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Applied behavioral analysis (ABA) is a type of therapy that can improve social, communication, and learning skills through reinforcement strategies.
Many experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder (ASD) or other developmental conditions. But it’s sometimes used in the treatment of other conditions as well, including:
- substance use disorder
- cognitive impairment after brain injury
- eating disorders
- anxiety and related conditions such as panic disorder, obsessive-compulsive disorder (OCD), and phobia
- anger issues
- borderline personality disorder
This article will focus primarily on the use of ABA for children with ASD, including how it works, how much it costs, and what to know about the controversy surrounding it.
ABA involves several phases, allowing for an approach that’s tailored to your child’s specific needs.
Consultation and assessment
First, you’ll want to consult with a therapist trained in ABA. This consultation is called a functional behavior assessment (FBA). The therapist will ask about your child’s strengths and abilities as well as things that challenge them.
They’ll spend time interacting with your child to make observations about their behavior, communication level, and skills. They might also visit your home and your child’s school to observe your child’s behavior during typical daily activities.
Effective ASD treatment looks different for every child. To this end, ABA therapists should mention specific interventions that fit your child’s needs. They may also ask about integrating certain strategies into your home life.
Developing a plan
Your child’s therapist will use their observations from the initial consultation to create a formal plan for therapy. This plan should align with your child’s unique needs and include concrete treatment goals.
These goals generally relate to reducing problematic or harmful behaviors, such as tantrums or self-injury, and increasing or improving communication and other skills.
The plan will also include specific strategies caregivers, teachers, and the therapist can use to achieve treatment goals. This helps to keep everyone who works with your child on the same page.
The specific type of ABA used may depend on your child’s age, challenges, and other factors.
- Early intensive behavioral intervention (EIBI). This is often recommended for children younger than 5. It involves an intensive, individualized curriculum designed to teach communication, social interaction, and functional and adaptive skills.
- Discrete trial training. This training aims to teach skills through structured task completion and rewards.
- Pivotal response training. This training lets your child take the lead in a learning activity, though the therapist often offers a few choices based on specific skills.
- Early Start Denver Model (ESDM). This involves play-based activities that incorporate several goals at once.
- Verbal behavior interventions. These can help children become more verbal or increase their communication skills.
ABA also relies on parents and caregivers to help reinforce desired behaviors outside of therapy.
Your child’s therapist will teach you and your child’s teachers about strategies that will help to reinforce the work they do in therapy.
You’ll also learn how to safely avoid types of reinforcement that are less effective, such as giving in to tantrums.
ABA therapists try to uncover causes of certain behaviors to help your child change or improve them. Over the course of therapy, your child’s therapist may adapt their approach based on how your child responds to certain interventions.
As long as your child continues treatment, their therapist will continue to monitor their progress and analyze which strategies are working and where your child may benefit from different treatment tactics.
The goal of treatment depends largely on your child’s individual needs.
However, ABA often results in children:
- showing more interest in people around them
- communicating with other people more effectively
- learning to ask for things they want (a certain toy or food, for example), clearly and specifically
- having more focus at school
- reducing or stopping self-harming behaviors
- having fewer tantrums or other outbursts
The cost of ABA can vary based on your child’s therapy needs, the type of ABA program you choose, and who provides the therapy. ABA programs that provide more services may have a higher cost.
Generally, 1 hour of ABA therapy from a board certified ABA therapist costs around $120, though fees can vary. Though therapists who aren’t board certified may provide treatment at lower rates, it’s recommended to work with a certified ABA therapist or a team that’s supervised by a certified therapist.
Some experts recommend up to 40 hours of ABA therapy each week. But in reality, therapists usually work with clients for 10 to 20 hours per week. This range can vary depending on your child’s needs.
Assuming your child needs an average of 10 hours of ABA per week at a rate of $120 per hour, treatment would cost $1,200 per week. Many children show improvement after a few months, but every child is different, and ABA therapy can last up to 3 years.
Managing the expense
ABA can be expensive, but most people don’t end up having to pay for the entire cost out of pocket.
There are a few options that can help:
- Insurance. Most health insurance plans will cover at least part of the cost. Talk to your insurance provider for more information. If you have insurance through your job, someone in the human resources department can also help.
- School. Some schools will fund ABA for a child, though the school may want to do its own evaluation first.
- Financial assistance. Many ABA centers offer scholarships or other forms of financial assistance.
In addition, therapists are used to navigating the ins and outs of insurance and paying for treatment. Feel free to ask for their advice on how to get your child’s treatment covered. They’ll likely have additional suggestions that can help.
Therapy can also take place in your home. In fact, some children do best with in-home ABA because they feel more comfortable in their usual surroundings. It can also make it easier for them to master certain life skills, such as getting dressed and using the bathroom.
But it’s best to only attempt ABA at home with the help of a licensed therapist, at least in the beginning. They can help you come up with a program that’s tailored to your child’s needs.
In addition, recent
Looking for more information about ABA before trying it out? These books are great primers for parents that you can order online:
If you’re ready to find a therapist, your child’s pediatrician is a good starting point. They can give you a referral or recommend someone.
You can also search online for local providers. Keep in mind that board certified behavior analysts (BCBAs) may work directly with some children, but in many cases they supervise other professionals or paraprofessionals who have ABA training.
Some professionals who aren’t certified in ABA may still have ABA training and be able to provide therapy that works well for your child. If you’d like your child to attend an ABA center, it’s a good idea to make sure that they have at least one BCBA supervising treatment.
Questions to ask
As you talk to potential therapists, keep the following questions in mind:
- How many hours of therapy do you think my child needs each week?
- Do you offer any special funding or scholarships (for schools and centers)?
- What methods do you use to discourage unwanted behaviors?
- How will you address self-harming behaviors?
- How many people will work closely with my child? What training do they have?
- Can you teach me how to use ABA techniques at home?
- Can I watch therapy sessions?
- Are there other approaches, such as skills training groups, that could help my child?
The Healthline FindCare tool can also provide options in your area if you need help finding a therapist.
ABA has been the topic of debate in recent years. Many autistic individuals and their advocates vehemently oppose this treatment and speak out against it.
Some criticisms include the following:
- ABA takes away a child’s human right to say “no.”
- Children under this treatment are bullied and belittled.
- ABA therapists are too rigid and don’t take into account a child’s individuality.
Many of these objections stem from the early history of this technique.
In previous decades, it typically involved up to 40 hours of therapy each week. Much of this time was spent completing tasks while sitting at a desk or table. Punishment was often used to address unwanted behaviors. And emphasis was often placed on making children more “normal.” The term “neurotypical” describes a person with typical developmental, cognitive, or intellectual abilities.
Today, people are increasingly recognizing the value of neurodiversity, which refers to the diverse ways the human brain can function. In response, ASD treatment is moving away from trying to “fix” people with ASD.
Instead, treatment focuses on changing behaviors that cause difficulty, allowing children to develop the skills and strengths necessary for a fulfilling, independent life. Unwanted behavior is generally ignored by therapists today rather than punished.
ABA has benefited many children living with ASD by helping them learn developmental skills. It can help improve communication abilities while reducing harmful behaviors, including self-injury.
Keep in mind that although ABA is considered to be an excellent therapy for assisting with many of the symptoms found in children who are diagnosed with ASD (such as stimming, head-banging, or self-injurious behaviors), this treatment may not be the best choice for all children.