As a well-established autism nonprofit service provider, our families often ask us how much ABA Therapy their child will need. And of course, this is an understandable question. Since we believe in individualized supports and that one size does not fit all, the answers to this question are as individualized as each child. However, there are several parameters to consider, and in this blog we outline some key factors that play a part in determining an appropriate amount of ABA Therapy for your child.
Applied Behavior Analysis (ABA) therapy is a widely recommended evidence-based approach to helping children with autism learn critical life skills and socially adaptive behaviors. The benefits of ABA Therapy can be life-changing for many individuals, which is why it is often considered the “gold standard” of autism treatment. However, every program is different and your child will benefit most from an approach that is uniquely customized and individualized. An important part of that planning involves the number of weekly treatment hours, which is often referred to as “treatment intensity.” There are differences of opinion in the ABA field on how many hours should be recommended as a standard of practice, and this blog is intended to help you decide as a parent which approach is right for your child.
The amount ABA therapy needed for a child can vary depending on several factors, including:
Therefore, the intensity of ABA therapy is determined on an individual basis. ABA therapy can range anywhere from a few hours per week to more intensive programs involving 20-40 hours of therapy per week. The duration of therapy may also vary, depending on the child's progress and ongoing assessment.
The first step is having a conversation about your family's goals and priorities, to make sure those are the primary focus of the assessment and treatment plan. When ready, a Board Certified Behavior Analyst (BCBA) will conduct an initial assessment and develop an individualized treatment plan based on the child's strengths, weaknesses, and specific goals. Once completed, the BCBA should review the results of the assessment with you to discuss recommendations for treatment. Your input is incredibly important at this stage to communicate which goals and priorities are most important to you and your family. It is also a critical time to discuss your child’s availability for therapy and other activities you want to continue outside of ABA therapy. All of these factors help determine how many hours per week your child may receive. The BCBA also typically must seek approval from your insurance plan for the number of hours requested based on the assessment results and treatment plan.
In the future, the supervising BCBA should conduct reassessments at least annually and communicate recommendations with you regularly to ensure that the therapy is tailored to meet your child's changing needs over time. Remember, every child is unique, and what works for one child may not be the same for another. It's important to work closely with professionals who can provide specialized guidance based on your child's individual circumstances.
If you feel that your child needs more ABA therapy hours than your BCBA has recommended, discuss your concerns directly with the BCBA and explain how you think your child would benefit from additional treatment. Therapy hours must be justified based on medical necessity, so your child’s needs and treatment plan goals must show how the additional hours will help. Total available hours may also be limited by what your insurance plan is willing to approve.
Unfortunately, many parents have experienced being pressured by ABA therapy companies to commit to a high number of hours per week regardless of their child’s need. The science of Applied Behavior Analysis (ABA) is supposed to be individualized in very specific ways, so it is not best practices to require 30 or 40 hours per week of every child. In fact, too much ABA can be harmful to the child and family well-being. The autism services industry has experienced rapid growth through private investment over the past decade, and unfortunately some ABA therapy models have been taken over by business interests that see full-time ABA as much more profitable. You as a parent should never have to fall prey to these unethical business practices.
If you are told that anything less than a high number of weekly hours is unethical or ineffective, you are being misled. That is simply not true, and does not align with any reputable research. What may be true is that the number of goals and the amount of progress a child can make will be less if the number of hours is reduced. However, as a parent that is completely your right to decide. Also keep in mind that the number of hours can change over time, so it is OK to start small and increase gradually if your child is responding well to the treatment approach.
Sometimes ABA therapy providers are not placing the same value as you are on activities your child does outside of ABA. There are many things in life that can help your child grow and develop, and you can always decide what you feel is best. That may include additional family time, other therapies, school, or recreational activities. No ABA therapy provider should tell you that you have to cancel these things to make time for therapy. Instead, they should work with you to accommodate a therapy schedule for your child that fits with your goals and values as a family, and they should be able to modify the treatment plan so that goals and therapy activities are adjusted to fit within the updated schedule.
There may be a minimum amount of hours that the BCBA feels are necessary to make any reasonable amount of progress, and they should be able to explain why, but typically that shouldn’t be more than 10 or 20 per week, depending on age and needs identified from the assessment.
All ABA therapy providers are different, and beginning an intensive therapy program is a huge commitment. Therefore, it is well worth your time to explore multiple options and only go forward with a provider that closely aligns with your needs and personal values. Here are some steps you can take to help you choose the best fit for your child:
For a good overview of common “Red Flags and Green Flags” to watch out for when evaluating ABA therapy providers, this blog has some great tips.
Ultimately, trust your intuition when choosing an ABA provider. Consider the overall impression you've formed during the research and selection process. Select an agency who you feel is genuinely invested in the well-being and progress of your child.
Remember that finding the right ABA provider may involve trial and error. It's important to regularly assess progress and communicate openly with the ABA Therapist to ensure the therapy is effective and aligned with your goals.
Contact our Family Support Team if you would like to learn how to get started with ABA Therapy or any other programs and services that we offer. Our Family Support Team is always available to help and is available at no charge to all members of the autism and developmental disability community. Schedule a free phone appointment that works with your schedule by visiting azaunited.org/supportcall
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