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Autism and bedtime routine

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


a child sleeping

Bedtime routine for children with autism

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

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

A typical daily routine for better sleep

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

Morning routine

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

Afternoon routine

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

Evening routine

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

Bedtime routine

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

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

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


girl-sleeping

Autism and the successful bedtime routine

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

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

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

Autism and bedtime routines: other considerations

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

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

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

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

Autism and bedtime routine

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


a child sleeping

Bedtime routine for children with autism

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

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

A typical daily routine for better sleep

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

Morning routine

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

Afternoon routine

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

Evening routine

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

Bedtime routine

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

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

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


girl-sleeping

Autism and the successful bedtime routine

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

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

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

Autism and bedtime routines: other considerations

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

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

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

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

Autism and Motivation in Children

Autism and motivation in children can be a challenging combination. Motivation can be difficult for many people. Plenty of us struggle to exercise regularly or eat well. This is true even though these lifestyle changes could likely make a large difference in our health and consequently, our quality of life. Motivating children with autism also requires empathy and patience.

Children with Autism Spectrum Disorder (ASD) are not always motivated to master basic tasks or life skills in the same ways as neurotypical children. Autism and motivation in children can seem incompatible. Or, perhaps your child is highly motivated to hyper-focus on certain tasks, just not the tasks you’d like them to choose. Motivating children with autism can be a struggle until you identify the specific factors that inspire your child.

Motivation

Each child with ASD may be motivated by different:

  • activities
  • enviroments
  • people
  • rewards
  • perceptions

It is important to spend time learning what is motivating to your autistic child. Then you can practice applying this information to help your child grow in their own motivation.

Intrinsic Motivation and Autism

In Applied Behavior Analysis (ABA) we sometimes discuss motivation by categorizing it in two ways—intrinsic and extrinsic. Intrinsic motivation refers to motivation that would be described as coming from within a person. That is, you do something because you like it.
For example, the prima ballerina rehearses 8 hours a day because she wants to be able to perform exceptionally. Autism and motivation in children can show up as an inner drive to accomplish a task or observe an activity. Your child may love cars and they are highly, internally motivated to sit by a window and watch traffic drive by or play with their own toy cars for hours.

Extrinsic motivation on the other hand refers to motivation that comes from others or our environment. For example, some employees in a manufacturing company may show up to work on time to avoid getting in trouble with the boss. Children with ASD may be motivated to put away toys with the reward of their favorite snack or TV show.

Behavior is affected by many influences. Autism and motivation both influence behavior. By observing patterns in your child’s choices, you can learn the best ways to encourage them to grow and learn new habits.

Autism and Motivation

Intrinsic and extrinsic motivational mechanisms apply to children living with ASD. Many children with autism are not interested in doing all of the things that we would like them to do. Motivating children with ASD to accomplish tasks or master skills is frequently different from motivating neurotypical children.

Some of our children on the spectrum may choose to engage in repetitive play or ignore others. Autism and motivation in children may look like your child only engaging in things that they find interesting. When this free time is interrupted, or when they are asked to move their attention to something or someone else, they may suddenly appear unmotivated to learn or disinterested. In some cases, other challenging behaviors can occur if we follow-through with our demands.

Factors that influence autism and motivation can be observed in your child. If you find your child happily engaging in an activity, take note of the type of activity and the environment. Certain types of play, food or stimuli may be preferred. For example your child may really enjoy playing with marbles. It may be helpful to ask the following questions to determine what is motivating children with autism. Does your child:

  • Suddenly stop enjoying or engaging with this activity if there is noise or music in the background?
  • Enjoy this activity more when they have different paths and features for the marbles to follow?
  • Like to play with marbles independently of peers, or do they enjoy others joining them?

Environmental inputs can influence children with ASD so strongly that motivation is impacted. An autistic child’s sensitivities are key factors in determining how autism and motivation should be approached to achieve the most effective outcomes.


Positive

Motivating Autistic Children: Intrinsic Motivation and Extrinsic Motivation Techniques

Without motivation, the learning process may be significantly slowed down or made to feel impossible. For this reason, every effort is made to increase a child’s motivation to learn at every stage of an ABA program. Ample time is spent finding out what things a child likes. Therapists will use reinforcer surveying or reinforcer sampling to determine the things that will motivate your autistic child long enough to learn. It is also important to learn what is not motivating to your child, so that you can avoid those challenges.

Motivation in an intensive Applied Behavior Analysis program may initially take the form of something extrinsic, such as being rewarded with their favorite foods, candies, or activities. Frequently, verbal praise and high-fives or anything that a child may find enjoyable can be used for positive reinforcement.

However, it is hoped that over time, this motivation will transition from extrinsic to intrinsic such that a child will engage in learning for personal joy and accomplishment. For example, a child may be motivated to build a block house because they are looking forward to feeling happy with the completed structure. To lead to this intrinsic motivation, rewards like candy or other foods can be systematically reduced while more internal, natural rewards take their place.


Motivational words

Motivating Children With Autism

Motivating children with autism is a multiple step process.

  1. Identify what your child enjoys on their own or is already intrinsically motivated to engage with or accomplish.
  2. Select rewards and positive reinforcements for your child to use as extrinsic motivation.
  3. Gradually, reduce the extrinsic rewards as you notice your child learning a positive habit or experiencing more positive feelings about accomplishing activities.
  4. Communicate with your child about the changes they are experiencing. Motivating children with autism gains momentum as your child feels supported and acknowledges their own positive progress.

Using extrinsic rewards is a common concern that others may have when considering an ABA therapy. However, professionals leading ABA programs plan ahead and strive to transition from extrinsic into more intrinsic forms of reinforcers over time. The use of transitional positive reinforcements, or extrinsic rewards, is an important factor in a child’s program that creates more positive associations with new behaviors.
If you are struggling to identify what motivates your autistic child or you would like to see changes in what motivates your child, it may be a good time to reach out to a trained professional. You can get help evaluating the influences of autism and motivation in your child. An ABA professional can also create a program tailored to your child to help them make progress towards motivational goals.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

Who can provide ABA therapy?

Applied Behavior Analysis (ABA) therapy is an evidence-based scientific technique effective in treating individuals with Autism Spectrum Disorder (ASD) and other developmental disabilities. In general, ABA therapy relies on respondent and operant conditioning to change or alter behaviors of social significance. The ultimate goal of ABA therapy is for the learner to gain independence by learning and developing new skills. Most experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder. The professional ABA therapists at LeafWing Center will provide you and your child what you need to get started with ABA therapy to ensure your child is receiving the highest quality autism care. The LeafWing Center is a premier provider of ABA therapy.

Who can provide Applied Behavior Analysis Therapy?

Applied Behavior Analysis (ABA) therapy is typically provided by Board Certified Behavior Analysts (BCBAs), Board Certified Assistant Behavior Analysts (BCaBAs), Registered Behavior Technicians (RBTs), and paraprofessionals.

A BCBA is a person who has met the educational and professional training requirements established by the Behavior Analysis Certification Board. A BCBA will typically hold a Master’s degree in Psychology, Child Development, or a related field. Some BCBAs may also hold a doctoral degree in one of these fields and are referred to as BCBA-Ds (doctorate level BCBAs). The primary duties of BCBAs include: conducting clinical assessments, establishing skill based and behavior goals, updating and modifying treatment goals, conducting parent and caregiver trainings, supervising Registered Behavior Technicians and BCaBAs, ensuring the ABA program is implemented correctly and effectively, and writing progress reports required by funding sources.

The role of the assistant behavior analyst

A BCaBA (assistant Behavior Analyst) works under the supervision and direction of a BCBA and has similar duties as a BCBA. A BCaBA is also certified by the Behavior Analysis Certification Board and has met the necessary training and education requirements. A BCaBA will typically hold a Bachelor’s degree in the field of Psychology, Child Development, or related field.

The role of the Registered Behavior Technician

As stated by the Behavior Analysis Certification Board, an RBT is a person who practices under the close, ongoing supervision of a BCBA, BCaBA, or BCBA-D. The Registered Behavior Technician is primarily responsible for the direct implementation of ABA services. This is the person who is typically working 1:1 with an individual in designated treatment settings (home, school, clinic, etc.) RBTs must be over 18 years old, possess at least a high school diploma, go through a designated training program, and pass other eligibility requirements. RBTs do not conduct assessments or create treatment programs, however they implement the treatment program designed by a Behavior Analyst and collect data on progress.

Leafwing Center’s ABA therapy for autism: Getting started

Leafwing Center’s ABA therapy for autism: Getting started

Ordinarily, obtaining an individual’s diagnosis report is the first step in the ABA therapy process. Diagnosing autism spectrum disorder (ASD) can be difficult because there is no simple medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s developmental history and behavior to make a diagnosis.

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. Many children do not receive a diagnosis until they are much older. While still others are not diagnosed until they are adolescents or adults. The diagnosis is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Once the diagnosis is made, a family can move forward with the process of starting ABA therapy. Both the insurance company and the treatment provider will require a copy of the diagnosis report. LeafWing Center will ask for a copy of the diagnosis report at the initial assessment as the first step in starting ABA therapy.

ABA therapy providers and authorizations for treatment

The next step in the process is for the learner to get authorization from their respective insurance company. The treatment of individuals diagnosed with Autism Spectrum Disorder (ASD) is generally covered by insurance but the coverages vary greatly. All 50 states now have mandates that require some level of insurance coverage for the treatment of autism. It is best to speak directly with your medical insurance provider when starting ABSA therapy to determine the specifics of your family’s coverage (e.g., copays, coinsurance, deductibles, maximums) and to ensure that ABA therapy is covered by your insurance. Leafwing Center will work with you and your family to determine whether ABA therapy is covered by your insurance.

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.

Additionally, some families opt to pay for ABA services out-of-pocket. LeafWing Center will review ABA therapy costs with a family who is starting ABA therapy.

Selecting a provider to start ABA therapy

The next step to starting ABA therapy is to select a well-qualified ABA therapy provider. LeafWing Center is based in southern California and is recognized for its excellence in providing ABA therapy to individuals diagnosed with autism.

Once you have made the decision to select LeafWing Center as your ABA therapy service provider, we will coordinate completing the required paperwork and work to obtain the necessary authorizations from your provider. From there, the initial assessment of the learner will be scheduled and completed. A BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor will be 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 the learner. This process is referred to as the Functional Behavior Assessment (FBA).

After the assessment is complete, and your funding source has provided authorization for ABA services, a treatment team will be assigned for your child. This team will include a Supervisor (typically a BCBA) and one or several Behavior Technicians.


Starting ABA therapy and getting to know your treatment team

Starting ABA therapy and getting to know your treatment team

You can typically expect Behavior Technicians to work one-on-one with your child. The length of these sessions may vary based on your availability and schedule, but it is typical for in-home or in-clinic sessions to last about 2-3 hours (sometimes more or less depending on individual factors). Expect to receive a coordinated schedule of services before the beginning of each month.

It is in these sessions where skill acquisition goals are targeted and the Behavior Intervention Plan (BIP) is implemented. The skill acquisition goals will be identified during the assessment process, before ABA therapy is started. These goals may include skills in the socialization, play, communication, academic, and other domains.

An ABA therapy program is highly customizable.

  • ABA therapy is adaptable to meet the needs of each unique person
  • Therapy can be offered in multiple settings – home, at school, and in the community
  • Teaches practical skills that have application in everyday life
  • Can be offered either in one-to-one or group instruction

Particularly in the beginning of the ABA therapy program, rapport building between the learner and the therapy team is essential. The staff assigned to work on your child’s team should strive to build a positive relationship with your loved one. Not only is this rapport building important at the beginning of services, it should be maintained throughout the duration of the program. Therefore, families can expect the first couple weeks of ABA therapy to include a lot of play and conversation with their child. Simply put, your child should feel comfortable and have fun with the Behavior Technicians. This helps ensure that your child associates positive experiences with the Behavior Technicians. This also helps with learning rates and ultimately produces more desirable outcomes.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

IS ABA therapy covered by my insurance

What is Applied Behavior Analysis?

Applied Behavior Analysis (ABA) therapy is an evidence-based scientific technique used in treating individuals with Autism Spectrum Disorder (ASD) and other developmental disabilities. In general, Applied Behavior Analysis therapy relies on respondent and operant conditioning to change or alter behaviors of social significance. ABA therapy differs from behavior modification in that ABA therapy changes behavior by first assessing the functional relationship between a particular or targeted behavior and the environment. The ultimate goal of Applied Behavior Analysis therapy is for the learner to gain independence by learning and developing new skills resulting in an increase in positive behavior while reducing the frequency of negative behaviors.


What is Applied Behavior Analysis?

An introduction to Applied Behavioral Analysis

Applied Behavior Analysis is the applied science of behavior formalized by B.F. Skinner. It is sometimes referred to as Behavior Modification, ABA, or Behavior Analysis. The theories, laws, and techniques have their foundations in years of basic research and describe some of the most fundamental things we know about behavior. Some early influences on the field of ABA include Watson, Thorndyke, Pavlov, and groups of psychologists, philosophers, and scientists in the late 1800’s and early 1900’s that pursued empirical science.

Hallmarks of Applied Behavioral Analysis

Contemporary hallmarks of ABA include the Law of Reinforcement, functions of behavior, contextualism, and determinism. Let’s briefly look at these areas to get a better understanding of the field of Applied Behavior Analysis.

Law of Reinforcement

Simply put, the Law of Reinforcement states that behavior that is reinforced will continue to occur or will occur more often in the future. Conversely, a behavior that is not reinforced will not occur or will decrease in occurrence over time (though, sometimes we see a short increase after reinforcement is discontinued for a behavior that has been previously reinforced).Through a great deal of clinical experience, it has become apparent that one challenge with really applying this law and understanding its fundamental truth relates to a not having a good understanding of what reinforcement is or can be. Some general misunderstandings include the assumption that consequences most people would describe as positive or pleasant will function as reinforcers. For example, most people would assume that receiving a thank you note would be a reinforcer for a job well done. In practice, this is not the case. There are individuals that would have no interest in a thank you note, but would rather prefer a pay increase. There are, of course, some that would.

Oftentimes, people attribute what they would find reinforcing to another person. Life shows us, this is not the case. Conversely, when we talk about reinforcement, something that we think may be reinforcing may in fact be punishing (a consequence that causes a behavior not to occur or to decrease in the future). Similarly, reinforcers can vary in their magnitude or effectiveness depending on the environment and on what has happened in the time before the reinforcer is being used.

One final thought is that behavior is often under multiple schedules. Some of the schedules are reinforcing and some of them are punishing. The effects of the reinforcers and punishers that are a part of each schedule vary. This makes it challenging for all but only the most skilled Behavior Analysts to have a good understanding of reinforcement, reinforcers, and schedules of reinforcement. The field of Behavioral Economics is making strides in empirically describing these concerns. However, the law of reinforcement remains one of the important concepts in Applied Behavior Analysis.

Behavioral Function

One of the more recent (relatively speaking as it dates back to the very early ’80’s) concepts in Applied Behavior Analysis is behavioral function. Previous to this notion, the field was more commonly known as behavior modification and behavior was mainly changed by modifying consequences (e.g., reinforcers and punishers).

Research in the early 80’s demonstrated functional relationships between problem behavior and the conditions that reinforced it. This research led to the concept of behavioral function. Simply, a behavior must be analyzed in terms of what function (i.e., purpose) the behavior served for the individual performing it.

Nowadays, we commonly look at the inappropriate behavior that children with autism perform in these terms. We ask, “are they performing this behavior for attention? Are they performing it to escape or avoid something that they do not like? Are they performing the behavior to get access to something that they want? Are they doing it because it gives them some sort of pleasure?”

Additionally, there are two questionnaire-based assessments, the Questions About Behavior Function (QABF) and Motivation Assessment Scale (MAS), that assist users with determining the function of the behavior in question. The QABF was developed with adults who have developmental disabilities and the MAS was developed with children diagnosed with developmental disabilities.

Contextualism

Contextualism is a concept somewhat close to behavior function. In short, contextualism refers to analyzing behavior in terms of the context that it occurs. What are the characteristics of the environment? Is it loud? Quiet? Hot? Who is there when the behavior happens? What happens right before the behavior occurs? What happens earlier in the lead up to the occurrence of the behavior? What happens after?
All of these questions are things that we ask when we analyze behavior. Taking these things into consideration is why we refer to Applied Behavior Analysis as contextual.

Determinism

Our final hallmark of ABA is one of the more ephemeral concepts. It is complex and philosophical in nature and oftentimes needs to be reflected on to really get a grasp of it. This is the concept of determinism. This is also one of the more controversial concepts in ABA. Essentially, the concept of determinism says that our behavior is under the influence of our learning histories, the antecedents that occasion the behavior, and the consequences that reinforce or punish it. We are not operating under the umbrella of free will.

Like was said earlier, this is a controversial concept. Some say that our verbal behavior (i.e., thoughts) can control our behavior. In some cases, it may mitigate our behavior and, of course, it is behavior and therefore is under the same influences of antecedents, consequences and learning history. However, with the exception of the species-specific behavior with which we are born, we are products of our learning histories and present environmental factors.

ABA therapy and skill development goals

Looking beyond the foundations of applied behavior analysis

Applied Behavior Analysis is an elaborate science of behavior and it has been applied in many arenas (businesses, animal training, individuals with developmental disabilities, individuals with Traumatic Brain Injury, etc.,). There are many laws and principles and even more techniques based on these laws and principles. Some of the main hallmarks remain those referenced above (i.e., reinforcement, functions of behavior, contextualism, and determinism).

Applied Behavior Analysis therapy is effective in identifying and treating challenging behaviors. Effective ABA programs will identify challenging and undesirable behaviors at the onset of services. Once the challenging behavior(s) have been identified, a comprehensive Behavior Intervention Plan (BIP) will be established. An effective BIP should include research-backed principles used to reduce the unwanted behavior and should also include replacement behaviors. Replacement behaviors are behaviors that achieve the same result as the challenging behavior but are considered to be socially appropriate, easy to engage in, and, generally speaking, more desirable than the challenging behavior. For example, if it is determined that a learner engages in aggressive behaviors to escape a difficult task, replacement behaviors which will be taught may include requesting a break or asking for help. Hence, one of the ways in which ABA therapy is effective is through the assessment and treatment of undesirable behaviors.

Challenging behaviors

A child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these signs:

  • Performs repetitive movements, such as rocking, spinning or hand flapping
  • Performs activities that could cause self-harm, such as biting or head-banging
  • Develops specific routines or rituals and becomes disturbed at the slightest change
  • Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
  • Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
  • Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
  • Doesn’t engage in imitative or make-believe play
  • Fixates on an object or activity with abnormal intensity or focus
  • Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture

Applied Behavior Analysis therapy and skill development goals

Another way in which ABA therapy is effective is through the identification and targeting of skill development goals. Applied behavior analysis therapy will typically address skill deficits across several domains. These domains will vary and depend on the individual needs of the learner. For example, skill development goals may be targeted to address deficits in communication, self-help skills, motor skills, social skills, or play skills. Again, the specific skill development goals that are chosen by the family and ABA team will vary based on the current clinical needs of the learner. Ultimately, the goal of skill development programs is to improve the learner’s quality of life and promote more independence.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

Individualization in the Treatment of Children with Autism

Autism Spectrum Disorder (ASD) is a condition related to brain development that impacts how a child perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior. The term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and severity.

Many families ask similar questions when considering treatment options for their child who has been diagnosed with autism spectrum disorder. What is Applied Behavior Analysis (ABA) therapy and is it an effective treatment for children with autism? What makes ABA therapy effective in helping improve the lives of those affected with autism? How does ABA therapy involve the family? Is ABA therapy the right treatment for my child with autism? The professional ABA therapists at LeafWing Center will provide you and your child the support and therapy required to ensure your child is receiving the highest quality autism care by developing a plan individualized to their needs.

Individualization of a child’s autism treatment plan

In ABA therapy programs, the individual’s behavior is the primary focus when it comes to intervention development, execution, and monitoring. As such, the design and implementation of all ABA programs must be individualized. This is not only an ethical requirement, but also clinically relevant because each child has their own strengths, skill deficits, unique environments in which they spend time, learning histories, and distinctive biology. These factors must be considered during the design of an ABA program. Autism is a spectrum disorder and that means there are a lot of differences in the characteristics that each individual may have.

By way of example, the goal of teaching pretend play skills to a child who has limited pretend play skills might be a high priority goal. The same goal, however, might not be a high priority goal for a different child who already demonstrates age level pretend play skills since he or she already has this skill in their repertoire. In the case of the latter scenario, it may be more clinically appropriate to teach ways in which the pretend play skills can be expanded upon, generalized, or to target different curricular areas in which there are deficits. This is an example of how one particular goal may not be clinically appropriate for two different children.

As mentioned earlier, individualization should take a learner’s strengths and skill deficits into consideration. With this, a learner’s strengths can be built upon while the areas of deficit are strengthened. Remember, ABA is never ‘one size fits all’ and a good program should rely on assessment tools such as observations, interviews, clinical assessments, and collaboration with the learner’s family to establish individualized goals that are in the best interest of the client.

How are autism treatment programs individualized?

Below are a few ways in which individualization can be achieved in an ABA therapy program:

  • Consider the interests and preferences of the child. Create ways to incorporate these into the ABA program
  • Consider the socio-cultural values of a child’s family, along with their top concerns as they relate to behavior challenges and skill deficits
  • Through use of validated clinical methods, explore the child’s strengths and deficits as they relate to major domains – socialization, communication, self-care, motor skills, etc
  • Promote collaboration between a child’s family members, other professionals (teachers, speech therapists, occupational therapists) in the child’s life, and the ABA provider

Though the list above is not exhaustive, it does provide an illustration of how a child’s autism treatment program can be individualized to suit their specific needs.


ABA therapy

ABA therapy is individually designed to help treat children with autism

ABA therapy programs are effective in treating children with autism because they create very structured environments where conditions are optimized for learning. Over time, these very structured environments are systematically changed so that the environment mimics what a child could expect if and when they are placed in the classroom. Essentially, an ABA therapy program works with a learner by creating a somewhat unnatural or atypical learning environment for the child, such as teaching them in a distraction free, one-to-one environment in their home. The structured environment makes it more conducive for the child to learn. The learning environment will change over time so that it more closely resembles a typical classroom environment – an environment the child will encounter when they are of age to attend school or are reintegrated into a typical classroom setting. It is important to note that the main premise of an ABA program is teaching a child, “how to learn,” so that they will no longer need such structured and specialized services. The ultimate goal of ABA therapy is for the learner to gain independence by learning and developing new skills resulting in an increase in positive behavior while reducing the frequency of negative behaviors.


ABA therapy and children

ABA therapy effectively treats children with autism

Autism affects every child differently, and, while cases of autism may be similar, no two cases are ever the same. Some children with autism may be mildly or moderately impacted while others may be profoundly impacted. Applied Behavior Analysis (ABA) therapy is a type of therapy that can be individualized to improve social, communication, and learning skills through positive reinforcement of those children diagnosed with autism. Most experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder. ABA therapy benefits both the autisitc child and their family:

  1. ABA therapy is more fully supported by scientific research than any other treatment option
  2. ABA therapy helps both the learner and the parent(s)/caregiver
  3. ABA therapy teaches skills necessary for socialization
  4. Parents and teachers can capitalize on strengths and skills of the learner
  5. Children are better positioned if they are able to function independently
  6. ABA therapy can prepare children to advocate for themselves

Applied behavior analysis (ABA), has been shown to help a wide range of children with autism spectrum disorders (ASDs) learn skills that increase their independence and improve their quality of life into adulthood. Children with autism each have their own diverse life experiences; therefore, each child requires an individualized assessment and treatment services.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

When is a good time to start ABA therapy?

When a child is first diagnosed with autism, parents and caregivers can be overwhelmed by thoughts wondering “what now?” One thing experts agree on is that starting therapy as soon as possible is the best and most effective means to treat your child’s autism. The earlier the intervention the better, so beginning Applied Behavior Analysis (ABA) therapy immediately following autism diagnosis is critically important in getting the most out of your child’s treatment. There are various important reasons why an “early start” enhances the effectiveness of any ABA therapy program. The LeafWing Center’s experienced and professional team of ABA therapists will work with you to ensure a thoughtful and effective ABA therapy program is provided to your child upon their autism diagnosis.

Reasons to start ABA therapy after your child’s autism diagnosis

Generally, “earlier is better” when it comes to starting ABA therapy. The best time to begin ABA therapy is typically immediately after a child’s autism diagnosis. At younger ages, children go through more frequent critical periods in their development. These critical periods are maturation stages in which the individual is particularly sensitive to stimuli in their environment. Teaching certain concepts in these formative years pays dividends in the long run.

Additionally, the earlier a child learns critical and age relevant behaviors and skills, the more productive and meaningful their time at school will be. The child will be able to access more of the curriculum if the necessary prerequisite skills are targeted early on. For example, a child who is taught to raise their hand to ask for help, initiate a social play interaction, and count from 1-10 during ABA therapy may gain the ability to absorb more from the academic and social environment at the school setting.

Research supports an early start for ABA therapy

Research shows that a child who starts ABA therapy in childhood has the potential to make significant improvements and emphasizes that ABA therapy is most effective the earlier it begins. Access to inclusive educational settings in a mainstream classroom is among the significant long term gains made by children who received early access to ABA therapy.


Start ABA therapy

Benefits of Starting ABA therapy early

Research indicates that early intervention can improve challenging behaviors and children’s overall development. Another reason early intervention is important is to ensure that challenging behaviors are addressed early on so that they do not have the opportunity to become entrenched with age. Without an individualized, function-based intervention plan, challenging behaviors can become worse (e.g. increase in frequency, duration, and severity) over time. This is because reinforcement, over time, can strengthen behaviors. If a young child is constantly engaging in challenging behaviors, without a behavior plan in place, those challenging behaviors may be inadvertently reinforced, therefore contributing to the possibility that they may worsen over time.

Early intervention provides the skills necessary to set the child up for long term success. The more skills a child is equipped with early on, the more of their social and learning environments they will be able to access as they grow. In fact, teaching “pivotal behaviors” and “behavior cusps” are a crucial component of ABA programs, particularly during earlier stages of the ABA program. While these two terms are related, they refer to behaviors that, when learned, result in new and positive changes across many areas of a child’s life.

It’s never too late to start ABA therapy

While there are significant benefits to starting ABA therapy as early as possible, there is a point at which it is “too late” to start. ABA programs are highly individualized to the needs of the learner and Behavior Analysts take into consideration numerous factors when designing an ABA program. These will include the learner’s current behavioral, social, academic, communication, self-help, and other needs from different curricular areas. This is why many individuals benefit from ABA therapy even when starting a program later in their development.

Therefore, while “earlier is better” is the common recommendation by most clinicians, ABA therapy can benefit many learners at various stages in their development due to its emphasis on individualization.

Starting ABA therapy to prevent your child’s autism from getting worse

Can the symptoms that define an autism spectrum disorder (ASD) diagnosis get worse?” The answer is yes, but, with the right ABA therapy provider, the symptoms can get better.

For families that are just now starting their ABA-based therapy services at home and/or in a school setting, it is crucial to identify what these symptoms or difficulties are exactly. Upon identifying, assessing, planning and implementing proper treatment programs, these symptoms can be either directly or indirectly addressed by the ABA services. With proper guidance of a BCBA, a sound comprehensive treatment plan may facilitate gains over a targeted amount of time.
A child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these symptoms:

  • Performs repetitive movements, such as rocking, spinning or hand flapping
  • Performs activities that could cause self-harm, such as biting or head-banging
  • Develops specific routines or rituals and becomes disturbed at the slightest change
  • Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
  • Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
  • Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
  • Doesn’t engage in imitative or make-believe play
  • Fixates on an object or activity with abnormal intensity or focus
  • Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture


When to start ABA therapy

Untreated autism spectrum disorder symptoms worsen over time

There are some conflicting studies about autism and the prevalence of symptoms over time. That said, as with any symptom, untreated autism spectrum disorder symptoms will get worse over time. It is important then for families who have not yet received any prior ABA-based services to seek ABA therapy services in order to begin the process of managing the symptoms and reducing the learner’s undesirable behaviors. Early interventions have proven most effective in the treatment of autism. Those early interventions not only give children the best start possible, but also the best chance of developing to their full potential. The sooner a child gets help, the greater the chance for learning and progress. In fact, recent guidelines suggest starting an integrated developmental and behavioral intervention as soon as ASD is diagnosed or seriously suspected.

Families who previously received ABA therapy services may find themselves in a future position where they are having difficulty addressing the behaviors of their now older learner. Those families need to again seek out ABA therapy services to effectively address their child’s more current needs.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

Child with light bulb thought

Why Does ABA Help Children With Autism?

Autism Spectrum Disorder (ASD) is a condition related to brain development that impacts how a child perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior. The term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and severity.
Many families ask similar questions when considering treatment options for their child who has been diagnosed with autism spectrum disorder. What is Applied Behavior Analysis (ABA) therapy and is it an effective treatment for children with autism? What makes ABA therapy effective in helping improve the lives of those affected with autism? How does ABA therapy involve the family? Is ABA therapy the right treatment for my child with autism? The professional ABA therapists at LeafWing Center will provide you and your child the support and therapy required to ensure your child is receiving the highest quality autism care.

ABA therapy for children with autism: Early childhood development

We all know that typically developing children learn throughout all waking hours, even when they are not being formally taught. Typically developing children watch other children, watch adults, watch TV, learn from school, and incorporate what they have learned into their repertoire. Oftentimes they only need to see something once or twice before it comes easily to them. Parents are often amazed at what their children are learning and frequently ask, “where did you learn to do that?” When children learn to speak, they often begin to ask questions of others in their environment. From the basic “why” question that parents so often get asked to more elaborate questions about “How this thing works, or how that thing works”. They become their own self-contained information seekers.

Learning is different for children with autism. Children with autism learn much less from their environment. They are deficient in what’s called observational learning or learning via imitation. In other words, children with autism aren’t as skilled at learning by watching others do something and imitating what they saw without specific instruction. Children with autism typically have decreased language skills, understand less of what is said to them, and ask fewer questions of others. For most children with autism, you cannot expect to put them in a classroom setting and have them learn and absorb what the teacher is saying, mainly as a direct result of the characteristics of autism.

ABA therapy for children

ABA therapy is designed to help treat children with autism

ABA therapy programs are effective in treating children with autism because they create very structured environments where conditions are optimized for learning. Over time, these very structured environments are systematically changed so that the environment mimics what a child could expect if and when they are placed in the classroom. Essentially, an ABA therapy program works with a learner by creating a somewhat unnatural or atypical learning environment for the child, such as teaching them in a distraction free, one-to-one environment in their home. The structured environment makes it more conducive for the child to learn. The learning environment will change over time so that it more closely resembles a typical classroom environment – an environment the child will encounter when they are of age to attend school or are reintegrated into a typical classroom setting. It is important to note that the main premise of an ABA program is teaching a child, “how to learn,” so that they will no longer need such structured and specialized services.The ultimate goal of ABA therapy is for the learner to gain independence by learning and developing new skills resulting in an increase in positive behavior while reducing the frequency of negative behaviors.

Other reasons ABA therapy works for children with autism

ABA therapy programs are also highly individualized and account for the difficulty a learner may have transitioning from one learning environment to the next. A child with autism may not necessarily practice a skill at school just because they learned that same skill at home. The ways in which an ABA therapy program can be effective depend on several factors including, but not limited to, the individual needs of the learner, frequency of treatment, specific interventions, and the environment in which services are implemented. With ABA therapy, the earlier the intervention, the better.

ABA therapy effectively treats children with autism

ABA therapy effectively treats children with autism

Autism affects every child differently, and, while cases of autism may be similar, no two cases are ever the same. Some children with autism may be mildly or moderately impacted while others may be profoundly impacted. Applied Behavior Analysis (ABA) therapy is a type of therapy that can improve social, communication, and learning skills through positive reinforcement of those children diagnosed with autism. Most experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder. ABA therapy benefits both the autisitc child and their family:

  1. ABA therapy is more fully supported by scientific research than any other treatment option
  2. ABA therapy helps both the learner and the parent(s)/caregiver
  3. ABA therapy teaches skills necessary for socialization
  4. Parents and teachers can capitalize on strengths and skills of the learner
  5. Children are better positioned if they are able to function independently
  6. ABA therapy can prepare children to advocate for themselves

Applied behavior analysis (ABA), has been shown to help a wide range of children with autism spectrum disorders (ASDs) learn skills that increase their independence and improve their quality of life into adulthood. Children with autism each have their own diverse life experiences; therefore, each child requires an individualized assessment and treatment services.

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

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

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

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

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

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

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

How do I start ABA Therapy?

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

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

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

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

How is Applied Behavior Analysis Different From Psychology?

The answer to this question is that while many people have historically viewed behavior analysis as a branch of psychology, the two disciplines take fundamentally different and antithetical perspectives to account for variability in human behavior.

In general, Behavior Analysis does not concern itself with mental states or inner thoughts when it comes to describing why we behave the way we do. Rather than focusing on “the mind,” behavior analysts look at behaviors, or in other words, what we do, as a consequence of things that happened previously. Simply put, we will repeat things when the consequences are pleasant and we will stop doing things when the consequences are unpleasant. Behavior analysis, as it suggests, focuses on treating behavioral problems from a purely behavioral perspective/lens. Functional analysis, gathering of data to establish trends, and then a subsequent intervention program or plan that utilizes various forms of operant learning are then applied.

Psychology focuses on the mind. Psychology as a discipline largely hypothesizes internal explanations (personality traits, mediating forces and other structures in the brain, etc.) explain differences in human behavior. Psychology looks to explain behavioral variability by appealing to internal causes that are typically seen as inside the mind (e.g., mood states, personality traits, hypothesized structures such as ego and/or drive states)

In short, the difference can be stated as follows: In the ENVIRONMENT (Behavior Analysis) versus inside the MIND (Psychology).

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

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

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

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

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

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

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

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