The Complete Guide: Steps To Getting Started With ABA Therapy For Your Child

If your child has been diagnosed with autism spectrum disorder (ASD), you’ve likely heard about Applied Behavior Analysis (ABA) therapy. More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism, with studies showing gains in intellectual functioning, language development, daily living skills and social functioning. This comprehensive guide will walk you through every step of getting started with ABA therapy for your child.

What is ABA Therapy?

Applied Behavior Analysis involves many techniques for understanding and changing behavior, and is a type of research-based behavior therapy for people with autism and other developmental disorders. Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association. “Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness.

Step 1: Obtain an Autism Diagnosis

The first and most crucial step in accessing ABA therapy is ensuring your child has a formal autism diagnosis. In order for your child to be approved for ABA services, your insurance provider will require a current copy of your child’s psychological and/or diagnostic evaluation to confirm they have an autism diagnosis. Most insurance companies only cover ABA therapy with an Autism diagnosis.

Getting a Diagnosis:

Contact your pediatrician for a referral to a developmental pediatrician, psychologist, or psychiatrist
Schedule a comprehensive evaluation that includes behavioral assessments
Ensure the evaluation meets your insurance company’s specific requirements
Specific requirements will vary across different insurance payors and may include a prescription for ABA therapy by your child’s primary care physician

Step 2: Verify Insurance Coverage

A federal mandate now requires insurance companies in all 50 U.S. states to provide coverage for services like ABA for individuals with an autism diagnosis. By 2021, every state in the U.S. had adopted this insurance mandate.

Key Questions to Ask Your Insurance Provider:

Is ABA therapy covered by my insurance as a benefit for my child?
How much does my insurance cover for ABA therapy? What is my copay or coinsurance? What is my individual or family deductible for ABA therapy?
Some insurance carriers will require a letter from your child’s treating physician stating why ABA therapy is medically necessary. Therefore, make sure to ask the insurance representative if you will need a letter in order to begin treatment

Coverage Details to Understand:

All Medicaid plans must cover treatments that are medically necessary for children under the age of 21. If a doctor prescribes ABA and says it is medically necessary for your child, Medicaid must cover the cost
Insurance companies may require prior authorization before beginning ABA therapy to ensure that it is medically necessary. Insurance policies may have limits on the number of hours or sessions of ABA therapy that they will cover each year

Step 3: Research and Choose a Qualified Provider

Finding the right ABA provider is critical for your child’s success. Be sure that someone on their staff is credentialed or licensed in ABA. Ask questions about the credentials and qualifications of staff to ensure that there is a Board Certified Behavior Analyst (BCBA).

What to Look For in a Provider:

Credentials and Qualifications:

A board-certified behavior analyst (BCBA) provides ABA therapy services. The Board Certified Behavior Analyst® (BCBA®) certification is a graduate-level certification in behavior analysis. BCBAs are independent practitioners who can provide behavior-analytic services and supervise the work of RBTs, BCaBAs, and other professionals who implement behavior-analytic interventions
Any credential only shows that the professional has passed a test and has met a minimum standard of supervised practical training, find out about all of their experience with children like yours

Safety and Professional Standards:

Background checks are common practice for most providers. If you hire your own front line therapist or are bringing a provider into your home, make sure that a background check has been done on them
Ask for references and talk to other parents who have used their services

Program Structure:

Data collection is a critical component of ABA programs. All providers and centers should be able to regularly provide you with data in a format that is understandable including a summary with trends that show whether or not your child is improving
Intensive ABA programming should not be for life. There should be a transition plan to move the child out of therapy and into more natural settings (e.g., school, community)

Step 4: Initial Assessment and Evaluation

Once you’ve selected a provider, the formal process begins with a comprehensive assessment. First, you will have a consultation with a Board Certified Behavior Analyst (BCBA) specializing in the treatment of individuals with autism using ABA. This consultation is called a Functional Behavior Assessment (FBA), which includes two main sections.

The Assessment Process Includes:

First, the BCBA will ask about your child’s strengths and abilities as well as their challenges. There will also be questions related to your child’s background information, typical behaviors, and family health history
Finally, the BCBA will ask parents and family members involved to share their goals for treatment
The second consultation is the interaction and observation portion of the FBA. The BCBA will observe and interact with your child in a comfortable setting

Step 5: Treatment Plan Development

A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences and family situation. The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too.

What Your Treatment Plan Will Include:

Treatment goals are written based on the age and ability level of the person with ASD
The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation)
A formal reassessment and progress report is typically generated every 6 months

Step 6: Begin Therapy Sessions

“Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. However, the amount of therapy your child receives will be individualized based on their needs and your insurance coverage.

What to Expect During Sessions:

The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis
ABA therapy treatment for your child is rewards based. When your child completes a task correctly, demonstrates positive interactions, or achieves a goal, they’re given a reward to motivate repeated practice and behavior
The first step is for therapists to establish a good relationship with your child. If your child trusts his therapists and enjoys spending time with them, therapy will be more successful – and fun!

Understanding the Investment

Without insurance, ABA therapy can be expensive. ABA therapy costs $62,400 to $249,600 per year without insurance coverage. The monthly costs for ABA therapy can range from $4,800 to over $20,000 per month without insurance coverage. However, insurance coverage can significantly reduce the cost of ABA therapy. According to Forbes, ABA therapy often costs around $17,000 per year without insurance coverage, with a large number of people paying significantly more. With insurance, however, the cost can be significantly less.

Parent Involvement is Key

Parent involvement is a crucial component of successful ABA therapy. By actively participating in your child’s ABA therapy program, you are not only helping your child learn new skills, but you are also strengthening your bond and creating a positive learning environment. Remember, you are your child’s most important teacher, and your involvement can make a significant difference in their development.

Ways Parents Can Support ABA Therapy:

Make sure to ask the therapist how they involve parents in the treatment process. For treatment to be effective, parents and therapists need to take a joined-up approach, with parents continuing many of the techniques between each therapy session
Because of this foundation of ABA (applied behavior analysis), you can learn ABA concepts and apply them at home with your children. You can use ABA strategies with children with or without disabilities, including those with autism spectrum disorder
Be patient with your child’s progress and remain consistent with your approach

Taking the Next Steps

Deciding to start ABA services is an important decision and having the right information and supportive team can make a huge difference. Remember that you don’t need to rush the process. Resist the urge to choose a therapist as soon as possible and don’t set arbitrary deadlines for yourself. It’s fine to take your time until you find an ABA therapist partnership that’s right for you.

Speak with your pediatrician or other medical provider about ABA. They can discuss whether ABA is right for your child. They can write a prescription for ABA if it is necessary for your insurance. From there, you can begin the journey that has helped countless families see meaningful improvements in their children’s development and quality of life.

References

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