Frequently Asked Questions About ABA

What is Applied Behavioral Analysis (ABA)?

ABA uses a systematic approach to teaching complex skills through the use of positive reinforcement and motivation. It is a program of intensive one-on-one teaching based on research first published by B.F. Skinner in 1938 and later expanded upon by many others. ABA is also sometimes referred to as "Lovaas", after Dr. O. Ivar Lovaas, a professor of psychology at UCLA, who pioneered the use of ABA in teaching autistic children and documented its success.

ABA is an intensive, structured teaching program. Lessons to be taught are broken down into their simplest elements. These elements are taught using repeated trials where the child is given an instruction (like "do this" or "touch object" or "look at me"). Correct responses and behaviors are rewarded with lots of positive reinforcement. When incorrect responses occur, they are ignored and appropriate responses are prompted and rewarded. Undesirable behaviors are approached in the same manner. Initially the program teaches simple skills like table readiness, imitation, attention and others. Once mastered, these skills are combined into more complex skills, like language, imitation, play skills, social interaction and more. Since children within the autism spectrum vary enormously in their strengths and weaknesses, individualized lessons are developed to meet the particular needs of a given child.

While the initial teaching is often repetitive and involves a large amount of structure and imitation, significant effort goes into teaching the child how to learn and into making sure that the lessons are fun for the child. As the child advances, the highly structured program becomes more flexible. The lessons move out of the home and into the school and the community. This helps the child to generalize what he has learned so that he may better take advantage of the educational and social opportunities available in his community and require less professional attention as he grows older.

Is there any research to support that ABA is effective for children with Autism?

Yes. The most thorough studies of ABA for young children with autism have been conducted at UCLA. In the groundbreaking 1987 study an intensive treatment experimental group of 19 children with autism received 40 hours of one to one ABA instruction. Of the 19 children who received intensive treatment, 9 children (47%) successfully completed regular first grade and obtained above-average scores on IQ tests. The average gain in IQ over the course of treatment was 37 points. The 47% group was reevaluated in 1993 when they were on average 13 years old.

Results indicated that the effects of intensive treatment persisted. Eight of the nine children continued to succeed in regular classrooms. Blind examiners could not distinguish the formerly autistic children from typically developing children of the same age on measures of cognitive, academic, social, or adaptive skills. For the children who did not achieve normal functioning, sizable decreases in inappropriate behavior and acquisition of basic language were most often achieved. These children became more active members of their families and were usually able to learn in special education classrooms.

Additional research results are summarized in chapters 3 and 4 of the book Behavioral Intervention for Young Children with Autism edited by Maurice, Green & Luce. This book summarizes the published

research, which indicates that at this point in time, the most effective treatment for children with autism is early and intensive intervention using ABA.

How do you get started in an ABA program and who oversees the program?

The first step in starting an ABA program is to hire a service provider to oversee your program. You can find a list of local and national service providers from FEAT of NC (336) 773-1377. You should talk with as many as possible and select one that will be the best fit for your child and family. Any reputable service provider should be willing to provide you with references. Take the time to talk with at least one family receiving services from each service provider you are considering before you make your final decision. Once you have selected your service provider, they will assist you in the steps you need to take to prepare for your ABA program.

There are a few center or school-based ABA programs in North Carolina, but generally, parents run ABA programs at home. You will need to hire and train tutors, prepare a therapy room, buy supplies, reinforcers, and toys to use in therapy, and set a therapy schedule. Ask your service provider to give you an extensive list of what you will need. It is also a good idea to locate a family in your area who is doing ABA therapy and ask them for guidance. You should sit in on at least one ABA session to get a feel for how the program will flow. Remember — the more knowledgeable you are the more comfortable you and your team will be in your ABA program.

What is the optimum age to begin ABA?

Children who start therapy between the ages of two and three normally make the most progress. However, progress has been noted in children of all ages, including teenagers, once they begin ABA programs. ABA is a science of human behavior and its teaching principles apply to all ages. It guides us in how best to achieve goals of skill development and independence regardless of age or disability. Intervention based on ABA principles will help your child reach his full potential.

Where do I find tutors? How many do I need? What qualifications must they have?

Tutors can be found in several places. If you live near a college or university, your task will be much easier. You can advertise your positions to a variety of human service majors. The departments of psychology, social work, and special education are good places to start. You can post flyers on the departments' bulletin boards, or talk directly to professors and department heads to get leads on promising candidates. You can also recruit tutors by placing ads in the college and local newspapers, or by talking with child care providers.

You will need enough tutors to fill 35-40 hours of therapy a week, with each tutor typically working 6-10 hours a week. It is not necessary for a tutor to have special qualifications. However, courses in applied behavior analysis or operant learning theory would be helpful. Your consultant or lead therapist should be available to provide training to all tutors throughout the course of your program.

How much ABA does my child need?

An effective ABA program is designed to meet the needs of the individual child. The duration of the teaching sessions and the total number of hours per week should be based on a child's age and ability to adapt to the program. The teaching schedule is adjusted to the needs of the child. Often a child begins at approximately 20 hours per week and increases the amount of programming gradually. As discussed previously, the research documented success involves children who received 40 hours of ABA on a year-round basis for at least two years. Since no research has been published to identify the optimum level more precisely, most families try to target 40 hours per week.

People who are unfamiliar with how an ABA program actually works may question the ability of a young child to "handle" 40 hours per week of intense instruction. It helps to remember that a typical child naturally spends at least that much time playing and learning on his own. One of the key tasks for your team will be to ensure that the time is fun as well as educational. In the battle for your child's future without autism, every hour the child spends in non-productive, self-stimulatory activities is critical time wasted.

What is the cost of an ABA program?

The cost of an ABA program will vary depending upon what service provider you have, how many tutors you hire, how much you pay them, and how many hours of therapy your child will do. FEAT of NC parents report that their home programs cost between $25,000 and $60,000 per year. Here is a sample cost breakdown.

Consulting services (2.5 hours per week/$100 per hour) $ 250.00

Tutoring (40 hours/$10 per hour) 400.00

Tutor hours for weekly tutor meetings and monthly

training workshops 100.00

Supplies 50.00

Weekly total $800.00

The approximate annual cost of this 40-hour per week ABA program is $41,600. Other factors to consider will be travel cost for a service provider who is not local, cost of a private pre-school program for pre-school age children, and child care costs for siblings while parents are engaged in ABA therapy and meetings. Although ABA is expensive, any parent who has gone through the program will tell you that their child’s gains far exceed the cost.

What sources of funding are available for an ABA program?

Some parents have been extremely fortunate and their school system has paid for part or sometimes their entire program. You should contact your board of education and obtain a handbook on parents' rights, which will outline your rights under the Individuals with Disabilities Education Act (IDEA). This law states that all children with disabilities between the ages of three and twenty must be provided with free, appropriate public education. Your county has a director of exceptional children who is responsible for coordinating services for autistic children. This person can be reached by calling your local board of education.

CAP-MR/DD is a Medicaid-funded program that provides substantial funding for families that qualify. There are a limited number of slots available each year. This program is administered by your local mental health agency. When you contact their office, families who meet eligibility requirements will be assigned a case manager. This person can provide you with all the information you need and can guide you through the application process.

Your insurance company will probably not pay for your program. Many insurance companies deny that autism is a medical condition. However, some parents have been successful in getting funding through their insurance, so this option should be pursued to the fullest.

There are also many fundraising efforts that work well. Golf tournaments, raffles, fund raising dinners, donation cans in restaurants, and letters to different business, churches and various non-profit organizations have yielded good results for some families.

Is running a home program stressful?

Running a home program can be stressful especially in the initial stages. Finding the tutors, training, building the program, and setting up the ABA room -- all of these are stressful. In addition, the program completely changes the child's previous routine and he may react strongly to the intrusion. However, the program does settle into a routine as the team members learn their roles, and as the program focuses on identifying and replacing the child's maladaptive behaviors (such as tantrums). In addition, many parents feel their stress level decrease once they begin doing something proactive about their child's condition and seeing the results as their child progresses. Most families agree that the benefits of an ABA program significantly outweigh the stressful times they have endured.

Where can I find out more about ABA?

A list of recommended reading is provided by FEAT of NC. In addition, there is a wide range of web sites that focus on autism in general and ABA in particular. Sites that we have found particularly helpful include:

Families for Early Autism Treatment www.FEAT.org

How do I contact the FEAT of North Carolina chapter?