ABA vs. ABA Therapy
What is Applied Behavior Analysis?
Applied Behavior Analysis (ABA) is the science of understanding behavior. This method was created by B.F. Skinner in the 1920’s. The purpose of the field of ABA is to create significant change for individuals who may be struggling to create positive change. This is done by taking data, observing, and analyzing the environment to address the root issues. Once data is collected and all variables are considered, this is used to create personalized interventions to assist the individual or animal. The ultimate goal of teaching any skills utilizing ABA is to generalize any skills being taught. This means a skill that might be taught at home or with parents, should be able to be implemented with other people and in other public settings. Delivery of the strategies may look different depending on the practitioner's purpose, values and training.
In the field there are currently 3 roles you can take on: a registered behavior technician (RBT), board certified behavior analyst (BCBA), or a BcABA (assistants to BCBA’s).
An RBT’s training typically requires a bachelor's degree and a minimum of 40 hours of online course training and a competency exam. A BCBA’s training requires a minimum of a master's degree, a competency exam, along with 2,000 hours of fieldwork supervision by another BCBA.
The application of ABA is a tool widely used in therapy for children, animal training, organization behavior management for corporate companies, environmental science, physical fitness training, life coaching, teaching, nutrition, marketing, and more.
What is ABA Therapy?
The term “ABA therapy” started in the 1950’s by a clinical psychologist Ivar Lovaas, who expanded on Skinner’s ABA concepts as a way to help the lives of autistic children. The method of ABA became more widely known when in 2014 the Affordable Care Act required insurance to cover medically necessary treatment of children with Autism.
In today’s society, there are many ABA clinics companies who operate under insurance and offer ABA therapy for children with autism. The purpose of these clinics are to teach autistic individuals socially significant skills based on a comprehensive assessment.
In an ABA therapy company, you will typically have two professionals you come in contact with. An RBT (the direct therapist who works with the child) and a BCBA/BcABA (a program manager who runs the assessments, creates the programs, supervises the RBT’s training, and provides parent training).
Where does ABA therapy take place?
ABA therapy can take place in the home of the family, in an ABA clinic, schools, and within community outings such as going to the playground or going grocery shopping. The location will depend on what each individual ABA company offers.
How do ABA companies determine the number of hours my child gets?
Once insurance has approved a family, a company BCBA will run a specific assessment on the individual. Once the assessment is completed, a report will be written to submit to insurance, including a requested number of hours. These hours should be based on the level of support an individual needs and what the assessment results show.
It is important to note that while ABA companies will give a recommended number of hours to caregivers, caregivers have the right to decline or request a different number of therapy hours. Discuss this with your BCBA to understand why those hours are recommended.
What is the difference between ABA therapy and other types of therapies such as speech or OT?
ABA training focuses on understanding root causes of behaviors (why we do what we do), analyzing behaviors, and understanding how to modify the environment and break down behaviors into smaller steps to help an individual succeed when feeling overwhelmed. This tool can technically be applied to any type of therapy or goal, and most therapists from different fields already utilize ABA strategies without realizing it. However, ABA is most often referred to for those who struggle with challenging behaviors or habits and need assistance with how to respond.
In an ABA clinic, they will work on a variety of life skill goals based on the assessment they run. This may look like increasing engagement, trying new foods, toileting, or communicating needs. If the child has additional therapies such as occupational therapy or speech, your ABA therapist should be collaborating and requesting goals from their other therapies to ensure goals are being incorporated and generalized into their sessions.
Are all ABA Therapy Companies the same?
No. Just like there are different teaching methods or different philosophies on health, there are a variety of approaches and delivery methods that an ABA company can use. Approaches will depend on the training and values of the company so it is always helpful to ask questions on what those are. Goals may also vary based on the type of assessment the BCBA utilizes.
Additional differences may include differences in behavioral philosophy such as:
Methodological Behaviorism: Believes only in providing interventions based on what we can observe on the outside.
Radical Behaviorism: Believes in considering internal behaviors as well as external behaviors such as thoughts and feelings when providing interventions.
Methods and deliveries of how programs are run may also vary from company to company such as using:
Natural Environment Training (NET), Skills Based Training (SBT), Joint Attention Symbolic Play Engagement and Regulation (JASPER), Precision Teaching & Acceptance Commitment Therapy (ACT), Discrete Trial Training (DTT), and more.
It is important to recognize that ABA teaching methods are not used just in ABA but in many fields by doctors, teachers/professors, nurses, speech therapists, play therapists, and more—but it may not be called “ABA”.
Becoming a BCBA is just the beginning
Let me tell you about a time where I was ruled by fear – the fear of failing the BCBA exam. It wasn't just about passing a test; it was about my entire sense of worth. When I failed the first time around, it’s difficult to put into words the sense of worthlessness I felt. I had tried the usual routes, applying behavior analytic principles: task analysis, study groups, and the works. But something was missing. The breakthrough came when I realized I needed to look deeper, to embrace a more holistic approach. In my second round of studying, that sense of worthlessness stirred something in me. I dissected my emotions like behaviors, dove into trauma-informed therapy, and confronted the ghosts of my past. I unearthed the driving forces behind my fear – childhood wounds, past traumas, and my current relationships. It wasn't linear. It was messy, years of probing, testing, and letting go of previous parts of myself. I learned the power of vulnerability and self-awareness, but more shockingly, I passed that second round.
A small part of me believed the letters 'BCBA' would magically fix everything. I imagined a balanced life with clarity, confidence, and mastery in my skill sets. But the truth is, the letters alone didn't change everything. They were a beginning, not an end. The real transformation happened when I integrated compassionate, non-traditional ABA principles, emotional regulation, and my own lived experience into the work that I do. That's the passionate transformation I want to offer you, a focus on professional development and self-care.
I know what it's like to feel trapped by fear, to desire a life where work isn't a burden, but a passion. My journey may be unique, but my struggles are universal. We all have barriers, but few have the courage to face them head-on, to learn the art of resilience. I've walked the path of making mistakes, confronting uncomfortable truths, and rebuilding myself from the ground up. Now, I wake up every day excited for my work, and confident in the work I do, a feeling I never thought was possible. I've learned to be my own best advocate and I feel alive.
Imagine a life where you're not just a BCBA, but a truly empowered clinician or therapist. A life where you conquer your fears, find your purpose, and practice what you love. That's the transformation I offer you through mentorship and coaching. It's not a quick fix; it's a journey, a deep dive into yourself. But the freedom, the fulfillment, the 'I love what I do' feeling is worth every step.
Sensory Processing, FAQ’s & Solutions
If you are a therapist, clinician, or teacher, it’s important to understand how sensory processing can impact children and adults. The vestibular system, (which largely impacts sensory processing challenges), is responsible for balance, motion, and movement. It can impact a person’s ability to process information, both from the body awareness and cognitive level (such as executive functioning skills). Executive functioning skills include cognitive skills such as impulse control, memory, problem solving, planning, and focusing.
What does the vestibular system do?
Provides you with a sense of balance and an awareness of your spatial orientation (Am I upside down? Am I sideways?)
Orient information about the speed and direction of movement (How fast are you going?)
Facilitates posture and a stable base for visual and auditory information
Regulates muscle tone
Signs of an Inefficient Vestibular System:
There are two types of sensory processing challenges, and many kids experience a mix of the two. One is oversensitivity (hypersensitivity). This leads to sensory avoiding—kids avoid sensory input because it’s too overwhelming. The other is undersensitivity (hyposensitivity). This causes kids to be sensory seeking—they look for more sensory stimulation because they may not be getting enough.
Hypersensitivity/ Over Response:
-Fearful of Heights (playground equipment)
-Does not like feet off the ground
-Sensitive to touch (people touching, playdough/gooey items, etc.)
Hyposensitivity/ Under Responsive:
-Needs more input
-Craves spinning/swinging
-Difficulty sitting still and remaining in seat
For additional information you can refer to:
Sensoryprocessing101.com
sensationalbrain.com
HYPERSENSITIVITY (OVER-RESPONSE)
HYPERVISION means that their vision is too acute. For example, they notice the tiniest pieces of fluff on the carpet, complain about ‘moths (air particles) flying’, dislike bright lights, look down most of the time and may be frightened by sharp flashes of light. Under fluorescent lights such children can see a 60-cycle flickering: the whole room pulsates on and off.
Individuals with HYPERHEARING are generally very light sleepers, are frightened by sudden unpredictable sounds (for instance, telephone ringing, baby crying); they dislike thunderstorm, crowds and are terrified by haircut. They often cover their ears when the noise is painful for them, though others in the same room may be unaware of any disturbing sounds at all. Sometimes hyperauditory children make repetitive noises to block out other disturbing sounds.
Children with OLFACTORY HYPERSENSITIVITIES cannot tolerate how people or objects smell, though their carers can be unaware of any smell at all. They run from smells, move away from people and insist on wearing the same clothes all the time. For some, the smell or taste of any food is too strong, and they reject it no matter how hungry they are. They are usually poor eaters, gag/vomit easily and eat only certain foods.
Some individuals with ASDs are HYPERTACTILE. They pull away when people try to hug them, because they fear being touched. Because of their hypertactility, even the slightest touch can send them into a panic attack. Parents often report that washing their child’s hair or cutting nails turns into an ordeal demanding several people to complete it. Many individuals refuse to wear certain clothes, as they cannot tolerate the texture on their skin. Some children with hypertactility overreact to heat/cold, avoid wearing shoes, avoid getting ‘messy’ and dislike food of certain texture.
Children with VESTIBULAR HYPERSENSITIVITY experience difficulty changing directions and walking or crawling on uneven or unstable surfaces. They are poor at sports. They feel disoriented after spinning, jumping or running and often express fear and anxiety of having their feet leave the ground.
Individuals with PROPRIOCEPTIVE HYPERSENSITIVITY hold their bodies in odd positions, and might have difficulty manipulating small objects.
HYPOSENSITIVITY (UNDER-RESPONSE)
Sometimes the senses of children are in ‘hypo’, so that they do not really see, hear or feel anything. To stimulate their senses they might wave their hands around or rock forth and back or make strange noises.
Children with HYPOVISION may experience trouble figuring out where objects are, as they see just outlines, then they may walk around objects running their hand around the edges so they can recognise what it is. These individuals are attracted to lights, they may stare at the sun or a bright light bulb. They are fascinated with reflections and bright coloured objects. Having entered an unfamiliar room they have to walk around it touching everything before they settle down. Often they sit for hours moving fingers or objects in front of the eyes.
Children with HYPOHEARING may ‘seek sounds’ (leaning their ear against electric equipment or enjoying crowds, sirens and so on). They like kitchens and bathrooms – the ‘noisiest’ places in the house. They often create sounds themselves to stimulate their hearing – banging doors, tapping things, tearing or crumpling paper in the hand, making loud rhythmic sounds.
Individuals with HYPOTASTE/HYPOSMELL chew and smell everything they can get (e.g. grass, play dough). They mouth and licks objects, play with feces, eat mixed food (for instance, sweet and sour) and regurgitate.
Those with HYPOTATILITY seem not to feel pain or temperature. They may not notice a wound caused by a sharp object or they seem unaware of a broken bone. They are prone to self-injuries and may bite their hand or bang their head against the wall, just to feel they are alive. They like pressure, tight clothes, often crawl under heavy objects. They hug tightly and enjoy rough and tumble play.
Children with VESTIBULAR HYPOSENSITIVITY enjoy and seek all sorts of movement and can spin or swing for a long time without being dizzy or nauseated. People with vestibular hyposensitivity often rock forth and back or move in circles while rocking their body.
Those with PROPRIOCEPTIVE HYPOSENSITIVITY have difficulty knowing where their bodies are in space and are often unaware of their own body sensations, for example, they do not feel hunger. Children with hypoproprioceptive system appear floppy, often lean against people, furniture and walls. They bump into objects and people, stumble frequently and have tendency to fall. They have a weak grasp and drop things.
*Source from IntegratedTreatmentServices
Solutions
Hypersensitivity (Over-Responsive)
Use cup in place of water fountain
Recess Time: Swings, slide, sitting up, avoid go around
Provide opportunity for movement: run errands, assist teachers
For tactile (touch) sensitivity:
Give advance verbal warning
Help them set boundaries (teach them to state “I don’t like that” / “It hurts”)
Do “heavy work” -push, pull, climb, lift items; (this helps them calm and organize their body)
Adapt activities/artwork for sensitivity (i.e.instead of squeeze glue have Glue Dots or Glue sticks ready for them instead)
Use ear plugs/ear muffs for those with hyperhearing
Sensory “tent” (quiet time without stimuli)
Hyposensitivity (Under-Responsive)
Adaptive Seats: Use a Ball Chair, Air-filled cushions, tennis balls, yoga ball, rocking chair-- anything that provides input
Movement Breaks (errands, stand at desk, etc.)
Do not take recess privilege away
Recess time: Rotary Swing, slide on tummy
Schedule movement prior to seat work or any sitting activity
Provide Sensory Gym time
Use Weighted Vest / Pressured Garments
Deep Pressure Squeezing on the arms and legs
Fidget toys (provide during circle time/seating time)
Chewable Jewelry
CamelBak® water bottle is a good outlet for constant chewing
Have a Sensory Bin: Sand, rice, beans, cotton ball, dried oatmeal, pom pom’s, leaves, playdough, small exercise balls, squishy items, spikey items, soft items, bubble wrap, etc.
(Can call it a “break” box)Look into a sensory diet (OT’s would do this)
Provide calming music
Foot Fidget: tie a piece of exercise band around the base of the front legs or a desk or add this foot fidget to the desk to give busy legs something to do
Cup for drinking water/milk with a chewy straw to help with chewing
Designated “special place” for lining up (front or back)
Rocking back and forth with a partner to row row row your boat song
Yoga: especially the inverted pose
Cuddle / Pod swing
1. Develop a crash/quiet corner AKA Sensory corner
Sensory-seeking students should have a place to get out some energy, and a corner with a few pillows can be just the place. This allows them a place to seek more physical sensory input by falling or crashing on the pillows. For further sensory input, you could even provide a heavy blanket or weighted lap pad and fidget toy, maybe even some squeezy balls or squeezy slime. This would allow a sensory-seeking student the physical sensation they crave. On the other hand, an overstimulated student can escape to the same quiet corner. Consider arming this corner with sunglasses or headphones for hearing protection for the sensory-avoiding student.
2. Consider heavy work
Sometimes sensory seeking students need a bit of “heavy work” to give them sensory input. It may be as simple as moving a desk or a stack of books — but it gives the sensory seeking body some big-muscle exercise and can result in a well-balanced sensory student. Consider teaming up with another teacher and having your sensory-craving student move heavy books/object from one classroom to another, or have a sensory-seeking student help you put up chairs at the end of the day. Alternatively, remember that a sensory-avoiding student might need a break from large body movement.
3. Space
A hypersensitive child might be overwhelmed at the sights, sounds, and even smells of the classroom. Don’t be afraid to give them space and time. If they are consistently overwhelmed by the closeness of their fellow students, giving them a special spot in the classroom that maximizes their personal space can help. Consider the hypersensitive child’s visual environment as well; while most children love a brightly-colored classroom, a particularly sensitive child might need a view that is a bit more barren.
4. Recess
Use recess to your best advantage. Encourage hypo-sensitive children to run and swing, making large-muscle movements that will help them balance their sensory needs for a calm body in the classroom. At the same time, allow hypersensitive children to withdraw from the noise and activity of their classmates and stay inside to read or relax.
5. Fidget
Sensory seekers often have roaming hands. Keep those hands full or busy — arm sensory seekers with stress balls or provide a small strip of rough aplix attached to the bottom of their desk. Some sensory seekers enjoy wearing rubber-band bracelets or have special pencil holders that give them the input they crave.
6. Take a seat
Some solutions for sensory seekers can be implemented right where they sit. A large rubber band or exercise band around the legs of a desk can provide a sensory-seeker an opportunity to push, bounce, or pull at the band and decrease other movements that might disrupt the classroom. Some students respond well to the sensory input of bumpy seat cushions. Some teachers have even replaced all of the seats in their classroom with exercise balls, which allows all children to work out their wiggles during the day.
Whether seeking or avoiding, children learn best when their sensory systems are well-balanced. A few well-placed tricks can help with classroom management and also allow opportunities for enjoyment of education in students who might not otherwise learn well. These solutions can work not only for diagnosed sensory students, but for any student who might benefit from them.
TYPES OF SENSORY INPUT:
Sight: Visual patterns, certain colors or shapes, moving or spinning objects, and bright objects or light.
Smell: Specific smells. Some kids like to smell everything, while some kids are able to detect—and object to—smells that other people don’t notice.
Hearing: Loud or unexpected sounds like fire alarms or blenders, singing, repetitive or specific types of noises (like finger snapping or clapping).
Taste: Specific tastes (like spicy, sour, bitter, or minty) and textures (like crunchy, chewy, or mushy), chewing or sucking on non-food objects (like shirt sleeves or collars).
Touch: Touch from other people, touching and fiddling with objects, tight or soft clothing, and certain textures or surfaces.
Heavy Work/Proprioceptive FAQ:
Which therapist provides support for this?
Occupation therapists who specialize in sensory processing typically specialize in this area (keep in mind not all occupational therapists have this training)
What is heavy input or proprioceptive activities?
Any activity that requires using the core or our muscles. Think weight lifting. Painting with a paintbrush may feel good as a sensory activity, but it is not necessarily a heavy input activity because you may not be using much muscle for that.
What are examples of heavy input activities? Anything with…
Crawling/climbing
Pushing heavy items
Pulling
Bouncing
Chewing
Carrying heavy items
Examples can include cleaning such as using a vacuum, pushing a heavy buggy cart, bouncing on a ball, carrying a grocery bag, obstacle courses that require crawling on the floor, climbing foam blocks as an obstacle course, pulling stretchy bands, stomping feet, pushing the wall, pulling velcro, chewing on a chew, moving furniture, jumping jacks, lifting a heavy lid, playing with theraputty (not regular putty), catching or pushing a weighted ball
How often and when should proprioceptive activities be offered?
Prior to circle time or any sitting activities
After any long period sitting task (including meals)
Heavy input activity should also be offered as one of the free play choices
More than one activity should be offered at all times (free access)
How long can a child sit still or attend based on science?
2 year old: 4-6 minutes (10 minutes if it is a highly preferred activity)
3-4 year old: 5-15 minutes (15 minutes if its a highly preferred activity)
Signs a child needs a heavy work activity?
Climbing furniture
Pushing furniture
Running back and forth multiple times
Spinning
Biting/chewing random items
Bending over backwards or extending their body in some way
Holding or squeezing an object very tightly
Bangs a body part repetitively or a an object repetitively
REMINDERS:
ORAL: Remember for Oral sensory seeking (such as chewing), it’s not that they WANT to chew. It’s that they have an oral sensory NEED to chew. Telling them to stop is not going to help. Instead, you want to give them a safe outlet to chew on.
TOUCH: Everything in your world is affected by the way your tactile system interprets it…hugs, clothing, the grass or sand under your feet, the food you eat, the coffee you drink. All of these things have one thing in common- Touch. The tactile system is invaluable in developing emotional security, social skills and academic learning.
VESTIBULAR: Your vestibular system provides you with a sense of balance and an awareness of your spatial orientation (Am I upside down? Am I sideways?) It orients information about the speed and direction of movement (How fast are you going?) and facilitates posture and a stable base for visual and auditory information.
If you're under-responsive to vestibular input, you may be able to tolerate a lot of movement before it registers, therefore your body may be in constant motion. If you are over-responsive, or hypersensitive, to vestibular input, you may not be able to handle movement at all! Because of this difficulty, you may avoid activities that challenge your balance and coordination.
Classroom Routine flexibility:
Flexibility in offering a sensory break during any routine activity is very important for the purposes of preventing big behaviors and feelings from occurring and ensuring a child’s needs are being met. If a child walks away from a routine activity, offer an engaging sensory or heavy input activity. Once this occurs, you can bring them back to the task or activity at hand. If it appears they need more, you can prompt “more time” and offer more.
Consistency is Key. If you attempt to provide an adaptive object, refrain from simply offering it once or expecting it to be effective after one attempt. Repetition is key, as well as Teaching the individual how to use it as a replacement. Most importantly, ensure assent-- the agreement through body language, gestures, or vocal communication by the child or client that they are okay with receiving this alternative. If it appears they find it aversive or they do not want it, it’s time to get creative, and remember to break it down when introducing it!
Sensory processing challenges can often stem from developmental delays or abnormalities in the brain activity of an individual, side effects of medications, passing on of certain genetics, epigenetics of trauma, and more.
Who is the expert? Discerning the difference between a behavior analyst, pediatrician, neuropsychologist, occupational therapist, psychologist, and special education teachers
Often times, it is difficult for parents, teachers and even clinical professionals to navigate who the expert is in diagnosing a child, providing therapy, or addressing specific concerns. Below, I have pasted a list of common fields that get misconstrued for their expertise:
You’ll often find that behavior analysts or behavior technicians working in the behavioral therapy field within autism. But keep in mind, that they do not specialize in autism or necessarily have thorough training in neurodivergent development. They specialize in analyzing behavior and using evidence-based tools to create (overt) behavior change for individuals.
Not all people who specialize in behavior are behavior analysts. They may be RBTs, BCaBAs, or just behavior specialists with a master’s degree. To be a behavior analyst you had to have passed the licensure exam and completed several supervision hours. Because our field is often working in the autism field, many parents may refer to BCBAs to answer questions about their child’s autism. However, it is important to recognize that our training and education do not necessarily include courses specifically on autism, therefore if you are looking to understand autism and the way their brains are wired, it is better to seek out an autism expert.
Pediatricians do not diagnose, assess, or understand autism or other diagnoses (unless they specialize in this). They specialize in the basic developmental life stages of a child.
I have heard many times parents tell me that their child doesn’t have autism because their pediatrician said they don’t. Eek! It’s important to note that pediatricians do not have the authority or training to diagnose if a child has any disability. What they can do is assist you with discerning if your child is meeting appropriate milestones, if they are eating enough and getting enough nutrient, or to treat health conditions (such as fever, pink eye or ear infection).
Neuropsychologists do not specialize in behavioral or therapeutic experts. They are experts in evaluating and diagnosing an individual (such as with autism, ADHD, etc).
These are the people you want to seek out if you are looking for a diagnosis (especially autism). They may recommend behavioral therapy, speech, or occupational therapy for an individual— but they are not experts in any of those fields.
Occupational therapists are not necessarily experts in physical therapy (and vice versa) or sensory integration. They are experts in motor skills to assist with performing activities in daily life due to setbacks (i.e injury, illness, disabled)
These experts take a holistic approach and focus on motor skills/fine motor skills to assist with specific day-to-dayy tasks. *Not all occupational therapists have knowledge or experience in sensory integration, they had to have had specific training in this field- always ask if they are trained in this if you are not sure! (Sensory integration can assist individuals who have difficulty regulating their bodies or engage in stimming (repetitive behaviors), making choices, regulating their emotions, problem-solving, and more).
Psychologists are not necessarily experts in behavior change/ behavior therapy and do not prescribe medication.
They specialize in using evidence-based tools to address the traumatic or cognitive aspects of your life to assist with mental health.
These experts are the typical therapists you may seek out for help. Their expertise can have a very wide range of focus and training specialties (marriage/adults/teens/families/anxiety/trauma/multigenerational issues/abuse/depression) so make sure you look for one that is an expert in your specific issues!
Special education teachers (or teachers in general) do not necessarily have training in classroom management or children with disabilities. They are trained in school standards, special education policies, child development, and general education psychology.
Effective behavior management is not typically part of the training courses for special education teachers (or teachers in general). Their educational courses typically do not dive deep into the various disabilities of children that they may encounter in the actual classroom either. Their focus is primarily on learning how to teach school subjects at various learning levels through the school system. Occasionally, an experienced special education teacher may have knowledge of positive behavior support systems (this system is not necessarily data-driven) or have pursued an additional degree to help them become a more competent teacher however, what degree/focus this is can vary. School policies that a teacher may follow for disruptions or behavioral issues with students also do not typically follow an evidence-based method for how to effectively respond (i.e. they use a lot of punishment procedures such as detention, time out, etc.). Some schools, however, may hire a behavior coach (someone who specializes in applied behavior analysis) to assist students with specific challenges. If your school has the funding for this, then you are in luck!
What to be vigilant about with insurance-based ABA Companies
What are insurance-based ABA companies? They are ABA companies that provider services to families who are eligible to receive behavior intervention services under their insurance due to a diagnosis of their child. Below, are just some of the facts and information that may assist you if you have ever had services from a company.
Insurance-based ABA Companies are typically dictated by what insurance is willing to pay for. Insurance however, can limit some of the quality services that may be necessary for a family to receive. This can include (but not excluded to): in depth behavior technician trainings, team meetings outside of session to communicate, or additional admin work such as creating content and resources for families. Most of you already know what the pro’s are to receiving ABA services from an insurance-based company (just read the companies motto!), however most will not tell you the possible side effects of behind-the-scene operations from the employee or company perspective. If you have been a victim of an ABA company or worse, traumatized by the lack-of-quality of one, below are some important notes that might help:
• It is important to note that insurance providers who decide what services are billable to insurance by the ABA companies are not educated, trained, or necessarily well versed in the field of applied behavior analysis
• Insurance providers expect an X number of programs to be run at the same time, oftentimes this could be up to 30+ programs being run simultaneously in one session by the behavior technician. It is important to ask, is this something you are okay with? Does this set your child up for success?
• Insurance companies require an assessment and goals that stem from those assessments. The problem with that is while assessments can be helpful, not every individual needs one (much less 30+ programs) to be successful. Ask yourself, Are all these goals relevant and socially valid for your child? If utilized for the wrong reasons, this can set the entire ABA team (including the client) up for failure or trauma.
• It is important to note that many individuals may be more motivated by the compensation aspect than maintaining top notch quality services. That may mean ABA companies are not willing to pay out of pocket for their employees for important aspects of quality service such as in-depth training, meetings outside of sessions, and additional administrative time when needed. If they did, they would lose money. This leaves their employee’s (BCBA’s/RBT’s) less motivated and uncompensated, which may result in high turnover rate. Furthermore, this creates a toxic dynamic of untrained therapists and BCBA’s who are not held accountable for possible unethical decisions or actions that are being implemented with a client.
• Many ABA companies get stuck in a cycle of accepting more families/clients before they have hired enough RBT/BCBA’s for these families. That means either the family gets their hopes up by the company only to go several months without services, or there is high turnover rate from the company due to the urgency to hire, and the family can go through as many as 3-4 different RBT’s/BCBA’s within a 6 month period, This can result in frustration and a bad experience with the ABA field, making long term support for their child become unattainable, or potential for trauma if the behavior technician is not adequately trained due to the urgent need for staff by the company.
• Insurance providers require company staff to check mark “communication and social skill deficits and repetitive and restrictive behaviors” (since this is considered part of the diagnosis) in order to submit notes. There is a current shift where many individuals see those with autism (and other diagnosed labels) as individuals who are wired differently and learn differently, rather than having skill deficits or restrictive behaviors-because this directly affects how we perceive the services we offer. For families or trending BCBA’s in the field who do not possess these traditional beliefs about individuals with autism, you need to ask, what does this say about the company or staff who are following insurance protocols such as these?
This does not mean that all insurance-based ABA companies approach services like this, although it may be difficult to find a quality company. Receiving quality services from an insurance-based ABA company is going to depend on many factors: the individuals who take your caseload (not necessarily the company) and their training experience, the values of the company (and if they actually follow those values), how the company compensates and treats their employee’s, and so much more. Furthermore, having the ability to receive free behavior intervention services for families who cannot afford it is as a service is very necessary. At the end of the day, the conclusion should not to veer away from insurance-based companies, but to be vigilant, do your research, ask questions, and reach out for advocacy services when you aren’t certain if you are receiving quality services. Please refer to my advocacy services to learn more.