Should I Consider ABA for my Autistic Child? Pros and Cons of ABA Therapy for Children with Autism

Applied Behavior Analysis (ABA) therapy is a common approach to help children with autism learn and develop. It's been around since the 1960s and focuses on teaching new behaviors using reinforcement, like access to toys or small amounts of food. ABA aims to help children with autism improve their communication skills, behavior, and overall quality of life.

Opinions about ABA vary widely, with some families praising it as a lifeline for children facing significant behavior challenges or learning difficulties, while others, particularly adults with autism, criticizing it as abusive and extremely harmful to autistic individuals.

As someone who's worked with ABA techniques, as well as many other alternative autism therapies and as an autism mom, I've seen both its benefits and potential drawbacks. In this blog post, we'll take a closer look at the pros and cons of ABA therapy for children with autism and discuss whether it might be a good path for your family to take with your child.

What is ABA Therapy for Autism?

Applied Behavior Analysis or ABA is a type of therapy that helps children learn new skills and improve behaviors. Originally developed in the 1960s and 1970s, ABA wasn't initially specific to autism or even teaching. Instead, it was used to understand how people learn in general. In ABA, therapists use techniques to understand why a child does certain things and help them learn new ways to behave.

ABA therapy can occur in schools, therapy centers, or homes, where a therapist visits to deliver therapy or parents are trained to deliver during the day. During ABA sessions, therapists often work one-on-one with children, using games, rewards, and activities such as puzzles or toys, to teach them new skills, like talking, playing, or pre-academic or academic skills such as letter matching or recognition. ABA can help children with autism learn important skills they need for everyday life, such as how to communicate better, follow routines, or manage emotions. It can also be used to help with challenging behaviors, like tantrums or not listening.

Should I Consider ABA for my Autistic Child?

Pros of ABA

Evidence-Based

ABA therapy is one of the most extensively researched and evidence-based interventions for autism. Numerous studies have shown that well-implemented ABA programs can lead to significant improvements in social, communication, and adaptive skills. This is why over and over again insurance companies will often offer to pay for ABA services when other therapies that might also be very effective are not considered. This access to ABA therapy for autistic children is a big draw for many families, as it's one of the few therapies often covered by insurance companies, making it more accessible and affordable for families seeking support for their child's needs.

Individualized

ABA therapy is tailored to each individual's unique needs and strengths. Therapists should conduct comprehensive assessments to develop personalized treatment plans that address specific goals and challenges. Like any good therapeutic plan, ABA when done correctly is built entirely around the strengths and challenges of each individual and takes into account personality and learning styles.

ABA Breaks Skills Down

ABA focuses on teaching concrete skills in a step-by-step manner. This style of therapy breaks down complex skills into smaller, achievable tasks, making it easier for individuals with autism to learn and practice new abilities. Many autistic individuals become overwhelmed easily when too much information is presented at once or when they feel like the cannot be successful when beginning a new task. Breaking tasks down into very small parts is helpful for these tendencies.

ABA is Data-Driven

ABA therapy relies on data collection and analysis to monitor progress objectively. This data-driven approach allows therapists to make data-based decisions and adjust the intervention as needed for better outcomes. I like the fact that ABA decisions are based on concrete data, however, I have seen in many instances, data taken inconsistently, or the type of data chosen to take, is not the most relevant to the individual's needs.

ABA can Address Behavioral Concerns in Autism

ABA can help manage challenging behaviors by identifying their underlying causes and implementing strategies to reduce or replace them with more appropriate alternatives. Many other therapies or traditional learning programs have no method in place to address difficult behaviors and because autistic individuals often struggle with challenging behaviors it may make it difficult for them to receive therapy in more traditional settings.

I have seen remarkable results with structured ABA with individuals who have not developed any verbal or augmentative communication and exhibit challenging behaviors, when other therapies were not even possible to attempt.

ABA Has a Wide Scope of Application

Another significant advantage of ABA therapy is its versatility in addressing a wide range of skills and goals. While some therapies may focus only on specific concerns, ABA can target nearly any skill that a child needs to develop. This includes essential social skills like asking for help or greeting others, self-help skills such as dressing or brushing teeth, and learning skills like matching and sorting.

ABA is also able to be integrated into other therapeutic approaches. For example, speech therapists or occupational therapists may incorporate ABA principles into their sessions to enhance the effectiveness of their interventions. However, it's important to note that not all therapies are compatible with ABA. Approaches like Floor Time may conflict with ABA principles and would not be suitable to combine.

Cons of ABA or Considerations

Ethical Concerns

At the heart of the debate surrounding ABA therapy lies a profound ethical dilemma, is it

ethically justifiable for one person, whether a therapist or caregiver, to attempt to modify the behavior of another, particularly when that behavior pertains to deeply ingrained aspects of an individual's identity? This question raises fundamental concerns about autonomy, consent, and the balance of power in relationships.

"Why Can’t I Just be Me”?

Some people are against ABA therapy because they feel it focuses too much on making kids act a certain way, based on what society thinks is right. This makes us think about who gets to decide what's okay for kids to do. Should it be the therapist, parents, or what everyone else thinks? Or should kids with autism have more say in how they want to behave?

Some people worry that while ABA therapy helps kids with autism learn important skills, it might also stop them from being themselves and thwart creativity.

Some people fear that following strict rules could make it hard for kids to express themselves the way they want to. This brings up big questions about whether it's more important for kids to fit in with what's considered 'normal' or to be proud of who they are, even if they're different from others.

What is “Good Behavior”?

Deciding what counts as 'good behavior' isn't always easy because it depends on where you come from and what your family or community thinks. What's okay in one place might not be okay somewhere else. That's why it's really important for therapists doing ABA to be respectful and understanding of different cultures. They need to realize that what's normal for one group might not be the same for another, such as looking someone in the eyes.

To do the right thing, therapists and caregivers need to carefully consider everyone's feelings and differences. This means including people with autism in decisions about their treatment, making sure they have a say in what happens. It's also important to create environments where they feel confident speaking up for themselves and making choices and teaching autistic individuals to speak up for themselves. Above all, we must respect the dignity and rights of individuals with autism, understanding and appreciating their special points of view.

ABA is Unnatural

Many people feel that traditional ABA is unnatural and doesn't translate into autistic people using the skills in the environment where it is most important. For example, a child might learn how to ask for a toy in a therapy session with an adult but never generalize this same behavior at home with a sibling or at preschool with a peer. Many newer versions of ABA are working to improve this deficit, aiming for more effective outcomes.

One such approach is the Denver Early Start Model. In this model, therapists focus on teaching skills in natural environments, like the home or community settings, rather than just in therapy sessions. By practicing skills in real-life situations, children are more likely to use them outside of therapy. Similarly, the Early Start Denver Model (ESDM) combines developmental and behavioral approaches to promote social, communication, and cognitive skills in young children with autism and stresses a child led approach. I have worked in the Early Start Denver Model (ESDM) and do feel it is a much better version of ABA, however, it may be difficult for families to find such a program near them.

Another example is Pivotal Response Treatment (PRT), which targets pivotal areas of development to create widespread improvements in communication, behavior, and social skills. These approaches recognize the importance of teaching skills in contexts that are meaningful and relevant to the child's everyday life, increasing the likelihood of generalization and long-term success.

Time and Cost-Intensive

ABA therapy can be time-consuming and expensive, as it typically involves frequent and structured sessions. While ABA therapy has shown effectiveness in promoting desired behaviors and skills, it’s important to acknowledge the commitment it entails. Most research showing impressive results has looked at children receiving high quality therapy for as much as 40 hours a week, which may not be realistic in many situations.

Additionally, the costs associated with ABA therapy can be substantial, if not covered by insurance. These expenses can include fees for certified behavior analysts who assess children and develop appropriate goals, behavior technicians who deliver the majority of therapy, or special schools that are based on ABA.

Conclusion

While ABA therapy has helped many children with autism learn new skills and behave better, it's important to think carefully about whether it's right for your child. Every child with autism is unique, and what works for one may not work for another. As we've seen, some families have seen great improvements with ABA, while others have concerns.

If you're considering ABA for your child, it may be helpful to observe some therapy sessions first to see how it looks in different settings and with different therapists and talk to other parents who have experience with it. From my own experience, I believe it's definitely worth considering if your child has significant learning challenges or behaviors that are making life difficult for your family and impacting their personal growth. Remember, you know your child best, and whatever decision you make, it's important to prioritize their well-being and happiness.