but thanks for breaking that down, Rei.
John Lubbers: And I think too, another thought, another way to kinda talk about this a little bit or bring some life to this guys is that there’s a big movement nowadays for integrated care and so where ABA can teach speech, so does speech and language pathology, speech therapists in the notion of integrated care, if the two professionals are working in tandem, both the speech therapist and the behavior analysis team, the behavior analytic team, it can really result in some nice calls for the individual that we’re working with.
Sevan Celikian: Absolutely. Coordination of care, interdisciplinary teams. Awesome guys. Next question. Is ABA therapy covered by Medicaid?
Rei Reyes: As of February, 2019. It really depends on where or which state you live in. Although the Center for Medicaid and Medicare services have told the States back then to provide medically necessary diagnostic and treatment services to individuals living with ASD. It appears that unfortunately not all States in the U S have followed the directive. Again, that was back in 2019. So things may have changed since then. But you know, for folks here in California, Medi-CAL does cover ABA. But regardless of where you live or you can reach out to ABA agencies in your area, in your state and ask if your state has a Medicaid program that covers ABA services.
John Lubbers: And I think it could be expected that the time Rei, like you said, CMS has put out the suggestion in the rule to cover Medicare, Medicaid, the States will start to adopt as they are better informed and as their policy and infrastructure kind of builds out. So I would expect, and in the future we will have universal coverage.
Sevan Celikian: Thank you guys. That’s very helpful. Is ABA therapy effective?
Rei Reyes: You know, in behavior analysis and we have the same, for example, like reinforcement, reinforcement. The procedure reinforcement procedure is basically defined by its effect on behavior. Sometimes you’ll hear, Oh, you know, I did positive reinforcement, at school today, it didn’t really work. You know, so what did I do Rei? And of course, you know, in my head I’ll think, well if it has no effect on the behavior, you want to have an effect on them. It’s not reinforcement. So by definition, ABA or principles under ABA are effective by definition. You just got to have to do it right? That’s where it really boils down. You’ve got to have competent individuals, again.
John Lubbers: Yeah, I get asked that question occasionally by families, will it help my son or daughter? Is it gonna help? And or even how much will it help? And I usually answer in almost all cases, there is some success, whether that be a small modicum of success or significant progress. There are so many variables that weigh into whether or not it’s successful that it’s really hard to kind of give an answer without really getting into it and doing it. But, and almost my clinical experience in almost all situations, I have seen some success, some progress, whether it’s a few things important, but a few things or a lot of things that have been taught, learned in progress is evident.
Rei Reyes: And it really boils down to the specific goals for each individual. And we know that in our practice that the goals or behavioral goals for the vast number of clients we work over the years, they’re all very different. You know, some goals will not require as much like work I guess, whereas some it is, it’s very comprehensive where everybody has to be on the same sheet. So yes, definitely.
Sevan Celikian: Right on you guys, and I agree, the successes almost always there just varies on the level of success that we get. Is ABA therapy good?
Rei Reyes: I had to think about this when I read that. Is ABA therapy good. As a behavior analyst, my default is to approach something good. Okay. What does that mean? I have to operationally define what is good, for most people, what they’re probably did, how they will define good is again, is it effective? Does it work? That’s, that must be good. You’re right. We must agree that that’s pretty much what they probably mean. So coming back to the very similar question that I’ve asked that I’ve answered earlier, it’s is it good if we mean is it effective? Yes. ABA therapy has been shown to be good in addressing behavioral challenges associated with ASD.
John Lubbers: And I would add to that guys that to now, you know, best practices and behavior analysis is really moving, has moved and is moving farther in the direction, you know, positive behavior supports, reinforcement-based approaches. So it’s very benevolent, benign and humane in terms of its approaches. So from that perspective, I think I would also agree with you, Rei. Yeah, it is good. It’s effective. It’s benign, benevolent and efficacious. So it is good.
Rei Reyes: Yeah. And I’m glad you brought that up. I never read it that way. That kind of good. So in a way as yes, you’re right, it is positive behavior supports. You know, we want, we always want to focus on implementing interventions, procedures based on positive reinforcement. Thanks John.
Sevan Celikian: So this next question is kind of a little bit of a curve ball is ABA, therapy.
Rei Reyes: Okay, let me try this one. Applied behavior analysis ABA as we know it is a branch of the science of behaviorism. ABA looks into how our principles of behavior can be applied in the natural setting in order to promote better lives for individuals. You know, focusing on pro-social behaviors and all that. So ABA therapy and how it is used as therapy for each individual varies greatly depending on each individual’s very specific needs. So it is therapy.
Sevan Celikian: Right on. Thank you Rei. Thanks for answering those questions.
Rei Reyes: You know, you’re welcome. So is that it? I think you’re next, Sevan.
Rei Reyes: What do you have for me, Rei?
Rei Reyes: Right. All right, so let me be the interrogator this time, Sevan. First question or first statement commonly asked on the internet, where do ABA therapists work?
Sevan Celikian: That’s a great question and that’s one that we get asked to, especially at the beginning of services. Sometimes parents, caregivers, they’re curious about, okay, can behavior therapists come to school with my child or all the sessions going to be in the home, can we go out places? So this is a great question and it really depends on the needs of the client. It also depends on family preferences. It also depends on their approach to use by a given ABA agency or an individual provider. It may be organizations might be much more clinic-based, others might be more in home or school-based, like actual environments, you know, where the child is throughout their day. Generally speaking though, ABA therapists will work in places where the services are needed.
Rei Reyes: Yes.
Sevan Celikian: And this will typically include four environments and that’s the home environment, the school environment, a clinic environment, and the community. One of the most common places where services take places, the home setting. So this is where a child and his family spend most of their time. This is also the child’s natural environment. You know, many of their toys, they’re there. The instructional tools, the household items, the familiar people and activities. These are all within immediate access in the home setting. It really is the kiddos natural environment, and this can be beneficial to learning. So let’s say we’re teaching a child to wash their hands, maybe in the early stages, teaching a child to wash his hands in his own bathroom sink can promote effective learning. The syncs familiar, it’s accessible. The environment can be modified easily to make the task easier, like using a stepping stool or moving soap and towels around. It’s also important though that once the child learns to to wash his hands in his own sink, that he’s able to generalize that skill to other settings and people. And that’s referred to as generalization, which we’ll cover in a different podcast. So the home setting is one of the most frequent places in which services are provided. The school setting is another very common place where ABA therapists work. So typically the ABA therapists will be a part of the child’s IEP team and will play an integral role in facilitating the child’s behavioral social communication and play goals among other goals as well. And like I was saying earlier, sometimes parents will ask, okay, can we go places? Can we go to the park play dates? And the short answer to that, and this will vary on different agencies, policies and stuff, but generally, yes, the community settings are very important place for ABA therapists to provide their services. These might include trips to the grocery store or, or a play date or the park. And it’s a great way to facilitate generalization. So those are the skills that the child has learned in the home or school sessions, which can be applied out in the community. This is also a great way to work on novel goals that simply can’t be targeted in the home or school setting. For example, creating a short list of needed items from the grocery store and helping a parent retrieve them or initiating play or, or a conversation with a peer playing at the park. One of the great things about ABA, and I’m sure all of you will agree with me, is that each program is highly individualized to meet the needs of the learner.
Sevan Celikian: So ABA therapists can work where the services are needed most.
Rei Reyes: Yes, and that’s important right there. As long as we have some clinical justification why we’re somewhere or doing something somewhere, yes, we can go within reason of course.
John Lubbers: I would agree with that guys as well, that you know, like you said, Rei, there’s a clinical justification and typically some sort of goal or objective, you know, or a plan when you go into the community, we’re going to address these things. So it’s like a pre-planned agenda for that and then it’s great. Yeah. Then community is great too, like savant said, to generalize skills and to really practice them in natural environments. That’s critical to generalization and maintenance of the skills that we’re teaching.
Rei Reyes: Yes. Right on. All right, Sevan. Next one is “Which insurance covers ABA therapy.” I’m sure a lot of folks out there are interested about this one.
Sevan Celikian: Yeah, for sure. And there’s always changing information or information that’s constantly being updated out there from state to state or from insurance to insurance across the board. But as of right now, all 50 States do have mandates that require at least some level of insurance coverage for the treatment of autism. ABA is considered an evidence based therapy, so it’s not considered experimental. And with respect to MediCal and Medicare, these insurances cover all medically necessary behavioral health treatment services for beneficiaries. So that will typically include children diagnosed with with ASD. Since ABA is an evidence based and effective treatment for individuals with ASD, it is considered a cupboard treatment when medically necessary and many cases private insurance will also cover ABA services when medically necessary, but we always say that in these cases it’s best to speak directly with your medical insurance providers to determine the specifics of the coverage because those vary widely.
Rei Reyes: Exactly.
Sevan Celikian: The co-insurances, the doctor bills, the maximums and that’s just good practice and helpful to ensure that ABA is in fact a covered benefit.
Rei Reyes: Yes. Just like any other, I guess for medical insurance and any other medical thing you have going on? Will it be covered by insurance? Yes, you’re covered. It really boils down to the details, the copays co-insurances and that’s a big thing.
John Lubbers: Yeah, those are excellent points guys. And I think if we were to describe in the global that it seems like as time passes we’re seeing more and more coverage. So more and more options for families to get treatment covered. Like we talked about a little earlier and the private insurances are covering it and more States in Medicare, Medicaid is starting to cover it with time. We’re even seeing a little bit of an extension into, in some cases with Medicaid, MediCal, Medicare where a diagnosis is not necessarily a requirement, but the requirement now is a need. So from my perspective, it looks like it’s becoming more and more widespread coverages, which is great for our families.
Sevan Celikian: Right. More and more we’re moving in the positive direction, the right direction when it comes to this stuff.
Rei Reyes: Okay. Next one. “Who can provide ABA therapy?”
Sevan Celikian: Great question. So ABA therapy is typically provided by board certified behavior analysts, BCBAs, Board Certified Behavior Analysts, BCaBA’s, Registered Behavior Technicians, RBT’s. I know it’s a lot of letters, so bear with me guys and paraprofessionals and by paraprofessionals, we mean individuals who are in the field working towards one or more of these certifications under the supervision of of a BCBA. Speaking of a BCBA, a BCBA is a person who has met the educational and professional training requirements established by Behavior Analysis Certification Board. So BCBA will typically hold a Master’s Degree in Psychology or Child Development or related fields. And some of these BCBA’s may also hold a doctoral degree in one of these fields and they’re referred to as BCBADs. There’s one more letter for you guys or acronyms. So the primary duties of a BCBA includes conducting clinical assessments, establishing skill based and behavioral goals, updating and modifying treatment goals, conducting parent and caregiver trainings, supervising staff such as the RBTs and the BCaBA’s, and really ensuring that baby program is implemented correctly and effectively. And the BCBA’s are also responsible for presenting data, writing progress records meant communicating with funding sources. The duties of a BCaBA are similar to BCBA, however, they work under the supervision and direction of a BCBA and the BCaBA will typically hold a bachelor’s degree and one of the previously mentioned fields, psychology, child development and so on. And finally an RBT. So an RBT, a registered behavior technician is a person who practices under the close ongoing supervision of a BCBA or a BCaBA or a Doctorate level BCBA and they’re primarily responsible for the direct implementation of ABA services. So folks, these are the people that are doing the one on one sessions.
John Lubbers: Yes. And I like to add guys, I what we’re seeing a little bit stateside is we’re seeing some variation within the States. So California has a one set of statewide laws that apply on who could do it. New York has another and more and more States are adopting more and more requirements. In terms of who can provide it but likes Yvonne said it is universal that behavior analysts, BCABAs, BCBAs, BCBA-Ds and RBTs are providers for the service.
Rei Reyes: If I can add here, I mean it’s still, evolving as we speak. Certifications, requirements are still being redefined, you know, continually and this is good for the public. Things are getting stricter, which means in the end, you are ending up with someone who’s really qualified to perform those responsibilities and if there’d be BCBA-Ds, BCBAs, RBTs, BCaBAs, you know, it’s all for the betterment of everyone.
Sevan Celikian: Surely and sometimes other professionals like marriage and family therapists or even licensed clinical social workers may also provide ABA therapy in some instances. But like you guys pointed out, the majority of ABA services are provided by the behavior analysts and the registered behavior technicians and technicians.
Rei Reyes: All right. “Who needs ABA therapy Sevan?”
Sevan Celikian: That’s a good question. So I just want to point this out before I answer the question. There is a little bit of a misconception out there that the principles of ABA are specific to autism.
Rei Reyes: That is common. I can agree to that. It’s always like an association ABA, autism.
Sevan Celikian: Right. And we are, we are intertwined in many ways. But it’s also important to note that the principles and methods of ABA are, they’re scientifically backed and these can be applied to, to any individual. With that said, though, children, teenagers and adults with ASD can greatly benefit from ABA therapy, especially early intervention. ABA therapy can benefit individuals by targeting challenging behaviors, attention, skills, play skills, communication, motor social skills, and many others. Also, individuals with other developmental challenges such as ADHD or or intellectual disability can also benefit from ABA therapy as well. Many, many people stand to benefit from the principles and methods.
Rei Reyes: ABA therapy, ABA base interventions, you know you can see these have being views a lot in other settings as well, like school settings, they’ve been implemented in those as well as work settings as well. Next one Sevan. “Who created ABA therapy?”
Sevan Celikian: Yeah, that’s a great question. We can probably talk about this for a long time, going back to the origins and so on. So Dr. Ivar Lovaas and BF Skinner are considered to be the founders of ABA by many scholars and practitioners. Dr Lovaas has conducted a lot of the original research for ABA in the 1980s at UCLA along with Robert Koegel. But many scholars and practitioners and behavior analysts might agree that much of the groundwork of ABA was laid out by BF Skinner, yes. Harvard trained psychologist who really focused on operant conditioning and schedules of reinforcement and maybe most importantly, the applications and implications of behavior analysis. So those are the individuals who founded.
Rei Reyes: Yes. Yes.
John Lubbers: And likely we were saying guys, and kind of giggling, Behavior Analysis 101. There’s even debate within our field where it starts.
Sevan Celikian: Lot of debate.
John Lubbers: Yeah. You know, does it start with Pavlov and classical conditioning? Does it go to John Watson and his work classical conditioning? E.L. Thorndike and the law of effect or is it a lot of folks really give a lot of weight to folks like Baer, Wolf, and Risley and Sid Bijou and like you guys said Lovass and all those guys. So there’s a lot of contributions I guess in our field from some important people that are brought us to modern day behavior analysis.
Rei Reyes: Yeah. Yes. Amy, if we’re going to look at AB…and… I don’t want to spend so much time on this cause I can, but we should not, but I always look at it this way. If it’s behavior analysis, the science of Behaviorism, you know, Skinner is up there, you know, and we’re in, when it comes to ABA as we know it and ASD, I always associate those with Dr. Lovaas. The way I kind of like process the information, you know, at least when people ask me, you know, so it’s just a clarification that we provide to you guys, our listeners.
John Lubbers: I remember I’ve attended, not to totally go off on a tangent. I remember attending a conference where Ivar Lovaas spoke and he in his speech was, or his presentation was crediting Sid Bijou for giving him his start and I’ve heard others say that some of the Kansas esteemed faculty Bear, Wolf, and Risley might’ve also had a hand in that as they crossed paths at the University of Washington, but it’s really interesting. You almost have to get the story right from the person now to see, you know kind of what their thoughts are.
Rei Reyes: Yes, yes, yes. It’s again, it’s a very interesting topic as our listeners can observe right now. All right, moving along. We have to move on and move forward. “Who qualifies for ABA therapy?”
Sevan Celikian: Typically, individuals diagnosed with autism will qualify for ABA therapy services. However, again, like we talked about earlier, it’s important for families and caregivers to really check with their insurance providers, their school districts. In some cases, the qualification or or coverage for ABA services have expanded from only individuals with autism to individuals with other developmental challenges as well. Like John had touched on earlier. So again, best to to check based on specific need and funding source, but generally speaking, individuals diagnosed with autism will typically qualify for ABA.
John Lubbers: Like you said, Sevan too, it’s kind of dynamic. You know what today, right now at the recording of this podcast is one, one, one environment, one situation. But in another six months there might be some updates. So it is good to kind of check with an expert for sure.
Sevan Celikian: Yes. Yeah, there’s a lot of information that’s constantly changing when it comes to the funding and the qualifications of, of receiving benefits and things like that. So I agree.
Rei Reyes: Right on. Thank you Sevan, John. The next one “Who benefits from ABA therapy?
Sevan Celikian: Kind of like what we were discussing earlier, anyone and everyone can benefit from the application of, of ABA principles and methods. With respect to ABA therapy though like one on one sessions, individuals living with, with ASD or other developmental challenges can greatly, greatly benefit from ABA therapy.
Rei Reyes: Thank you, sir. Next one. “What ABA therapists do?”
Sevan Celikian: Oh, the day in the life of a ABA therapist.
Rei Reyes: The day in the life of.
Sevan Celikian: Yeah, good times.
Sevan Celikian: So this depends a little bit on on the clinical needs of an individual, but as we all know, because we all used to be ABA therapists.
Rei Reyes: Yes, we all come from there.
Sevan Celikian: The work of an ABA therapist can be quite dynamic. Typically an ABA therapist’s job will include implementing the behavior intervention plan. BIP. Yes, running skill building lessons. So these are commonly referred to as programs in the field of ABA. I’m sure parents familiar with the field or caregivers familiar with the field have heard that term a lot. Also engaging in play with the client and conducting reinforcement sampling. There’s a lot of play that takes place during ABA sessions, especially with our younger learners. Yes, with respect to the BIP, the behavior intervention plan, that’s specific to each client and it’ll likely consist of one or more ABA-based principles to reduce unwanted behavior and increase desirable behavior.
Sevan Celikian: So the techniques the ABA therapists might use, they might include positive reinforcement, redirection, shaping procedures, extinction procedures and that’s just to name a few. We won’t go too deep on that today. The programs the ABA therapist run. Those will also vary significantly from individual to individual and it’s always based on their clinical needs. So those might include lessons such as washing hands, tying shoes, number, letter, color identification, initiating, maintaining play, reciprocal conversation, motor skills. And really the list just goes on and on. You guys know how it is. And it’s important to note though that the BIP and the skill building programs are established by the supervising BCBA and ABA therapists do not conduct the assessments, but they implement the BIPs and the programs during the one on one sessions. A good ABA therapist, a strong experienced, ABA therapists will spend a lot of time creating motivation, capturing motivation, and really having fun with the learner and creating learning opportunities throughout the session.
Sevan Celikian: Everything’s a learning opportunity. Even during play there’s sharing, there’s turn-taking taking place. There is following the rules of the game and it’s really a lot going on. So the job of an ABA therapist is dynamic. It’s fun and it requires a lot of creativity, a lot of skill. And really that’s what ABA therapists do. They implement the BIP, they implement the programs and they create fun, accessible, and productive play and learning opportunities with the learners.
Rei Reyes: Thank you, Sevan. What does ABA therapy stand for? What is ABA?
Sevan Celikian: Well that’s a, that’s a fast one. ABA stands for applied behavior analysis. Are you sure you’ve got it covered Sevan? Should we expand on this?
Rei Reyes: All right, but it is up there so we must answer. Okay. And your last one, what is ABA therapy used for Sevan?
Sevan Celikian: Good question. Simply put, ABA therapy is used to analyze and change behavior more specifically ABA therapy targets, unwanted behaviors, undesirable socially inappropriate behaviors and aims to replace those with desirable socially appropriate behaviors. So that’s one of the things that ABA therapy is used for. Okay. ABA is also used to teach age appropriate and essential skills. And like we talked about earlier, these vary widely depending on the clinical needs of the learner, but they might include self help skills like you know, the brushing teeth tying shoes or more academic or motor skill or social based items. It really depends, but it’s safe to say that overall ABA is used to help people achieve their goals.
Rei Reyes: Thank you, Sevan. Thank you very much for answering that.
Sevan Celikian: My pleasure. That was fun.
Rei Reyes: I guess it’s your turn asking the questions again.
Sevan Celikian: All right.
Sevan Celikian: All right, back to me. So next question on our list. Manjit, do you want to answer this one for us? What can ABA therapy look like?
Manjit Sidhu: All right, very good question, Sevan. So ABA therapy sessions are customized for each child. No two children are the same, so neither are their ABA treatment plans. They’re going to be very different for each child. A practitioner will work with the client and their families to develop a treatment plan that’s unique to that child and it’ll be based on their skill assessments. Most sessions, however, include several types of different interactions that will prepare the individual for a variety of situations outside of the therapy sessions. Keep in mind that treatments in an ABA session are always one-on-one and ABA therapy can focus on teaching skills such as brushing teeth. Like you said earlier, tying shoes, dressing, asking and answering questions, learning your colors, your numbers, playing, sharing, taking turns. And the list can go on and on and on. So what does a therapy session look like? It’s completely individualized. Like you mentioned earlier, that’s a lot of play involved. A lot of incidental teaching, a lot of learning opportunities are created. So it’s different for each child and it’s different each day.
John Lubbers: Keeping in mind this can be at the home, the clinic, the community, a variety of settings and that would factor into what it would look like as well.
Sevan Celikian: Definitely. We are a very dynamic field we’re all over. Right on guys. Next question for you Manjit, what is ABA therapy?
Manjit Sidhu: So applied behavior analysis is a type of therapy that can improve social skills, communication skills, learning skills through positive reinforcement. It also helps reduce challenging behaviors. Many experts consider ABA to be the gold standard treatment for children with ASD or other developmental conditions. ABA uses distinct principles to understand the relationship between a child’s behavior and their environment and how one can influence the other. So simply put, ABA therapy focuses on behavior. Therapists work with the client and their families to manage challenging behaviors and they encourage positive behaviors and they help build life skills.
Sevan Celikian: Right on. Great answer. Thank you Manjit. What does ABA therapy help with?
Manjit Sidhu: So ABA therapy helps decrease the challenging behaviors and it helps to develop socially significant skills. It helps teach motor skills, like I said earlier, communication skills, daily living skills. So some more examples would be language, reading and writing, potty training, eating, fine motor skills, personal self care, and even domestic skills. It can help improve attention and focus. We can work on memory as well as academics. So basically ABA can be helpful in learning a wide range of skills.
Sevan Celikian: I love it. It’s great how expansive the field is in terms of what we can teach and the types of skills that our learners can learn.
Manjit Sidhu: Right. There’s no limits, right?
Sevan Celikian: That is so cool. What does ABA therapy consist of?
Manjit Sidhu: So ABA therapy incorporates behavioral techniques such as reinforcement, prompting, and fading strategies, extinction. Those are just to name a few. And again, we could go on and on with that list. Strengths are expanded on and generalized and deficits are replaced with skills in order to help the individual be more successful in their environment.
Sevan Celikian: Awesome. So what is ABA therapy training?
Manjit Sidhu: So this is kind of something that you touched on earlier, Sevan. Professionals are required to have met educational and professional training. To be at the BCBA level, you’re required to hold a Master’s degree in psychology or related field, complete additional ABA classwork, gain experience through a supervised practicum or fieldwork. And of course pass the national certification exam to be credentialed. For the RBT level, you’re required to complete a 40 hour training and a BCBA will complete an observational assessment and then you go on to do the written exam. And like you said earlier, for an RBT, they’re closely supervised by a BCBA throughout.
Sevan Celikian: Right on Manjit. The next question is, when did ABA therapy start?
Manjit Sidhu: So ABA roots began in the 20th century. ABA therapy was first developed by Dr. Ivar Lovaas and Robert Koegel at UCLA in the 1980s. The early foundation of ABA programs involved both reinforcement and punishment techniques. However, over the last 50 years, researchers and practitioners have developed a range of other ABA based interventions and techniques.
Sevan Celikian: Awesome. I’ll combine these next two questions for you Manjit. When to start and stop ABA therapy?
Manjit Sidhu: Okay, so the right time to start ABA therapy is as soon as the individual shows signs of autism or is diagnosed with a developmental disorder. According to the CDC, receiving therapy at a young age can have a significant impact on the child’s ability to learn new skills and overcome any challenges. And it helps increase success in school and in life. So basically to answer, when to start therapy, the earlier you start, the better it is. Now, when should you stop therapy? There’s no timeframe, there’s no concrete rules to when one should stop ABA therapy. It really depends on the child and the family. Basically the child’s progress. So usually services can end when the client’s goals have been met and generalized. However, in this case, services are never stopped abruptly. They’re systematically faded out. So you just, even though you’re making progress and you’ve met all your goals, you just don’t come to an end. This is a way to make sure that the learned skills are maintained outside of ABA sessions and that additional issues don’t arise. You know how we were talking earlier about generalizing, what you’ve learned in the home, are we able to generalize that out in the community? Slowly decreasing the hours helps to ease the transition for both the child and the family. But there are cases where services are just stopped and those can be, personal reasons for the family. But from a therapy, clinical standpoint, it’s, we don’t, we don’t just say, okay, we’re done.
Sevan Celikian: That’s great that you pointed that out. We want to fade out gradually when possible for the reasons you pointed out and also to prevent any regression, we want to sustain those, those gains. Great. Why do ABA therapy?
Manjit Sidhu: So ABA therapy is a scientific set of principles that are based on research that helps build meaningful and significant social behaviors for the family and the individual. There have been hundreds of studies that have been done that shows that, you know, ABA therapy is effective. So best of all, ABA is an all encompassing approach to build skills in the areas that are needed to live out a valuable and a fulfilling life.
Sevan Celikian: Thank you Manjit. Why is ABA therapy so expensive?
Manjit Sidhu: The cost of ABA can vary. It’s based on your child’s or the individual’s therapy needs. The type of ABA program that you choose, who provides the therapy. ABA therapy is administered by highly trained professionals. It’s intended to be intensive. It requires rapidly, rapidly changing supplies and materials, you know, so hence the cost. ABA can be expensive, but most people don’t end up having to pay for the entire cost of their pocket. Most health insurance plans will cover at least a portion of the cost. So it’s best that families or individuals reach out to their insurance providers for more information on the cost.
John Lubbers: Yeah, and I might add, it’s great point, Manjit as you were answering this, I was thinking that it’s even a possibility to use flexible spending accounts or health spending accounts that you may have set up through your employer or you may consider setting up through your employer. So that might also be an avenue to help defer or reduce the cost as much as possible.
Manjit Sidhu: Right? Yeah, if they’re there, I’m sure there’s so many different options. Once you start looking into it, there’s help out there for financial help as well.
Sevan Celikian: And we have one last one for you, Manjit. Why is ABA therapy important?
Manjit Sidhu: So ABA therapy is important because it uses evidence based behavioral principles to modify behavior. As I mentioned before, it’s the gold standard of treatments. So there is more scientific evidence supporting the implementation of ABA than there are of any other treatment. It’s important because it gives the individual the necessary skills that they need in order to perform many of their life’s functions independently.
Sevan Celikian: That is super helpful. Thank you. Thank you Manjit, that’s all I have for you.
Rei Reyes: And I think it’s my turn. I will be asking Dr. Lubbers now. First question for you, how much ABA therapy is needed?
John Lubbers: This is a good question and it gets asked of us often when we do assessments and start ABA treatment. The amount of ABA therapy sometimes referred to or sometimes spoken about as the intensity of treatment or the intensity of therapy varies from person to person and is really highly individualized. The factors that can affect the intensity of treatment can and can include the breadth of the treatment or how many things we’re trying to address or in other words, the complexity of the program. Are we teaching language and social skills and play skills and pre academic skills and a variety of different skills? Then generally you could, you would imagine there would be more intense program and more hours. Also how resistant or rigid the the behaviors for change are or how difficult it is to make those changes can also affect how much therapy is needed. There is some research, however, where our young kids, early intervention, it is research based and research proven that you know 25 or more hours per week or the requirements, the intensity, the number of hours that are associated with best case results in best case responders.
John Lubbers: So in sum it varies from individual to individual and it varies on the types of goals that you’re working with and the nature of those goals. We do have some research that says with the little ones that more intensive programs are more helpful, more successful, but it is very individualized.
Rei Reyes: Right on. Next one is, how much ABA a therapy costs?
John Lubbers: Great question as well. So in general ABA therapy, like Manjit, like Sevan, like you said, Rei in previous answers, it can be expensive and it can kind of be cost prohibitive. And the reasons for that are those reasons that we’ve already articulated. It’s intensive, it’s highly specialized. There’s a lot of materials and training and and things that are involved that make that service expensive. However, the good news is more and more with the changes in the legislation both nationally and statewide. More and more we’re getting coverage from mandatory or required coverage from the private insurance plans from the Medicaid, Medical, Medicare entities and so it’s becoming easier to access like I just mentioned a minute or so ago. Another option could be using flexible spending accounts or health savings accounts as a way to pay or defer costs as well. So it is expensive, but there are more and more ways to get it either completely covered or partially covered as time passes.
Rei Reyes: And I guess it’s really just best to have that communication with the provider, you know, and maybe they can help you, I’ll give you the right information and lead you to the right direction and hopefully keeping those costs down as much as possible.
John Lubbers: Great. Great point. Rei, because of the specifics of everybody’s situation where they may reside, all those variables, it’s always really good to get the consult consultation with a skilled provider in your area.
Rei Reyes: Right on. Third, how is ABA therapy effective?
John Lubbers: Well, like some of our questions earlier, this one we could probably do an entire show or a series of shows on. The short answer to that would be it’s an approach, a treatment approach that is based on years of scientific research, both in the lab and in the and in the community and applied settings. These techniques and the approaches that we use have been demonstrated to be effective across a variety of individuals in a variety of situations and over time. So they’re really well supported approaches. That being said, one size does not fit all. And what I mean by that or what’s meant by that is there are usually a few different approaches within behavior analysis, a few different evidence based practices within behavior analysis that can be used to address particular goals. And so if one is not, the, is not having success, your ABA practitioner and professional is likely to be able to suggest other approaches. So there are a variety of different approaches and they are almost all, they’re all research proven.
Rei Reyes: And that’s something that our listeners our families out there they must, they must keep in mind that there’s a lot of information that we can use but we won’t use all of them at the same time, in behavior analysis, we want to be able to do the least amount of intervention that is the most effective and then change when needed. You know, if something’s not working and then we make some changes. Cause sometimes, people get frustrated very easily and very early, in the services and it gives them a bad, I guess a experience from the get go. And it shouldn’t be like that. It is trial and error sometimes.
John Lubbers: Yes. And some of the techniques just take time. It sometimes just takes time to change behavior and teach behavior and it’s not a quick fix. And that’s important to kind of keep that in mind.
Rei Reyes: And especially for positive reinforcement based interventions. So one thing about anything that is based on reinforcement is that it does take time and that’s what we need to remind our listeners. It takes time, right? We can do something that will have immediate results, but we will not go there. We will not do it because they’re punitive in nature and we will not base intervention on punishment. But that’s for a different day and different topics. Yeah.
Rei Reyes: Ok, thank you very much Dr. Lubbers. Next question. How long does ABA therapy lasts?
John Lubbers: This is also highly individualized. It can vary from individual to individual. Some of the factors that would influence the variability in treatment would be how many things are you working on? What is your starting point, what is your end point? What do you want to work towards in terms of goals? So there’s a lot of variability in there in terms of that, what is the environment that you’re working within? Having said that as well, in general, research says that for our best practice interventions for children with autism spectrum disorders generally lasts between one to three years. And that time is what you can expect to really commit to ABA treatment. There are exceptions. There are clients that we’ve worked with where six months is adequate, eight months, nine months, 10 months is adequate or sometimes where it’s particularly complex and it might go beyond three years, but in general best practices suggest one to three years.
Rei Reyes: Right on. Thank you sir. Next one, how to get ABA therapy?
John Lubbers: There are a few ways to go about this and like we’ve talked about earlier in the podcast, you know, insurance really is where insurance and Medical, Medicare, Medicaid is really the direction that seems everything seems to be moving towards. But in some other environments in the public school setting there is the IEP process and IDEA is an option for getting ABA services in the public school setting. In some states there are state supported developmental disabilities, organizations, and agencies and those can be options as well here in California as well. Here in California we have the Regional Center system and that’s an option as well. It has changed over the last 10 years as the legislation has come into play, but there are usually there are increasing numbers of options to get ABA therapy and again, this is the kind of thing where it might be best suited for a family, a parent or a caregiver to contact an ABA or a professional and get some guidance.
Rei Reyes: Right on. How much is ABA therapy per hour? You’re getting a lot of how much questions?
John Lubbers: Yes. Yeah. Yeah. That’s really the focus of the people from my group. All right. Cost is going to vary widely from area to area. In general, like we’ve said, it is expensive because of the specificity and the intensity and some of the logistics like we’ve talked about, it’s community based, it’s home based, you know there’s a lot of logistical issues in there to get the specific costs though. If you’re looking to pay for this out-of-pocket or using a flexible spending account or a health savings account, I would suggest, we would suggest that it’s probably best to contact the providers in your area and you can just do an internet search for them or you can even go to the BACB’s website and look for providers in your specific area. I think you search by zip code now and you can reach out, yeah, you can reach out directly to them and ask them for what we typically refer to in the industry is a private pay rate.
Rei Reyes: Right on. Thank you. How to do ABA therapy yourself?
John Lubbers: Okay. Controversial area and there are a couple of ways. When I was looking at this, there are a couple of ways really to look at this. First and foremost, this is generally not a do it yourself area, a DIY kind of thing. Like they say in the keeping in the DIY theme, this is a more complicated project and you might want to get a professional. However, it is still around the world, it is still finding a professional in your area still can present some difficulties or rural areas. Yes, exactly. And areas outside of the United States.
John Lubbers: So in those situations there are a couple of directions that you can go. What we would recommend is is first of all, you know you can go to the BACB’s website and look for professionals in your area by zip code, by country, by state, however you want to search. If you’re coming to us from another country or you’re looking for a professional from another country, go to some of the local universities, look in the psychology departments, the special education departments, those departments that would most closely be associated with behavior analysis, and if there is not a behavior analysis department. And increasingly around the world there are universities that are teaching behavior analysis as a specific discipline. Yes, definitely. So, definitely reach out to those folks. There are organizations, companies, agencies that will provide a variety of different supports for you in a remote location. And sometimes they call it a workshop where they’ll send out a qualified trainer to your area, train a team of people, professionals, and those people will work with your child and they’ll just supervise them remotely.
John Lubbers: Another way would be to kind of nowadays is we’re getting video supervision or video technology and video conferencing is getting better and more secure. Organizations are more adopting and adapting to using video to supervise. And so we’re able to do that and we’re even starting to see some of the law change with respect to, you know, the acceptibility of, they call it telehealth, telehealth and telemedicine. So it’s becoming more and more easier to gain access to these services. So what we would say in sum is it generally would recommend you don’t do it yourself because it is complicated, it is specific. You do need a lot of education and you need a lot of expertise and experience in these, in this specific area to be able to do it effectively. So we would recommend you move in those other directions.
Rei Reyes: How to start ABA therapy at home?
John Lubbers: The best way to do this is to contact a local trained and experienced provider in your area. However, like I was just saying, sometimes if you live in a rural area or outside of a big country outside of the United States, it can be difficult. And if this is the case and you don’t have local options, you may look back to those universities and colleges in your area. More and more are starting to employ BCBAs as faculty, they’re starting to have behavior analysis programs. You can ask them, you can reach out and ask to them, ask them for suggestions or help or what directions that they suggest that you turn in, turn to. And because they’re local to the area or more local, they may have some additional resources for you. You can contact the large companies in the large cities and ask them, and like I was mentioning a minute ago, sometimes there’s these workshop options or video supervision or some other ways of providing service to individuals and you know, areas where it’s hard to find somebody.
John Lubbers: The last thing we would recommend and we have recommended is to look at the local autism support groups or parent support groups in your area. Usually there’s a small group of folks composed of parents in the same situation as you and they might have some experience or some resources or some recommendations to look at and the directions to look at. So those would be the suggestions that we would make.
Rei Reyes: Thank you. Another one, how to get ABA therapy covered?
John Lubbers: Like we’ve mentioned before, this is complicated and it’s probably best if you have a treatment professional to speak with to look into the specifics of your situation and to give you information. Like I mentioned before, however, if that’s not an option or if you prefer to do things yourself, more and more States are adopting the medical necessity criteria for autism spectrum disorder and ABA therapy.
John Lubbers: Okay. Like we’ve discussed in the past, earlier in the podcast, and with time more and more are and will adopt this requirement. So if you live in a state that has the medical necessity criteria and the first thing you should do is contact your insurance and verify what coverage your insurance will provide you or Medicare or Medicaid or Medical, depending on what of the CMS coverages would cover you as well. After you’ve verified that coverage, the next thing you should do to get ABA therapy covered by your insurance or Medical, Medicare, Medicaid is to make sure that the person you’re trying to get the therapy for has a current diagnosis of autism spectrum disorder. With most of the private insurances, the commercial insurances, they require that of your provider before they’ll authorize services for assessment or services for intervention. We did talk earlier in the podcast.
John Lubbers: In some cases we’re starting to see where some entities will cover if there is a behavioral necessity and not necessarily a diagnosis, but it’s usually best to kind of get some assistance from a provider because they can help you think through some of the questions and answers and some of the variables in your specific situation.
Rei Reyes: Right on. Okay. Last one, John. How to learn ABA therapy?
John Lubbers: Love this question. Nowadays there are many graduate programs and undergraduate programs to get training in ABA and ABA therapies, so that would be first recommendation is just do an internet search, look and see for ABA training programs in my area and you’ll get some results back. There are a lot of distance learning or online coursework and courses out there, so even if you’re not geographically close to a university, you can sometimes find an online program that would be recommendation number one is to get that formal education.
John Lubbers: Additionally, there are resources on the internet that give you some basic education on the specifics in ABA therapy. You could probably YouTube specific ABA therapy techniques and you’ll find some decent resources or you can even look to, you know, if you know somebody who’s getting it and getting ABA therapy, that is, it’s likely that a part of, or a component of that therapy for that individual is to train the caregivers or stakeholders that are surrounding or important or a part of that person’s treatment. So you might also be able to get some ABA training and to learn some ABA techniques and get some basics in ABA therapy to be able to learn ABA therapy from a provider that’s providing services for somebody you know. So there are a variety of ways and we do recommend that you do seek that out because it’s a really specified approach.
Rei Reyes: Yes. And that was the last from our list of the most searched ABA keywords John.
John Lubbers: Well those were great guys. We really got a chance to cover a lot of interesting material. So we have, yeah, I think these are like 40 of them. 50 of them maybe, yes. Yeah. 40 or 50 questions and all these are again the things that everybody was looking for on the internet. The things that they were searching questions that the the listener reader has out there. And again like Sevan and we all said, you know, we apologize guys for the, sometimes there’s a little overlap or redundancy, in the questions and also sometimes the questions are, or the area where information is being sought is not in the form of a question or it’s a fragment. We did that because we really wanted to address specifically what you were looking for, so we left them as they were searched and just answered them as best we could so we hope this was very helpful for you. I’d like to thank Rei, Sevan, Manjit you guys for answering the questions and to you the listener. If you have additional questions, please visit us on our website and suggest topics, ask questions, interact with us, we will answer your questions. We will take your feedback and your responses and try to address them in future podcasts. Otherwise, I’d like to thank you for listening and look forward to seeing you all again in the near future.
Sevan Celikian: Thank you all. We hope this helped.
Manjit Sidhu: Thank you for listening.
Rei Reyes: Thanks everyone.
Outro: For more insight from the LeafWing Center, please visit the LeafWing Center website and blog page at LeafwingCenter.org. Email us at [email protected] or visit us at your favorite social media outlet. Feel free to submit questions or comments about this or future podcasts and we will put links to information discussed in today’s show on the website. We look forward to next time. Thank you.