---
date: "2023-11-19"
speaker: "Nichole Sagar"
organization: "BCBA, Owner of All of Everybody (ABA Clinic)"
topic: "ABA Therapy: What It Is, How It Helps"
blurb: "Nichole Sagar is a Board Certified Behavior Analyst. She is the owner and operator of All of Everybody, an ABA clinic here in Kansas City."
---

# Nichole Sagar - ABA Therapy: What It Is, How It Helps

**Date:** 2023-11-19  
**Organization:** BCBA, Owner of All of Everybody (ABA Clinic)

> Nichole Sagar is a Board Certified Behavior Analyst. She is the owner and operator of All of Everybody, an ABA clinic here in Kansas City.

## Notes from November 19th - Nichole Sagar - ABA Therapy

[All of Everybody](https://www.allofeverybody.com/) 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](https://www.cdc.gov/ncbddd/autism/treatment.html))
- 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](https://www.bacb.com/)

### ABA Designations
- **[Board Certified Behavioral Analyst (BCBA)](https://www.bacb.com/wp-content/uploads/2022/01/BCBAHandbook_231023-2-a.pdf):** 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)](https://www.bacb.com/wp-content/uploads/2022/01/BCaBAHandbook_231023-a.pdf):** Undergraduate degree, 40+ hours supervised practice. Typically RBTs studying for their BCBA.
- **[Registered Behavior Technician (RBT)](https://www.bacb.com/wp-content/uploads/2022/01/RBTHandbook_231023-a.pdf):** 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](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1310980/pdf/jaba00083-0089.pdf)). Meta-analysis of ABA history: [Slocum et. al. 2014](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883454/)
- Key milestones:
  - 2013 - [DSM-5 Identifying Autism Spectrum Disorder](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883454/)
  - 2014 - [Mental Health Parity Act](https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity) / [Kansas Parity Laws](https://www.paritytrack.org/reports/kansas/statutes/)
  - 2014 - [House Bill 2744](https://www.kslegislature.org/li_2014/b2013_14/measures/documents/hb2744_enrolled.pdf) requiring fully funded insurance plans cover ABA
  - 2014 - [BACB licensure recognized by Kansas](https://kslegislature.org/li_2014/b2013_14/statute/065_000_0000_chapter/065_075_0000_article/065_075_0003_section/065_075_0003_k/)
  - 2019 - [AMA published billing codes for ABA](https://www.ababillingcodes.com/about/history-2/)
- CDC autism rate: 1:150 in 2000 to [1:36 in 2020](https://www.cdc.gov/ncbddd/autism/data.html)
- [ABA rules for ethical practice](https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-230119-a.pdf)

### 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