At-Home Autism Therapy: What Works & What Doesn’t
More children are being diagnosed with autism around 2 years old, which means that their first sessions with a behavior therapist may work best at home. At-home autism therapy with an applied behavior analysis (ABA) therapist simply means that the therapy takes place in your home.
Your child can get at least 20 hours of therapy per week, in an environment in which they are comfortable. The techniques used in therapy sessions can be used at other times at home.
Parents can train in some forms of therapy that may support the lessons learned in ABA sessions. The work parents do with their children is critical, but it’s important for children to work directly with licensed ABA therapists. At-home autism therapy can make a big difference in your child’s life.
At-Home Autism Therapy Works Best for Young Children
Children with autism benefit from working with behavior therapists as early as possible. As a parent, you may wonder what the best environment for your child is.
Should you find a nursery program for your child that offers applied behavior analysis (ABA) therapy? Should you go to a clinician’s office a few times a week? How do you ensure your child takes lessons from behavior therapy and understands that they apply to a range of settings, including at home?
One of the best ways to support your child, especially if they are younger than grade-school age, is to bring behavior therapy into the home. Many ABA therapists work one on one with their clients in a range of settings, including coming into your home.
You can also receive training yourself in particular approaches to therapy, which you can then use to interact with your child. Research into various therapies shows that interventions from caregivers, especially parents, support your child’s growing understanding of social interactions with others, effective communication, and cognition.
At-home behavior therapy, like all forms of behavior therapy, is most effective for younger children with autism. While people of any age can benefit from behavior therapy, early intervention can result in the bigger gains in the shortest period of time.
As a result, many of the interactions used during various forms of therapy are based in play. We’ve outlined some of the most common at-home autism therapy approaches to support your child’s development, behaviors, cognition, and communication.
Approaches to Autism Therapy That Can Work at Home
There are numerous types of behavior therapy for children with autism, and many of these are effective when a therapist works individually with the child. This means therapists may see children in their offices or at school, but for early interventions with children younger than kindergarten age, at-home autism therapy seems to work best.
Applied Behavior Analysis (ABA)
This is the leading form of behavior therapy for people with autism, including young children. ABA therapists may work in their own offices, or they may work in schools, daycare centers, or clinics. They also work individually with clients in their own homes, which is again particularly beneficial for very young children.
The main strategy for ABA therapy is positive reinforcement. Behavioral change is encouraged by giving the child a reward for adaptive behaviors. ABA therapists don’t punish maladaptive behaviors, instead focusing attention on positive changes. The therapist will understand the child’s needs through observation and measuring positive behavioral change. They can then change tactics if one of their approaches is not working.
A large part of ABA therapy treatment planning and progress uses the ABCs, or antecedent–behavior–consequence.
- Antecedent: This is the inciting event that occurs before the target behavior. This might be an object like a toy, or a request from the therapist or parent.
- Behavior: This is the result of the antecedent, which is the child’s response that might either be maladaptive or adaptive.
- Consequence: This is what occurs as a result of the behavior, which might be the parent’s response to their child’s maladaptive behavior, the therapist’s reward for the adaptive behavior, or something else.
Treatment goals for ABA therapy often revolve around:
- Verbal and nonverbal communication.
- Social skills and interactions.
- Independent care, such as bathing, dressing, and meal planning.
- Playing and leisure time.
- Physical strength and motor skills.
- Cognition, learning, memorization, and academic study skills.
Since ABA therapy requires specific training and certification, a parent is rarely the person who implements this program. Instead, an ABA therapist will come to your house to work with your child on a regular basis.
Early Start Denver Model (ESDM)
This type of behavioral therapy is specifically geared toward young children, often 1 to 4 years old. ESDM uses play interactions with children and therapists or their parents to build communicative social relationships, which encourages the children to pursue better social interactions as they get older.
This form of behavioral intervention is also intentionally developed as at-home autism therapy to include parents, siblings, and other family members of the child with autism. Parents can be trained in ESDM too, so they become parent coaches. As coaches, they can administer autism interventions and skill-building exercises through daily activities and playtimes.
ESDM was developed at the MIND Institute at UC Davis. Some medical studies show that ESDM is highly effective as an early, at-home autism therapy, while it is less effective for older children.
Like ESDM, this at-home autism therapy focuses on young children, 22 to 48 months old, who are diagnosed with autism early in life.
Developed in the late 1990s, floortime’s hypothesis relies on the idea that children with autism need specific types of social interaction to improve their ability to understand verbal and nonverbal communication with others. When these children do not receive this type of social focus, they miss one or more out of six common behavioral milestones. Specialists in floortime recommend 20-minute blocks of this treatment, 6 to 10 times per day, rather than multi-hour sessions.
There is currently little research on the effectiveness of floortime therapy. Studies that investigate floortime do not use standard developmental milestones. Instead, they use the definitions provided by those trained in this type of therapy.
Pivotal response treatment (PRT)
This form of behavioral therapy supports children in developing their own internal motivation to perform certain behaviors, including learning, socializing, and communicating with others. When parent training and clinician-delivered interventions were combined, a recent study found that children experienced greater increases in adaptive behaviors and skills.
A study of at-home autism therapy using PRT methods, observing children between the ages of 2 and 5 who had significant language delays, found that over 24 weeks, the children who participated in the combined treatment at home had greater improved overall utterances compared to other groups. The combination involved one hour of parent training sessions with clinicians and five hours of at-home autism therapy for children.
Young children diagnosed with Level 2 or 3 autism may need early interventions in speech therapy, especially if a child stops learning new words and phrases, or begins to lose verbal communication skills, at a young age.
While some forms of at-home autism therapy involve parents working with therapists or training in specific therapeutic approaches, speech therapy relies on professional speech-language pathologists (SLPs). For very young children, 3 years old or younger, SLPs usually come to your home and work with your child.
Speech therapy addresses language, speech, and nonverbal skills problems, including:
- Strength in the jaw, tongue, and facial muscles.
- Approaches to making clearer sounds.
- Matching emotions and facial expressions.
- Noticing body language changes and identifying the emotion behind them.
- Responding to questions.
- Matching a picture with the correct word and meaning.
- Modulating tone of voice.
Some SPLs may help children learn alternative means of communication, including gestures and sign language, or use of communication devices, if it becomes evident that the child will be much less verbal or even nonverbal as they get older.
Nutrition and dietary therapies
Children with autism may begin refusing foods. They may develop food avoidance. Some medical research suggests that higher rates of stomach upset, diarrhea, and constipation from food sensitivities in people with autism may be part of this food refusal trend.
To support health, many parents eliminate gluten (wheat protein) and casein (cow milk protein) from their child’s diet. The upside of these stricter diets is that attention is turned to healthier sources of fiber, protein, and vitamins and minerals. In the short term, you may choose to give your child a dietary supplement so they get enough vitamins and minerals, particularly if they are picky eaters.
This is a type of supportive, complementary therapy that you can perform at home. Family meals are also an important way for children with autism to socialize and communicate, and mealtime can be an important learning time for children with autism.
You should not begin removing foods from your child’s diet without talking to your pediatrician. A behavior therapist can also help to manage food refusal or avoidance problems. If you remove nourishing food like whole grains or yogurt from your child’s diet without replacing them with healthy alternatives, your child may still suffer from malnutrition and will not overcome food avoidance. Make sure your child’s pediatrician, behavior therapist, and any other relevant specialists are part of the conversation.
ABA Therapy Is the Foundational Approach for At-Home Autism Treatment
Long-term behavior therapy is often the best way to support children with autism, starting at a young age. At-home autism therapy is a good way for parents to see their children grow and develop in a safe and comfortable setting with the help of a behavior therapist.
ABA therapy is one of the most thoroughly studied evidence-based treatments for children, adolescents, and adults with autism. Since ABA therapists can work with children in any environment, it is common for a certified ABA therapist to meet with your child in your home. An ABA therapist can observe the home environment, your interactions with your child, and other interactions with the family, and this all informs the treatment plan.
Beyond treatment sessions, the family can offer support for behavioral changes. This family involvement encourages your child to grow their communication and socialization skills in everyday interactions. This reinforces the lessons learned in therapy, resulting in a much greater impact than if the work simply stopped at the end of a therapy session.
Other types of behavioral therapy, discussed above, can work with ABA therapy and support the basic treatment plan. Talk to your child’s doctor about the best comprehensive treatment plan for your child. While at-home ABA therapy is often the backbone of treatment for autism, other therapies can add to the overall structure, helping your child to receive the most robust plan and the most well-rounded results.
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Applied Behavior Analysis (ABA). Autism Speaks.
Homepage. Early Start Denver Model (ESDM).
Parent Coaching Certification. Early Start Denver Model (ESDM).
Outcome for Children Receiving the Early Start Denver Model Before and After 48 Months. (July 2016). Journal of Autism and Developmental Disorders.
Is There Science Behind That? Autism and Treatment with DIR/Floortime. Association for Science in Autism Treatment (ASAT).
A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT. (September 2019). Pediatrics.
Speech Therapy. Autism Speaks.
Treatment of Autism Spectrum Disorder in Children and Adolescents. (August 2016). Psychopharmacology.
The Evidence-Based Practice of Applied Behavior Analysis. (May 2014). Association for Behavior Analysis International.