If you have a child on the autism spectrum, your doctor may have recommended ABA therapy. However, with up to 40 weekly hours of intensive treatment, this type of intervention is a major commitment. Continue reading to learn more about how ABA therapy works and why it is so effective.
What Is ABA Therapy?
Applied Behavior Analysis (ABA) is a form of behavioral therapy that focuses on reinforcing desired behaviors and reducing unwanted ones.
ABA is an effective treatment recommended by many health professionals and the only autism therapy endorsed by the US Surgeon General. Commonly considered the “gold standard” for treating autism, it has been proven highly successful in helping autistic children progress and develop a variety of skills, including:
- Activities of daily living
- Communication skills, such as initiating conversations and responding to questions
- Social skills, for example, understanding social cues like facial expressions and body language
- Basic academic and pre-academic skills.
ABA therapy is based on using positive reinforcement in the form of rewards and other incentives. When the desired behavior is followed by a motivator, such as praise, a special toy, or activity, children are more likely to repeat the action. Over time, this method can encourage positive behavioral changes.
ABA Therapy Strategies
ABA therapists use a variety of strategies that are based on the individual strengths and weaknesses of each child. The most commonly used ones include:
- Discrete Trial Training (DTT)
- Early Start Denver Model (ESDM)
- Pivotal Response Training (PRT)
- Early Intensive Behavioral Intervention (EIBI)
Discrete Trial Training (DTT)
Discrete Trial Training was one of the first interventions developed for treating autism. It is effective in teaching autistic children new skills, ranging from very simple to more complex ones.
DTT consists of breaking down skills into smaller, “discrete” components in order to make them easier to master. Children get rewards for their achievements, which encourages them to continue learning.
This technique is typically used with autistic children aged 2-6 years, although it can be effective at any age.
Early Start Denver Model (ESDM)
The Early Start Denver Model consists of teaching verbal, cognitive, and social skills through play. The program can be implemented in a variety of settings, both in one-to-one therapy sessions, group sessions, preschool or specialized child care settings, and at home.
ESDM is used for autistic toddlers ages 12 to 48 months as well as preschool children who show early signs of autism. Autistic children with significant learning challenges can also benefit from this therapy.
Pivotal Response Training (PRT)
Pivotal Response Training focuses on four key (pivotal) areas of development: motivation, self-initiation, self-management, and responsiveness. The purpose of this technique is to help children with autism develop more complex communication and social skills through play and various other child-initiated activities.
This strategy targets autistic children aged 2-6 years, but can be used at any age.
Early Intensive Behavioral Intervention (EIBI)
Early Intensive Behavioral Intervention can help autistic preschoolers build positive behaviors, while reducing unwanted ones. Therapy sessions are done in a one-on-one setting with a trained therapist. Children are taught new behaviors by breaking tasks into small steps that are easier to learn and rewarded for their achievements. Difficult behaviors are ignored.
EIBI requires 20-40 weekly hours of intensive therapy, often combined with other treatments such as speech and occupational therapy.
Modeling consists of demonstrating desired behaviors, either in person or through a video, and asking the child to copy them. Through imitations, children will be able to generalize their newly acquired skills to more complex and difficult situations.
How ABA Works
ABA immerses children in a positive, caring environment in which they receive treatment that is specially tailored for their individual needs and preferences.
ABA interventions usually start with discrete trials therapy, where the therapist asks the child to perform a certain task, for example, to clap, point at a color red, or produce the sound “s”. If the child does as asked, he or she is given a reward such as a treat, praise, or the possibility to engage in a favorite activity. The therapist will gradually introduce more complex tasks.
ABA therapy can be done at home, in school, inpatient programs, and many other settings. As a parent, you will be also trained to provide support for your child in different environments.
In the following section, we take a look at the typical ABA therapy timeline.
Timeline of ABA Therapy
ABA therapy is a process that consists of several stages:
- Conducting assessment
- Reviewing results and making a recommendation
- Creating a treatment plan
- Implementing treatment
- Evaluating progress.
During the initial stages of ABA therapy, a Board Certified Behavior Analyst (BCBA) performs an assessment of the child based on direct observations, the child’s medical history, previous treatments, and interviews with the child’s family and teachers.
Reviewing results and making a recommendation
After conducting the assessment, the therapist reviews the data to determine what behaviors should be changed and how many hours of therapy are needed. The ultimate goal of the treatment is to help the child become as independent as possible and ensure improved quality of life.
Creating a treatment plan
The therapist decides whether the child needs a focused or comprehensive treatment and makes a plan for therapy sessions.
Focused ABA typically consists of 10-25 hours of one-on-one therapy and/or group therapy. This type of treatment is used when there are few challenging behaviors that need to be improved, for example, social skills or daily living skills.
Comprehensive ABA requires 25-40 hours of one-on-one weekly therapy sessions. This type of intensive treatment program is usually recommended for children who show deficits in most areas of development.
The therapist implements the treatment using a variety of ABA techniques and strategies, some of which may also be initiated by the child.
Throughout the treatment, the therapist regularly measures the child’s progress. Evaluations are done every few months to help determine whether any adjustments are necessary. As the child progresses, the number of weekly hours of therapy can be increased or reduced as needed.
In the following section, we explain how you will know when it’s time to discontinue ABA therapy for your child.
When Should One Stop ABA Therapy?
ABA therapy often involves two to three years of intensive intervention, followed by another couple of years of focused treatment. But even when your child begins to master the goals, ABA services are not simply discontinued. It is common to gradually decrease the number of hours of therapy until it eventually stops.
The therapist will review or discontinue ABA therapy in the following cases:
- The child has met the goals
- The child learns new skills spontaneously from the natural environment and does not need direct instructions
- Parents and teachers can successfully manage and reduce the child’s problem behaviors
- Parents are able to implement behavior plans and teach strategies without the help of a therapist.
Specialists also recommend stopping ABA therapy when:
- The child isn’t showing any progress over time
- The family and therapist disagree on the treatment plan
- The child doesn’t meet the criteria for autism.
What happens after your child finishes ABA therapy?
Discontinuing ABA therapy doesn’t mean that your child is “cured”. It is still important to follow the transition plan to make sure that the child maintains all the learned skills. The child’s behavior should be closely monitored for several months following therapy. The therapist will help you understand what is considered a typical behavior and in what circumstances your child may need support.
Specialists suggest starting occupational therapy, physical therapy, or a speech program where your child can continue fine tuning the acquired skills. Some children may also need to return to ABA therapy.