6 things to consider before starting ABA therapy

ABA (Applied Behavioral Analysis) therapy is one of the most common and thoroughly researched therapies for autism, but it is also one of the most heavily debated topics in the autism community. Some autistic people describe ABA as traumatic and criticize the practice for conditioning autistic children to seem more “normal” and adhere to social norms. 

Not all ABA is created equal, and it’s not “one size fits all.” There are many different approaches to ABA therapy and the quality of providers can vary greatly from place to place. High quality ABA uses evidence based practices to teach new, functional skills and reduce harmful behaviors. Strategies used in ABA have helped children learn how to ask for help, use the toilet, and learn safe self-soothing techniques.

Here are some questions to ask yourself when deciding if an ABA program is right for your child:

Are you ready for the commitment? 

When considering ABA for your child, be sure you’re factoring in the time, energy, and emotional commitment involved. Some ABA therapy providers have long waitlists, so obtaining a spot can be a long game. Because of this, the provider will want a commitment that your child will attend a certain minimum number of hours, usually 10-40 per week, depending on their treatment plan and goals. It’s important to consider how that will affect your child, your family, and your existing lifestyle. We’ve heard some parents express that they committed to a large number of therapy hours only to realize it wasn’t a good fit for their family’s life, or that it was too much for their child. 

Expert Tip: A good ABA provider will collaborate with you to figure out the right amount of therapy hours for your child. Just because the maximum amount of hours has been recommended for your child does not mean you need to commit to that amount.

It’s also not uncommon for it to take a few months to see the benefits of ABA in your child’s life, so bear in mind that it might not be an overnight transformation. This requires patience because it can become frustrating to not see results as fast as you’d like. Here is the complete step-by-step guide to successfully start and eventually finish ABA therapy.

Will ABA sessions be covered by insurance? 

Most insurance plans in the US cover ABA if your child has a formal autism diagnosis, but the specifics vary from state to state. If you’re leaning toward ABA, look for providers that either take your insurance or offer services at an out-of-pocket price you can afford. The number of hours your BCBA recommends will have to be approved by your insurance, and if there’s any remaining out-of-pocket expense, you’ll have to ensure it fits into your budget.

Expert Tip: Think about opening an ABLE Account. An ABLE account is a tax-advantaged savings account that can help fund the expenses associated with your child’s care including education, therapy, assistive technology, and personal support services.

How much involvement are you comfortable with? 

Your child is not the only one who will engage in ABA —as a parent, you will also be an active participant in their therapy program by working collaboratively with their BCBA (Board Certified Behavior Analyst) and RBTs (Registered Behavior Technicians). You should expect to have weekly or monthly parent training sessions with your child’s BCBA where you will review progress on goals, discuss questions or concerns, and learn ways to reinforce new skills your child is learning. There may even be occasions when you join the ABA sessions with your child. But even when the therapy session has ended, all the schedules, strategies, and supports must remain in place which will require your effort outside of scheduled therapy time.

If you’re leaning toward in-home ABA, that means someone (usually a RBT) entering your home for several hours at a time, multiple days a week. For some families this may feel like an intrusion of privacy. When deciding if ABA is right for your child, you’ll want to think about how comfortable you are with your child’s providers being actively involved in your family’s  day-to-day life. 

Expert Tip: You should feel empowered to ask questions about your clinical team’s education and experience when searching for someone to work with your child to ensure they will be the best fit for your family. 

Is ABA therapy at home better than in the clinic? 

While children may learn skills for daily tasks better in your home environment, a clinical therapy experience can be better for preparing your child for school and social interactions. When deciding between a home-based program or a clinical approach, you’ll want to consider what your top priorities are. Do you want help with your child’s daily tasks like teeth brushing and potty training? In-home might be the way to go. Want to get your kiddo ready for school and help them communicate better with the world around them? In-clinic is probably the best fit.

Expert Tips: Whether in-home or in-clinic, afternoon therapy appointments (3-7pm) usually have the longest waitlists so it's a good idea to add yourself to several waitlists. Be sure to check in regularly. Be flexible with your schedule when getting started. Your ideal schedule may be possible after a few weeks or months, and sometimes it’s better to just get “in.” You can make scheduling adjustments later. Virtual ABA options are now also available and might be a good option for some children.

Is the ABA program ethical? 

For ethical ABA, the goal isn’t to make your child behave “normal”, but to help them become more independent, improve communication and self-regulation skills, as well as keep them safe by figuring out ways to minimize self-injurious behaviors. Autism-positive providers look at stimming/repetitive behaviors and “tics'' as a necessary and normal part of an autistic person’s life – not as something to be stopped or shamed. 

For example, one ABA method is called DTT (Discrete Trial Training), but there are harmful and helpful ways to perform it. Some providers may direct the child to sit down at a table and repeat a desired action, such as “touch the purple ball”, and then provide an incentive if the child completes the action. This is not so ethical, and in some cases can be downright abusive. (It’s also what many would refer to as “old ABA”.) Other providers may approach this same method by using natural play and intuition —an RBT helps the child identify colors while playing with blocks – which is a far more ethical and helpful approach.

Expert Tip: You can usually tell if a provider is autism-positive by the language they use to describe their services and methodology. Before committing to an ABA provider, be sure to discuss their processes and methods with them and read parent reviews. What type of ABA do they practice? Is stimming discouraged? Will your child be forced to perform tasks in order to get “rewards”? How do they handle meltdowns? Ethical ABA allows your child to be themselves, without conforming to neurotypical ideals.

What are the goals? 

Every child is different, and every parent’s goals for their child will be different. If your main concern is your child’s speech and language development, speech therapy may be a better fit. If your goal is to increase your child’s overall communication, socialization, and expressive language skills, then ABA may be just the ticket.1 

Expert Tip: A combination of therapies (such as ABA, speech therapy, and occupational therapy) can be beneficial for autistic kiddos. Different therapies target different challenges autistic kiddos may face, so consider what you feel would best improve your child’s life, and work with that in mind. 

Next steps 

Finding the perfect, high quality ABA program can be overwhelming without the right resources. It can be a bit of trial and error until you find the right ABA provider for your child. Many parents ask other parents for recommendations. If you’re in the US, our directory’s algorithm shows the best in-network ABA therapists in your area.