Why are you reading this? Maybe the answer is that your child has autism, or your sibling, or your friend’s child, or maybe for another reason entirely. Whatever the answer, you may be involved in the decision of where someone is going to go to receive autism therapy services via applied behavior analysis. Therefore, it’s going to be very important for you to be able to distinguish between good and bad ABA therapy centers. The difference between good and bad ABA centers can be huge.
ABA stands for applied behavior analysis. It’s a form of therapy that’s based on the principles of behavioral psychology. It’s one of the most common therapies used to treat autism and it’s endorsed by the surgeon general. ABA is widely popular due to its proven effectiveness in improving the lives of individuals with autism.
An ABA center is where individuals with autism can go to receive ABA therapy. You’ll soon learn that not all ABA centers are created equal. In this blog post, we’re going to a look at the important aspects of ABA therapy programs. You’ll learn what questions to ask ABA therapy centers and how their answers will inform your decision-making.
The Therapy Program
Should be customized to your child’s needs
No two children are exactly the same, right? Since this is true, it makes sense that no two children will have exactly the same therapy needs. They will have different behavior problems and will be behind in different developmental milestones. Therefore, ABA centers should never be offering cookie-cutter therapy programs.
In designing a therapy program, the ABA center should be performing a deep assessment of your child’s needs. Any worthy assessment should be based off formal, standardized assessment tools like the VB-MAPP and the AFLS. An analysis of your child’s current skills will be produced from this assessment. Then, a board certified professional will design a therapy program tailored to your child and their current skills. Additionally, the ABA center should be asking for the parent’s input in the initial and ongoing assessment. Parents add value to the assessment by providing information about behaviors the child is having and skills they are lacking. This is also a chance for parents to communicate the goals they have for their child. Goals can range from basic life skills like toilet-training to more sophisticated skills like vocal communication.
Let’s say you ask the ABA center “how will you create the right therapy program for my child?” There answer should not talk about the therapy programs they offer for your child’s age range. Age range doesn’t necessarily say anything about your child’s therapy needs. The ABA center needs to start with where your child is developmentally and behaviorally; then build a program from there. They should not try to fit your child into a pre-designed therapy program.
If a center says they will begin with an initial assessment and then build your child’s therapy program based on what they see in that assessment and the feedback you give them, you should begin to trust them. The more an ABA center shows they’re willing to tailor therapy programs to each child, the more confidence you should have.
Based off formal assessment tools
In the previous section, we mentioned VB-MAPP and AFLS. These are formal assessment tools used to evaluate the skill sets of an individual diagnosed with autism. They should be part of the foundation and structure of any great ABA curriculum.
The VB-MAPP is an assessment tool used to determine an individual’s social and early learner skills. VB-MAPP stands for Verbal Behavior Milestones Assessment and Placement Program. Quality ABA centers use the VB-MAPP, or something similar, to assess a child’s skills and then guide the design of that child’s goals.
The AFLS is another assessment tool that could be used by an ABA center to assess your child’s needs. AFLS stands for Assessment of Functional Living Skills. AFLS assesses the more practical, functional skills like toileting, dressing, basic communication and self-management.
There are even more tools that ABA centers could be using like the ABLLS and the Essentials for Living. These tools not only allow the therapy team to do an initial assessment of a child, but they are also designed for continued monitoring and measurement of your child’s progress. The therapy team uses these tools to re-evaluate the effectiveness of the therapy program.
Consider asking an ABA center if they are using these tools to initially evaluate and continually monitor their children. Without these tools and the data they provide, an ABA center would have far less visibility into your child’s needs and progress.
Based on data, continuously monitored with data
Speaking of data, data is the lifeblood of any quality ABA program. Data guides decision-making about the therapy program. Data allows the therapy providers to monitor both the improvement in challenging behaviors and the acquisition of new skills. Data gives therapy providers the eyes to see if the therapy is working or not.
Here’s an example. Let’s say that when your child first comes to a center, they may spend 60 minutes of every day flopping on the floor and screaming. A proper ABA center should be tracking the amount of time they are doing this. Every single time they engage in a behavior, the therapist assigned to your child should be making a record of it. So through the course of the day, they can see when and how often your child engages in a problematic behavior. Over time, it will become possible to see a trend in the frequency of problem behaviors from one day to the next. The therapy program supervisors will use this daily/weekly trend to decide how well the intervention is working. Eventually, they’ll want to see the 60 minutes of daily tantrums become 30 or 15 minutes. This declining trend in tantrums could indicate that the program is working. On the flip side, if that 60 minutes of daily tantrums consistently stayed at 60 minutes over the course of several months, this might indicate that something about the therapy program wasn’t working. In the case of a program not working, the program supervisors should be able to re-examine the child’s behavior and shift the therapy program accordingly.
For an ABA therapy program supervisor, not seeing the data is like not seeing much of anything. The staff should be looking for the data to know if your child is improving in their therapy program. Consider asking the ABA center “what kind of data do you use to track my child’s progress?” and “can I see the data?”
Therapy programs should be a combination of social skills, natural environment training and table work. The percentage of each of these 3 components will be customized to your child’s needs.
Every ABA therapy program should be based on 3 different components of ABA.
One of these ABA components is social skills training. The child should be learning social skills by communicating with the therapist, working on eye contact improvements and socializing with other children at the center. To make sure your child is getting the right social skills training, you want to know that they will have appropriate peer groups of the same age. A 10 year old will not gain as many social skills interacting with only 5 year old children as opposed to if they were interacting with children of their own age. If an ABA center doesn’t hesitate to bring your child into their center despite a clear lack of an appropriate peer/age group for your child, this is a cause for concern.
Your child’s ABA therapy program should include natural environment training. Natural environment training involves using the principles of ABA therapy in natural environments or “the real world”. If your child only learned at a table in a therapy room, then they would have a harder time applying their teachings to other situations. By integrating therapy into “natural environments” like a kitchen, a bathroom, or even a playroom, your child becomes more equipped to use their new skills in the rest of the world and in your home. Make sure to ask the center if they will use natural environment training in their therapy program.
Lastly, your child’s therapy should include table work. Table work is the initial teaching arm of the therapy program. Table work provides an environment that is engineered to reduce distractions. The reduced-distractions environment of table work creates focused learning experiences for your child. This part of the therapy program allows your child to become more desk-ready. Through table work, they will become more accustomed to the kind of setting they will experience in a regular classroom as well as at a desk job.
Using all 3 of these ABA components makes sure the child gains skills in a well-rounded manner. Additionally, make sure that the ABA center is customizing the proportions of these 3 components to your child’s goals.
Intensive ABA should be 1 on 1
An intense ABA therapy program means there will be a lower ratio between therapists and children. Additionally, an intensive ABA therapy program should strive for a 1:1 ratio between therapists and children as much as it can.
A 1:1 ratio has a positive impact on teaching the therapy. With a 1:1 ratio, the therapist can be fully aware of all your child’s behaviors, struggles, triumphs and skills. Your child won’t have the best chance of reaching their potential without this 1 on 1 setting. Even if your child is participating in group activities at an ABA center, there should be a therapist assigned to each child in the group. Each child’s therapist can watch them closely and make sure they are learning everything correctly within the group. Additionally, if a child in the group needs more help to master certain skills, then their assigned therapist can make sure they are getting that extra attention. This level of attention can’t be given from one teacher to several children. It’s simply impossible.
The 1:1 ratio also has benefits beyond the learning part of the therapy program and impacts the general operation of the center. Even small amounts of time where therapists must manage multiple children can result in behaviors going unnoticed and safety becoming increasingly at risk. When you add in children with more aggressive behaviors, a therapist managing multiple children will be an especially unsafe situation.
Ask the ABA center how often your child will be 1:1 with a therapist. If it’s possible, try to find a center that provides 100% 1 on 1 ABA therapy. This means that at NO point during the therapy program will your child be without a 1 on 1 setting with a therapist.