ABA Therapy: What It Is, How It Helps

Notes from November 19th - Nichole Sagar - ABA Therapy

All of Everybody has openings 8am-3:30pm, and they also have openings in their social skills group.

What is ABA

• "Applied behavioral analysis is an evidence based practice used to change behavior of individuals, in particular those with an autism diagnosis." (CDC)
• ABA focuses on the use of reinforcement, manipulation of the environment, assessment of behavior based on the antecedents and consequences surrounding the behavior
• The licensing body for ABA therapy is the BACB

ABA Designations

• Board Certified Behavioral Analyst (BCBA): Masters degree or higher, BACB exam, continuing education. BCBAs create treatment plans, observe and instruct RBTs. Caseload of 5-10 patients.
• Board Certified Assistant Behavior Analyst (BCaBA): Undergraduate degree, 40+ hours supervised practice. Typically RBTs studying for their BCBA.
• Registered Behavior Technician (RBT): High School education, 40 hours of training. Work one-on-one with patients. Caseload of 1-5 patients.

Good vs. Bad ABA

• The "evidence base" for ABA therapy began in 1968 at KU (Baer et. al. 1968). Meta-analysis of ABA history: Slocum et. al. 2014
• Key milestones:
• 2013 - DSM-5 Identifying Autism Spectrum Disorder
• 2014 - Mental Health Parity Act / Kansas Parity Laws
• 2014 - House Bill 2744 requiring fully funded insurance plans cover ABA
• 2014 - BACB licensure recognized by Kansas
• 2019 - AMA published billing codes for ABA
• CDC autism rate: 1:150 in 2000 to 1:36 in 2020
• ABA rules for ethical practice

Ethical Practice Key Points

• Implementation of reinforcement procedures FIRST; punishment only when reinforcement exhausted (Section 2.14)
• Development of replacement behaviors when decreasing a maladaptive behavior
• Only decrease behaviors if harmful to individual, harmful to others, or disrupts ability to learn
• Goals should always generalize and fade out supports
• ABA therapy should be individualized
• Avoid unnecessary physical prompting

Common Criticisms Addressed

• "You feed M&M's to kids all day" - Edible reinforcers are a last resort. They do not give intrinsic motivation. Question your BCBA if they use edibles too frequently.
• "ABA just turns people into robots" - Robotic behavior patterns result from not fading reinforcements and generalizing skills appropriately. Good clinics balance compliance and self advocacy.
• "ABA gives kids whatever they want" - First 2 weeks an RBT "pairs" with patient through play. This builds trust for effective therapy.

Questions to Ask an ABA Company

• How do they support the family and siblings?
• How do they collect data? During treatment or after?
• What age ranges do they serve?
• What is their experience with your child's severity level?
• "If your therapist is not answering your questions or is offended by the questions then look for another therapist"

All of Everybody's Culture

• Promote exercise and healthy habits in therapy
• Modification over medication when possible
• Limited edible reinforcement
• NO electronic reinforcement! (No iPads!)
• Frequent collaboration with additional service providers
• Therapy can include the whole family
• BCBAs supervise 20% of RBT's hours
• Services include: after school clubs, assistance in schools, family relationship building, peer groups, sleep training