What is ABA therapy?
And what parents should expect
More recently there have been conversations arising about the ethics of ABA therapy (Applied Behavioral Analysis). Visit the Therapist Neurodiversity Collective to learn more about these concerns.
Disclaimer: This blog is meant to present information in regards to commonly asked questions about ABA therapy and is not meant to be a recommendation to any individuals.
What is ABA therapy intended to be?
ABA stands for applied behavioral analysis, a fancy title for therapy that reduces unwanted behaviors and increases desired behaviors. For example, a possible ABA goal might be to reduce the undesirable behavior of hitting others when the child becomes frustrated. There might also be a goal for increasing the child’s skill in feeding himself with a spoon.
Who is ABA therapy intended for?
Therapy is typically used for those on the spectrum but can be used in several other situations to correct unwanted behaviors and help those who may need it. For example, those who may have had a brain injury and may need to work on new behaviors that may have developed or become out of control. These behaviors are helped because this is a form of therapy that involves positive reinforcement typically. ABA is usually used to improve daily life for children and adults, including; communication skills, social skills, and learning skills. Since all these things are essential to everyday life, ABA is intended to create a better life for the person receiving therapy.
What training does an ABA therapist person have?
Requirements may vary based on the particular company and the state. For example, in California, most ABA therapists I’ve come across during my work as a speech-language pathologist are young women in college pursuing a degree in something related to education. The actual requirements are only a high school diploma and a certain amount of hours of supervised training. The supervisor will be a Board Certified Behavior Analyst, and this should be the parent’s main person to contact. The pay is usually pretty low for new ABA therapists, so therefore the turnover is quite significant. Hopefully, your child will retain the same supervisor, and you can and should frequently check in with the supervisor to make sure your child’s needs are being met. Remember, you can always request a new therapist or supervisor.
What should I expect when my child starts ABA therapy?
A supervisor and ABA therapist will evaluate your child first and then meet with you to create an overall plan which will include goals for your child and therapist to accomplish. Your child will continue to be evaluated, and new goals will be made as your child progresses. The first evaluation may be in your home and public settings like school to make goals based on multiple situations. The goals will be tailored to your specific child.
Why are ABA therapists so physical with my child?
Physical prompting is a therapy technique that has been considered common practice in ABA therapy. Physical prompting is literally moving a child’s hand or body to do something required to complete a task. For example, if a therapist wants to teach a child to put the letter ‘A’ puzzle piece into the letter ‘A’ spot, but he/she doesn’t know what to do, then the adult might use his/her own hand to help them put the puzzle piece into the appropriate place. That’s physical prompting, also called “hand-over-hand” prompting.
Physical prompting should be done gently and in an encouraging way, and never in a rough or controlling way. I don’t believe in forcing a child to do anything. Speech therapy and ABA therapy should be therapeutic, not stressful for the child or the adults.
If you feel uncomfortable with the way any individual, regardless of their credentials, is being physical with your child, you have the right and the responsibility to speak up. I encourage you to have an honest conversation with the therapist and their supervisor, and if it is necessary, request someone new who will be more respectful of you and your child.
Why do ABA therapists make my child do the same things over and over?
Repetition is a crucial component in teaching any new skill. Many ABA programs are very structured and consistent with the same set of activities that are repeated in the same order. The repetitions are done to give the child many opportunities to learn and improve a particular skill. Many autistic children thrive when given a routine of activities to participate in, rather than free play, so this repetition method is very beneficial. It helps them create that routine or makes what routine they do have even better.
Experienced therapists have learned how to walk the line between repeating a task and drilling. The drilling method often creates a negative experience for the child and results in the child resisting the therapy or not trusting the therapist.
Especially when it comes to working with toddlers, the adult must be aware of the situation and sensitive to the child’s current emotional state. While it may be the adult’s goal to complete a series of tasks in therapy and collect a certain amount of data, it may not be what the child needs that day. The child may need more than practicing how to use a shape sorter, and they may need to feel a sense of security and a safe place for expressing themselves. This might look like a period of time spent on a low-pressure activity like coloring, where they aren’t expected to “perform” but can just be exploring; this way, they can feel more comfortable with less pressure, and they may perform well when they don’t know they are being watched. Too often, I find adults quiz young children more than they teach them. Let’s be real; your child is three years old – should they be getting a pop quiz every three minutes, or should they be experiencing new activities like art, music, science, etc., in a fun and playful way? I personally believe the latter is much more effective.
Why do ABA therapists use so many rewards?
Rewards are one way to motivate a person to do more of something, especially when it is particularly difficult or uninteresting. Think about it, we all love getting rewarded for doing hard things, but this can be done too often or inappropriately.
Experienced therapists learn the balance of using rewards to motivate children and helping a child to become self-motivated. Some parents have explained to me their concerns when an ABA therapist has used a reward system involving the iPad, for example. Every time the child did something they were supposed to, like tracing the circle, they were rewarded with one minute on the iPad. This was highly effective for the child, and they became very good at tracing a circle. BUT, the cost of that was the child began to become dependent on the reward, meaning the child would only perform when they were rewarded. So, in this case, the child would only trace a circle when they were offered time on the iPad in response. This caused a problem in the family’s life because they found that the child was much more resistant to do any task unless offered a reward, and preferably the iPad.
So while rewards are motivating, they also can cause problems. A more mature therapist will carefully choose appropriate types of rewards and how often to use them. Ideally, the rewards are lessened over time, as the child takes pride in completing tasks.
I encourage parents to think critically about ABA therapy before signing up for it. Visit the Therapist Neurodiversity Collective to learn more about the presented ethical concerns.
Common Questions about Autism
If you have insurance, a great place to start is with your pediatrician. Discuss your concerns with them and ask for a referral for a developmental evaluation from a pediatric psychologist and speech-language pathologist.
If you live in the United States and your child is under the age of three years old, contact your state Early Start program and ask for a developmental evaluation from their team of professionals. These services are state-funded and free of charge.
If you live in the United States and your child is under the age of three years old, contact your local school district and ask for a developmental evaluation by the school psychologist. These services are state-funded and free of charge.
Contacting a licensed professional in your area is the best way to get answers, but of course, this process takes time. I'm sure you are feeling worried and want to start something right away to help your child. That's why I've created the online course for parents called How to Teach a Toddler to Talk.
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Disclaimer: This information is meant for general education and not to diagnose. Every child is different, and Autism Spectrum Disorder is a complex developmental disorder that can manifest differently in other people.
Note: I am electing to use identity-first language to describe the Autistic community in this blog because it is the preference of many Autistic people.