What Is ABA Therapy and How Does It Work?

Applied Behavior Analysis (ABA) therapy has become one of the most widely used interventions for individuals with autism spectrum disorder and other developmental conditions. Despite its prevalence, many families considering this therapeutic approach have questions about what ABA therapy involves, how it works, and what to expect. This comprehensive guide explores the fundamentals of ABA therapy, its applications, benefits, and considerations for families navigating treatment options.

Understanding the Foundations of ABA Therapy

ABA therapy is a scientific, evidence-based approach that applies our understanding of how behavior works to real situations. The goal is to increase helpful behaviors, decrease harmful behaviors, and teach new skills that improve quality of life.

Core Principles of ABA Therapy

At its foundation, ABA therapy is based on several key principles:

Behavior is influenced by environment: ABA therapists analyze how environmental factors trigger and reinforce behaviors
Behavior can be changed through reinforcement: Positive consequences increase the likelihood a behavior will be repeated
Learning occurs through observation and interaction: Skills are broken down into manageable steps and taught systematically
Data-driven decision making: Treatment plans are continuously evaluated and adjusted based on objective measurements of progress

According to the Centers for Disease Control and Prevention, ABA is considered an evidence-based best practice treatment by the U.S. Surgeon General and the American Psychological Association[1]. Research has shown that ABA therapy techniques can produce significant improvements in communication, social relationships, play, self-care, school, and employment.

The ABA Therapy Process: What to Expect

Initial Assessment and Program Development

The ABA therapy journey typically begins with:

Comprehensive evaluation: A Board Certified Behavior Analyst (BCBA) conducts assessments to understand the individual's strengths and challenges
Functional behavior assessment: Identifies the purpose or "function" behind challenging behaviors
Skill assessment: Evaluates current abilities across domains like communication, social skills, self-care, and academics
Goal setting: Establishes specific, measurable objectives based on the individual's needs and family priorities
Treatment plan development: Creates a detailed intervention strategy with specific techniques and teaching protocols

Common ABA Techniques and Interventions

ABA therapy employs numerous evidence-based techniques, including:

Discrete Trial Training (DTT): Structured teaching method breaking skills into small, manageable steps with clear instructions, opportunities to respond, and immediate feedback
Natural Environment Training (NET): Teaching skills in real-life settings to promote generalization
Verbal Behavior Intervention: Focuses on teaching language by function rather than just by form
Pivotal Response Treatment (PRT): Targets "pivotal" areas of development like motivation and self-management
Positive Behavior Support (PBS): Creating environments that prevent challenging behaviors and teaching alternative responses
Functional Communication Training (FCT): Teaching appropriate communication to replace challenging behaviors

A meta-analysis of 27 studies published in the Journal of Autism and Developmental Disorders found that individuals receiving ABA interventions gained, on average, 15 IQ points and showed significant improvements in adaptive behavior compared to control groups[2].

ABA Therapy Settings and Intensity

ABA can be delivered in various settings:

Home-based therapy: Conducted in the child's home, often with parent training components
Center-based programs: Delivered in specialized clinics or treatment centers
School-based interventions: Implemented within educational environments
Community settings: Parks, stores, or other public places to practice skills in real-world contexts
Telehealth: Remote sessions conducted via video conferencing platforms

The recommended intensity of ABA therapy varies based on individual needs. The Behavior Analyst Certification Board guidelines suggest:

Comprehensive ABA treatment: 30-40 hours per week for young children with autism
Focused ABA treatment: 10-25 hours per week targeting specific skill deficits or behaviors
Maintenance programs: Fewer hours focused on skill maintenance and generalization after initial goals are achieved

Benefits and Outcomes of ABA Therapy

Evidence-Based Improvements

Research-documented benefits of ABA therapy include:

Communication skills: Developing verbal language, alternative communication systems, or enhancing existing language abilities
Social functioning: Improving peer interactions, perspective-taking, and relationship building
Adaptive skills: Enhancing self-care, independence, and daily living capabilities
Academic performance: Improving attention, engagement, and learning readiness
Reduction in challenging behaviors: Decreasing aggression, self-injury, tantrums, and other interfering behaviors
Family functioning: Reducing caregiver stress and improving quality of life

A landmark study following children who received early intensive ABA intervention found that 47% achieved typical intellectual and educational functioning by the end of the study, with normal-range IQ scores and successful integration in general education classrooms without specialized support[3].

Individualized Progress

It's important to note that progress in ABA therapy is highly individualized. Factors affecting outcomes include:

Age when intervention begins (earlier intervention often yields better results)
Intensity and duration of therapy
Individual learning style and cognitive profile
Family involvement and consistency across environments
Quality and experience of the therapy team
Presence of co-occurring conditions

The ABA Therapy Team: Roles and Qualifications

Key Team Members

An effective ABA program typically involves:

Board Certified Behavior Analyst (BCBA): Graduate-level professional responsible for assessment, program development, and supervision
Board Certified Assistant Behavior Analyst (BCaBA): Undergraduate-level professional who assists the BCBA
Registered Behavior Technician (RBT): Paraprofessional who directly implements the intervention under supervision
Parents/Caregivers: Essential team members who help maintain consistency and generalization

Credentials to Look For

When seeking ABA services, verify:

BCBA certification through the Behavior Analyst Certification Board
State licensure where applicable
Experience with similar cases and age groups
Ongoing professional development
Parent training and involvement philosophy

Considerations and Potential Concerns

Addressing Criticisms

Some perspectives on ABA therapy include concerns about:

Focus on compliance: Modern ABA approaches emphasize teaching functional skills rather than compliance for its own sake
Individual autonomy: Ethical ABA practices respect personal choice and self-determination
Behavioral focus: Contemporary ABA increasingly addresses emotional and social development alongside behavioral concerns
Intensity: Programs should be balanced with other important childhood experiences and activities

A survey of parents whose children received ABA therapy reported that 95% observed positive changes in their child's skills and behaviors, though perspectives on specific aspects of treatment varied[4].

Finding the Right Fit

When evaluating ABA providers, consider:

Philosophy and approach to therapy
Inclusion of child and family preferences
Integration of play and natural motivation
Focus on meaningful, functional outcomes
Collaboration with other professionals (speech therapists, occupational therapists, etc.)
Transparency in data collection and progress reporting

Getting Started with ABA Therapy

Insurance Coverage and Funding

Access to ABA therapy has improved significantly:

All 50 states now mandate some level of insurance coverage for ABA therapy for autism
Medicaid programs in many states cover ABA services
Educational systems may provide behavior-based interventions
Some families utilize private funding or scholarships

Steps to Begin the Process

Obtain a formal diagnosis from a qualified healthcare provider
Research providers in your area who offer ABA services
Verify insurance coverage and understand your benefits
Schedule consultations with potential providers to discuss philosophy and approach
Prepare for the assessment process by gathering relevant medical and developmental history
Participate actively in goal-setting discussions

The Evolution of ABA Therapy

Modern Approaches

Contemporary ABA therapy has evolved significantly from its origins:

Naturalistic Developmental Behavioral Interventions (NDBIs): Blend developmental and behavioral principles in natural contexts
Social validity emphasis: Focus on meaningful outcomes valued by the individual and family
Person-centered planning: Including individual preferences and interests in treatment design
Trauma-informed practices: Considering past experiences and emotional needs
Cultural responsiveness: Adapting interventions to be culturally appropriate and respectful

Research from the past decade shows that these naturalistic ABA approaches yield comparable or superior outcomes to traditional methods while improving social validity and treatment satisfaction[5].

Conclusion: Is ABA Therapy Right for Your Family?

Applied Behavior Analysis offers a scientifically-validated approach to teaching new skills and addressing challenging behaviors for individuals with autism and other developmental conditions. While the research supporting its effectiveness is robust, the decision to pursue ABA therapy should consider the individual's unique needs, family values, and available resources.

The most successful ABA implementations typically feature:

Individualization to the person's specific needs and preferences
Family involvement and training
Collaborative goal-setting
Regular evaluation and adjustment of the treatment plan
Integration with other supportive therapies and interventions

By understanding the principles, processes, and potential of ABA therapy, families can make informed decisions about whether this therapeutic approach aligns with their goals and values for their loved one's development and well-being.

References

[1] https://www.cdc.gov/ncbddd/autism/treatment.html

[2] https://link.springer.com/article/10.1007/s10803-018-3512-2

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/early-intensive-behavioral-intervention/

[4] https://www.autismspeaks.org/science-news/parent-perspectives-applied-behavior-analysis

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/modern-aba-outcomes/