Soon after a child is diagnosed with autism spectrum disorder, pediatricians will often give parents a range of treatment options, one of which is applied behavior analysis (ABA). ABA therapy is one of the most widely recognized and empirically backed treatments for autism spectrum disorder.
Still, it is also relatively unknown to those who are not familiar with developmental or intellectual disabilities. So, when starting ABA sessions, there is often a lot of confusion. The best types of ABA sessions resemble play, which can cause parents to be confused about the science behind it. Many of the behavioral terms online can be confusing, and misunderstandings about ABA can be concerning, leading to significant stress for parents. Hopefully, I can help clarify things.
This article aims to dispel some of the mystery and provide a clearer picture of what can be expected during an ABA session. Every session for every child looks a little different, but there are certainly some common elements to look out for. Knowing a bit more about the practices and the reasons behind them can help families be more active partners in therapy and even use some of the ideas outside of session times so that the things learned in therapy can be applied across all settings.
Before the ABA Session Starts
A lot of preparation goes into an ABA session before the therapist even begins working with the child directly. The behavior therapist (typically referred to as a BT or RBT if they are nationally certified) may review data from previous sessions to assess progress or consult with their supervisor, a Board Certified Behavior Analyst (BCBA), to identify areas that require further attention.
They may notice that progress is slower in certain skills or behaviors, and spend more time during the session focusing on that particular area. This helps them focus their work to make sessions as efficient as possible and ensures that they build on skills that have already been learned. Having a plan of action ensures that the session is organized and has clear, measurable goals.
The environment also plays a huge role. In fact, I would go as far as to say that the environment is one of the most important factors in any ABA session. A room with too many distractions, too loud, too quiet, too dark, not enough toys, any of these things could easily make or break a session.
BTs will try to set up the space in a way that helps to make it comfortable and inviting without too many distractions and increases learning opportunities. This could mean bringing or moving around toys, tools, picture cards, or other items. A calm and organized but fun and approachable setting can set the stage for success. When the environment is well-prepared, it also helps to reduce frustration and increase learning.
BTs may also take some time to discuss the upcoming session with caregivers. This is always a good idea, as caregivers can provide context that might otherwise be unknown if the session starts without a check-in. It allows families to share updates such as how the child slept, if they ate recently, if there have been any changes in routine, or if there are other aspects of their time outside of sessions that may impact learning. These small details can help the BT adjust their approach as needed for that day. It also gives parents an opportunity to ask questions, make suggestions, and be overall more involved with sessions.
A good BT also always ensures that they spend some time during every session building rapport with the child. This might be playing with their favorite toy, playing fun games, or simply just spending time talking to them. I believe the best and most successful ABA sessions resemble play, and that building rapport should always be occurring. Starting the session with positive and friendly interactions helps ease the child into more structured teaching. Making sure it starts fun can also help the session remain enjoyable throughout.
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The Structure of an ABA Session
Pairing
As mentioned in the prior section, the first part of a session typically begins with what is commonly known as “pairing.” This is when a therapist focuses on connecting with the child, establishing motivation, and setting the stage for a fun and engaging session. This is something that should continue to happen throughout a session, but starting by focusing on pairing explicitly without working on other instructions helps the child get warmed up and ready for more structured activities.
When people are motivated, they can learn more effectively while enjoying the process. The same goes for children with autism. Boring sessions lead to minimal results, and the best sessions look fun for all parties involved.
Previously Mastered Skills
After spending some time at the beginning focused on pairing, the BT may start by working on some previously mastered skills. These quickly attainable successes help build momentum and confidence, another essential component for a successful session.
If the child knows a lot of colors and letters, maybe the first structured part of the session will include identifying colors and letters. Starting with these types of known skills can set a positive tone and re-establish the value of reinforcement. Positive independent responding leads to positive reinforcement. It also sets the therapist up for behavioral momentum, where the child is more open to responding to more challenging instructions when first presented with easier instructions.
New Learning Targets
After pairing and working on some maintenance targets, new learning targets are slowly introduced. These are the specific goals targeted during a session. These can include activities such as requesting items, improving imitation skills, practicing self-help routines, labeling items, sharing, perspective-taking, and many other possibilities. These target skills can be more discrete and specific, such as identifying objects, or more complex that involve the use of chaining or task analyses to teach.
When working on these types of acquisition targets, the goal is to challenge the child and teach while also keeping the session positive and allowing them opportunities for success. To make sure of this, prompts and reinforcement are used throughout the session, especially while learning these new skills. Prompts are used when the learning target is a bit more challenging to do independently. BTs will also use a mix of both mastered and acquisition targets to keep engagement high and to make sure that reinforcement is accessible throughout.
Types of Activities in an ABA Session
There are many different skills that one might see while observing an ABA session in action. Here are some that are the most commonly used during sessions:
Discrete Trial Training (DTT)
This is a teaching style where a skill is practiced by repeating multiple times in short sessions. For example, if the goal is to learn to identify body parts, DTT targets for this overall goal may include “touch nose” and “touch ears.” So, the therapist will work on these two more specific targets multiple times throughout a session, reinforcing the child with a preferred toy or activity each time they successfully follow the instruction.
Natural Environment Teaching (NET)
With NET, learning happens in the context of play and other everyday activities. It requires a bit of creativity and impromptu skills from the BT. A child might learn the names of colors while playing with toy blocks or learn to request their favorite snack during snack time. It’s a fancy word for finding and using opportunities for learning as they appear. While DTT is more of a contrived learning situation, NET is more natural.
Functional Communication Training (FCT)
FCT helps children replace challenging behaviors with more appropriate forms of communication. Instead of engaging in aggression if they want access to a toy, they might be taught to point or use an AAC device to ask for the toy in a way that doesn’t harm others. Over time, this reduces frustration for both the child and their caregivers. Communication is almost always a skill that is targeted in ABA, even if FCT is not used for a child.
Social Skills Practice
Social skills are another pretty big component of ABA sessions. This could involve role-playing activities, turn-taking games, or engaging with other peers. Children with autism often struggle when it comes to engaging with other peers, and so it is not uncommon for BTs to target skills that relate to socializing with others!
Daily Living Skills
Skills such as brushing teeth, cleaning up, putting on clothes, washing hands, and toileting are taught to build independence. These types of skills are often more complex and use behavioral interventions such as chaining to teach.
Data Collection and Progress Tracking
One of the biggest components of ABA therapy is data. During sessions, BTs record how a child responds to each activity and target and record any instances of problem behavior that occur. They track whether prompts were needed for them to respond correctly, as well as other information, such as preferred reinforcers and the duration of activities. For ABA professionals, the more data the better! ABA data ensures that any changes made are based on evidence and not guesswork.
BCBAs train BTs on data collection to make sure that the information recorded by BTs is accurate and reflective of the child’s actual behavior. This accurately collected data helps BCBAs assess the progress made during sessions, even when they are not physically present to observe. For example, if a child consistently struggles with a certain step of a target, a BCBA can observe this and make adjustments to the target or the teaching strategy used to teach it. If the data for that particular step indicates that the child is no longer struggling with it, the modification is evidence-based and helps support the child’s progress.
Parents may see data sheets used during the session that are filled with different symbols, numbers, or random notes. Or, they may not see a physical data sheet at all. Many BTs now utilize different ABA programs that enable them to collect data using a tablet or phone via an app. If parents want to know more about how the data is collected or see the data inputs for themselves, they should check in with their BCBA. BCBAs would be more than happy to supply that information and can often create graphs from the raw data that are easy to read, which illustrate progress.
Sensory and Emotional Considerations
Many children on the spectrum have unique sensory needs, and therefore, ABA sessions often include adjustments to ensure they are comfortable. Lowering light brightness and using noise-cancelling headphones are the most common ways to adjust the environment for children.
This helps the child remain calmer and maintain emotional regulation. If a child becomes overstimulated or frustrated, BTs are trained to use a variety of different strategies (such as sensory breaks, shifting to other activities, offering calming tools, etc) to help the child regulate. This helps reduce meltdowns while also teaching children to cope with stressors.
Myths and Misconceptions About ABA Sessions
There are many different misconceptions that I’d like to clear up. Of course, some of these misconceptions are grounded in some truth. ABA, in its infancy, was incredibly rigid and had a lot of ethical concerns. There was a lot of intensity in early ABA, and there was a focus on making autistic people appear as neurotypical as possible.
Times have changed, and the field has evolved to be more trauma-informed and more assent-based, with a focus on prioritizing the autistic person’s needs and assent. With that being said, here are some common misconceptions about ABA therapy:
“ABA sessions are rigid.”
Some components of ABA are more rigid than others, like with DTT trial targets. Structure is essential for some types of targets, but good ABA therapy does a great job with balancing structure with flexibility by adapting to the child’s needs and interests.
Flexibility allows them to stay motivated, while the structured tasks allow for discrete trials when needed. The sessions overall should not come across as rigid. Even with the structured activities, ABA sessions should always look like both the child and the BT are having fun.
“It’s all about table work.”
If most of the ABA session is being done at the table, it is being done wrong. Much of the learning happens through play, movement, and real-life activities. As a BT, I worked in a clinic where I spent a lot of time in the gym area, outside, in the kitchen area, and in the library area. Some work was done in the child’s table area, but not nearly as much as the others. In fact, the best learning occurs outside the classroom, as learning in various environments helps children generalize learned skills across multiple settings.
“ABA only focuses on problem behaviors”.
Behavior management is a part of ABA therapy, but it isn’t the only focus. If a child engages in problem behaviors often or the behaviors are dangerous, behavior management may play a bigger role.
However, even with focusing on behavior, other skills are still being taught. For example, with FCT, there is a focus on problem behaviors, but communication skills are also being taught. The focus is never just about reducing problem behaviors. It’s always a combination of reducing problem behaviors while teaching more effective communication, toleration, and coping skills.
How to Get the Most Out of ABA Sessions
To get the most out of sessions, I would encourage parents to prepare their child before the BT arrives (if sessions are in-home). This might include finding a suitable area for the session, gathering their favorite activities, and letting them know that they will soon start the sessions.
In my experience, I would also say that removing a tablet (if they use one) may also be good to do before a session starts. Using the tablet as a reinforcer is fine, but sometimes children struggle to transition from using the tablet to starting a session. Having them prepared to learn is best without having the BT need to begin by removing their tablets.
Open communication is also crucial. Parents should feel comfortable sharing observations, concerns, and successes that occur outside of ABA sessions to best prepare the BT and to make sure all parties are on the same page. When parents reinforce skills outside of sessions, children are more likely to generalize what they learned outside of therapy time.
Communicating and asking the BT questions is essential for parents to learn how to do that. Consistency is also important here. Ensuring that parents are aware of what the BTs are teaching and identifying opportunities to reinforce those same skills. Parents also play a huge role in helping to maintain skills that have already been mastered. ABA sessions are where the learning starts. It’s up to parents to carry those lessons on beyond the therapy room and into daily life.
