ABA therapy questions answered by autism expert Dr. Melanie Hsu

Beaming Health’s co-founder Marissa Pittard sat down with autism expert Melanie Hsu, Ph.D. to talk about the science behind autism and the different therapies that can help children thrive. Dr. Hsu answered the most common questions about autism and chatted live with parents. In this clip, Melanie answers parents’ questions about ABA therapy. 

This transcript has been edited for length and clarity. You can find the full video conversation in the Beaming community. 

Is ABA the best therapy?

ABA is very popular because it is very well studied. There's a lot of really great things about ABA because it is very data-driven, so you're constantly evaluating and constantly moving forward. 

ABA is really great at some things, but not so great at other things. Especially with individuals, you have to look at what you’re targeting. 

ABA is really good at teaching specific skills. It's also great at trying to teach other ways of regulation and minimizing some behaviors that may be harmful. There are some individuals, for example, who engage in a lot of self-harm, and ABA is very good at targeting some of those things as well. 

As a psychologist, I often like broad-based, developmentally based programs that have a component of ABA. These programs also do other things like understand the regulation piece, understand the communication piece, and then provide insights that can be really helpful. So, ABA can be really helpful as a part of a larger comprehensive program.

Has ABA changed for the better? 

It's really interesting because in psychology, psychiatry, and medicine, there are many things in the past that, looking back, we can't believe we ever did. So, if you think about some of the things that you learned in history, for example, of things that we thought would be helpful, things like bleeding people because we thought that this would help and not realizing of course that this might cause other problems.

Unfortunately, ABA did have a negative reputation, especially in the beginning for basically forcing people to conform very specifically and rigidly to what was considered normal. There wasn't an understanding of neurodiversity, as well as labeling behaviors as being bad rather than, ‘this isn't helpful to you’ or ‘this is actually getting in your way.’

Now, hopefully, most of us are trained to think about things from a functional standpoint. ‘How is this behavior helping you?’ or ‘how is it getting in your way?’ It's not necessarily wrong or bad, it's just we want you to make decisions about what you want to do knowing what the effects are.

ABA, especially in the beginning, because pure behaviorism can feel very cold, can feel very sterile. You can see videos of how ABA used to be done many years ago that look pretty bad. Videos where the individual is clearly upset and the person is not paying attention to that and is just moving on. There are many negative things, especially what might have happened in the past. 

I do think that ABA has changed for the better. A lot of ABA companies actually incorporate many other ways of working with children that are much more broad-based and much more developmental. 

There's always room for improvement, always in anything.  As well as taking in feedback from families to make things better, I do think that it is absolutely moving in a good direction, but there's always a lot of room for improvement. 

How can you tell if ABA is working?

Ask the question, “are we making progress towards the goals?” 

One great thing about ABA is every six months, or ideally more often, they're supposed to be doing an analysis of how the child’s movement towards goals and progress. It’s the same in IEPs (individualized education programs). There are goals and then there's a breakdown of what constitutes movement. 

As a parent, I would recommend that you work in close conjunction with your treatment team to say, ‘What does this mean?’ because sometimes the data points don't always make as much sense outside of the session. To be like, ‘How is this movement towards the bigger goal?’ 

Checking in with your team can be really helpful.