When your child has autism spectrum disorder (ASD), you’ll likely find yourself working with a whole team of medical professionals. However, the most important professional in your child’s immediate post-diagnosis life is going to be your applied behaviour analysis therapist or, more precisely, your team of ABA therapists.
ABA is the recommended intervention—often labelled “the gold standard” because it’s considered the most evidence-based treatment—for your child and often the only service that’s publicly funded. All of which explains why it makes sense to learn as much as you can about ABA as soon as possible.
Applied behaviour analysis puts the emphasis on learning how to learn. It’s based on the principle of analyzing behaviour in real-life situations with the ultimate goal of encouraging behaviours, through positive reinforcement, that help an individual learn. It is also effective at discouraging behaviours that interfere with learning. In ABA, the focus is on step-by-step or incremental learning—a particularly effective method for children with autism. Another standard practice in ABA is prompt-fading, or gradually lessening the amount of assistance a child requires in order to achieve a desired skill—for example, progressing from hand-over-hand guidance to more subtle gestures or from verbal instruction to visual cues.
Comprehensive ABA treatment or intervention—also sometimes referred to as intensive behaviour intervention or intensive behaviour therapy—involves 25 to 40 hours of intervention per week and helps kids learn a broad range of skills. Focused ABA involves 10 to 25 hours of intervention per week and helps kids learn a few specific or target skills in a particular area. The decision about which service a child or individual with autism should receive should be based on their individual needs. The therapy is usually put into practice by a supervising therapist who, in turn, assembles and works with a team of therapists.
One important thing to look for in an ABA team is openness to other professionals involved with your child’s treatment. Marchese, founder and executive director of Breakthrough Autism, an applied behaviour analysis treatment centre in Toronto, recommends an ABA plan “be constructed according to your child’s needs.”
“The system has to be dynamic,” she says. “Applied behaviour analysis therapists want information. That means maintaining good relationships with speech and occupational therapists. Or, if a child has challenging behaviours, we definitely want to hook in with the paediatrician to make sure there is not a medical problem.”
The accreditation to look for in hiring an ABA therapist is board-certified behaviour analyst (BCBA). A BCBA is considered an “independent practitioner who provides behaviour-analytic services.”
Most important, a good ABA program should be committed to including parents in its day-to-day workings. Among other things, that means coaching parents in basic ABA principles and strategies. Two of the key lessons will likely be learning how to break skills into small, incremental steps, as well as learning how to practise the art of positive reinforcement. So while all parents know how to catch their child behaving badly, the focus, in ABA and with an ASD child, should be on catching them doing something good and rewarding them for it.
Any program you choose should be functional and practical, says Marchese. “We want the parent coaching aspect of the program to be about what’s doable for the family. We’re not going to ask parents to take 100 trials of data or anything like that. We are going to look at what is feasible. Can you practise teaching a skill once a week? If you can, that’s great!”
In the past, applied behaviour analysis has been criticized for being excessively rigid, even robotic, in its application. In recent years, though, programs have evolved, becoming more naturalistic, particularly when it comes to younger children on the spectrum. Sunbul Rai, director of the ABA Little Tots Program in Saskatoon, recommends parents look for enthusiastic, engaging and dedicated ABA therapists.
“Being able to play with a child in a fun and creative way is a critical skill all ABA therapists should have. They should be able to bond [with] fairly quickly,” Rai adds.
She also advises choosing someone you like, since you will be spending a lot of time with your child’s ABA therapists. In other words, trust your instincts. “If a parent’s gut is telling them ‘no’ about a therapist, then they should follow their gut until they find someone who is the right fit for their entire family,” Rai says.