ABA Therapy: What is ABA?

Applied Behavior Analysis (ABA) is a therapy rooted in the science of learning and behavior. Using principles of ABA, children and adults can learn to improve their communication skills, social skills, and daily living skills while also addressing problematic or challenging behaviors. The primary goal of ABA therapy is to teach helpful skills that promote independence and reduce harmful behaviors.

At its core, ABA provides a lens to understand why a behavior is happening and how to change behavior through positive reinforcement. Positive reinforcement is the idea that by rewarding certain behaviors, it may increase the likelihood those behaviors happen again in the future. For example, parents might reward their child with 15 minutes of iPad time if they brush their teeth without throwing a tantrum.

Challenging behaviors like tantrums, aggression, and self injury can be targeted and reduced through teaching replacement skills. This may look like teaching someone to ask for a break, taking deep breaths, or going for a walk instead of harming themselves or others when they are feeling upset or frustrated.

The history of ABA

ABA is one of the most common and thoroughly researched therapies for autism. It is also one of the most controversial. As the demand for ABA therapists and the controversy surrounding ABA continue to grow, it’s important to understand the history and its current state if you are considering ABA for your child.

ABA was first popularized for autistic people in the 1970s by Dr. Ole Ivar Lovaas. The earliest forms were highly structured and seemed unnatural. Children were forced to do multiple drills for long periods of time in sterile clinic rooms. Many of these children, now adults, developed symptoms of PTSD according to a 2018 study.¹ Lovaas and his colleagues also used punishment procedures when children did not follow directions. Verbal and physical abuse, such as slapping and electric shock were unfortunately common punishments.

Today, many of the early practices are no longer used in ABA therapy and are considered highly unethical. ABA has evolved into a more modern, person-centered, evidence based approach emphasizing natural environment learning and delivering interventions within a child’s natural activities (play) and natural routines (going to the grocery store). High quality ABA programs focus on teaching skills that are important to the individual and their family. For younger learners, ABA programs will incorporate a lot of play and games, and for older learners there is more emphasis on promoting skills for independence in the community and workplace. Regardless of the age, good ABA programs use a strengths-based approach to teach and improve skills.

ABA seems so controversial. Is it actually “good” now?

Although ABA therapy has changed significantly over the years, many still criticize ABA for being too rigid for autistic people. Opponents feel that some therapists place too much emphasis on eliminating problematic behaviors without enough consideration for teaching new skills.

Critics also argue that ABA therapy attempts to teach children how to act “normal.” Sometimes children and adults will rock in their chairs, flap their hands, or engage in other repetitive behaviors. These behaviors, also known as “stimming,” are not harmful and serve a unique purpose to that person. By targeting these behaviors to reduce or eliminate, it sends a message to the learner that what they’re doing is wrong and they should act like people around them at all times. Fortunately, parents and autistic people themselves are now encouraged to be more involved in ABA and to voice what they want for their children.

High quality ABA therapy does exist where the goal is not to “fix” children, make them appear “less autistic”, or change who they are. The goal is to help people learn all that they can so they can live to their potential while embracing their unique, individual personality traits.

The benefits of ABA

How does ABA therapy work?

When most people think of therapy, they might imagine spending an hour a week talking to a therapist in their office. ABA looks very different.

Typically, ABA therapy occurs multiple times a week and can take place in the home, community, or in a clinic setting. The frequency and length of sessions is determined based upon the needs of the child and goals for the family. Most ABA programs range between 10–25 therapy hours per week.

There is no “one size fits all” approach to ABA therapy and each treatment plan is individualized to meet the unique goals and needs of each person.

Click here for the 5 steps you can take to start and eventually end ABA therapy if you have a child with autism.

Is ABA covered by insurance?

ABA is usually covered if you have an autism diagnosis. Autism is typically the only diagnosis insurance will authorize for ABA services since its benefits have been researched extensively.

Insurance will sometimes make exceptions for non-autism diagnoses like Down Syndrome but it’s not common and can be a battle. ABA can be helpful as a treatment for traumatic brain injuries or for children with Down syndrome but it will usually not be covered by insurance.

Always check with your specific insurance plan to confirm that ABA is covered for your child’s diagnoses and that the provider you are seeking care at is in-network.

The evidence behind ABA therapy: how effective is it?

Though there are many therapy options for children with autism, most have not been studied as widely as ABA. ABA therapy is considered an evidenced based best practice treatment meaning it has been researched extensively and shown to be useful and effective in teaching new skills and reducing harmful behaviors.²

The most important thing is finding what works best for your child and family. ABA therapy can provide tremendous value but it’s important to have a provider and therapists that are a good fit for your family. Throughout therapy, keep an eye on your child’s response to ABA. If your child smiles at their therapist, is engaged in sessions, and learning meaningful new skills then it is a good fit for your child. If they are resistant to therapy, become very upset when they see their therapist, and are not making any progress then you may want to think about other options to support their learning and development.