ABA Therapy in Home vs Clinic Based Therapy

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What is ABA Therapy?

Applied Behavior Analysis (ABA) therapy is an evidence based treatment, which means effective, science-based therapy that’s been thoroughly researched and studied.^1,2 It is typically used for treating autism spectrum disorder (ASD).

The following symptoms may show that you or someone you love needs ABA therapy. It’s important to remember, though, that not everyone displays all or any of the following symptoms:

• Avoids or breaks eye contact
• Doesn’t respond to name by nine months
• Doesn’t display joyful, sad, angry, or astonished facial expressions by nine months
• Doesn’t engage in simple interactive games like pat-a-cake by 12 months
• Makes few or no gestures (i.e., does not wave goodbye) at 12 months
• By 15 months, does not share interests with others (i.e., shows you an object that they like)
• By 18 months, does not point to show you something intriguing
• At 24 months, does not recognize when others are harmed or unhappy
• By 36 months, does not observe or engage in play with other children
• By four years old, does not pretend to be someone else during play, such as a teacher or a superhero
• Does not perform for you in song, dance, or acting by five years old
• Sets toys or other items in a line and becomes irate if the order is changed
• Repeatedly uses the same words or phrases (called echolalia)
• Uses the same playstyle with toys every time
• Is concentrated on object components (for example, wheels)
• Upset by the slightest changes
• Possesses obsessive interests
• Must adhere to specified procedures
• Flapping hands, rocking the body, or circling oneself
• Demonstrates unique reactions to sounds, smells, tastes, sights, or feelings
• Delayed language and motor skills
• Delayed abilities in learning or thinking
• Inattentive, impulsive, or hyperactive behavior
• Seizure or epilepsy disorder
• Unusual sleeping/eating patterns
• Digestive disorders
• Unusual emotions or mood swings
• Anxiety, tension, excessive worry or the absence of fear, or unexpectedly high levels of fear

According to respondent and operant conditioning principles, ABA therapy employs research-based strategies to alter significant behavior, such as social skills, communication, reading, academic performance, fine motor skills, sanitation, grooming, and job readiness.³

ABA therapy services are not “one size fits all.” Instead, they’re tailored to each learner’s abilities, requirements, interests, preferences, and family circumstances. The program’s objective is to assist each participant in developing daily living skills that will increase their independence and success both now and in the future.

Programs for ABA therapy assist with the following:⁴

• Boosting language and communication skills
• Enhancing academic performance, social skills, memory, and focus
• Reducing problematic behaviors

ABA therapists will begin by thoroughly evaluating each patient’s abilities and preferences. This will be used to write detailed treatment objectives, and it’s also possible to include the family’s priorities and ambitions. The lesson plan divides skills into doable, practical steps. Then, the therapist demonstrates each stage individually, working from the simplest to the most difficult.

Development is monitored by gathering data throughout each therapy session. The person’s progress is continuously evaluated toward their goals thanks to data. The program personnel, participants’ families, and the behavior analyst routinely meet to review the data. Afterward, they can prepare and modify lesson plans and objectives accordingly.

ABA therapy can take place at home or in a clinic. The following illustrates the significant differences between ABA therapy in home vs center-based.⁵

The therapist employs a range of ABA techniques. Some are led by the therapist, while the autistic person leads others. Parents, relatives, and caregivers also receive training to enhance learning and skill practice throughout the day.

Children with autism will have numerous opportunities to learn skills and put them into practice.

Both scheduled and unplanned circumstances can result from this. For instance, a student learning to greet others would get to practice this skill with their teacher in the classroom (scheduled) and on the playground during recess (unplanned).

The student receives much encouragement when they exhibit helpful abilities and socially acceptable conduct. Positive social relationships and pleasurable learning are prioritized, while behaviors that are harmful or hinder learning are not reinforced.⁶

Benefits of In-Home ABA Therapy

The below are potential benefits of in-home ABA therapy:

• Familiar Environment:⁷ There’s nothing like the comfort of your own home. You or your child’s BCBA can observe behavior and understand how a typical day goes because you’re at home, which is your natural environment. Also, your child may be more willing to participate because they meet with their therapist in a welcoming and secure environment. In-home ABA therapy eliminates distractions and the need to adapt to a new environment.
• Convenience: You don’t have to travel anywhere to get therapy. This is another fantastic advantage of ABA therapy in home vs center. By coming straight to your door, the BCBA eliminates any potential difficulties you could experience when moving from home to a new setting. Treatment times are set up to accommodate your needs while the rest of your family’s routine is unaffected. In addition, early toddlers’ and children’s bodies and brains must grow and develop for parents and other caregivers to maintain a schedule that allows for appropriate nap times. This is difficult to follow in a clinical setting.
• Family Involvement: When the family is involved, ABA therapy is most effective. In addition to providing your child with high-quality treatment, qualified therapists instruct parents and other members of your child’s support network on how to participate in daily ABA therapy. Incorporating siblings and other family members in each session with in home vs clinic-based ABA therapy is simple. While your child’s therapist observes and guides you through each interaction, your child can practice social and communication skills with the family.
• Ability to Address In-Home Behaviors: Sometimes, some habits are more prevalent when your child is at home. A therapist can easily address these behavioral issues in their natural setting with home-based ABA therapy.

Benefits of Clinic Based ABA Therapy

The below are potential benefits of clinic based ABA therapy:

• Structure: According to some research, ABA therapy delivered in a center rather than at home may accelerate a child’s learning and development. This can be the case because your child finds it harder to focus when undergoing ABA therapy at home because they are more lured by comfortable distractions.
• More Supervision: You can find more BCBAs when you receive ABA therapy in a center. While having a BCBA visit your home produces favorable results, having multiple therapists observe allows them to work together and immediately exchange ideas.
• Supports the Move to Regular Environments: Most families of autistic children want their child to transfer to typical settings like a classroom. Your child can practice that transition much more quickly in center-based ABA therapy than at home. Therapists can set up various scenarios in a facility, such as those that mimic the classroom, where they’ll have opportunities for socialization.
• Social Engagement: The chance to practice social contact is one of the critical benefits of center-based ABA therapy. Your child can apply their learning within their individualized treatment plan without leaving the building.

Cost & Insurance Coverage for ABA Therapy

While many insurance carriers are mandated to cover the cost of evidence-based therapies for autism treatment in most states, including Tennessee, a variety of factors influence the overall cost of ABA therapy. Some of the most significant factors include:

• 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 each year for some children with autism.⁸ In addition, therapy can range from 20 to 40 hours a week. With all that in mind, an hour of in-home ABA therapy typically costs $120 – $150.

According to the Centers for Disease Control and Prevention (CDC), children with autism require an average of $17,000 more in care annually than children without the condition. Children with severe autism may need an extra $21,000 per year compared to neurotypical peers.

Again, however, the above are average expenses that depend on various factors, including location, provider, and plan.

Thankfully, ABA therapy is far less expensive with insurance coverage.⁹ 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 12.¹⁰ A good generalization is that insurance coverage for behavioral health services pays about $30,000 annually for caring for one child with an autism spectrum disorder.¹¹

Insurance may be able to help cover the cost of therapy. Find out if your insurance provider can help with the costs by calling your insurance company.

How to Choose the Best ABA Therapy

When deciding on applied behavior analysis services in Tennessee, it’s crucial to remember that a therapist will potentially be assimilating into your family’s daily routine for a prolonged period with ABA therapy in home vs center-based.

Whichever treatment you decide to proceed with, it’s essential to verify information and ask plenty of 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.¹²
  • If the patient is your child: Does the therapist have experience working with children similar in age and behavior? If so, in what capacity?
• Specialties and services offered
  • 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 insurance companies do they work with?
• What are their hours?
• Pricing?
• How long does a typical ABA therapy session run?