What ABA therapy looks like

 

If you have secured a tutor or therapist that you are happy with, I would strongly advise that a contract be drawn up prior to the onset of any services. This is to highlight to one another what your roles and responsibilities are for the duration of the contract, the days and times that suit both of you to schedule therapy sessions, pay rates and pay dates, and what happens in the event of cancellation, sick leave, holidays, etc. and most importantly, what notice of termination is to be provided by both parties. It is good to be clear from the start with your therapist and in moving forward, with both of you knowing what to expect from each other. This also avoids any friction and unnecessary complications down the line if something ever arises, like a late cancellation etc.  

Next you need to establish with your tutor, are they equipped with enough experience to design, write up and deliver an ABA individualised education programme and/or behaviour support plan for your child, or will you need to hire a BCBA to come on board to do this for you. Do they feel comfortable with the responsibility of the entire IEP or would they prefer supervision from a BCBA? If so, the cost of this is typically incurred by the family, while also paying for your tutor, if your tutor is not under the home tuition scheme.

In the design of an IEP, goals should be selected not just by the therapist, but by both parent and therapist, on what you both deem as necessary for your child. Input from other professionals is always encouraged and can oftentimes be invaluable to a new therapist who is unfamiliar with your child. Perhaps your ABA therapist might offer alternatives or prerequisite targets that are needed before targeting a skill of interest, and parents may offer up what is needed in the home and outside of the home, in other environments, and what is a priority for the family at the moment.

 

If your therapy hours are small and limited, then a decision must be made on how best to utilise these hours efficiently and how to maximise effective outcomes from this limited therapy time. Perhaps this time is better spent demonstrating to parents and teaching parents how to run programmes with their child for the rest of the week, or alternatively, perhaps both therapist and parent can devise and prioritise a hierarchy of skills to be targeted, and the therapist can start with the most pressing skill to be taught and work her way gradually through the list, one skill at a time, as therapy sessions progress, while parents and caregivers work on these skills outside of session to maximise learning.

As a side note to the above and an important piece on its own, whether a child has one hour of ABA therapy a week, or twenty hours of ABA therapy a week, parents and caregivers must always be on board, working with their therapist on the same skills that are being targeted within session, and to continue to work on their childs skills and targets outside of therapy hours. It is imperative for effective learning that this occurs.

Therapy sessions are a small fraction of the week and parents and caregivers are the people who spend the most time with their children, and this is where the most learning opportunities are, and where more learning will occur for children, when mom and dad teach them. This can seem daunting at first for parents, especially taking data, but once adequate training and supervision has been provided to parents, it becomes run of the mill and becomes embedded into daily life and routines and more importantly, amazing progress is made.

Parents and therapist should resemble something like a team, working together toward a common goal. It can be frustrating when this does not happen, not just for therapists, but for parents too. Eventually the relationship between parent and therapist can break down and become awkward, therapy sessions are deemed ineffective by both parties, which can eventually lead to termination of services, which leaves therapists feeling like they have failed a family and parents feeling like money has been spent, time wasted and a child is left with no skills. Teaching is a joint effort by both parents and therapists, and more often than not, without both parent and therapist inputs, children simply can not learn. 

 

Parents must give their permission for any and all assessments to be carried out and parents need to give their consent to all programmes before its implementation. It is recommended that this is given in writing.

Review meetings should be held when needed, where both therapist and family, and BCBA if applicable, sit down and discuss progress to date, review the data of each programme and discuss plans for going forward and if any new programs are needed. An IEP is constantly evolving and its always moving!

 

Children who receive more hours of quality behavioural therapy have better outcomes. Research findings indicate that a minimum of 20 hours per week, up to 40 hours per week is deemed very effective and most beneficial to learning outcomes, which is why parents are encouraged to learn all that there is to know about their childs programmes, so that they can implement procedures in a manner that is cost effective to them and save on hiring a therapist for a bulky amount of hours each week. Also, teaching should not be for a set amount of hours each week, but happen all day every day, as natural opportunities occur. 

Not only for this cost effective reason, but more importantly, children require consistency across all people and settings in their environment, to promote generalisation of all the new skills that they are learning, which is why all persons familiar to the child are encouraged to get involved, to maximise learning outcomes. Some children can learn to demonstrate a skill with their therapist, in their therapy room, yet never demonstrate this skill with other persons, in other environments, because they have never had to practise it in this way. We call this skill (the ability to demonstrate the skill across all persons and settings), generalisation, and generalisation is the key outcome for all home programme goals, but this is impossible to achieve if all stake holders are not actively involved in the teaching of the child. 

 

Some parents might feel that their child is too young for therapy. Children as young as 18 months can be involved in ABA therapy, and you can experiment with the number of hours suitable for your child. Again, this is an individualised therapy, and works at the pace and developmental stage of your child. 

Typically ABA sessions are 2.5-3.5 hours in duration, filled with fun and excitement. Your child should love being there. Breaks are incorporated into sessions if you feel that your child requires a break from all the fun and excitement. It should be a pleasant experience overall, for all involved.