What Is ABA Therapy? Everything You Need To Know

When your child has been diagnosed with autism spectrum disorder (ASD), or has been showing the signs of ASD, it can leave you with many questions.

Will you be able to learn all that you can about ASD to help your child?

Will you be able to find individualized treatment to encourage your child’s development?

Will your child be able to accomplish all of their hopes and dreams throughout their life?

Having a child receive an ASD diagnosis is a powerful, life-changing moment. You may feel unsure about the path forward. You may feel isolation and loneliness. You may even feel anger or sadness. These emotions are a natural reaction — as a parent, you love your child unconditionally — and help exists to chart a path forward to a brighter future for you, your child, and your family.

One of those paths is through the use of ABA therapy. ABA, or applied behavior analysis, is an evidence-based best practice that includes a variety of techniques to help your child increase desired behaviors and decrease undesired behaviors.

Since the 1960s, ABA therapy has been studied and used as an effective treatment methodology for autism and related developmental disorders.

“Applied Behavior Analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior.” — Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991

Within this discipline, ABA providers are charged with the improvement of socially significant behaviors. Socially significant behaviors include communication, social skills, academics, reading, and adaptive living skills such as gross and fine motor skills, toileting, dressing, eating, personal self-care, domestic skills, and work skills.

Learn more about what to expect with ABA therapy, who can provide ABA services, and commonly used ABA terms. Plus, get tips on choosing an ABA provider to suit your child’s unique needs.

Ready to get started on the path toward learning and data-driven progress? Let’s dive in.

How ABA Therapy Works

How ABA Therapy Works

What is ABA therapy? It is a structured, evidence-based approach to therapy that is based on the science of learning and behavior. It can be adapted to meet the needs of each individual, including where therapy is delivered — at home, at school, and in the community. Research suggests that ABA should begin early in a child’s development, preferably prior to five years of age, but it can be effective in adults as well.

ABA providers are trained to teach skills that individuals will use throughout their everyday lives, including communication and language, social skills, self-care activities, play and leisure, motor skills, and academic skills for use in school. Whether in one-on-one sessions or group sessions, all individuals receive a program written to meet their unique needs and progress goals.

An ABA therapy program will have a number of steps and can last as long as required to achieve improvement. Experts will work with you and your child to:

  • Identify behaviors that should be altered/addressed
  • Set goals and outline expected outcomes
  • Begin measuring changes and improvements
  • Evaluate your child’s current status
  • Help your child learn new skills and how to avoid negative behaviors
  • Review data regularly and report on progress
  • Work with you and your family to plan for future behavior modification as needed

But what about the science behind ABA therapy? That’s where the ABCs come into play.

The ABCs of ABA

As you’re learning more about ABA therapy, you may run across what’s called the “ABCs of applied behavior analysis.” This stands for antecedents, behavior, and consequences. These ABCs map out the process of determining why a child is exhibiting a specific behavior and enable behavior analysts to determine whether or not treatment has effectively led to behavior change.

1. First, the antecedent. This is what occurs immediately before a behavior occurs. It can be a verbal trigger, such as a question or command, or a physical one, such as the presence of food or a loud noise. It can stem from something in a child’s environment or be an internal thought or feeling.

2. Next, the behavior result. This is how the child responds to the antecedent, such as by taking an action, issuing a verbal response, or showing a lack of response.

3. Finally, the consequence. This is what follows the behavior and teaches children the effects of their actions. Consequences include either position reinforcement following the desired behavior or no reaction for inappropriate behaviors. Punishment, or negative reinforcement, is not used in ABA therapy and is considered unethical.

To analyze a child’s current behaviors and encourage behavior modification, the behavior analyst needs to consider the intersection of the ABCs for each behavior displayed. For example, if a child is learning to try new foods, they may be reluctant to eat carrots for the first time. The antecedent would be the presence of an unknown item on their plate. In response, the child may refuse to eat or cry when asked to try the carrots. This is the behavior resulting from the antecedent. As a consequence, the behavior analyst removes the carrot from the child’s plate.

Sometimes, however, it isn’t quite so easy to identify the true antecedents — and therefore appropriate consequences — of behaviors. Say a child is refusing to put away a specific toy in order to do a different task. In this case, the antecedent would be the child being asked to store the toy for a period of time. The behavior would be the child’s refusal, and the consequence would be the toy being taken away or the child not being able to perform the desired task instead.

However, it may be that the toy was recently lost, disrupting the child’s bedtime routine. Once found, the child may actually be fearful of losing the toy again and has increased their attachment in response. Therefore, the antecedent would actually be a fear of losing the toy. Consequences in this case may differ from when a child outright refuses to put the toy away.

Behavior analysts must be able to dig deeper into all the factors surrounding behavior in order to interpret them accurately and to identify methods of modifying behavior positively. With repetition and continued work, the child will learn to modify their behavior to achieve better consequences.

ABA Services

What is ABA therapy used for? The short answer is: almost anything! If it is a behavior, and it can be observed, ABA principles exist that can be used to either increase or decrease that behavior.

Interventions are designed to address the development of critical skills as well as the reduction of challenging behavior. While there is no cure for autism, ABA providers help children with ASD learn to live fully and independently.

When your child is first entering into ABA therapy, your behavior analyst will begin with an assessment to look at the child’s medical history and previous treatments. You and your family will be interviewed to help identify challenges and progress goals. Your provider will also conduct an observation in an initial session with your child.

Following the assessment, your behavior analyst will set goals for your child to work toward. Your child’s goals will not look the same as those of another child, because ABA programs are fully personalized to your child’s current baseline, development progress, and learning timeline. Both the date of when therapy begins and a target date for successful behavior change should be outlined.

All ABA programs should include a definition of the behavior, antecedents, consequences, prevention, and any de-escalation procedures required for your child’s unique circumstances. Functional behavior assessments or skills-based assessments should be completed regularly to provide insight into your child’s progress.

Program plans should also note any other providers who will be working with your child, such as speech-language pathologists (SLPs), occupational therapists (OTs), psychologists or psychiatrists, and special education teachers if your child is of school age. Transition plans should note how your child will move between these different services and learning environments. Your program will be performed by the behavior therapist, under supervision by the behavior analyst. ABA programs can last as long as needed, and timelines will depend upon the complexity and severity of your child’s behavior needs.

In addition, you and your family are an integral part of your child’s care. The behavior analyst will provide education and support to parents, caregivers, and siblings. In fact, the more the merrier! ABA is far more effective when everyone is on the same page and is working together to reinforce positive behavior and skill development.

ABA therapy may be offered in multiple settings, including various types of clinics, schools, in your home, or in your community — anywhere that your family needs support in teaching and reinforcing the skills necessary for lifelong success.

Who Can Provide ABA Services?

Who Can Provide ABA Services?

To provide ABA, providers must be certified by the Behavior Analyst Certification Board, Inc.® (BACB®) or a similar certifying body. Providers are licensed clinical therapists with additional training and experience in ABA therapy and methodologies.

Board Certified Behavior Analysts®

At the highest level are Board Certified Behavior Analysts (BCBAs®). To be eligible for this certification, individuals must hold a graduate degree, complete behavior analytics coursework, conduct fieldwork under supervision, and successfully pass the BCBA certification examination. To remain certified, BCBAs must complete continuing education units each recertification cycle.

Depending on the state, BCBAs may also need to become licensed in order to practice. BCBAs with doctoral or postdoctoral training in behavior analysis may choose the Board Certified Behavior Analyst-Doctoral® (BCBA-D®) certification; however, it does not grant any privileges beyond the BCBA certification.

BCBAs can provide ABA therapy independently, creating programs, analyzing program data, and modifying programs appropriately. In addition, BCBAs can supervise the work of Board Certified Assistant Behavior Analysts® (BCaBAs®), Registered Behavior Technicians® (RBTs®), and other ABA therapy professionals.

Board Certified Assistant Behavior Analysts

Next up are BCaBAs. To become a BCaBA, individuals must hold at least an undergraduate degree, complete behavior analytics coursework, conduct practical fieldwork under the supervision of a BCBA or other qualified professional, and successfully pass the BCaBA certification exam. To remain certified, BCaBAs must complete continuing education units each recertification cycle.

BCaBAs are qualified to provide ABA services under the supervision of a BCBA. Any BCaBA who does not have a qualified supervisor will be considered inactive and may not practice or use their BCaBA certification until ongoing supervision is set up. BCaBAs may also supervise RBTs.

Registered Behavior Technicians

Finally, RBTs assist in delivering ABA therapy and practice under the direction and close supervision of an RBT Supervisor and/or an RBT Requirements Coordinator. The Supervisor or Coordinator is responsible for all work RBTs perform.

To be eligible to apply for RBT certification, individuals must be at least 18 years old, have completed high school-level education or equivalent, pass a background check, obtain 40 hours of qualified training, and successfully complete an initial competency assessment. Afterward, they must submit an RBT certification application and then successfully pass the certification exam.

RBTs must receive ongoing supervision to improve and maintain ABA, professional, and ethical standards and to ensure high-quality services are being provided to clients. In addition, RBTS must complete an RBT renewal application every year, including an RBT Renewal Competency Assessment, to maintain their certification.

Other Providers and Team Structure

Some other licensed professionals, such as child psychologists, may be trained to provide ABA therapy. Even if they are licensed by another certifying body, they may choose to pursue a credential from the BACB® to further their skills and show their commitment to behavior analytics best practices.

Most ABA therapy involves customized programs designed by a BCBA. The RBTs or BCaBAs implement the programs to achieve significant progress in a child’s cognitive, language, social, behavioral, and adaptive skills. The BCBA then is able to focus on clinical and supervisory responsibilities, ensuring effective case management with the support of everyone on a child’s ABA team.

Defining Common ABA Terms

Common ABA Terms

There is a wide variety of ABA types, and you’ll encounter a number of applied behavior analysis terms related to therapeutic and teaching approaches. Let’s explore common terms so that you can find an approach that will benefit your child.

Discrete Trial Training (DTT): DTT is a structured ABA technique that breaks down skills into small, “discrete” components. Using a step-by-step method, experts encourage skill development by providing children with tangible positive reinforcement. Through repetition, children can master these activities and build upon their previous learning.

For example, when a child is learning shapes, the clinician would start by identifying a square. When the child correctly points out a square, they would receive a small reward. The clinician would continue by having the child identify a circle, followed by another small reward. Then, they would move on to having the child identify both shapes together. After identification is solidly established, the clinician could encourage the child to begin using the shape names. Every step builds upon the next and is continuously reinforced.

Incidental Teaching (or Natural Environment Training): This approach is centered around skills that are relevant to the child’s daily life and interests. The clinician allows the child to choose activities and follows their lead to reinforce appropriate behaviors. This can help the child build general skills that are transferable to everyday situations. For example, if a child shows interest in toy cars, the clinician could use the cars to help the child identify the car colors, encourage the child to take turns sharing the cars with the clinician, and build their vocabulary.

Verbal Behavior Therapy (VBT): VBT is focused on four-word types: mand, tact, intraverbal, and echoic. Clinicians will begin by teaching mands, also known as requests, moving on to tacts (words used to draw attention), intraverbal (words used to answer questions), and echoic (words that are repeated). For example, a clinician would ask a child if they want an apple and hold up the fruit. The child would then need to respond — not verbally at first, but eventually, they would get to that point through repetition. This helps the child create a connection between the word, the object to which the word refers, and the child’s need or desire.

Pivotal Response Training (or Treatment): Pivotal response training, previously called the natural language paradigm, focuses on specific behavioral elements that cover a wide range of individual skills. These include motivation, response to multiple cues, self-management, and social initiations. This therapy is led by the child and emphasizes natural reinforcement. For example, if a child wants to play with a specific toy, as long as they meaningfully attempt to communicate their desire, they will be rewarded with that toy.

Behavior Skills Training (BST): BST is an evidence-based approach involving training to implement behavior change. It consists of multiple treatment components to develop a wide variety of skills, both simple and complex. For example, a child may need to be taught how to wait while another individual completes a specific task, such as a parent talking on the phone or a sibling playing with a toy. BST can simulate these events for instruction and practice to model appropriate waiting behavior and provide feedback while a child learns this new skill.

Picture Exchange Communication System (PECS): PECS is an alternative or augmentative communication system that encourages communication through the use of pictures. For children who are completely nonverbal, PECS teaches a fast, self-initiating, functional communication system. For example, a child would begin using simple icons to make requests or share their needs, but they’ll learn to connect multiple pictures to build a complete “sentence.”

Early Intensive Behavioral Intervention (EIBI): EIBI is generally used with younger children, specifically those under the age of five. Based on the principles of applied behavior analysis, EIBI breaks core skills down into small, manageable tasks. Emphasis is placed on general skills that your child will use in their everyday life. More complex tasks are also divided into easy-to-achieve mini tasks, and complexity increases as your child progresses through their ABA program. For example, when a child is learning to feed themselves, they may first learn how to properly chew and swallow, then how to hold a utensil, and then how to use a utensil to bring a bite to their mouth.

Functional Behavioral Assessment (FBA): An FBA is an evaluation based on behavior. It’s used to identify and understand a child’s challenging behaviors and then uncover solutions. A plan is then developed to teach and encourage positive behavior.

Individualized Education Program (IEP): Your child’s school may develop an IEP to plan for the special education instruction, support, and services your child would need to thrive in school from kindergarten through 12th grade. To be eligible for an IEP, your child must have at least one of the 13 disabilities listed in the Individuals with Disabilities Education Act (IDEA). In addition, the disability must affect the child’s educational performance, plus their ability to learn and benefit from the school’s general curriculum.

Why Consider ABA Therapy for Your Child?

Why Consider ABA Therapy for Your Child?

Now that you know what ABA therapy is, let’s explore the reasons why it’s been used and considered a best practice for decades.

At its core, ABA therapy supports children with ASD in a number of ways. It not only increases positive behavior but actually teaches skills to replace challenging behaviors. It naturally reinforces positive behaviors and can build upon them incrementally to generalize a child’s skills from one situation to the next. For children who are not yet in school, ABA therapy can prepare them by increasing their social skills, helping them focus on and comply with assignments, and improving their cognitive ability.

As a parent or guardian, ABA therapy can also make you more aware of how your child’s behavior is responding to your reinforcement. For example, you may be unintentionally rewarding challenging behavior by giving it attention. ABA therapy can help you identify antecedents to craft a proper consequence to guide your child toward optimal learning outcomes.

Let’s dig further in to the applied behavior analysis benefits:

ABA Is Effective

ABA therapy has been around for more than 60 years — and there is 60 years’ worth of research demonstrating its effectiveness. ABA is a recommended best practice found to promote an overall healthy lifestyle via nutrition, exercise, sleep, stress management, and social support.

In a meta-analysis of ABA intervention studies, which analyzed a large number of variables associated with treatment, ABA methodologies were found to be very or moderately effective in improving:

  • Intellectual abilities
  • Communication skills, expressive language skills, and receptive language skills
  • IQ (provided by non-verbal tests)
  • Adaptive behavior (in total)
  • Socialization

Evidence shows that the intensity and frequency of ABA therapy matter as well. Research indicates that a strong relationship exists between treatment intensity and a child’s mastery of learning objectives — higher treatment intensity was associated with greater progress.

Additionally, there is support for comprehensive programs that facilitate learning both in the clinic and in the community. In fact, participants who received both home and center-based ABA services were found to master 100% more per hour while at the center than at home. At the same time, children participating in home- or community-based programs can better improve their self-help and social skills.

Evidence shows that the intensity and frequency of ABA therapy matter as well. Research indicates that a strong relationship exists between treatment intensity and a child’s mastery of learning objectives — higher treatment intensity was associated with greater progress.

Additionally, there is support for comprehensive programs that facilitate learning both in the clinic and in the community. In fact, participants who received both home and center-based ABA services were found to master 100% more per hour while at the center than at home. At the same time, children participating in home- or community-based programs can better improve their self-help and social skills.

ABA Is Customized for Your Child

What is ABA therapy for one child might not be reflected in your child’s program — and that’s to be expected. ABA is individualized, child-centered care centered around a child’s strengths, not their deficits. Just as ASD encompasses a range of unique diagnoses, ABA therapy also covers a variety of techniques.

ABA programs are based on research and measurable behavior data, which allows BCBAs to specifically identify the kinds of activities a child enjoys and use them to motivate the child during therapy sessions. Your child’s ABA program is constantly being assessed and re-assessed to make sure that it’s working. If it’s not working, this assessment data can help the BCBA choose a new direction for your child’s program, making it seamless to adapt to the process and skills of your child’s unique learning style.

Your child’s BCBA will also be able to provide you with the data they have gathered in the form of a personalized assessment. This information can inform your part of your child’s care and allow you to make informed parenting decisions in alignment with your child’s ABA therapy progression.

In addition, ABA programs can be delivered across environments. This multisite model allows BCBAs to address the most challenging skills in a distraction-free, center-based environment while encouraging generalized skill development in your child’s busier home or school settings. If your child has no problem integrating new social skills while at the center but struggles to do so at home, the BCBA can integrate training to encourage social interaction in all the environments your child will experience throughout their lives.

ABA Can Be Used in Tandem With Speech and Occupational Therapy

After your child is diagnosed with ASD, you may realize that your child needs a full suite of therapy services, such as ABA, speech, and occupational therapy. In fact, it’s been reported that interdisciplinary work, cooperation, communication, and team intervention are not only needed but justified.

Research has found positive outcomes associated with collaborative therapy for individuals with ASD — specifically, it found that ABA therapy can be used to support the work of other disciplines with effective communication and role transitions. But what does this look like in practice?

  • Speech-language therapy focuses on communication skills, as well as feeding and swallowing. Your BCBA may work closely with SLPs if your child is experiencing delays in talking, vocabulary, eating, or drinking. Your SLP will provide primary speech and language intervention services, they will also provide the ABA clinician with helpful strategies for building communication skills in ABA therapy sessions. Studies report that better collaboration between ABA and SLP professionals could result in higher quality care for individuals with communication impairments.
  • Occupational therapy focuses on helping children successfully accomplish the tasks associated with daily living. Your BCBA may collaborate with an OT if your child is experiencing delays in coordination, fine or gross motor skills, or movement and body awareness. Your OT will be the primary clinician for building these skills, but they’ll provide data and strategies to your BCBA that they can incorporate. With successful collaboration, ABA and OT teams can improve outcomes.

With this broad level of expertise, an ABA/SLP/OT team can provide you with a high level of insight into your child’s development. In fact, this “interprofessional merge of therapy procedures” has been found to not only influence clinician behavior positively but also improve behavior and learning outcomes in children with ASD.

What To Look for in an ABA Provider

What To Look for in an ABA Provider

When you’re looking for an ABA therapy provider, you should evaluate your options for these qualities:

  • Adequate, high-quality staffing: You’ll want to ensure that your ABA provider is certified by the BACB® or has appropriate supplementary training and education. In addition, all RBTs and BCaBAs should be supervised by a fully certified and licensed BCBA. When starting ABA therapy, ensure your clinician spends time pairing with your child. To pair is to get to know your child, discover what they enjoy, and identify what they don’t enjoy. Through pairing, your clinician can determine your child’s motivations and how to incorporate those motivations during their ABA program.
    Ask how your clinician will keep you informed and report on your child’s progress — it’s essential that you have two-way communication to fully support your child. Finally, make sure the ABA center has proper staffing in place so children are properly supervised, safe, and given the attention they need to achieve their goals.
  • A safe, structured environment: ABA program sessions should never be all work and no play. At the same time, they should be structured around achieving progress, using data to inform decision-making. Introduce yourself to every professional
    who will be interacting with your child to ensure you feel comfortable and safe with every member of the team. Likewise, ask how background checks are handled at the organization.
    Consider interviewing the team who will be working with your child to see how they approach program development and assessment. Visit the center, if you’re considering center-based ABA therapy, to evaluate it for cleanliness, safety procedures, and how children are guided through various parts of their program. Finally, ask how skills are developed outside the clinic or center and how children are supervised in the home or community.
  • Realistic goal-setting and expectations: Remember that ABA providers should not promise to cure your child — or promise overnight progress. Instead, they should set realistic expectations based upon your child’s health, behavioral challenges, program hours, and how challenging it is for your child to carry over skills to other settings. Your providers should also work with you to set goals and report on progress frequently to allow you to reassess your expectations.
  • Goals aligned with you and your child’s needs and priorities: Similar to the above, your provider should not set goals without your input or without considering what your child needs. Providers should focus on measurable skills that can be used in real-world settings, such as those that make it easier for your child to go to school, spend time with family, and head out into the community.
    Programs should also work to expand skills by building upon them and to help children transfer skills they’ve learned to other areas. Be sure to discuss your schedule with the entire care team to help shape the ABA program around the times that work best for you and your family.
  • Proper documentation and data collection: ABA is nothing without data collection and documentation. Remember that ABA therapy is based upon measurable skills — you should be able to establish a clear baseline and see progress or lack of progress throughout your child’s ABA program. Providers should always return to the documented program plan and the data to support their decisions and program changes. They should also be able to explain this data to you in a way that helps you understand. Consider asking for examples of how providers document data and use it with current child clients (without identifying information, of course, to remain HIPAA-compliant).

How To Find an ABA Provider

Know that no ABA provider is the same. It may take some time to find one that’s right for your child and your family.

To find a qualified ABA provider, consider asking for recommendations from your child’s pediatrician, school administrators, or others who care for your child and who are familiar with ASD. Your health insurance provider will often have a list of ABA providers covered under your plan.

You can also find a BACB®-certified professional through the BACB® Certificant Registry, where you can search by certification type, status, location, or name. Similarly, consider using the Autism Care Network for a list of more than 20 sites across the U.S. and Canada. Autism Speaks also offers a Resource Guide to share ABA providers across the country.

Finally, you can conduct a web search for ABA providers in your area. Note that this may require you to do a little more vetting on your own, from evaluating certifications and education to investigating service offerings.

Are You Ready To Begin ABA Therapy for Your Child?

Are You Ready To Begin ABA Therapy for Your Child?

As you begin looking into ABA therapy for your child, you’ll begin by completing the intake process. Depending on your availability and any necessary insurance approvals, the process typically takes two to four weeks.

At Alternatives ABA, we’ll work closely with you to finalize insurance details so we can begin working with your child right away. Once we’ve received your submission, our team will review and reach out to set up an initial call. This will help us learn more about your child and answer any questions you may have. Our clinicians are highly experienced in ABA, OT, and SLP — but you are the expert on your child and the most critical member of our team. The more information you can provide, the faster we’ll be able to identify your child’s strengths and opportunities.

After that, we’ll schedule an in-person assessment and provide a personalized treatment plan for your approval. Services are available in our centers, in your home, or remotely via secure telehealth. We invite you to begin the intake process to join the Alternatives ABA community. Together, we’ll discover a brighter future — see the endless possibilities for your entire family!

Ready To Explore Endless Possibilities?