Choosing who you work with and what they do for your child is often one of the most important decisions you’ll make as a parent. When it comes to your child, ensuring they have the best treatment options available so they grow and thrive is a heavyweight on your shoulders. No doubt, if you’ve been researching treatment options, you’ve seen the pros and cons associated with applied behavioral analysis therapy (ABA). You’ve probably even read some ABA therapy horror stories.
We won’t sugarcoat it. There are good and bad associated with every type of service out there, whether for a child with ASD or someone suffering from heart disease or another tackling depression. We want to provide an accurate resource on what ABA therapy is, what the pros and cons are, and address ABA horror stories so you can make the best decision possible on helping your child succeed in life.
What is ABA Therapy?
Applied Behavorial Analysis for autism is a therapy type that is hyper-focused on the connection between language and learning. A behavioral therapist will encourage a child with ASD to focus on positive outcomes vs. negative outcomes, encouraging a child through the use of positive reinforcement in whatever activity they’re focusing on at the time. ABA is shown to be one of the effective therapy methods for autism spectrum disorder (ASD) based on clinical studies.
Why Are There ABA Therapy Horror Stories Out There?
The use of positive and negative reinforcement in therapy types in various clinical settings has always been up for debate. This is why ABA therapy horror stories exist from parents, children, therapists themselves, and the media. Unfortunately, not all therapy types work for everyone, and even more unfortunate, improperly trained behavior therapists or improperly supervised behavior therapists can potentially cause more harm than good.
Pros and Cons of ABA Therapy
Let’s discuss some of the pros and cons of applied behavioral analysis therapy so you understand the good and the bad:
What Are the Pros of ABA Therapy?
- Increased functional communication skills: Before starting ABA, parents will mention that they either can predict what their child wants at specific times because they know them so well or play a guessing game trying to figure out what they need. These options aren’t practical. With ABA services, families will see an increase in a child’s ability to functionally communicate their needs or wants using their words, pictures, or pointing.
- Improved socialization skills: We work on introducing appropriate skills such as turn-taking, increasing tolerance of non-preferred activities, enhancing conversation skills, working on sportsmanship, problem-solving, and identifying emotions. The introduction of these skills lay the foundation for improving a child’s ability to interact appropriately with their peers and siblings.
- Increasing Independence: Many children we work with have difficulty completing many adaptive skills on their own. We target these skills by breaking them down and using task analysis to determine what are the specific steps that we need to work on.
- Decrease maladaptive behaviors: We analyze behaviors and determine the function to identify appropriate replacement behaviors that serve the same function. For example, a child may hit someone to access a preferred item. We introduce the replacement behavior of asking for the desired object (using their words, pictures, or pointing). The introduction of this skill decreases the need to hit to gain access.
What Are the Cons of ABA Therapy?
- Major time commitment: Families need to commit to a specific amount of time after school and/or on the weekends to ensure that the appropriate amount of therapy is received.
- Not a quick fix: Improvements don’t happen overnight. We need time to analyze and change behaviors. This takes time.
- Behavior change: Families need to understand that changes in behavior can not only occur for their children. They must realize that some of their responses may need to change for maximum success.
Is ABA Therapy Right for Every Child?
No, it’s not. Like any other therapy, medication, or treatment potentially recommended for your child, there are some options that will not be right for them. This is why working with an ABA team who can get to know your child is essential to creating an overall treatment plan that is customized to your child’s needs. This is what makes or breaks ABA therapy or any other treatment options on the table.
Now, we’ll share some of our own stories with how ABA therapy has worked for children at Ascend Autism, as well as some cases where it didn’t and why. We want to show you both sides of ABA therapy so you can see how it works and doesn’t work in real-life autism cases. You can read all the horror stories out there you want, but until you truly understand how it works and how it doesn’t, you can’t make an educated decision on what’s suitable for your child.
When ABA Therapy Worked at Ascend Autism
- 6-year-old boy: Started services when he was five years old and exhibited a lot of non-compliance and unpredictable behaviors (e.g. tantrums). In addition, he had a challenging time getting along with his sister and was overly aggressive towards her. After receiving services for 1.5 years, the non-compliance and maladaptive behaviors have decreased substantially, and he can now interact with his sister and play games together.
- 3-year-old boy: Started services when he was a two-year-old and had minimal functional communication skills. After receiving services for ~one year, he is now communicating in full sentences and his overall conversational skills have improved dramatically.
- 5-year-old boy: Started services when he was four years old and had significant communication and social skills deficits. After receiving services for ~six months, he has displayed substantial improvements in functional communication, verbalization, imitating others, turn-taking, sharing, and other peer-to-peer interactions.
- 8-year-old boy: Started services when he was seven years old and was barely making any sounds. He started off struggling to make it through a one-hour session. After receiving services for ~one year, he verbalizes and imitates sounds that he hears from others. His functional communication has improved significantly, and he can now attend telehealth sessions for ~15 hours per week.
- 18-year-old girl: Started services when she was 17 years old and was having significant difficulty with social skills. She was in her own world and was not interacting with others (family and friends included) while neglecting the most basic, daily living skills. After receiving services for ~one year, her ability to be independent and interact with family and peers has improved significantly. She could even attend her prom, which was previously thought to be an unattainable goal before starting services.
When ABA Therapy Didn’t Work at Ascend Autism
- 10-year-old boy: ABA services were provided to a ten-year-old boy displaying significant maladaptive behaviors, including severe aggression and violence towards siblings and pets. The boy had other significant, comorbid diagnoses (psychological and mental illness) that proved to be very difficult to predict and work with. In addition, other medical professionals were frequently testing out new medications and dosages to treat the different diagnoses, which contributed to the unpredictable behavior. Lastly, the family was not consistent with administering the medications, which added to the unpredictability. As a result, it was determined that in-home ABA services were not the right fit because he required more intensive support (e.g., hospitalization program or residential program) that focused on his other diagnoses.
- 11-year-old boy: ABA services were provided to an 11-year-old boy who displayed significant escape behaviors, aggression, and deficits with communication. The boy’s primary guardian was his grandmother (80+ years old). Unfortunately, she was physically unable to meet the physical demands of caring for the boy. It was clear that there needed to be further buy-in and support from other family members but that was deemed to be not possible. As a result, it was determined that the boy required more intensive support (i.e., a residential program).
- 6-year-old boy: ABA services were briefly provided to a six-year-old boy who struggled with language and any functional communication. We hit a roadblock because mom was overly protective and frequently coddled the boy. To effect any change in behavior (for both neuro-typical children or children with ASD), there will be some discomfort or displeasure (e.g., a child cries when you take away a toy or don’t allow them to eat candy for dinner). In this child’s case, the mom could not bear seeing her child become mildly upset if he did not get immediate access to what he wanted. Due to the mother’s inability to allow these types of interactions during therapy sessions, it was determined that ABA services would be ineffective in achieving any meaningful outcomes.
- 2-year-old boy: ABA services were briefly provided to a two-year-old boy who had significant communication and social skills deficits. His profile would greatly benefit from holistic, early intervention ABA services. However, the parents’ expectations were misaligned and unrealistic. The parents expected ABA therapy to “cure” the boy’s autism in a short amount of time, and the parents expected to see significant improvement in a matter of weeks. Due to the misalignment of timeframe and expectations, it was determined that ABA services were not the right fit.
- 4-year-old boy: ABA services were provided to a four-year-old boy that needed assistance building functional communication and improving attending skills. Unfortunately, the family envisioned ABA services as purely an extension of school and only desired short sessions (one hour or less) focused on “school” skills. Even though the treatment plan was mutually discussed and finalized before the start of services, there was a misalignment of what skills would be worked on and how they would be worked on. Due to the misalignment of session expectations and unwillingness to work on overall adaptive skills, it was determined that ABA services were not the right fit.
How Do You Know If ABA Therapy is Working?
As you can see from the above examples, ABA therapy is not as cut and dry as some of the horror stories you see out there make it out to be. There are a lot of reasons why it may or may not work, some you can control and others you can’t.
Here are some tips for ensuring ABA therapy is working for your child and what to do if it’s not:
- Make sure your child’s therapist and your family are on the same page about what treatment entails and what the goals are for it.
- Do regular check-ins with your child’s Board Certified Behavior Analyst (BCBA) to determine where they are meeting goals.
- Check-in with your child, too. While they may not understand the progress towards their overall goals, you can ask them how they feel about working with the team, if anything is going wrong, and other questions to gauge how they’re doing.
- Pay attention to how your child interacts with the world around them outside of treatment. Seeing them do things differently than they’ve been working on is a good indicator ABA therapy is working for them.
- If you notice things don’t seem to be progressing, or your child isn’t using what’s taught during ABA at home or in other settings, it’s time to talk to your child’s BCBA and adjust the treatment plan or discuss other options. Don’t be afraid to ask questions and advocate for your child.
You should begin to notice changes in your child and how they interact with the environment based on the timeline and goals set forth by your child’s BCBA when starting ABA therapy. If your child isn’t hitting their milestones, it’s time to discuss this with their BCBA and adjust the treatment plan accordingly.
What Are the Alternatives to ABA Therapy?
Most autism spectrum disorder (ASD) treatments are broken down into four categories: behavior and communication approaches, dietary approaches, medication, and complementary and alternative medicine. In addition to ABA therapy, the following may be beneficial to children and work in conjunction with applied behavioral analysis according to the CDC:
- Assistive Technology
- Developmental, Individual Differences, Relationship-Based Approach
- Occupational Therapy
- Social Skills Training
- Speech Therapy
How to Learn More About ABA Therapy
We encourage every family to perform independent research on ABA therapy and all treatment options presented for their child. Your due diligence and direct involvement in your child’s autism diagnosis and treatment plan are critical for your child’s success. Don’t let anybody make you feel otherwise. Take the time to learn everything you can about autism, as well as the treatment options available. Ask questions and always advocate for your child and their well-being.
Two resources Ascend Autism recommends to learn more about autism, ABA therapy, and other treatment options are:
Avoiding Your Own ABA Therapy Horror Story
The Board Certified Behavior Analyst you work with should be certified and continue their education in the field once they receive that certification. This ensures they are up to date on the latest practical application of the therapy in a clinical setting. They should set up a treatment plan and goals as they meet with you, your child, and understand what behaviors need to be worked on for your child’s overall success. If the above isn’t happening, this is where ABA may prove to be pointless or a negative experience for anyone.
This is why choosing the right partner to work with your child and family through their autism diagnosis is critical to avoiding issues with treatment. The same could be said of any diagnosis for an adult or child – you have to understand your diagnosis, research the treatment options available for it, vet the partners you work with for treatment, and adjust what you’re doing if the treatment isn’t effective or the provider isn’t the right fit. You have to be an advocate for yourself, and you have to be one for your child, who can’t always speak up for themselves.