While Intensive Applied Behavioral Analysis refers most often to therapies that focus on verbal skills & behavior, non-intensive has a greater emphasis on the appropriate social skills that are needed to function in society.
While there are many things about autism that are highly debated, one area that all experts agree on is that starting ABA as soon as possible is crucial. While it’s unusual to have wait-times to start professional ABA in Wisconsin, it may take may take time for a new therapist to be hired and trained in some of the rural areas – which may lead to a gap in service. If that happens, parents might consider learning ABA therapy styles and techniques on their own (books, internet, you tube, etc) in order to get the process started while they are waiting for professional services. It’s also important to add that ‘do it yourself’ ABA should be thought of as a gap-filler, and not necessarily a long term solution.
WHAT IS IT?
ABA is a therapeutic technique by which a child is taught appropriate methods to communicate, instead of doing so with negative behavior or inappropriate communication or unresponsiveness. ABA is technically defined as ‘the science in which the analysis of behavior is used to improve socially significant behavior’.
In short, an analyst helps to determine the areas of focus, and trained therapists then work with the child on those behaviors. Analysts make observations of specific behaviors – including the factors that might be triggering those behaviors. Positive reinforcement is used to shape appropriate responses and new behavior.
ABA was first developed in the 1970’s by O. Ivar Lovaas
Unlike intensive therapies (which are usually done in the family home, for more up to 40 hours a week), non-intensive is often in a clinical setting, for 3 – 15 hours a week. Some time is spent one on one with a therapist, and other time may be spent with like-minded peers, putting new skills into practice.
This type of ABA therapy often is recommended for children who are higher functioning, Asperger’s, Pervasive Development Disorder (PDD), or for those who may have reached a higher level of functioning following intensive therapy.
ABA is an evidence-based treatment program for autism spectrum disorders. Evidence-based, meaning that it’s been documented in multiple studies to significantly improve many of the negative aspects of autism, at multiple levels of functioning.
BEHAVIOUR ISN’T JUST BEHAVIOR
ABA is based on principles of ‘behaviorism’ – a psychological theory that explains how people learn and behave. It asserts that behavior isn’t random – that all behavior has a purpose. According to this theory, behaviors that are reinforced with a positive consequence (treat, reward) or those that accomplish a desired outcome (receiving what they have a need for) are more likely to be repeated and used in the future.
Behavior has a purpose. Often there is an unmet need that’s sensory (noise is too loud, lights are too bright), or they want to escape (I really don’t want to do this work right now), or feels good (I want to climb on things because it helps me to feel centered) or their need is for something tangible (I want more French fries).
Even for children that are able to speak, being able to express their needs in an appropriate way (or for that matter, articulate their needs in any capacity at all) can be a significant challenge.
Here is a video that explains the purpose of behavior, and gives a great example of how one of the goals of ABA is to replace negative behavior with appropriate responses and requests.
ABA often refers to the ‘ABC’s’. Antecedent (what happens), Behavior (what occurs), the Consequence (what took place as a result).
An example might be:
Antecedent: Mom is eating something on a plate.
Behavior: Child takes something from the place & runs away with it.
Consequence: Child eats what they’ve taken.
ABA looks at the entire process of what’s happening. In the example above, the analyst might determine that the child has learned that when they do X behavior, that Z is the outcome – or that when they take food off of someone’s plate, even without asking, they’re able to eat it.
ABA’s goal is to give the child an appropriate method to express what they need, in a way that is socially acceptable.
GET IT COVERED.
Talk with your private health insurance company to inquire about the coverage, co-pays, deductibles and coverage limitations on your current policy, and any specific ABA providers they work with. Not all insurance companies have to work with all providers.
ABA does fall under the 2009 mandated insurance coverage laws in Wisconsin, but ABA services are still subject to per-visit copays. Here is more about insurance coverage in Wisconsin when it comes to ABA services.
It’s important to note that Medicaid (Or Wisconsin’s FORWARD card) does not cover ABA. Since Medicaid is paid for using federal funds, and since coverage of ABA is not a federal insurance requirement, Wisconsin’s Medicaid program does not cover ABA therapy services.
In the absence of private health insurance, contact the Wisconsin Department of Health Services to inquire about coverage options for ABA services. Due to the very high demand for these services the wait can be years – so don’t delay.
Some families pay out of pocket, receive grants, or utilize other resources until coverage for ABA can be arranged. If ABA is done on your own, it should be considered only as a gap-filler until professional services can be received.
HOW TO GET STARTED
The first step in starting ABA Therapy is for a licensed therapist to conduct a Functional Analysis. All ABA providers have one. In this process, behaviors that interfere with meaningful functioning in the classroom or in the family are identified. The therapist then uses that information to identify the purpose of the behavior, in order to correct the problematic behavior.
WHATS IT LIKE?
Most non-intensive ABA programs are based upon Pivotal Response-type techniques, which are loosely structured and focus on social functioning, relationship skills, appropriate communication and daily living skills.
It’s often play-based, and centers on appropriate social communication & behaviors and alternatives to undesirable behaviors. Motivation strategies are an important part of the approach.
Sessions often take place in a clinical setting, and time is spent in a combination of one on one time with a trained therapist, and with like-minded peers, practicing newly learned interaction skills in a controlled environment.
Each program is tailored to meet the goals and needs of the individual. As the child gets better at certain tasks, the focus of each session changes to accommodate more advanced goals and needs.
Different ABA providers tend to specialize in one method or the other. It’s a good idea for parents to investigate and have some familiarity with the differences between intensive and non-intensive therapy so they have a sense of what they think might be the best fit for their child.
And remember – if you try one type and it’s not the right fit, try the other method. Also remember that improvement may take weeks to months to be seen, and may be subtle at first. If you have concerns about your child’s progress with non-intensive ABA, share those with the lead therapist or supervising clinician.
In January of 2014, an in-home ABA therapy session in the Milwaukee area was video recorded by a parent who had become concerned about her nonverbal son. She was noticing unusual behaviors, but was unable to personally observe the sessions due to a policy in place by the service provider. The video recorded session reportedly shows aggressive handling of the child on the part of the therapist. Law enforcement officials are investigating.
Our volunteers have talked with families and therapy service providers, and have offered hints, tips and points to think about to help keep our children safe when working with any therapy provider.
Please note: This information was compiled by a parent volunteer from public sources, and is not intended to be medical or legal advice.
For specific questions about your circumstances regarding this topic, contact your Regional Center for Children & Youth with Special Health Care Needs. The Centers are staffed by specialists who can help get answers, find services and connect you to community resources. Their services are free, unbiased and private.