So, you have decided to enroll your child in Applied Behavior Analytic (ABA) services! Whether it is with BCOTB or another provider, there are some things to keep in mind when starting these services. ABA can be a remarkably effective approach, but it is not a magic wand and takes hard work, time, and participation from everyone involved. We celebrate small, gradual successes that often snowball into improved communication, performance at school, independence with daily living skills, and a host of other things!
A common question from families starting out is how much therapy to aspire for. The answer is personal to your family and situation: any amount is often better than nothing and more is often better than less. The more you’re able to put into it, the more you will get from it; however, if there are barriers (e.g. financial, time, etc.) be sure to communicate these with your provider as it will dictate how best to serve your family. For instance, if you’re only able to commit a few hours per week to ABA therapy then your provider may find it best to do less one-on-one work with the individual but more time supporting the family, teaching caregivers valuable techniques and general working tips. Many insurance plans will cover ABA therapy but require a diagnosis on the autism spectrum or of Down syndrome. While insurance may help with financial barriers, there are options to privately pay for your therapy services as well. It is important to note that these diagnoses are not required to get a benefit from ABA therapy, only for your insurance to help pay for the service. While a formal diagnosis may help paint a clearer picture of the individual and provide some knowledge as to common deficits to expect, behavior analysis is a science of behavior and can benefit anyone.
Behaviors tends to hold a negative connotation, but ultimately, they refer to any action we do. We may wish to decrease some behaviors and increase others. As behavior analysts, we understand that all behavior (even the bad) is trying to communicate some need or desire. It is important to be open with the behavior analyst you’re working with when discussing these behaviors and never embarrassed or apologetic. We are not here to judge your parenting; we seek to understand the behavior and what it may be communicating.
The people we serve are unique and have individualized needs, which means that traditional/standard techniques may sometimes fall flat or need to be supported. This results in a highly individualized plan of care that is constantly adapting and evolving. These adaptations tend to occur more frequently early into the individuals therapy services as they learn what to expect. We are constantly evaluating what we’re doing and monitoring progress. If this progress is too slow or stagnant, we make informed changes to best support the individual’s ability to learn the skill. This often comes in the form of additional prompts that we will eventually need to fade out/remove. We are constantly trying to fade out our supports to best promote independence and build skills. Many of our learners can become dependent on this support, so we want to make sure we are effectively challenging their abilities by gradually removing those supports, like training wheels on a bike. Our goal is for the learner to grow the skills to independently support themselves and require us less and less!
Once you have decided ABA services are the way you wish to go, you’ll need to schedule an assessment. It is common for children to not show us all or even much of their skills during this initial assessment. It is a completely new environment to explore, surrounded by new people, and often it is the first time they’ve been away from their family. Parent’s are welcome to observe the assessment and can even be a part of it if they feel it will be easier for their child; however, our children tend to want to be in mom or dad’s arms instead of exploring a new space or listening to a new person. The assessor will want to speak with the parents to learn what they are seeing. We will explain what we saw during the assessment, the areas we feel are important to work on, and ask what concerns the parents have. We want to make sure that we are working to improve areas that are significant to you as well as building the skills necessary to grow their abilities. Once the information is gathered, the behavior analyst will write up a report to request services for the child through their insurance provider (if applicable) by objectively outlining the child’s current skill level, the skills that we wish to work on (with input from the family), and any problem behaviors we are going to be tracking and working to reduce. We will complete these steps again (usually every six months) as a progress report. Once we receive approval from the insurance company (if applicable), we are good to start services!
Beginning therapy is a gradual process. We will spend extra time pairing with the child, which means we are having fun and playing! We are establishing ourselves as a fun, reinforcing person while building up our relationship and value to the child. We need the child to want to be at therapy and want to be around us, so they are motivated to listen to us when we start asking them to do more challenging things. As the child becomes more comfortable with us and shows an understanding of what we’re doing, we begin gradually increasing the amount and difficulty of the tasks asked of them. This process may take an hour, a week, or even a month; it depends on the individual and our ability to pair with them.
Once this relationship has progressed, we will start discussing parent support sessions. These are times where caregivers will join us during our one-on-one sessions so we can begin describing our process, modeling how we run programs, and troubleshooting any concerns the caregiver may have. Consistency is paramount in ABA therapy and it is very important that what we are doing in the clinic is being followed in other environments as well. This means that our suggestions need to be feasible to be implemented in all environments and if this is a concern, speak with your behavior analyst to see if there are modifications that can be made. We only get to see your child for a handful of hours every week so if the expectations we present during therapy are followed by other people in the child’s life across a variety of environments (e.g. home, school, the grocery store, etc.), we often see better results! It can be confusing to a child if there isn’t consistency across environments and it can result in slower progress for skill building and reductions in problem behavior. In many cases, we are challenging the child to learn a new way to communicate. They may be used to whining or engaging in tantrums to get what they want. They may have done this their entire life to some success! If we’re teaching a child to use their words and calm voice to ask for desired items during therapy, but whining is still being reinforced in other environments, the whining may become stronger and more resilient.
It will be difficult at first! For many of our kids, problem behaviors is how they communicate. They’ve known it their whole life and have become pretty good at it! It may work for them now, but as their needs become more complex, a more complex means of communication will be necessary. Problem behaviors tend to get worse before they get better, don’t panic! Think of it like when your TV remote isn’t working properly. If you press the volume button and it doesn’t work, you may press the button again, you may press it harder or more rapidly, you may start moving your arm around to try to get different angles. The point is, when something you’re used to doing no longer works, you try doing it more with more intensity or with slight changes to see if it will result in the desired effect. If you press the button harder and the remote works you may continue to press the button hard as opposed to changing the batteries. The same is true for problem behaviors! If whining stops working, the child may whine more or possibly whine harder/louder and may even add slight changes or additions like flopping on the ground. We need to show them that all they needed to do was change the battery (ask with a calm voice instead of whining). The more these calm voice requests are reinforced the more likely the child will take this approach the next time they want something instead of whining.
Problem behaviors are common in the population we serve. Just like our approach for skill development, problem behaviors can be unique and require an individualized approach also. It is common for problem behaviors to be ignored or handled with minimal response. This is because of that communication component. We know that these behaviors aren’t because the kid is naughty, but it is their way of telling us what they want or don’t want. We may ignore these behaviors, wait for the child to calm down, and then prompt them to ask for whatever it is that they want. Although it may seem like they’re getting away with their poor behavior, they’re learning that whining doesn’t seem to get a response out of their therapist, but using their words does! As time goes on and we’re able to show how effective their words can be and how ineffective their tantrums are at getting them what they desire, we often see a shift from the child towards using the more appropriate communication!
Once we start breaking down some of these barriers, skill development tends to be easier! Our approach works to improve verbal behaviors, which doesn’t necessarily mean using your voice to talk. This is the end goal in many cases but what is more important is being able to effectively communicate with your environment, currently. Talking is remarkably important but it can also take time to develop. It is common for us to be building up these skills while simultaneously teaching the child how to use alternative communication (e.g. a tablet-style device, an icon exchange system, sign language, etc.). These alternative methods aren’t meant to be their primary means of communicating, forever. It gives the individual a more precise and appropriate means of telling the world around them what is going on in their head. This often alleviates problem behaviors as well, resulting in less frustration and more learning!
As learning progresses, we will continue to speak with caregivers regularly to provide and receive updates. We want to know what issues you’re dealing with outside our walls to see if there’s anything we can do to help. The evaluation of progress isn’t just done for insurance authorizations; we want to make sure that the limited time we have with your child is utilized effectively! If progress isn’t being made, changes may be required. As mentioned previously, we are doing our best to toe the line between supporting their development with prompting and promoting independence by fading these supports out. Your case manager will formally evaluate program progress at least once a month; however, they are constantly monitoring the data and making changes on a weekly, if not daily, basis!
ABA therapy can be effective for nearly anyone needing to build skills and/or lessen problem behaviors. It has a rich, ever-growing scientific foundation but it’s not easy! It takes hard work, time, and dedication from your ABA team, from you and others in your child’s life, and from your child. Our jobs as behavior analysts are to help you through this process and walk with you and your family on this journey. There is no magic wand to fix our problems so give us a call and see how we can help!
**BCOTB has been Tampa’s leading provider of pediatric ABA therapy since 2003. With four clinic locations throughout the Tampa Bay area, we know that our clinic is the right spot for your early learner! BCOTB focuses on in-clinic early intervention for children from birth to ten years old. BCOTB accepts most major insurances, including, but not limited to: Aetna, Anthem, Baycare, Beacon, BCBS, Cigna, CMS, Florida Blue, Humana, MHNet, Meritain Health, Magella Health, UnitedHealthcare, and TRICARE.**