What Is ABA Therapy? How Does It Work?

ABA therapy, or Applied Behavior Analysis therapy is a type of therapy that revolves around the science behind behavior and learning.

reuben kesherim
Published By Ruben Kesherim
July 7, 2023

What Is ABA Therapy? How Does It Work?

What is ABA Therapy?

ABA, or Applied Behavior Analysis therapy is a type of therapy that revolves around the science behind behavior and learning. It is designed to help people with autism overcome learning and behavioral challenges that prevent them from integrating effectively into society, school and the workplace.

ABA therapy is highly tailored to each individual person with autism. What one person with this condition undergoes in his or her ABA therapy can vary dramatically from what another person experiences and learns in his or her own therapy sessions.

This type of therapy also involves one-on-one sessions with highly trained and licensed mental health professionals, such as registered behavior technicians, or RBTs, as well as Board Certified Behavior Analysts, or BCBAs.

These mental health professionals adapt therapy sessions as clients' needs and behaviors change over time.

The ultimate goal of ABA therapy is to help people with autism become as independent and capable as possible by improving social skills, such as communicating, making eye contact, holding logical and meaningful conversations and planning and organizing one's day effectively.

ABA therapy is likewise designed as an early childhood intervention resource for parents and caretakers of children with autism. Therapy can begin as early as when a patient is just a few years old, and in some cases younger than that. It can also continue until the patient is as old as 18 to 21 years of age, if not older.

Who Does ABA Therapy Help?

ABA therapy is designed primarily to address behaviors and learning challenges in people with autism. In fact, many doctors, mental health providers, parents and caretakers regard it as a vital resource in addressing the main symptoms of this condition.

This type of therapy uses positive reinforcement to introduce and solidify effective behaviors, learning skills and communication. It has proven successful in helping people with autism remain in school, learn coping mechanisms and social skills that let them integrate better into society and, in some cases, work jobs and become self-sufficient.

However, ABA therapy can also help other people who struggle with behavioral or communication disorders. Some of the conditions this type of therapy can be used to address include:

  • Dementia
  • Substance abuse
  • Cognitive challenges resulting from brain injuries
  • Borderline personality disorder
  • Eating disorders
  • Anger issues

It can also be used to address common mental health conditions like:

  • Anxiety
  • Panic disorder
  • Obsessive compulsive disorder
  • Phobias

People with these conditions can benefit from ABA therapy and regain important social skills they need to resume their normal everyday lives.

For the most part, however, ABA therapy is regarded primarily as a tool for addressing symptoms of autism. People who take part in it learn vital skills like how to get dressed, brush their teeth, make simple meals and perform other basic tasks needed to live independently or semi-independently.

How Does ABA Therapy Work?

ABA therapy involves a variety of methods used to address learning and communication challenges in people with autism. It is a highly flexible resource and can be adapted as the support and learning needs of each client varies. It can also take place at school, in the home or in a medical or mental health environment.

The primary goal of ABA therapy is to teach skills that are most useful in everyday life.

Many sessions involve one-on-one time with a mental health professional. However, some ABA therapy sessions can involve learning in groups.

Regardless, ABA therapy primarily focuses on using positive reinforcement to gain desired behaviors and learning and communication skills in clients.

Positive reinforcement can come in the form of getting a reward, such as a toy or sticker, when the patient demonstrates or learns the desired behavior. Positive reinforcement is more likely to garner repeat desired behaviors and help patients learn what they are supposed to do and how they are supposed to act better.

ABA therapy also involves the use of what is called the ABC Steps. ABC in ABA therapy stands for Antecedent, Behavior and Consequence.

The antecedent is what takes place prior to the desired behavior. The behavior is the response to the antecedent, and the consequence is the result of the behavior. These steps are designed to teach patients how to learn, communicate and behave effectively in everyday life.

What Does an ABA Program Involve?

Despite being highly tailored to each individual patient, an ABA program includes components that are the same for everyone enrolled in it. The program starts with the parent or caretaker of a child with autism meeting with a trained ABA therapy provider.

This provider and the parent or caretaker discuss how the child behaves, what symptoms he or she exhibits and what behavioral and learning challenges the child faces.

The next component of the ABA program involves coming up with a plan for addressing these challenges. The plan will be designed for each person's specific needs and focus on reaching certain behavioral and learning goals.

Interventions included in plans for patients can include:

  • Early intensive behavioral intervention, or EIBI
  • Discrete trial training
  • Pivotal response training
  • Early start Denver model, or ESDM
  • Verbal behavioral interventions

Whether or not any of these interventions and what specific ones are used will depend on a variety of factors, such as a patient's age and behavioral and learning challenges he or she experiences most often.

The last two components of an ABA program will involve caregiver or parent training, as well as frequent evaluations.

It is vital that the person or people caring for the child with autism know how to guide behavior and learning toward the desired goals. Evaluations also ensure goals are being met in a timely and reasonable fashion.

ABA Techniques and Philosophy

The underlying philosophy of ABA therapy revolves around using positive reinforcement to gain the desired behaviors and communication skills in clients. Sessions can involve learning skills from a licensed mental health professional. However, the mental health professional can also take cues from the patient and follow them to design specific sessions tailored for him or her.

Techniques used in sessions also teach clients how to behave in practiced settings as well as in naturally occurring events outside of the classroom, medical or mental health environment or home.

For example, a client may learn how to say hello and shake a person's hand or give a hug in practice sessions during ABA therapy. With positive reinforcement, the same client will know how to exhibit this behavior if or when it occurs outside of the ABA therapy setting.

Positive reinforcement has been shown to garner more successful instances of repeat desired behaviors in patients.

It helps ABA therapy offer high success rates in addressing autism in children.

It should be noted, however, that positive reinforcement is never used to encourage undesired behaviors, such as tantrums or violence, in clients. Clients receive no praise or rewards for engaging in these kinds of actions.

Who Provides ABA Services?

A variety of mental health professionals can provide ABA services to people with autism. Most ABA services fall under the supervision of mental health providers known as Board Certified Behavior Analysts, or BCBAs. BCBAs have master's degrees in areas like education or psychology.

They additionally have sat for and passed the required state board exam to become fully licensed behavioral analysts.

BCBAs may supervise other mental health professionals who likewise are capable of providing ABA services, however. One of the most common mental health provides who initiate and guide sessions is an RBT, or registered behavior technician.

This technician typically has an undergraduate degree in psychology or education and can provide ABA therapy services as long as he or she remains under the supervision of a BCBA.

Many RBTs serve as the initial contact in ABA services and are most hands-on with ensuring patients get the tailored services they need during sessions.

Finally, licensed clinical therapists can likewise provide ABA services. They have the professional training to work hands-on with people of all ages who show signs of autism. They also have educational credentials that can include a master's degree in psychology or education.

Many therapists also obtain doctoral degrees in clinical psychology. They are capable of designing and holding ABA therapy sessions without having to remain under the supervision of a BCBA.

What is the Evidence that ABA Works?

Medical and mental health authorities like the U.S. Surgeon General and the American Psychological Association regard ABA therapy as an evidence-based best practice treatment for conditions like autism.

It garners the label as “evidence based” because it has undergone numerous scientific tests designed to gauge its usefulness, effectiveness and quality in treating patients with autism.

Further, it is evidence-based, in part, because it entails a variety of methods used to address autistic symptoms and behaviors in patients.

All of the methods revolve around antecedents, or what takes place before a certain behavior, and consequence, which occurs because of the behavior in response to an antecedent.

Even more, dozens of studies have shown that long term or intensive ABA therapy services provide the best outcomes for most patients with autism. That is to say, patients get the best results when they remain in ABA services for at least one to three years. They most notably show improvements in areas like:

  • Social functioning
  • Daily living skills
  • Language development
  • Intellectual functioning

The same studies show adults who likewise engage in ABA therapy services show improvements in the same areas.

Is ABA Covered by Insurance?

Private healthcare insurance companies may cover some or all of the costs of ABA therapy services. This coverage can largely depend on where clients and their parents or caretakers live. Coverage likewise relies on whether or not a pediatrician or other medical provider deems the ABA therapy services to be medically necessary for the patient in question.

However, Washington D.C., as well as 38 states, require healthcare insurance companies to cover medically necessary ABA therapy services for children with autism.

Likewise, Medicaid will also cover it as long as a healthcare provider like a pediatrician prescribes it for the covered patient.

It is important to note that, in many states, children with autism may be eligible for Medicaid coverage. This coverage can act as secondary to the primary healthcare insurance of parents or caretakers who have custody of children with autism. It can also act as a primary source of healthcare coverage if the parent or caretaker has no other form of health insurance.

This coverage may pay for most or all of the costs of ABA therapy services for children with autism. Parents and caretakers can ensure their children receive the services they need to address challenges associated with autism without worrying about paying expensive therapy bills.

Where Do I Find ABA Services?

Parents and caretakers of children with autism can use a variety of methods to find ABA services where they live.

They can start by talking with their children's pediatrician and asking whether or not ABA therapy could be a viable option for addressing autistic challenges and behaviors.

The pediatrician may provide a prescription for ABA therapy services if the child's insurance requires it before services begin.

Parents and caretakers can then find out how much coverage their health insurance provides and what their specific benefit is for these services. If needed, they can also use online resources to find ABA services in their area or ask their pediatrician or their child's special education providers for recommendations.

They can then contact their desired ABA provider and request an evaluation. They are encouraged to have a list of questions ready to determine whether or not the provider can offer effective services, as well as whether or not the services may be the best option for addressing their children's autistic behaviors.

These questions can include:

  • Are the services licensed through the state?
  • How many BCBAs and other mental health providers are on staff?
  • What type of insurance does the provider accept?
  • Is there a wait list for services?
  • How many hours of services per week can a patient receive?
  • How is patient progress monitored and evaluated?
  • What does a typical ABA session with the provider look like?

Parents and caretakers can also inquire about how much supervision mental health providers undergo and whom provides their supervision while working with patients with autism.

References:

  1. https://www.autismspeaks.org/applied-behavior-analysis 
  2. https://www.webmd.com/mental-health/what-is-applied-behavior-analysis 
  3. https://www.spectrumnews.org/features/deep-dive/controversy-autisms-common-therapy/ 
  4. https://www.healthline.com/health/aba-therapy