Does ABA Therapy Work? Progress Parents Can Expect

Applied behavior analysis is one of the most commonly recommended behavioral therapies for children who are diagnosed with autism spectrum disorder. But what makes it so popular? How can it be so easily trusted when there is so much misinformation out in the world relating to autism, its causes, and its treatment?

Many hail it as the gold standard in autism intervention, while others have raised concerns about its effectiveness and ethical implications. Even though I have practised ABA therapy for many years, I still think its critics make points that need to be addressed.

Learning more about exactly what ABA is and what it entails can help parents make more informed decisions about whether it might be worth trying.

What Is ABA Therapy?

ABA therapy, in short, uses behavioral principles to change behaviors. It is an evidence-based practice that helps us to better understand why people do the things that they do. It uses evidence-based and systematic interventions to improve socially significant behaviors while reducing challenging behaviors that may be impeding an individual’s ability to thrive.

It utilizes things like positive reinforcement, measurable goals, and relies on observable actions to make changes.

ABA can help to improve communication skills, self-care, social skills, motor coordination, academic readiness, and more. It is delivered in a variety of different settings, including in the home, in schools, or in autism clinics. 

What Is the Goal of ABA Therapy?

The first and most important goal of ABA therapy is to improve the quality of life and independence for the autistic individual. Assessments help practitioners identify areas where an individual may be struggling and create goals specific to those areas of need. These goals may include communicating more effectively, performing daily tasks independently, reducing aggressive or other dangerous behaviors, practicing self-advocacy, and more. 

ABA also focuses on teaching new and adaptive behaviors while reducing those that are harmful or interfere with learning and social participation. This includes dangerous behaviors (self-injury, aggression, elopement, property destruction), but can also include behaviors like disrobing, tantrums, sexually-inappropriate behaviors, screaming, or disruptions. In school-aged children, ABA can focus on classroom readiness, inclusion, and other foundational skills.

Evidence Supporting ABA Therapy

As a practice that prides itself on using evidence-based interventions, it only makes sense that ABA as a whole strives to be backed by science. ABA practices have been tested, reviewed, refined, and improved over decades through various scientific research designs.

Though ABA tends to focus on the use of single-case experimental designs, other types of designs have been used and have given evidence that ABA is one of the most effective treatments for autism spectrum disorder.

There has been a lot of misinformation about autism and treatments for it, and so making sure that we look for true evidence is more critical now than it has ever been. I have heard of gluten-free diets, oxygen therapy, red 40-free diets, exercise, medications, chelation therapy, injections, stem cell treatments, and holding therapy, all being used as a way to “cure” autism. None of these comes even remotely close to the level of support and evidence that ABA has. Simply put, there is overwhelming evidence that ABA is effective. 

If that overwhelming evidence is not enough, ABA is also endorsed by the U.S. Surgeon General and the American Psychological Association as an effective and evidence-based approach for treating autism spectrum disorder. Longitudinal research has indicated that children who receive high-quality ABA services show significant gains in school readiness and long-term functioning. Meta-analyses and systematic reviews also consistently report positive outcomes from ABA therapy. 

What Do Outcomes Look Like?

As is evident from decades of overwhelming research, ABA therapy has been shown to support significant improvements in various developmental areas. Children who receive ABA services often make gains in areas like language development, cognitive functioning, motor skills, daily living skills, social interactions, emotional regulation, social skills, and self-care skills, just to name a few.

For some, especially those who begin at an early age and receive high-quality services, progress can be absolutely substantial. This can lead to greater independence and more meaningful connections with others. 

As a behavior analyst, I am well aware of the significant impact ABA services can have. I have watched children who began services completely non-vocal and isolated leave talking in complete sentences with more friends than they can count on their fingers.

I once worked with a child who would frequently disrobe, urinate on the floor, bite, throw toys, and tackle others to the ground. He left with a new device to communicate with, hundreds of new words to use, and nearly zero of those previous behaviors.

This is not to say that all ABA journeys are as successful as these ones. Nearly all the cases I have worked with have made great progress and left with more skills and independence than they arrived with. However, those who started earlier and those with the most passionate behavior technicians had by far the most success. 

Outcomes are certainly not one-size-fits-all. Several key factors influence how effective ABA therapy will be. For example, the age at which someone begins plays a significant role in their outcomes. Earlier intervention is generally better.

A Note On ABA Therapy Schedules

Also, the intensity and consistency of therapy are important. Older studies have recommended up to 40 hours of therapy a week, but I personally do not believe that number is necessary for positive outcomes. High-quality ABA therapy, delivered at 10-15 hours a week, is significantly more effective than 40 hours of low-quality ABA therapy.

Family involvement (which includes families using skills taught in ABA therapy outside of therapy hours) is also important.

Finally, the training, supervision, and experience level of the therapist can greatly impact the quality of ABA services.

For more on this topic, see our article on how long ABA therapy lasts.

Limitations and Criticisms of ABA Therapy

While I am certainly a voice of support for ABA services, I would not be shy to say that there are a lot of valid criticisms of it, especially since the beginnings of ABA therapy were not very kind to the autistic community.

Many autistic adults who underwent ABA as children report feeling that the therapy emphasized compliance over autonomy and that goals were more focused on “masking” and less on authentic self-expression. 

Forced masking can easily lead to anxiety, identity issues, shame, and burnout later in life. Much of the ABA field in earlier days did just this, creating goals that were intended to make neurotypical people more comfortable rather than focusing on what may truly be best for the individual.

Today, trauma-informed care and prioritizing autonomy are essential in high-quality ABA care, but it would be a disservice to the autistic community to pretend that damage from earlier ABA frameworks doesn’t still exist. BCBAs have a required and moral obligation to continue their education for as long as they are practicing, and learning about such ethical concerns is certainly a part of that journey. 

Another criticism is the wide variability in the quality of ABA programs and providers. Not all therapists are equally trained, and not every program is tailored to the individual. There are many, many ABA companies whose primary focus is profit at the expense of clinical quality.

These issues can lead to inconsistent or even harmful practices, particularly when outdated methods are used, therapy becomes overly rigid, or inconsistent teaching results in inconsistent learning. ABA is not a one-size-fits-all type of treatment, but sometimes it is applied that way by low-quality providers. High-quality and effective ABA should be flexible, person-centered, and adaptive. 

Ethical considerations have prompted a growing shift in how ABA is practiced and how BCBAs choose a company to work for. Many professionals and organizations have moved towards more compassionate and trauma-informed approaches as opposed to compliance-first, with an aim of appearing neurotypical. Best practices should continually evolve and incorporate feedback from autistic individuals. 

Alternatives and Complements to ABA Therapy

While ABA is the primary intervention recommended and used by families, there are certainly alternative and complementary therapies that families can choose to use to support their child’s development. One growing area is Naturalistic Developmental Behavioral Interventions (NDBIs), which utilize many strategies also used in ABA within natural, play-based settings. Examples include the Early Start Denver Model and Pivotal Response Treatment. These build skills through child-led interactions. 

Speech and Occupational therapies are also incredibly popular choices for families. These therapies target developmental domains related to communication, language development, sensory integration, and fine motor skills. Many autism clinics also offer speech and occupational therapy, in addition to ABA. Play-based and relationship-based therapies (e.g., DIR/Floortime) use emotional connection and social engagement as the foundation of learning. 

How to Evaluate If ABA Is Working for Your Child

Determining whether ABA therapy is effective starts with how individualized it is. If the goals and programs are written specifically for your child, sessions will be spent working on goals and skills that are significant to them.

These goals might focus on improving communication, building connections, creating independence, reducing problem behaviors, learning self-care, and many more. High-quality ABA sessions focus on specific goal areas while also utilizing skills that the individual already possesses in their repertoire, thereby facilitating optimal learning. 

Progress in ABA is typically determined through continuous data collection and progress monitoring. The data points collected during ABA sessions enable practitioners and families to monitor what is working and make adjustments to programming as needed. If continuous monitoring is not occurring, then learning can quickly stagnate, or regression may occur.

Collaboration with others is also a good indicator of high-quality ABA services. BCBAs work closely with behavior technicians, the child, parents, speech therapists, teachers, occupational therapists, and more. Collaboration is essential to ensure all members are aligned on treatment and services. ABA is undoubtedly not a static practice, and so changing the approach to learning may be necessary.

Perspectives from Families and Autistic Individuals

Experiences with ABA can vary from family to family, especially for those who got services through higher-quality ABA companies. Many parents would describe ABA as life-changing, especially when they see how much their children learn in terms of communication, self-regulation, and independence.

There are, of course, families who have not been as fortunate and did not feel that ABA was helpful to their family. For a greater chance of success, I recommend discussing specific companies with others to see if other families are willing to share their experiences with their ABA company. Reading company reviews online can also be beneficial. 

Many autistic self-advocates have raised valid concerns when it comes to their own experiences, and it is important to listen to those voices and strive to make changes so that others who experience ABA do not go through the same struggles.

ABA should not be based so heavily on compliance; it should respect the autonomy of the individual and focus on skills that will enable them to be the best version of themselves, for themselves. Appearing “normal” is not something that should be considered as a part of treatment. These voices have fueled important conversations about the need for more respectful and trauma-informed practices that celebrate neurodiversity rather than oppress it.

Practitioners are working now more than ever to strike a better balance between developmental progress, identity, and agency. The most effective and successful approaches to teaching are those that center on the person’s well-being through support and teaching meaningful skills.

Conclusion: So, Does ABA Therapy Work?

The evidence has consistently shown that ABA therapy can be highly effective in helping individuals with autism develop skills and reduce problem behaviors. Decades of research have been conducted and built upon that further prove its usefulness in practice. Effectiveness on the individual level is not guaranteed due to a lack of training and possible low-quality clinical practices, but the practice as a whole should not be so easily dismissed.

What matters the most is that ABA is applied ethically and in a way that respects the individual’s needs and comfort. For parents, making informed and child-centered choices begins with selecting the right ABA company and ABA providers, and speaking up if they have any concerns.

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