Pediatric ABA Therapy: Guide to When, Why & How Much?

Applied behavior analysis (ABA) is one of the most commonly used interventions to treat children with autism spectrum disorder (ASD) and other developmental issues. ABA is based on behavioral science and examines how the environment can affect learning and behavior. An ABA therapist will help examine why a child’s behaviors occur, under what circumstances, and what alternatives can be taught to help increase functional skills.

One of the most important predictors of outcomes for children with autism is whether they received access to early behavioral intervention. Early intervention starts with children under the age of 4 years old and is intensive in the amount of hours it requires, usually between 20-40 hours per week.

Research shows that the earlier a child with autism begins therapy, the better the outcome for that child. A study published in 2004 examined the differences between groups of children who had access to early behavioral intervention and those who did not.

The children who were diagnosed and began early intervention before 24 months of age showed the most reduced symptom severity and were more likely to be integrated in less restrictive environments than those who received no or late therapy, highlighting the importance of acting on an early diagnosis and beginning early intervention.

What is ABA Therapy?

ABA therapy is based on behavioral science and is rooted in the idea that all behaviors are learned, occur for specific reasons and can be unlearned and replaced by other behaviors. Behaviors are learned and maintained by the effect they have on their environment. For example, if a child requests a cookie and is given a cookie, the child is more likely to ask again in the future. If the request is denied, it is less likely that he will request it in the future and may look for alternative ways to get the cookie instead.

Another important principle in ABA therapy is that every behavior serves one of four functions: to escape from an activity, situation, person, etc.; to access tangibles, such as food, items, activities, people, etc.; to get attention from people and lastly, automatically reinforced behaviors, which are behaviors people engage in without any social meditation, such as eating, drinking, sleeping, and self-stimulatory behaviors, such as nail picking, hair twirling, etc.

Using these principles, ABA therapists can teach and improve social, communication, and learning skills in autistic children. Board Certified Behavior Analysts (BCBA) will collect data on the child’s baseline skills using a variety of assessment tools to examine the child’s strengths and where they may be falling behind compared to typically developing peers.

BCBAs will also note the behavioral challenges exhibited by the child and will conduct assessments to identify why the behaviors occur. Once the initial assessments have taken place, the BCBA will write a treatment plan that will typically target an increase in communication skills, prosocial behaviors, and life skills, as well as a decrease in problem behaviors.

These interventions will be highly individualized and specific, utilizing the child’s likes and interests to motivate them toward learning. Parent training and education are also important core principles of an ABA therapy program. Research shows that when parents of toddlers with ASD received training, they were able to implement strategies and goals to help support their child’s development.

The Benefits of ABA Therapy for Children

ABA therapy for children with autism is currently the gold standard methodology for teaching children with autism functional skills. Multiple studies have shown the beneficial effects of beginning therapy at a younger age.

One study found that enrolling students in therapy around 2 years old, compared with 4 years old, increased the likelihood of placement in a regular education classroom. Another study examined the effects of ABA on toddlers in a classroom setting and found that the children showed improvements in cognitive, communication, motor, socio-emotional, and adaptive skills. Furthermore, this study also showed more pronounced effects in children aged at or below 28 months.

Another study showed that compared to control groups, preschool children who participated in early intensive ABA therapy for 2 years exhibited higher levels of intelligence, language, activities of daily living, prosocial behavior, and better overall prognosis.

There are many published case studies that detail the effects of ABA. One such case study shows the positive effects of early intensive intervention on a 37-month-old boy with autism.

Pre-treatment, the child exhibited language levels behind his developmental age, poor eye contact, attention and coordination, inability to sit still for long periods, difficulty with changes, challenges with peers, and stereotyped behaviors. After 6 months of therapy, which included ABA services as well as speech and occupational therapy, the child exhibited gains in the above-mentioned domains. For example, the child was able to maintain eye contact, speak 1-2 words, interact with a wider variety of toys, and learn to identify shapes, colors, vehicles, fruits, and household objects. Furthermore, there was a reduction in stereotyped behaviors, including motor and verbal.

Core Components of Pediatric ABA Programs

There are a few key elements used to increase the success of pediatric ABA programs. One of the main components of ABA therapy is called discrete trial training (DTT). DTT is a systematic and highly structured way of teaching skills by breaking down large skills into smaller parts. Once the child has learned one small skill, the next skill in the hierarchy will be introduced. Often, but not always, DTT is taught at a desk in a structured fashion.

Another successful and commonly used methodology in pediatric ABA therapy is Pivotal Response Training (PRT). PRT is play-based and is initiated by the child, meaning that the direction of therapy relies on the child’s motivations. Here, therapists target “pivotal” behaviors for child development, such as communication and language, positive social behaviors, and reduction in self-stimulatory behaviors.

Similarly, Natural Environment Training (NET) uses the child’s natural environment in the program. For example, instead of working from a desk setting with the therapist’s materials, a session will typically involve playing with real materials that are familiar to the child and occur in their natural environment. Similarly to PRT, the session follows the child’s likes and interests to keep motivation high.

Despite the different approaches, one similarity is pediatric ABA therapy is usually intensive in the number of hours required for a program to be successful. A study from 2011 suggested that, for best results, 30 hours a week is necessary and that the program should run for a minimum of two years.

These interventions are individualized and tailored to meet each child’s needs. Before writing a treatment plan, the BCBA on the team will evaluate the child by conducting interviews with the child’s team, including parents, teachers, and caregivers, as well as by direct observation and record review.

Using these different methods, BCBAs can develop treatment plans that specifically target the weakness areas of each child. Furthermore, BCBAs will develop goals that are relevant to the child and their family to create the most meaningful changes.

The Role of ABA Therapists

Typically, an ABA team is formed by Registered Behavior Technicians (RBTs) and BCBAs. To become an RBT, the candidate needs to have a minimum of a high school diploma and undergo training and assessments set by the BACB, which is the governing board for ABA.

Specifically, candidates need to complete a 40-hour training course, pass a competency assessment observed by a BCBA, and pass an RBT exam. Once the therapists become RBTs, they require monthly supervision by a BCBA who will provide feedback and support to ensure the therapist is providing the best services to the child and caregivers.

BCBA candidates require a Master’s degree and need to obtain 2000 supervised hours by a BCBA before taking the exam. Once they have taken the exam, BCBAs maintain their credentials by completing continuing education units to ensure they are up to date.

Once the assessments have taken place, BCBAs will write personalized and specific treatment plans that target the child’s needs. Treatment plans will include goals to teach new skills, goals to reduce challenging behaviors and teach replacements, as well as family/parent training goals.

The RBTs will be the therapists who spend the most time with the children, implementing the goals and treatment plan as written by the BCBAs. The RBTs will take data during their sessions for the BCBA to keep track of and monitor the child’s progress. As the child begins mastering certain goals, the BCBA will adjust and introduce new, more complex skills. BCBAs also work very closely with the RBTs on the case and use their feedback to further individualize the programs.

Getting Started with ABA Therapy

Typically, obtaining an autism diagnosis is the first step in accessing specialized healthcare services for ASD. Consult with your pediatrician and follow recommendations from them to obtain ABA therapy.

A Google search should provide a list of providers in your area and a few calls should help identify whether they are covered in your insurance network. Once you have identified a provider you want to work with, the first steps will involve assessments, interviews, and consultations for the BCBA to collect information on the child and what the most pressing needs are. During this time, the BCBA will also be assessing how many hours the child should be receiving a week, as well as which RBTs may be a good fit for your child.

Most children with autism will be good candidates for ABA therapy. However, several different factors can influence what type of ABA a child should receive. For example, some children benefit more from highly structured teaching styles such as DTT, whereas other children thrive from the more play-based NET sessions.

The key is to monitor your child, including the progress you see within and outside of sessions, the child’s mood, etc. Parents are their children’s biggest advocates, so if you feel something is not working as it should, share your concerns with the BCBA to evaluate other available options.

What to Expect in ABA Sessions

ABA sessions usually last a minimum of 2 hours. When the RBT arrives, they will use a few minutes to organize their data collection sheets and any materials they may have brought with them, such as fun toys or work materials.

During the session, the RBTs will be running the programs written by the BCBA and will be taking data on whether the child responded correctly. BCBAs will observe approximately two sessions a month and will work with the RBT by modeling how to run certain programs, probe new skills, and provide parent training.

Parents and caregivers play an instrumental role in the child’s progress. During sessions, parents are encouraged to observe the RBT running the goals and managing the behaviors. At times, RBTs will ask parents to observe specific skills and then demonstrate those skills with their children. Furthermore, during home sessions, parents can benefit by following suggestions from the BCBA and RBT to arrange the environment in ways that encourage communication and other learning opportunities.

Measuring Progress in ABA Therapy

RBTs will take data throughout the session on how the child is responding to the treatment goals. This data will be reviewed frequently by the BCBA and relevant updates and modifications will made to keep progress and momentum.

A few times a year, the BCBAs will write progress reports for families and insurance companies to show progress across domains. These reports contain progress on current goals as well as new goals that will be introduced.

When writing the new goals, parents will be consulted to ensure that the programs cover relevant areas. Furthermore, formal assessments will be conducted during these times also to help develop new goals and identify areas where intervention is needed.

Challenges and Considerations

Adapting to ABA therapy can come with several challenges, both logistical and emotional. For instance, early intervention typically takes up a lot of time, averaging a minimum of 20 hours a week.

Finding the time for ABA can be hard, but typically, providers can be flexible and accommodate different schedules as well as provide services in different locations, such as after-school clubs, community settings, different family members’ homes, etc.

Furthermore, with small children, nap times are also important to accommodate. Again, plan with your team to ensure that your child is receiving services at times during which their learning can be maximized.

Another challenge may be adapting to the different ways in which ABA therapists will encourage you to interact with your child. For example, they may ask you to prompt your child to communicate with you in a certain way when requesting an item.

If your child has been used to interacting with you and having their needs met a certain way, they may be resistant to changes initially. Communicate with your BCBA about your comfort levels and concerns so that your child and you are comfortable with slowly introducing these changes.

Keeping open lines of communication with your team will be the best way to proactively address any issues or concerns. The ABA team is there to support you and your child and will want to make sure you are all comfortable and happy with the services received. Alerting them to any challenges you are having is the quickest and most effective way of dealing with these issues and making positive changes.

Insurance and Funding for ABA Therapy

If you have insurance, you can call your insurance company and obtain a list of in-network ABA therapy providers. (Note: If you have Cigna or Aetna insurance, we have guides on how to determine coverage at those links.)

If you do not have insurance, several resources can help cover the cost, such as Medicaid and Social Security Supplemental Income. You can also contact the service providers directly, as they may offer treatment on a sliding scale.

Elegir al proveedor de ABA adecuado

When choosing an ABA provider, there are multiple factors to consider. One decision to consider is whether home-based or center-based therapy will work best for your child. For instance, some homes may not be set up for effective therapy, such as if there are multiple siblings, a small teaching environment, rowdy pets, etc., in which case center-based therapy would be preferred.

After this decision has been made, select a few providers to ask follow-up questions. For example, questions to ask involve how many times the BCBA will provide in-home supervision to the therapist, how they collaborate with other services, such as speech and OT, whether the therapists will be required to obtain their RBT credentials, and what sort of approaches they use, such as NET or DTT.

Once you have made your choice of provider, it is good to commit to that provider for a few months to allow the child to adjust to the changes and for the child and therapist to get to know each other. After this period, if there are still persistent problems and your child’s and your needs are not being heard or met, you should continue to shop around and find a provider that may be a better fit.

Conclusión

ABA therapy can create a profound positive impact on a child’s development, helping to strengthen their communication, social skills, and coping strategies. These skills will help your child to have access to more independence and freedom as they grow up.

The decision to choose an ABA provider is a very important one and there are many aspects to consider. You are under no pressure or obligation to go to or stick with a service provider who you feel is not the best fit for your child and your family. There are multiple resources you can use, such as your pediatrician, neurologist, online or in-person support groups, etc. Ask questions, inform yourself as much as possible, and find the best team to support your child in their ABA journey.

Related Articles

Early Intervention ABA Therapy: A Parent’s Guide What Is a BCBA? Role, Training & How They Help 31 Señales Tempranas de Autismo en Bebés a Las Que Debes Estar Atento Provisional Diagnosis of Autism: What Parents Should Know