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As a Parent, 
What should I know about ABA 
for my child with Autism?


I was recently asked this question, again, and wrote a reply to the family.  In writing the reply I reviewed the materials we have available for parents and found some were updated.  I also found several new resources that I think are good additions to those materials we already recommended to parents.  Since I get asked this question regularly, I thought that writing a new article for our website would be a useful resource.  

The first section is about the question of 'Why ABA?'   Many sources will advocate for all sorts of treatments and as a parent you want to know - why one treatment over another?  That is an excellent question and my answer is that the selection of treatments should be guided primarily by what the research has to say about effectiveness of the treatments, who they work for, and availability.  So, what is the answer to 'Why ABA?'  The basic answer is that it remains the best research supported treatment for children with diagnoses of Autistic Disorder and PDD-NOS available based on independent reviews of the research.  The two big reports in the United States on what works with children on the Autism Spectrum are from the National Academy of Science's and the National Autism Center.  

  • The National Academy of Sciences Commission on Behavioral and Social Sciences and Education published the seminal work on what the science does and does not say about educating children with Autism in their 2001 book: Educating Children with Autism.  We at Reinforcement Unlimited, LLC urge every parent and service provider to read this critically important work.  To facilitate this we have added a link so that you can read the book for free.  NAS offers access to this book via a program called "open book" which allows you to read the entire work online at the National Academies Press website.  "The Open Book page image presentation framework is not designed to replace printed books. Rather, it is a free, browseable, nonproprietary, fully and deeply searchable version of the publication which we can inexpensively and quickly produce to make the material available worldwide."

  • The National Autism Center's "National Standards Report"   addresses the need for evidence-based practice guidelines for Autism Spectrum Disorders.  This report provides comprehensive information about the level of scientific evidence that exists in support of the many educational and behavioral treatments currently available for individuals with Autism Spectrum Disorders (ASD).  Reviewers and contributors represent a broad range of approaches to the treatment of Autism Spectrum disorders.  

Those two reports clearly conclude that ABA has the most research support for treating the fundamental issues challenging children with Autism - language and social skills development.  Interestingly, the NAS report was first challenged by those who just did not like the findings by them saying that it was "an inside job by behavior analysts".  Funny thing, there were no behavior analysts on the panel, they were pediatricians, speech pathologists, neurologists, psychologists, educators, and researchers.  

Once you have decided to pursue ABA for your child the questions of how much, when, and by whom necessarily come up.  Over the course of the last 5 years ABA has become a much higher profile treatment, primarily because it actually works, and with that popularity has come a huge influx of people claiming to do ABA therapy.  How can you, as a parent, know whether someone is qualified or not as an ABA provider when most states do not regulate the practice of ABA?  When you go to choose a physician you know that if they are not licensed by the state they will be put in jail if they try to practice medicine without a license and that insurance companies will not put them on their panel without some basic things like medical school, license, residency, DEA number to prescribe, etc. but with ABA there are no such credentialing standards.  So, how can you tell if someone is qualified to design, supervise, and implement an independent ABA program?  There are several resources that can be of real help to you as a parent:

  • The Association for Behavior Analysis International is the pre-eminent professional association for ABA in the world and has been the main professional organization for behavior analysts for many decades.  The Autism Special Interest group of ABAI is the main group of Autism experts within ABAI and has developed a parent guide to ABA services and service provider selection entitled "Consumer Guidelines for Identifying, Selecting, and Evaluating Behavior Analysts Working with Individuals with Autism Spectrum Disorders" which can be downloaded in PDF format directly from the ABAI website.  It has been in place since 1998 and has been revised and updated twice since then to reflect changes in practices and standards as they develop within the field.  

  • The Behavior Analysis Certification Board™ is the standard credentialing body for behavior analysts practicing in the field internationally.  The BACB maintains an online database that is made accessible to parents and anyone interested in researching whether or not someone is a Board Certified Behavior Analyst - or Board Certified Behavior Analyst - Doctoral (BCBA or BCBA-D), which are the two independent practitioner credentials from the BACB.  There is a third credential for those who are not qualified to practice independently but who have a basic knowledge of ABA, the BCABA or Assistant Behavior Analyst.  The database can be searched based on name, state, zip code, or country.

  • The National Autism Center has also developed a Parent Manual which tries to cover the entire Autism area for parents from what Autism is to how to review the research and select professionals to help your child.  It's far more cumbersome and lengthy than the ABAI Consumer Guidelines but also has much more details about basics across all relevant topics.  It's available for download in PDF after registering with the NAC.   The Center is a nonprofit organization dedicated to supporting effective, evidence-based treatment approaches for individuals with ASD. The 134-page manual focuses on helping parents as they make decisions about how to best help children with ASD reach their full potential. It begins with a review of the autism spectrum, symptoms, and co-occurring conditions, and identifies and describes effective treatments. Other topics include the importance of professional judgment, the role of family preferences and values in the decision-making process, and factors to consider when choosing a team of professionals to help their child.

The issues that come after deciding that ABA is the right choice for treatment and finding a qualified provider are typically how is ABA going to be paid for.  The answer to that question is very complex and the first factor, if you reside in the United States, is your state of residence.  More states each year have added mandates under state law for insurers to cover ABA therapy for children diagnosed on the Autism Spectrum.  Unfortunately not all states have such mandates.  So, if you are in a state with such a mandate then you may have insurance coverage for ABA.  However, even then you may not have coverage because state insurance laws do not apply to self-funded insurance policies.  There are several employers such as TimeWarner, Microsoft, and others that have directed their health insurance carriers to include coverage for Autism and ABA.  If you are employed by a company that has made that decision then it doesn't matter what state you live in, you've got ABA coverage.  Some states have Medicaid coverage for ABA, in fact Federal Courts just ordered Florida to provide such coverage, but that is currently the exception.  Some schools provide ABA services under IDEA, but again that is the exception and the services are often limited to a few hours per week and not the 25+ hours that are recommended by the two big reports cited from the NAS and NAC.  All too often parents are forced to make very hard decisions about whether treatment is provided to their child based on financial concerns.  We recommend that you investigate all sources of possible support and connect with other parents who have had to navigate the process already.  


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