Many children with Autism Spectrum Disorder (ASD) will be referred to receive Applied Behavior Analysis (ABA) services. ABA can provide intensive one-on-one teaching to promote desired behaviors (talking, following directions, self-help skills) and reduce problem behaviors (aggression, property destruction, tantrums). In Texas, most commercial medical insurance plans (including some offered through the healthcare.gov marketplace) will cover these services for children with autism. Though Medicaid and CHIP offer coverage in other states, they do not yet cover ABA in Texas. Below is a brief description of ABA, followed by some guidelines for assessing and choosing a therapy provider.
What is Applied Behavior Analysis?
Behavior analysis is a science that studies how behavior is learned and how it changes over time. Behavior analysts look at things in the environment that affect behavior. ABA aims to produce changes in behaviors that are important to the child, their family and the community. Through decades of scientific research, ABA has amassed a set of procedures for building desirable behaviors and decreasing problem behaviors. Examples include increasing reading, exercising, eating nutritious foods, following safe practices and communicating, while reducing self-injurious behavior, physical aggression, elopement and tics.
Although ABA is widely known for its effectiveness in people with autism, it should be noted that ABA procedures are effective regardless of the person’s diagnosis (or lack thereof). Virtually all of us have a few undesirable behaviors that we want to get rid of (e.g., spending too much time on social media, using our phones while driving) and don’t engage in many desirable behaviors as frequently as we’d like (e.g., eating more vegetables, exercising more). These are all situations that ABA can help.
What credentials should you look for in a Behavior Analyst?
ABA is both a scientific discipline and a profession. A professional behavior analyst who is credentialed by the Behavior Analyst Certification Board is called a Board Certified Behavior Analyst® (BCBA). To be a BCBA, a person must meet the three requirements below:
- Possess at least a master’s degree in ABA (or a closely related field) from an accredited institution. This entails completion of a specified number of classroom hours of graduate-level instruction in behavior analysis.
- Complete a specified number of hours of supervised clinical training in applied behavior analysis.
- Passing score on the Certified Behavior Analyst examination.
As of September 1, 2018, a person must be a licensed behavior analyst to practice ABA in Texas.
What is the role of a BCBA?
Once information about a client’s clinical needs is obtained, a BCBA is tasked with performing a few essential functions. Specifically, a BCBA should:
- Objectively define the clinical problem(s)
- Identify things in the environment that make the behavior of interest more or less likely to occur
- Design a way to objectively track progress, and train all relevant stakeholders on how to collect data
- Develop individualized intervention procedures to modify the behavior of interest. The intervention should also include an appropriate discharge plan, which should consider future environments and their corresponding resources and challenges
- Train all relevant stakeholders to effectively implement the intervention
- Supervise and monitor all relevant stakeholders to ensure that the intervention is carried out correctly
- Regularly look at clinical data to evaluate progress
- Revise the intervention and re-train all relevant stakeholders when necessary
What should you look for when choosing an ABA provider?
The following is from the Association for Behavior Analysis International: Autism Special Interest Group:
- All parents/guardians should exercise extreme caution when choosing a service provider to work with their children
- All parents/guardians are encouraged to obtain references from any potential service provider
- Parents/guardians should be aware that degrees from universities are not the same as certification
Given the vital role a BCBA plays in a child’s success, the selection of a service provider should probably start with their BCBAs. The Behavior Analyst Certification Board, the Association of Professional Behavior Analysts and the Association for Behavior Analysis International: Special Interest Group, have documents aimed at helping parents identify qualified BCBAs. In addition to using these three documents as guidelines, parents should also consider the following:
- The BCBA’s caseload. As listed above, a BCBA has to perform many tasks for each case. This means that more children on a BCBA’s caseload equals less time that a BCBA is able to devote to each case.
- How often the BCBA is on site. Supervising and training staff are essential to ensure correct implementation of an intervention. Additionally, a child’s intervention may have to be revised to ensure optimal progress. If a BCBA is not on site enough to perform these essential duties, quality of therapy may suffer, and a child’s progress may not be optimal.
- Touring the facility. It is important that parents personally visit the facility that they are considering for their child’s therapy.
- Direct observation of the children and behavior technicians. While touring a place, parents might want to evaluate whether the children and behavior technicians appear to be engaged and happy (e.g., by doing a smile count).
- Safety. In addition to inquiring about the facility’s safety practices, parents may want to personally evaluate whether staff members appear to take children’s safety seriously.
- Cleanliness of the facility. Given that children are typically enrolled in a program for as many as 40 hours a week for several years, parents may want to evaluate that the facility’s cleanliness.
Child Study Center at Cook Children’s offers several types of ABA services. For information about our services, please call 682-303-9243 or visit cscfw.org.
Cook Children’s Child Study team
Every child deserves results. Our world-class clinicians and highly-trained staff are dedicated to that mission.
Contact the Child Study Center at Cook Children’s to schedule an appointment or speak to our staff: 682-303-9200.
- Association for Science in Autism Treatment: https://asatonline.org/
- Association for Behavior Analysis International: Autism Special Interest Group: https://www.abainternational.org/constituents/special-interests/special-interest-groups.aspx
- Association of Professional Behavior Analysts: https://www.apbahome.net/default.aspx
- Cambridge Center for Behavioral Studies: https://behavior.org
- Behavior Analyst Certification Board: https://www.bacb.com
- Texas Association for Behavior Analysis: https://new.txaba.org