Applied Behavioral Analysis: Overview, Techniques, and Cost

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An ABA therapist works with a patient using building blocks.In the U.S., approximately 1 in 44 children have been diagnosed with autism spectrum disorder (ASD), according to the Centers for Disease Control and Prevention (CDC). This striking statistic can help raise awareness of the disorder and illuminate how the condition impacts individuals and their families.

Being aware of the prevalence of ASD also creates an avenue for people to learn about strategies, such as applied behavioral analysis (ABA), that can help those affected navigate the everyday challenges of ASD.

What is applied behavioral analysis? It is a form of therapy that can help individuals with ASD and other developmental disorders achieve improvements in language, communication, and social skills; strengthen attention and memory, and reduce problem behaviors. ABA therapy techniques can also help individuals with traumatic brain injuries, behavioral issues, and intellectual disabilities.

What Is ABA Therapy?

ABA therapy is a form of evidence-based therapy that combines multiple disciplines, including the science of learning and behavior, to improve behavioral, social, communication, and learning skills in patients. However, in describing what ABA therapy is, it’s important to emphasize that it’s not a one-size-fits-all solution.

ABA therapy is primarily used to treat children with ASD. Symptoms of ASD can vary widely, ranging from mild (lack of communication and social skills) to severe (cognitive impairment and epilepsy). While ABA therapy is most often used to treat ASD, it can also help children with other developmental conditions, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Benefits of ABA Therapy

ABA therapy techniques can be different for each patient, but many of the benefits or outcomes are the same, including the following:

Improved Intellectual Functioning

Intellectual disability impacts 31% of children with ASD, according to statistics from Autism Speaks. Intellectual disability can impact daily function. ABA therapy can help with intellectual disabilities by introducing relevant skills to help children make cause-and-effect associations and provide immediate rewards upon mastering a task.

Improved Memory and Cognitive Abilities

Improved memory and cognitive abilities can have a significant impact on a child’s success in life and in school. The effectiveness of ABA for children with autism is often revealed in their academic performance. Through ABA therapy, therapists can identify how children learn and implement strategies to help them focus and enhance their memory and IQ.

Improved Language Development

Developmental language disorder and autism are two distinct conditions. However, children with autism may present aspects of developmental language disorder. Difficulty communicating with others can lead to frustration and unwanted behavior, such as tantrums. Improved language development helps children communicate their needs and wants.

Acquisition of Daily Living and Social Skills

Social skills and daily living skills can mean independence for people with ASD. ABA therapy aims to help children acquire essential daily hygiene skills, such as handwashing and toilet training. Through ABA therapy, children can also acquire cognitive skills that allow them to perform actions such as cutting paper with scissors and interacting with others in various social settings.

Decreased Problematic Behavior

Problematic behavior in children with ASD can become an obstacle in their lives and in school. By teaching essential skills through ABA therapy techniques, such as positive reinforcement or discrete trial training (DTT), therapists can help decrease problematic behavior in children with ASD and other developmental disorders. A key to lasting success is to replace unwanted behavior with desirable behavior.

Improved Emotional Connections with Other People

Emotional connections with other people help individuals feel safe and secure and build trust-based relationships. This may be difficult to achieve for children with ASD who struggle to recognize and control emotional reactions. ABA therapy teaches appropriate emotional behavior. For example, an ABA therapist can use pictures to help a child associate facial expressions with an emotion.

Improved Focus

The inability to focus is often attributed to ADHD. However, the CDC reports that only 14% of children with ASD also have ADHD. The inability to pay attention can influence the trajectory of a child’s development in life and in school; for this reason, ABA therapy is often used as an intervention to help children improve their focus.

Better Control of Feelings

Children with ASD often struggle to manage their feelings; this can result in unwanted behavior. Behavioral analysts can teach emotional regulation techniques to help children understand, appropriately express, and manage their feelings to keep them under better control. For example, distress tolerance can help a child learn self-soothing skills, which can include the use of coping mechanisms, such as feeling a tactile object.

Applying ABA Therapy to Other Conditions

ABA therapy can also be applied to learned behaviors, such as eating disorders and addiction. Addictions.com reports that more than half of people with eating disorders also report substance use disorder. Mental health treatment, such as the principles of ABA, can be effective in treating these disorders to help replace negative thought patterns that trigger addictive behaviors with positive habits.

Individuals with anxiety and related mental conditions can also benefit from ABA therapy. According to the CDC, anxiety affects approximately 5.8 million children ages 3 to 17 in the U.S. While anxiety disorders can differ considerably, a primary aim of behavioral therapy for anxiety disorders is to enable individuals to understand what triggers negative thoughts and reactions to help them better manage their anxiety.

Resources: Learn More About ABA Therapy

The following resources provide more information on what applied behavioral analysis is and its benefits to children with ASD and for other developmental disorders:

ABA Therapy Techniques

Professionals who use ABA therapy can have various titles, such as behavior therapist or applied behavior analyst. Therapists and analysts apply ABA therapy techniques as independent professionals and clinicians or as members of interdisciplinary clinical teams.

Behavior therapists and applied behavior analysts can work in various settings, including residences, outpatient treatment facilities, and hospitals. The role of a behavior analyst can vary based on the setting they work in. For example, in schools, they guide parents, teachers, and school administrators in student behavior analysis to develop behavior plans.

Common ABA techniques include the following:

Positive Reinforcement

Positive reinforcement is a fundamental concept in ABA therapy that aims to strengthen desirable behaviors through a reward system. A key aim of positive reinforcement is to help children replace unwanted behaviors with desirable ones. Positive reinforcement during ABA therapy can also help children learn life skills that they can apply outside of therapy.

The three critical components of positive reinforcement and autism are:

  • Identifying a child’s needs. The first step in using positive reinforcement for autism is to see what the needs of the child are to set a goal, such as replacing problematic behavior with more desirable behavior.
  • Selecting reinforcers. An ABA therapist typically chooses reinforcers, or rewards, that children receive by successfully completing a task or activity.
  • Measuring outcomes. To determine whether goals are being met, it’s important to track and measure progress. This helps to determine the effectiveness of the ABA approach.

Discrete Trial Training

Discrete trial training (DTT) in ABA is a teaching strategy that involves identifying a behavior that needs to be replaced with another. Steps that a behavior therapist or a behavior specialist can take to help replace the behavior include the following:

  • Simplifying complex tasks. Break down the tasks associated with the behavior into smaller steps.
  • Introducing skills. Prompt the patient to take action that completes each step.
  • Give out rewards. Reward each step’s completion.

Connecting skills in this way helps the child to successfully complete all the steps in a task, reinforcing the target behavior. During the process, the reward system acts as a motivator to help the child take the next step.

Antecedent, Behavior, and Consequence

A fundamental element of what applied behavioral analysis is, the antecedent, behavior, and consequence (ABC) model can help individuals examine and understand their negative or maladaptive behaviors and learn how to modify them with expert guidance from an applied behavior analyst or a behavior therapist. The ABC technique is divided into three areas:

  • Antecedent. Describes the triggers immediately before a behavior. Triggers can come in various forms, such as a specific social setting or a topic of discussion. A therapist helps individuals identify these triggers.
  • Behavior. Represents the response to the trigger, whether an action or a verbal expression. For example, a behavior might be a tantrum when a child is instructed to go to sleep, This is what the therapist aims to change.
  • Consequence. Describes the immediate action following a behavior. A consequence can be positive and reinforced with a reward or praise. A negative consequence, on the other hand, is discouraged, helping reduce the chance of the problem behavior being repeated.

Modeling

Modeling is an approach that involves a therapist demonstrating the desired behavior for the patient to copy. For example, a therapist might provide a child with an example of an action to take, such as putting toys away or handwashing. A therapist can demonstrate the model behavior in person or use a video and guide the child to copy the action. The purpose of modeling in ABA is to build new skills, such as communication and social skills, play skills, self-help skills, and coping skills. Imitation is a key component of modeling, but the goal is not to get patients to simply copy an action — it’s to help them build new skills they can use outside of a therapy session.

Picture Exchange Communication System

Children with ASD who are nonverbal or who have little to no communication skills can benefit from the Picture Exchange Communication System (PECS). This approach facilitates interactions and communication using pictures. For example, a therapist gives a patient a picture with an image of the desired item, such as a toy. The therapist then asks to exchange the picture for the actual item. A successful exchange demonstrates an example of effective communication. A child with ASD can make requests, share a thought, or express feelings that can be symbolized within a picture card. The key aim is to create an environment where children can freely express their feelings and thoughts. These communication skills can then be used in other settings.

Natural Environment Training

With the Natural Environment Training (NET) approach, an applied behavior analyst targets skill development in an environment that the child will find comfortable, such as a play setting. This approach focuses less on structured lesson plans and encourages children to participate in activities they already enjoy, such as drawing and finger painting or playing with a favorite toy. An example of NET may include using a toy to help motivate the child to perform tasks while engaged in play. An analyst may instruct a child to place the toy next to another toy. By performing the task, the child shows understanding so that the next time the words “next to” are used in a different context, the child will be more likely to understand the instruction.

Six techniques that can help children with ASD.

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The following approaches can help children improve behavior and skills, according to the Association for Science in Autism Treatment and Autism Speaks: positive reinforcement; discrete trial training (DTT); antecedent, behavior, consequence (ABC); modeling; picture exchange communication system (PECS); and natural environment training (NET).


 

ABA Therapy Examples

ABA therapy programs vary based on the needs of each individual, but common elements exist. For example, identifying target behaviors to change is typically among the first steps. To get this information, a therapist may observe the child in an initial therapy session. A therapist may also evaluate a child’s existing skill set through exercises. In addition to observation, a therapist interviews parents and teachers for insights into problematic behavior and skills that need to be developed or improved.

With this foundation, a therapist sets goals and outcomes and determines how to measure progress. These details are typically included in a treatment plan: a document outlining a course of action and a plan of care. The treatment plan also includes details on assessing a child’s progress over time and making adjustments.

ABA therapy examples used in sessions are:

  • Task analysis — Breaks down skills into smaller, more easily manageable pieces
  • Chaining — Enables a child to follow complex, multistep directions
  • Prompting — Uses cues to improve the likelihood that a child will respond correctly to instructions
  • Prompt fading — Weans the child off a prompt once the child can independently perform a task without prompting
  • Shaping — Introduces a behavior or skill gradually, using successive reinforcement

Determining How Much ABA Therapy Costs

Receiving an ASD diagnosis can be stressful for any parent, and figuring out how to pay for treatment can make the experience even more overwhelming. Therefore, before entering into treatment, it’s important to consider the question, how much does ABA therapy cost?

In general, ABA therapy for autism can cost about $120 per hour if meeting with a board-certified ABA therapist. Factors that can determine the precise cost of ABA therapy include the following:

  • Therapy needed. At the outset of ABA therapy, an evaluation will be performed to assess a child’s skills. This process involves interviewing the parent to learn more about the child and family dynamics. This information is vital for determining the types of therapy that may be most helpful to the child.
  • ABA program is chosen. ABA therapy may require up to 40 hours per week for patients and families to see successful outcomes. The type of program chosen often depends on the severity of the condition.
  • Therapy provider. Mental health professionals can include psychologists, psychiatrists, and clinical social workers. When it comes to receiving therapy from an applied behavior analyst, the severity of the condition of a child with ASD often determines the type of provider. In some cases, specialization may be required.
  • Education, certification, and experience level of the provider. Certification and experience can play a crucial role in the cost of therapy. Individuals with doctoral degrees tend to be more expensive than those with graduate and undergraduate degrees.

Other factors to consider include the number of services offered (more services may translate into higher costs) and the location of the service provider (cost can vary by state). Insurance coverage also plays a role in determining the cost of ABA therapy

Seven elements that can affect the cost of ABA therapy.

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Factors involved in determining costs include the following, according to Elemy and Healthline: the type of ABA therapy needed, the ABA programs chosen, the therapy provider, a therapist’s qualifications, the number of services offered, location, and insurance coverage.


 

ABA Therapy Insurance Coverage

ABA therapy can be expensive, but it is beneficial for parents seeking to improve their children’s behavioral, social, communication, and learning skills. When considering the cost of ABA therapy, a crucial element is whether ABA therapy insurance coverage can help pay for it.

A majority of health insurance plans can help cover at least part of the cost, but financial support may vary by region. The three most supportive states for coverage for ABA therapy are California, Massachusetts, and Indiana. In these states, insurers must cover ABA therapy regardless of age or coverage limit, and individuals can get grants to help with treatment costs.

Other supportive states for ABA therapy insurance coverage are:

  • Colorado has the same insurer requirements that California, Massachusetts, and Indiana have, but individuals do not have access to grants to offset costs.
  • In Vermont, all children with ASD who are 21 years old or younger must be covered by all insurers. The state does not have coverage cost limits. Multiple grants are available.
  • Maryland has the same requirements that Vermont has, except the age limit for coverage is 19 years old or younger.
  • New Jersey. In New Jersey, children with ASD who are 21 years old or younger are covered. However, insurers do not have the mandate to cover patients. Coverage cost limits are nonexistent, and multiple grants are available.

Resources: Learn More About ABA Therapy Insurance Coverage

Insurance may cover the cost of ABA therapy. The following resources provide details on ABA insurance coverage in the U.S.:

Determining Whether ABA Therapy Is Right for Your Child

Research shows that ABA therapy is effective in helping autistic children develop skills and improve certain behaviors. Organizations such as the American Psychiatric Association and the American Psychological Association, as well as the surgeon general, all validate its efficacy in helping improve the lives of children with ASD and their families.

However, while the potential benefits of ABA therapy are clear, the final decision about whether to use ABA therapy to help a child rests with a child’s parents or caretaker. Important considerations in determining whether ABA therapy is the right approach are awareness of the child’s needs and emotions and the willingness of parents to be initiative-taking participants in the process. Following the recommendations of educated and experienced professionals can help in the decision-making process.

Infographic Sources:

Association for Science in Autism Treatment, ABA Techniques

Autism Speaks, Applied Behavior Analysis (ABA)

Elemy, “How Much ABA Therapy Costs (State by State)”

Healthline, “Is Applied Behavioral Analysis (ABA) Right for Your Child?”