ABA Therapy for Autism

Applied Behavior Analysis (ABA) therapy is an effective evidence-based treatment for people with autism spectrum disorder(s). It is a science-based therapy that has been thoroughly researched and studied, created by O. Ivar Lovaas in the 1960s.^1,2,3

The premise that every behavior has a purpose is fundamental to ABA. Your child can express their needs and desires through their conduct. However, this behavior can occasionally be complex and challenging to understand. Following response and operant conditioning principles, ABA therapy uses evidence-based strategies to change significant behavior, including social skills, communication skills, reading, academic achievement, fine motor abilities, cleanliness, grooming, and job preparedness.⁴

The usefulness of ABA therapy as an evidence-based treatment for autism and other disorders was supported by growing clinical evidence in the 2010s. Today, it is acknowledged as the most popular and successful treatment for autism spectrum disorders and the behaviors that go along with them.

Many, but not all, autistic children benefit from rigorous, long-term therapy based on ABA principles, according to more than 20 studies. A program that offers 25 to 40 hours of treatment per week for one to three years is “intensive” or “long-term.” These studies demonstrate improvements in social functioning, language acquisition, daily living skills, and intellectual functioning. Although fewer studies apply ABA principles to adults, they all show similar advantages.⁵

Treating autism may involve additional therapies, including medication and speech-language. Autism treatment is not “one size fits all.” Instead, it’s customized to meet each learner’s needs, interests, and family situations.

Types of ABA Therapy

ABA therapy can incorporate a variety of different intervention approaches, including the following:⁶

• Discrete Trial Training: A skill is dissected into its parts and taught one step at a time. The three parts of this method are as follows:
  • The antecedent (something that triggers the behavior)
  • The behavior (the response to the trigger)
  • The conclusion (what happens after the response)

If the behavior is effectively created, the person will be rewarded; however, if the desired response is not successfully produced, they will not be awarded.

• Early Intensive Behavioral Intervention: This method can be used to teach social, adaptive, communicative, and functional skills to young children. Typically, it is highly customized and comprehensive.
• Early Start Denver Model (ESDM): This method is frequently used for autistic kids between 12 and 48 months. Play activities are used to promote verbal, social, and cognitive development.
• Natural Environment Training: People learn and practice new abilities in settings more similar to their native environments after acquiring them through discrete trial training. For instance, after learning a particular talent, a child can start using it at home or school.
• Comprehensive ABA Therapy: This method provides ABA treatments that typically last several hours daily. Each week, therapists or registered behavior technicians (RBTs) interact with the patient for at least a few hours in various settings, such as the individual’s place of education. In addition to working with the patient directly, ABA therapists may also train parents and other caregivers on techniques that can be applied outside of ABA therapy sessions.
• Focused ABA Therapy: This therapy assists a patient in a challenging circumstance. It could also focus on particular abilities that a person needs to develop. The patient frequently works one-on-one with a therapist, but they may also hone these abilities in community settings or small groups.

Moreover, ABA can take place at an ABA clinic or the home. ABA centers and home-based care emphasize independence and success skills for the home and community. Other critical life skills are also taught through these kinds of interventions.

According to research, the best approach might combine services provided at home and in ABA therapy centers. According to studies, children participating in ABA center-based programs significantly improved their linguistic, gross, and fine motor skills. On the other hand, children who took part in in-home ABA therapy programs significantly improved their social and self-help abilities.⁷

ABA therapy begins with thoroughly evaluating each patient’s abilities and preferences. This evaluation is used to write detailed treatment objectives. It’s also possible to include the family’s priorities and goals. The lesson plan breaks down skills into manageable, valuable steps. Then, the therapist walks the patient through each stage one at a time, starting with the easiest to the most difficult.

Data collection is done throughout each therapy session to track development. The patient’s progress toward their objectives is regularly assessed, thanks to data. In addition, the program professionals, participants’ families, and the board certified behavior analyst (BCBA) routinely meet to review the data. Afterward, they prepare and modify lesson plans and goals accordingly.

The therapist uses a variety of ABA techniques. When the autistic person leads some, the therapist guides others. To improve learning and skill practice throughout the day, parents, relatives, and other caretakers may also receive training.

Children with autism will have many chances to pick up new skills and practice them. This may lead to both planned and unplanned events. For instance, a child learning to introduce themselves to others would have the opportunity to practice this ability with their teacher in the classroom (planned) and on the playground during breaks (unplanned).

Students receive encouragement and reinforcement when they exhibit helpful abilities and socially acceptable conduct. Positive social relationships and pleasurable learning are prioritized. At the same time, problem behaviors are not encouraged or reinforced.

Goals vary with each individual. However, the primary goal of any ABA therapy program is to support each participant in acquiring daily living skills that will promote their independence and success in both the present and the future.

The following may be signs that ABA therapy is right for you, your loved one, or your child:⁸

• Defiance: Defiance is among the most prevalent behavioral issues in children. When a child defies authority, such as disobeying an adult’s commands, they act defiantly.
• Lack of focus: An indication of attention deficit hyperactivity disorder (ADHD) may include difficulty focusing.
• Aggression: Since aggression is a learned behavior, you must consider the causes behind a person’s aggression.
• Meltdowns: Those with anxiety frequently experience meltdowns, which may indicate a disorder or other issue(s).
• Lack of self-control
• Lack of speech and language
• Lack of social skills

While most states, including Tennessee, require insurance providers to pay for the cost of evidence-based therapies for autism treatment, several factors affect the overall cost of ABA therapy. Some of the most significant of those include:⁹

• Geographic location
• Supply and demand for ABA therapists
• Child’s level of autism
• Hours per week necessary (10-20 is usually more than enough)
• Therapist’s desired rates and level of experience
• Duration (in months or years) of time spent working with a specialist

Forbes estimates the annual cost of ABA therapy, excluding insurance, is about $17,000. However, it might range from $45,000 to $100,000 for some children with autism.¹⁰ In addition, therapy sessions can last anywhere between 20 and 40 hours per week. With all that in mind, an hour of in-home ABA counseling usually costs between $120 and $150.

Children with autism require an extra $17,000 in care per year on average, according to the Centers for Disease Control and Prevention (CDC). Compared to their neurotypical peers, children with severe autism may need an extra $21,000 a year.

ABA therapy is much less expensive with insurance coverage.¹¹ According to Tennessee state law, contracts and plans that offer benefits for neurological illnesses must also provide health insurance benefits for treating autistic children under the age of 12.¹² A decent assumption is that the cost of caring for one child with an autistic spectrum disorder under insurance coverage is around $30,000 annually.¹²

In addition, medically essential treatments for children under 21 must be covered by all Medicaid plans. Medicaid must pay the cost of ABA if your child’s doctor prescribes it and certifies that treatment is medically essential.

But once more, the costs listed above are averages that vary depending on area, provider, and plan, among other things.

Athena Care has multiple behavioral health clinics in Tennessee, and we’re in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the most efficient way to determine the specifics of your ABA therapy coverage.

Allow our highly qualified care coordinators to handle the hassles of contacting your insurance provider for more information. A care coordinator will review your plan and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared and discussed remains confidential.

When deciding on an ABA clinic in Tennessee, it’s important to trust your instinct. In addition, you can determine whether a provider will be a good fit for your family by asking questions, including but not limited to the following:

• Credentials: education, training, license, and years of experience
  • Ideally, a therapist should be a Registered Behavior Technician (RBT). In addition to completing numerous hours of ABA training, Board Certified Behavior Analysts (BCBAs) monitor and supervise RBTs.¹³
    • How often do BCBAs provide direct supervision to therapists?
    How many BCBAs are on staff?
  • If the patient is your child: Does the therapist have experience working with children similar in age and behavior? If so, in what capacity?
• How is it decided when services are no longer necessary?
• Treatment techniques and philosophies
  • Does the therapist use only ABA techniques, or do they inject other forms of therapy into a session?
  • What does parent or family involvement look like in a typical treatment session?
• What does a typical ABA session look like?
  • How long does a typical ABA therapy session run?
• How do you determine objectives?
  • Do you accept parental input?
• What are the hours/pricing/accepted insurances?

ABA therapy has been linked to several successful studies demonstrating its effectiveness, including the following:

• A long-term, comprehensive ABA program can assist autistic children in enhancing their language skills, social skills, intellectual functioning, and daily living abilities, according to one study.¹⁴
• ABA therapies successfully enhanced social interactions, adaptive behaviors, language proficiency, and cognitive ability, according to a 2011 analysis of 27 trials. Also, these interventions helped children and adolescents feel less hostile and anxious.¹⁵
• According to a 2012 study, children with autism must receive at least 25 hours per week of ABA therapy because it has been shown to increase play abilities, behaviors, language, and social interaction.¹⁶

1. Selva, Joaquín Bc. S. “What Is Evidence-Based Therapy: 3 EBT Interventions.” PositivePsychology.com, 27 July 2022, positivepsychology.com/evidence-based-therapy.
2. “Evidence-Based Treatment (EBT).” GoodTherapy.org Therapy Blog, 1 Apr. 2016, www.goodtherapy.org/blog/psychpedia/evidence-based-treatment.
3. Zauderer, Steven. “History of ABA Therapy: Who Invented ABA Therapy?” The Treetop Therapy. www.thetreetop.com/aba-therapy/history.
4. “Applied Behavior Analysis.” Psychology Today, www.psychologytoday.com/us/therapy-types/applied-behavior-analysis. Accessed 10 Oct. 2022.
5. “Applied Behavior Analysis (ABA).” Autism Speaks, www.autismspeaks.org/applied-behavior-analysis.
6. Cherry, Kendra. “How ABA Therapy Works.” Verywell Mind, 4 July 2021, www.verywellmind.com/what-is-an-aba-design-2794809.
7. Molko, Ronit. “Home-Based Vs. Center-Based Services for Autism.” Forbes, 24 May 2019, www.forbes.com/sites/forbesbooksauthors/2019/05/24/home-based-vs-center-based-services-for-autism/?sh=2474952b1d35.
8. The Healthcare Business Today Team. “7 Signs That Let You Know Your Kid Needs ABA Therapy.” Healthcare Business Today, 15 Dec. 2022, www.healthcarebusinesstoday.com/7-signs-that-let-you-know-your-kid-needs-aba-therapy.
9. Molko, Ronit. “What Is Covered? The Insurance Landscape for Autism Services.” Forbes, 18 Apr. 2019, www.forbes.com/sites/forbesbooksauthors/2019/04/18/what-is-covered-the-insurance-landscape-for-autism-services/?sh=133bbd3325c2.
10. “Autism and Insurance Coverage State Laws.” National Conference of State Legislatures, 24 Aug. 2021, www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.
11. “Autism and Insurance Coverage State Laws.” National Conference of State Legislatures, 24 Aug. 2021, www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.
12. “ABA Therapy Cost: What to Expect.” Thread Learning, 9 Oct. 2019, www.threadlearning.com/blog/aba-therapy-cost-what-to-expect.
13. Cicolello, Megan M. “How Can I Best Prepare for an ABA Therapist in My Home?” Autism Parenting Magazine, 21 June 2021, www.autismparentingmagazine.com/best-prepare-for-aba-therapist.
14. Virués-Ortega, Javier. “Applied Behavior Analytic Intervention for Autism in Early Childhood: Meta-analysis, Meta-regression and Dose–response Meta-analysis of Multiple Outcomes.” Clinical Psychology Review, vol. 30, no. 4, Elsevier BV, June 2010, pp. 387–99. https://doi.org/10.1016/j.cpr.2010.01.008.
15. Dawson, Geraldine, and Karen Burner. “Behavioral Interventions in Children and Adolescents With Autism Spectrum Disorder.” Current Opinion in Pediatrics, vol. 23, no. 6, Ovid Technologies (Wolters Kluwer Health), Dec. 2011, pp. 616–20. https://doi.org/10.1097/mop.0b013e32834cf082.
16. Maglione, Margaret A., et al. “Nonmedical Interventions for Children With ASD: Recommended Guidelines and Further Research Needs.” Pediatrics, vol. 130, no. Supplement_2, American Academy of Pediatrics (AAP), Nov. 2012, pp. S169–78. https://doi.org/10.1542/peds.2012-0900o.