Guide to ABA Therapy: What Is It, Costs, Pros & Cons
No medication can eliminate autism spectrum disorder (ASD). But there are accepted therapies that help children with ASD succeed as they navigate the world around them. Applied behavior analysis (ABA) is one of the most commonly used therapies to treat autism. If you’re wondering “What is ABA therapy?” and if it can help your child with autism, you’re not alone. Many people outside of the autism community are unfamiliar with ABA therapy. Learn more about what ABA therapy is, how it can benefit people with autism, and ABA therapy pros and cons.
What is ABA Therapy?
ABA therapy is an evidence-based therapy designed to reinforce positive behaviors, reduce negative behaviors, and build social and communication skills. The main goal of ABA therapy is behavioral change. Therapy sessions are personalized for each client and geared towards goals that feel most appropriate for the child. Often, the behaviors families focus on are complex.
ABA aims to help people with autism understand how to approach and conquer everyday tasks. Experts say the therapy can effectively :
- Strengthen core skills. These can include communication, reading, and academics.
- Hone adaptive learning skills. Examples include motor dexterity, punctuality, and hygiene.
- Decrease negative behaviors. Tantrums, self-harming acts, and yelling could be the focus of therapy.
How Does ABA Work?
ABA is an intensive form of therapy. It works best when children practice with a behavioral technician for about 20 hours per week.
Ultimately, technicians are looking to reinforce or reduce behaviors based on whether they are desirable or unwanted.
Each session is different, but most follow an understandable and predictable model. The sessions involve:
- Goals. The technician identifies a small focus task for the day’s lesson.
- Rewards. Each time the child performs that task correctly , Autism Speaks explains, meaningful rewards appear. Praise, a toy, books, and access to a playground are all common rewards.
- Observations. Therapists look for triggers that block a child’s ability to complete a task, Autism Canada says. A loud noise, a cluttered room, hunger, or exhaustion could all prompt a child to shut down, act out, or both.
- Resolutions. With triggers identified, technicians can pose solutions. Removing the obstacle can help the child complete the task.
- Communication. Each session gives a technician a wealth of data. All of that information could help families as they guide the child through moments when the technician isn’t present.
Pieces of therapy can be practiced as homework. Technicians might encourage parents to use specific requests (“Please sit down.”) in response to a trigger (a stranger at the door). The more a child can practice the behaviors, the better.
Changing Behavior Through Repetition
Rather than asking a child to master a multi-step process in one session, a behavioral technician breaks things down into tiny pieces. With repetition, the child learns how to complete each step. Over time, the child handles a complex behavior in a whole new way.
While there are some conflicting opinions about the therapy, modern ABA can be stimulating and even fun for kids. For instance, Elemy uses a modern approach to ABA that focuses on play-based therapy and personalization.
Each child with autism is different, and therapy results can vary. But it’s common for families to speak of ABA in glowing terms. For example, one father interviewed by his local television station said the therapy his children got reduced the length of their tantrums from 45 minutes to just 2 minutes.
What Does a Typical ABA Session Look Like?
Imagine a child who has trouble staying seated during class. This is an incredibly difficult and complex task, particularly for a child with high energy and limited verbal skills. The family has identified this as a goal of therapy.
A session might look like this:
- Setting the stage: The technician sets up a small table and two chairs. The child should sit in one chair, and the technician in the other.
- Fun activities: The technician has a box filled with colorful objects. The child can see the box, but not what’s inside.
- The initial ask: The technician asks the child to sit in the chair. That request is repeated, perhaps with peeks at the box to entice compliance.
- Explanation: The technician discloses how many steps come next, perhaps by saying, “I have five different objects to share with you, and we’ll talk about them. I have five grapes here. Each time I share an object, we’ll eat a grape.” The child has no fears about what should happen next.
- The beginning: The technician opens the box, and the task begins. Each time the child leaves the chair, the command returns.
- Trigger warning: If the child leaves the chair, the technician looks for the prompt. Is the room too warm? Is the duration too long?
- The ending: With all five objects discussed, the team takes a break. They might run a lap around the yard, eat a snack, or head to the restroom.
- The repeat: The two come back to the table to try a variation of this task again.
It may seem like this is a simple sequence of a child answering questions. But that same child is learning that staying in their chair leads to good things happening. Leaving the chair means the game stops, and there’s no playtime interlude.
When the child goes to school, memories of this session might compel the child to stay seated, even if there’s something much more interesting to do.
Repetition is key to make sure these lessons really stick.
Modern ABA Is Different
ABA has been part of the ASD treatment toolkit for decades. Like most treatments, there are strong proponents of the therapy, and there are some detractors.
While the overall consensus is that ABA is effective for kids with ASD, some people believe that it has a limited place in the modern world. While it’s true that some people may not benefit from ABA, as with any form of therapy, many criticisms of the therapy stem from out-of-date information.
Critics often point to:
- ABA’s founder. The founder of ABA made many controversial statements about people with autism spectrum disorder, critics explain. He talked about his patients as though they weren’t human, and his goal was to help them blend in, even if that was detrimental.
- While the founder developed ABA, modern practitioners built on his ideas. In many ways, they’ve developed something entirely new.
- Therapists still want to help their clients succeed in the modern world. They hope their clients can live an independent life, and their work aims to make that possible.
- But these therapists also make allowances. They don’t pass judgment on the families they work with, and they don’t suggest that neurotypical people are somehow superior. Instead, they aim to lessen distress.
- Punishment. Old ABA therapy emphasized discipline over reward. If children wouldn’t complete a task, they were punished for that decision.
- Modern therapy emphasizes rewards. If a child decides to move forward with a task, they get something meaningful to them.
- Boredom. Critics suggest that ABA sessions can be repetitive, with children forced to repeat the same task over and over.
- Experts explain that modern therapists are trained to be energetic , engaging, and fun. They look for ways to make lessons like games, so children are more likely to participate willingly. The steps may be repeated, but the lessons shouldn’t be dull.
Despite advances, some people don’t enjoy ABA therapy, and that’s fine. No single type of therapy is best for every family and every situation. But families investigating solutions should know that some of the criticisms they read are based on an out-of-date understanding of a very old form of therapy.
How Much Does ABA Cost?
Trained therapists and technicians administer applied behavior analysis therapy. Treatment costs are reflective of the education and training needed to provide therapy appropriately. ABA is also intensive, and families often need many hours of care. These two factors drive up the cost of ABA treatment.
One hour of ABA therapy from a trained professional costs around $120 , experts say. If your family needs 20 hours of care each week, the overall cost can rise quickly.
Insurance may help. The National Conference of State Legislatures explains that 46 states and the District of Columbia enacted laws that mandate insurance coverage of autism care .
But those laws may not protect families from all expenses. Some plans don’t cover ABA specifically, and families may need to try less intense forms of care before they can get the help they need. Other plans come with high deductibles and copayments that families must cover.
Cost plays a role in the therapy families choose, but it shouldn’t be the only factor at play. For many children with autism, ABA is the best path forward. Families may need to push hard for coverage, but it’s worth the effort.
Find the Right Professional for Your Child
ABA seems like a straightforward therapy solution for a child with ASD. In reality, there are many different types of ABA, and each therapist might interpret guidelines differently.
Experts say the variation in ABA types can be confusing for parents. They may feel pressured to choose one over another. They may not even know where to turn for answers.
As you search for the right professional for your child, ask about:
- Certification. Does the person have an educational background in ABA? Can that person offer licensing or certification documents?
- Approaches. How does this person typically apply ABA? What do sessions generally look like? How is progress measured?
- Availability. How often will the person work with your child? Where will the sessions take place?
- Communication. What kind of input do parents have? How do parents participate in treatment?
- Insurance. Does the person accept your insurance?
Don’t be afraid to ask questions and be persistent. Your child will spend a great deal of time with this person, so it’s a critical decision.
Research has shown that ABA therapy is the best approach for decreasing problematic behaviors and boosting adaptive abilities in children with autism. While it can take some time to find the right ABA professional for your child, it’s worth the investment.
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- Benefits of ABA Therapy for Autism . Autism Parenting Magazine.
- Is Applied Behavioral Analysis (ABA) Right for Your Child? (June 2019). Healthline.
- Autism and Insurance Coverage: State Laws . National Conference of State Legislatures.
- What Is ABA Therapy Now, Really? Autism Support Network.
- Help: I Don’t Know How to Choose an Applied Behavior Analysis Provider . Autism Parenting Magazine.