What to Look for in a High-Quality ABA Therapy Program
By: Gabrielle Galto, MS, BCBA, NYS LBA
Autism Spectrum Disorder (ASD) presents us with unique and challenging symptoms across a number of areas including, but not limited to engaging in problem behavior, limited communication skills, decreased social interactions, and abnormal play and/or leisure abilities. These challenges can impact any individual’s daily life functioning and well-being.
This leads to some important questions when looking into Applied Behavior Analysis (ABA) programs for your child with ASD;
1. What does a high-quality ABA program look like?
2. How can I tell if my child has an effective ABA program?
3. What are the key indicators?
I will go into all three of these questions as best I can to illustrate what a well-rounded ABA program should look like and present those key indicators to identify for families already enrolled or address at the onset of services.
ABA involves many techniques for understanding and creating behavioral change that will lead to socially significant outcomes. In order to ensure you are obtaining high-quality care it is important that treatment is supervised by a Board-Certified Behavior Analyst (BCBA®). The BCBA® would oversee, supervise and train the behavior therapist or registered behavior technician (RBT). The therapist will then work directly with your child on goals outlined by the BCBA®. If you hear someone simply say they “do ABA,” that probably means they are not a qualified provider or have quality training.
Assessment
First off, an ABA program is not a “one size fits all” treatment modality, meaning it should be individualized to your child. I am sure you have heard the saying, “If you’ve met one person with autism, you have met one person with autism.” Even with common features of ASD, there is also great variability between individuals. This is why you want to make sure treatment is developed for the individual, not just the ASD since that can lend itself to ineffective treatment. Okay, so now that we got that out of the way, what is next?
Prior to the onset of treatment, a comprehensive assessment is needed to develop an individualized treatment plan. The assessment should include a thorough evaluation utilizing a variety of measures such as indirect and direct assessment of the child’s skills and functioning level. The assessment tools can vary depending on functioning level, for example some individuals may require a more language-based assessment (i.e., VB-MAPP), others social (i.e., Socially Savvy), or functional skills (i.e., Essential for Living). Regardless of what type of assessment tool is used (multiple may also be used), a main goal will include teaching and increasing independence of skills.
Next, a well-rounded treatment plan and recommendations should be based upon the assessment results that target the core deficits of autism spectrum disorder. Another factor to look out for is the inclusion of caregivers within the treatment process to provide for the most comprehensive treatment package. Some useful questions for caregivers can include: 1) How will care be coordinated across providers and teachers? 2) Is involvement with caregivers and/or siblings required? 3) How are the therapists trained? 4) How will you manage problem behavior? and 5) How do you plan on evaluating progress?
Programming
What does an effective ABA program look like, you ask? The treatment plan should include goals across the core deficits of autism, reduce any barriers to learning, and increase independence across environments (i.e., home, school, community). When looking at a treatment plan it is important that there are clear, concise objective goals that are building upon your child’s strengths. Next, goals should be taught systematically through the use of evidenced based practices emphasizing reinforcement systems. If services are not building upon a child’s strengths or do not have a reinforcement system in place, this could be a red flag. In contrast, if punishment systems are in place without any alternative reinforcement system, that is a big red flag.
Programing should be consistently monitored by a BCBA®, where if progress is not demonstrated this should be discuss with the provider(s). I always stress to my providers that if the child is not showing progress that is a signal for us that we are doing something wrong. A key indicator for quality care includes consistent oversight of the BCBA®, specifically when progress is not demonstrated assessment should be conducted and appropriate changes made to further facilitate behavior change. The BCBA® should schedule regular direct oversight supervising the client’s treatment plan and implementation. The number of hours can vary from case to case that typically will correspond with the amount of direct treatment hours provided. High-quality ABA should include consistent oversight of the client’s progress, technician’s implementation of behavior analytic techniques, and communication with the family.
Program goals can look immensely different across each person, which makes me a little resistant on describing what exactly an ABA program should look like. Again, with what I have described prior make sure that goals are targeting those core deficits of ASD; communication skills, social skills, and restrictive-repetitive behavior (including maladaptive behavior). It is important that goals are balanced across each of these areas, however programing may need to first focus upon reducing restrictive behavior prior to other areas to ensure success across additional domains. Important areas that indicate a quality ABA treatment plan include goals that target barriers to learning such as, compliance to tasks, weak or limited communication such as ability to request for wants and needs, problem behavior, self-stimulatory behavior, and/or obsessive-compulsive tendencies to name a few.
Instructional methods can include very structured teaching techniques to facilitate learning, but teaching should be further incorporated within multiple areas and environments. When teaching skills, it is important to see not only structured training sessions, but once mastered, a systematic plan for assessing and training within a more naturalistic approach. Therefore, some ABA programs can look very much like play to mimic how a natural environment may be set up for a child. When looking at a program targeting natural environment teaching some goals could include increasing appropriate play, language, and social skills. The therapist may start with a game or preferred play activity to work on turn taking, waiting, and may even refrain or hold back from giving the child an item to encourage communication. All the skills just mentioned often can occur on a day to day basis for a family and are required across a lifespan. These are the type of goals you want to see your child learning! Things that will continue throughout life, lead to other social interactions, and an overall happy healthy life!
Lastly, it is important that caregivers are able to replicate mastered skills to ensure that a child is able to demonstrate generalization, meaning they are able to exhibit skills learned with one person across a novel person (such as a parent). The BCBA® should plan on targeting this process and create a plan to ensure that success is observed with others. It won’t be socially significant if a child is only able to comply to a demand or communicate their needs in the presence of the therapist and not a caregiver. The treatment modality described is called parent training, which targets generalization and maintenance of skills. During these sessions other skills could be further targeted that may only be a concern when in the home or community with the parents or other caregivers. It is important that this part is included to ensure effective treatment is provided as this will further lead to the most progress for a family’s overall daily living.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
- Bailey, J. S., & Burch, M. R. (2005). Ethics for behavior analysts: A practical guide to the Behavior Analyst Certification Board guidelines for responsible conduct. Mahwah, N.J: Lawrence Erlbaum Associates, Publishers.
- Ellis, J.T., & Almeida, C. (2014), Socially Savvy: An assessment and curriculum guide for young children. New York, NY: Different Roads to Learning Inc.
- McGreevy, P., Fry, T., & Cornwall, C. (2012). Essential for Living. Winter Park, FL: Patrick McGreevy.
- National Autism Center (2009). National Standards Report. Randolph, MA.
- Sundberg, M. L. (2008). VB-MAPP: Verbal Behavior Milestones Assessment and Placement Program. Concord, CA: AVB Press.
For more information about ABA therapy or how we can help your child, contact Attentive Behavior Care today.