Our Approach to ABA Therapy

The beginnings of treatment are focused on the development of requesting (non-verbally through pointing and then verbal requesting), matching, sorting, imitation, understanding one-step directions and toy play. Typically children start with 10-15 hours per week and build up gradually until about 20-25 hours. Somewhere around the child’s third birthday or when the nap is faded, we recommend increasing it to approximately 30-35 hours per week.

For children who master the beginning skills, the program moves on to the development of conversation skills such as commenting, answering questions, and asking questions. Skills such as imaginary and symbolic play are taught, as well as an increased focus on peers and play with peers. Abstract and more advanced cognitive skills are also taught, exact skills being determined by what is age-appropriate for the child.

The final third of the program focuses on the development of expressive language skills, more advanced pragmatic (social language) skills, observational learning, following multi-step directions, and social cues (eye contact, gaining attention, reading facial expressions). In addition, age-appropriate cognitive and academic skills are taught.

Initially, treatment is based in the home since that is where young children spend the majority of their time. 

It is our belief that home-based services increase the amount that families are able to carry treatment gains over to non-treatment time. Research has also demonstrated better generalization for home-based programs as compared to school or clinic sites. As children gain skills, we begin to spend a portion of the hours in a school setting with an instructor from the home program there to facilitate social interaction, ensure generalization of treatment gains, and be a liaison between the home and school. As children progress, this instructor is systematically faded out. At the end of the program, hours are almost exclusively done in school and the home program becomes more minimal but can still be useful for skills more easily taught in a 1:1 setting.

Children First Speech Language Pathology and Psychology, PLLC bases our treatment on the science of ABA. There are more than 40 years of published, peer-reviewed, controlled studies on the efficacy of ABA in treating autism. By far the method with the most impressive data, long-term follow up, and replicated results, is what is known as the “Lovaas Method,” developed by the late O. Ivar Lovaas, Ph.D., at UCLA. Research conducted by Dr. Lovaas in the 1970s-1990s demonstrated that a sizable minority (47%) of children who receive intensive ABA services between the ages of two to seven were able to achieve normal levels of functioning by age seven and participate in mainstream classrooms without support. There have been numerous studies from around the world replicating those results. (See our “Research” tab for the references to find these articles). These children no longer qualified for an autism diagnosis, and were said to have “recovered.” Today, we use the term “best outcome” children to discuss this group.

Many of the children in the remaining 53%, while not losing their diagnosis, also have good outcomes and are able to participate in less restrictive educational settings, become verbal, and participate more fully in their families, communities, and schools. Some of these children develop age-appropriate cognition and academic skills but struggle to learn in large class settings. Others can learn well but demonstrate unusual social characteristics.

There is a small minority of children in the 53% who fail to make meaningful progress. Unfortunately, we are not able to identify these children at the onset of treatment and conclusive research about why these children differ is not known.

If you have a child diagnosed, we strongly recommend that you read “Let Me Hear Your Voice” by Catherine Maurice. It is an uplifting and well-written account by a mother whose children went through an intensive home-treatment program. It will give you a rough sense of what to expect — be aware there have been some changes since it was written, particularly in how we start treatment– and it will give you hope!

Whenever we start a child in treatment, it is always our goal to get him or her into a mainstream setting and fade services. For some children, it becomes clear over time that this is not realistic. We will work to find an appropriate special education setting somewhere between kindergarten and third grade. Some families choose to continue a home program; others decide to let the school be the primary place of learning going forward.

For most children who become “best outcome,” the course of treatment is three to five years, with decreasing intensity over the last 18 months.

Although the Lovaas approach is where our roots lay and the standard path we follow when things are progressing smoothly, we greatly individualize our treatment. Often, we devise a new program to tackle a challenge a particular child is having. We draw on new techniques as they become available, and do have training in Verbal Behavior methodologies. We believe in a multidisciplinary approach to therapy combining ABA, speech, occupational, physical, and educational therapy to most effectively help our children learn and grow.

We believe many children with autism can lose their diagnosis after several years of intensive therapy. These children are eventually able to participate in mainstream setting without additional support, and do not require additional ABA services.

Contact us today to discuss how to get started!