ABA THERAPY: PROS AND CONS

Applied behavior analysis (ABA) therapy is a type of therapy that is often used with children with autism. The goal of ABA therapy is to modify behaviors and teach new skills to improve one’s quality of life. It is not, however, without criticism. Let’s review a few advantages and disadvantages of ABA therapy to help you determine whether ABA is the right fit for your child.

Pros of ABA Therapy

  1. Evidence-based
  2. Caregiver involvement
  3. Individualization
  4. Team of qualified professionals
  5. Behavior reduction and skill development
  6. Variation in therapy settings

Evidence-based

ABA therapy is backed by decades of research demonstrating its effectiveness. Hundreds of research articles have been published showing significant results in the treatment of autistic children. A meta-analysis in 2020 found benefits in the areas of core ASD symptoms, communication, expressive language, receptive language, and socialization. Evidence-based practices are the most likely to result in meaningful improvement.

Caregiver involvement

A common component of ABA is caregiver treatment guidance. Involving caregivers in treatment is found to greatly improve outcomes. Empowering caregivers through training on the application of behavioral techniques, especially those that are specific to their child, is a major benefit.

Often referred to as “caregiver training”, a behavior analyst works directly with parents and/or caregivers. Caregiver involvement may include any of the following.

●      Training caregivers on the general principles of behavior

●      Training caregivers on behavioral strategies for teaching new skills

●      Training caregivers on the implementation of their child’s individualized behavior intervention plan (BIP) and treatment goals

●      Generalizing skills learned in sessions with caregivers

Individualization

ABA therapy is highly individualized to each child’s unique needs and interests. The goals addressed, activities conducted, and reinforcement used are all created specifically for the individual. Some children may have more formal, table-time work, while other sessions may be run in the natural environment, using naturalistic teaching methods. There is no one-size-fits-all approach to ABA therapy.

Team of qualified professionals

ABA therapy is overseen by a board certified behavior analyst (BCBA). BCBAs hold a master’s degree, in addition to successful completion of fieldwork experience hours. They are also required to pass an intensive exam to earn board certification. Many states require licensure on top of certification as well.

The BCBA typically oversees a team of behavior technicians who work directly with the child. Having multiple staff working with a child can be beneficial for natural generalization. Each behavior technician tends to bring their own strengths and teaching styles, which can be valuable.

Behavior reduction and skill development

ABA treatments are quite versatile. The science of human behavior can be applied to many different behaviors and skills. Individualized programming is created and implemented to address both skill challenges and reduce interfering behaviors. Skill development goals may relate to daily living, communication, social skills, self-regulation, and more. A multifaceted approach to both teaching new skills and modifying interfering behaviors is beneficial for overall progress.

Variation in settings

A particularly unique characteristic of ABA is that it can be conducted in almost any setting. Many children receive therapy in their homes. This allows for many advantages including parent involvement and monitoring of sessions. Read about other benefits of in-home therapy in this guide.

ABA therapy can also be conducted in schools, clinic settings, or out in the community. The main goal of ABA is for children to apply the skills learned in therapy to their natural environment. Therefore, it is common for ABA therapy to be implemented in whatever setting(s) the child will need to use those skills. For example, if a child is taught grocery store etiquette and money management skills, where would they need to apply those skills? In an actual grocery store! ABA therapy can therefore be conducted in a grocery store, with the child practicing those skills in the setting where they matter the most. This is one of the keys to long-term change in a child’s behavior.

Cons of ABA Therapy

  1. Time commitment
  2. More expensive than other treatments
  3. Waitlist and clinician shortages
  4. Not everyone sees the same results
  5. Not a quick fix
  6. Expectations for involvement

Time commitment

ABA therapy can be very time-consuming. This method of therapy typically occurs anywhere between 10 and 40 hours per week. Those receiving early intervention are typically recommended to receive 25-40 hours per week, though it depends on individualized needs. Typically ABA therapy is provided across two or more years.

More expensive than other treatments

With the extensive number of treatment hours and the duration of treatment that is common with ABA, it can become quite expensive. Without insurance, ABA costs roughly $120 per one-hour session. This can add up quickly, with annual costs ranging from $60,000 to $250,000.

While ABA can be expensive, recent legislation has mandated medically necessary diagnostic and treatment services for children with ASD, nationwide. As such, ABA services and other treatments deemed medically necessary should be covered under most healthcare plans and Medicaid. See more about what the mandates mean for your family based on your location here.

Waitlists & Clinician shortages

With federal insurance mandates and improvements in diagnostic criteria came a significant increase in the need for ABA professionals. Board certified behavior analysts (BCBAs) and registered behavior technicians (RBTs) are in high demand. As such, there are shortages in certain areas. Sometimes that means long waiting lists for services or starting services with a limited number of hours.

Not everyone sees the same results

Research has backed ABA therapy as a sound treatment for the challenges of autistic kids for decades. However, it is possible for some children to experience less pronounced progress. This may be due to a number of factors. The clinician(s) providing the treatment may be undertrained and/or providing subpar care. Some clinicians in the field may practice using outdated methods. Other barriers may be present if a child is not making progress through treatment. Playing an active role in your child’s treatment can help you to identify treatment progress and advocate for your child’s best interests.

Not a quick fix

This somewhat relates to the first con mentioned above. ABA treatment is commonly provided across a significant period of time, at many hours per week. ABA therapy is not a quick fix where treatment starts and huge gains are immediately achieved. There are many steps involved and progress likely won’t happen overnight. During the initial few sessions, the ABA therapists are likely to focus primarily on rapport building. This means sessions will be focused on creating a therapeutic relationship between the child and the ABA therapist through play or other preferred activities. As rapport is established, goals are slowly and systematically introduced, rather than immediately starting many goals. This process has been found to increase progress, but it can be challenging for people who are hoping for immediate changes. Behavior change takes time.

Expectations for involvement

In the pros, we mentioned caregiver involvement. While this is a beneficial factor in ABA, it can also be a challenge for many parents and caregivers. Many ABA programs may require caregiver participation, which can be difficult to manage for working parents or caregivers with other time-consuming commitments. Scheduling therapy sessions and caregiver training around your family’s schedule can be a challenge for busy families.

Putting it altogether

ABA, with all of its benefits, may not be the right fit for all families. It is important for each family to thoroughly consider the advantages, disadvantages, and what exactly ABA therapy will entail before deciding to move forward.

If you’re ready to find an ABA therapy provider in your area, check out this article on how to choose the best provider for your child.

Resources

American Speech-Language-Hearing Association. (n.d.). States With Specific Autism Mandates. https://www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/

Yu, Q., Li, E., Li, L., & Liang, W. (2020). Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis. Psychiatry investigation, 17(5), 432–443. https://doi.org/10.30773/pi.2019.0229

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