By Traci Ramos, M.Ed., BCBA, LBA
What is ABA therapy?
ABA stands for Applied Behavior Analysis therapy. It is a data driven evidence-based practice based on the science of learning and behavior. Behavior Analysis helps us understand how behavior is affected by its environment and how learning takes place. The principles of ABA are used to shape behavior, communication and adaptive functioning for individuals. ABA is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, academics and adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence.
ABA can be beneficial to anyone regardless of level of functioning. We all exhibit behaviors that can be shaped. Finding a provider, who is a good fit for your child and family, is vital to the therapy's success.
What is the difference between an RBT, BCBA and a CAS?
RBT (Registered Behavior Technician) requires a high school diploma, 40 hours of training in ABA, passing a competency assessment, and passing a separate written exam.
BCBA (Board Certified Behavior Analyst) certificate requires a master’s degree or PhD in Psychology or Behavior Analysis, 1500 hours of supervised fieldwork, and passing the national BCBA certification exam. Some states require additional licensing for that state.
CAS (Certified Autism Specialist) has a master level degree, two years of experience in the field, are required to maintain continued education in autism topics. CAS don’t have a specific master’s degree, some are may be physical therapists, teachers, psychologists, language pathologists, etc.—but the certification shows their knowledge in the field of autism. Frequently, those in ABA or BCBA therapy will seek out a CAS certification in order to better show they’re specialized in the field of autism.
What population typically needs ABA therapy?
ABA is most known as an evidence-based intervention for individuals with autism, but it is important to realize that ABA is not just for autism. Because ABA therapy is used to improve challenging behaviors, communication, social skills, poor academics, it is helpful for people of all ages and abilities. Many individuals with ADHD, anxiety, Down Syndrome, OCD, PTSD, and other developmental/behavioral disorders also benefit from ABA. Both children and adults receive ABA services in a variety of settings, including homes, schools, clinics, workplaces, and community settings.
How does a person qualify for ABA services?
Insurance typically requires an autism diagnosis for coverage of ABA services. However, ABA is occasionally covered for other behavioral diagnoses. In addition, ABA services are available to anyone in need when paying privately.
Does insurance pay for ABA therapy? If so, what does the typical coverage look like?
ABA services are typically covered by insurance when given the ASD (Autism Spectrum Disorder) diagnosis. Coverage varies by state, insurance and specific insurance plans. Following assessment, BCBAs, BCABAs or BCBA-Ds recommend a treatment plan and an intensity (number of hours) that would benefit the client based on data. Insurance either approves or modifies the number of hours allowed and authorization is given. Most insurance authorizations require re-approval every three to six months.
Is ABA a global therapy?
Yes, but internationally the number of BCBAs is scarce. There are approximately 23,000 worldwide with 21,000 of those providers practicing in the United States. Since there are only approximately 2,000 in the world outside of the US, ABA therapy is only truly accessible in about 20 countries*.
Is there an ideal age to begin therapy?
It depends on the individual, but the rule of thumb for a child with autism or other developmental disability is “the earlier the intervention the better." Those in the traditional “brain development” stage will have a higher likelihood of achieving full developmental capability than a child that starts therapy at a much later age. There are some infant studies currently being conducted. The University of Texas-San Antonio, for example, has a program called Project PLAAY that focuses on early intervention for infants that are considered “high-risk” for the ASD diagnosis.
Is there an age that you typically conclude ABA support?
Therapy is not dependent on age, but on the time required depends on the needs of the individual. There are instances where individuals are discharged based on a set criteria. Meaning, the individual does not require therapy to address additional goals or skills at that time.
How does ABA therapy work?
ABA is a flexible treatment and is adapted to meet the needs of each person’s needs. The therapy is administered in many different locations – at home, at school, in a clinical setting and in the community. In these settings, it teaches skills that are useful in everyday life. It is taught most commonly in one-on-one settings but can also be facilitated by group instruction.
What kind of teaching will be involved in my child’s program?
Each program is individualized based on need. An assessment is conducted prior to treatment to identify possible deficits in communication, socialization, and adaptive functioning. The treatment plan is tailored to client needs. Here are some of our most commonly used teaching methods:
Positive reinforcement: providing rewarding and valuable consequences following goal behaviors in order to make it more likely that these meaningful behaviors will occur again in the future (Ex. Praising a child for raising his/her hand before talking in class).
Discrete Trial Teaching: An instruction is given (ex. “touch your nose”, the child responds or is provided prompts in order to respond correctly, and reinforcement (feedback) is provided. This method is effective in teaching new skills because it provides multiple opportunities for instruction, modeling, feedback, and reinforcement.
Natural Environment Teaching: Child-led learning in the natural setting occurs with the use of reinforcement embedded into activities (ex. Child says “cracker” and gets a cracker or child points to or signs “ball” and gets a ball). Therapists engage with the child during play, meals, or other naturally occurring activities and seek out “teachable moments” when he/she shows interest in a certain person, item, or activity.
What strategies do you use to engage your clients? Establishing trust and motivation to participate is essential to an effective ABA program. We start by developing rapport, incorporating their interests, and providing minimal-to-no demands at first. We always attempt to meet the client where they are at. We believe in creating a positive experience by incorporating our clients’ interests into learning activities as much as possible.
How do you establish the goals and strategies for your clients? Goals based on functional behavior assessment and skill assessments. Some examples of common assessments used are Functional Behavior Assessments, VBMAPP, ABLLS, and AFLS.
How many hours a week do you think is recommended to see consistent behaviors and results? It depends on the individual. Individuals on lower end of the spectrum or individuals with severe problem behaviors typically require more hours than a higher functioning individual or an individual that exhibits a low level of challenging behaviors. The BACB offers practice guidelines for intensity of services based on the type of program. Focused ABA programs treat a limited number of target behaviors, while comprehensive programs address goals across multiple domains (communication, social, emotional, cognitive, adaptive, etc.). An ABA program may require between 10-40 hours per week in order to see consistent results. Treatment hours are increased or decreased based on the client’s progress and needs.
How often should the child’s supervisor be visible/present? Best practice is 10%. However, depending on the case, supervisors can/will supervise more often to meet the needs of the client.
How should parents get involved in ABA therapy? Be present during the session, actively participate in parent training, ask questions, and continue to use strategies outside of ABA sessions. It’s also important to be very honest with therapists about current functioning and what is feasible for the family. Keeping an open line of honest communication benefits the client. Parents may be asked to implement programs outside of therapy sessions or collect data on challenging behaviors and new skills. At the end of the day, we are all working towards the same goals – improve our clients’ quality of lives and helping them reach their maximum potential.
How does ABA therapy integrate with other ongoing therapies? ABA team can collaborate with other therapists on behavioral interventions and teaching strategies that will benefit the client across settings.
How has working with a HADDS client been different or the same as your other clients? We work with such a wide range of abilities, but most of our clients are individuals with autism. They say, “if you’ve met one child with autism, you have met one child with autism.” I feel like the same goes for anyone receiving ABA services due to the nature of how individualized each client’s program is. It has been exciting to be able to work with a HADDS client. For this client, even though there have been more needs in the areas of motor skills, receptive language and social strengths have played a huge role in the progress we’ve made!
For family members who are unsure how to initially engage with HADDS kids or any child with special needs/on the spectrum, what advice would you give them?
Follow the child’s lead, look for signs of motivation and play without demands. Build a relationship before implementing demands, longer sessions, or aversive tasks.
What is a common misconception about ABA?
We make our kids robots, that we use bribery, that ABA is unnatural, taking place mostly at a table with flash cards. People often think that we are just “Playing with kids”. There is always a method to our madness, even if it just looks like we are hanging out.
What questions should someone looking for an ABA provider ask?
Do you do ABA in home or at a clinic?
Are therapists allowed to transport the children?
How many years have you been in practice?
How many providers (therapists and supervisors) are employed by ABA agency?
Do you offer parent training?
How much ongoing training do your therapists receive?
How do you manage safety concerns?
Do you have a waitlist?
Which insurances are you in-network with?
What questions may help prepare parents in terms of what to expect?
How will you determine my child’s goals?
How many therapists will be on my child’s team?
How often should the provider and parents meet to sync on progress?
What is the process for a parent telling a therapist they don’t like something that’s happening?
How is data collected and charted and how can I as a parent have access?
What kind of parent education is offered?
How often is data assessed to create new goals?
How will therapists develop rapport with my child and keep him/her motivated to learn?
About the Author
Traci Ramos has been working with individuals with special needs for over 15 years. She worked with individuals from children up to early adulthood in the home, school, and community settings. Traci is a Board Certified Behavior Analyst (BCBA) and holds a current Texas teaching certificate. She received her Bachelor's degree in Interdisciplinary Studies from The University of the Incarnate Word and her Master's
degree in Special Education (with an emphasis on autism and ABA) from Texas State University. Traci and her husband, Mark, are proud parents of three boys!
*Reference: https://www.special-learning.com/international
Introduction to Behavioral Health Treatments: https://www.autismspeaks.org/sites/default/files/2018-08/Behavioral%20Health%20Treatments.pdf
A Parent’s Guide to ABA: https://www.autismspeaks.org/sites/default/files/2018-08/Applied%20Behavior%20Analysis%20Guide.pdf
Applied Behavior Analysis Treatment of Autism Spectrum Disorder Practice Guidelines: https://www.bacb.com/wp-content/uploads/2017/09/ABA_Guidelines_for_ASD.pdf