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Behavior is the bridge between our thoughts and our actions. ​Every small step in behavior leads to a giant leap in potential.

Applied Behavior Analysis (ABA) therapy has established itself as a cornerstone and is considered to be a gold standard in the treatment of autism spectrum disorder (ASD) and other developmental challenges. This evidence-based approach not only aims to modify behavior but also seeks to empower individuals by fostering essential life skills. To fully appreciate ABA, it’s essential to understand its historical roots, key components, and evolving practices.

A Brief Glimpse into the History of ABA
 

Applied Behavior Analysis (ABA) has its roots in behaviorism, a psychological approach that focuses on observable behaviors rather than thoughts or feelings. This movement began in the early 20th century with pioneers like John B. Watson, who emphasized the importance of studying behavior. In the 1930s and 1940s, B.F. Skinner expanded on these ideas, introducing operant conditioning, which involves using rewards and consequences to influence behavior.

The formal development of ABA as a unique field started in the 1960s, largely thanks to Dr. Ole Ivar Lovaas. His work with children with autism demonstrated how behavior modification techniques could effectively improve social skills and communication. In 1987, Lovaas published a key study showing that early, intensive ABA could lead to significant developmental improvements—so much so that some children could even transition into regular classrooms. Lovaas’s program included 40 hours a week of intensive and rigid clinic-based ABA. As a result of this research, early intervention programs were launched, and ABA became more popularized as the best form of intervention. 

(This short documentary provides an overview of the classic Lovaas study on intensive early intervention using behavior therapy for autism. It showcases the evolution- in some cases remarkable- of several children with autism over a span of 20 years, highlighting the long-term effects of behavior therapy:  https://www.youtube.com/watch?v=oGhIcAnBQZ4 )

Nevertheless, at that time, the application of ABA was rigid and unnatural. Children were required to sit through multiple, repetitive drills to learn skills and sequences, and the number of hours of intervention were exhausting. The popularization of his methodology created a mindset among some parents and providers that intervention must be highly structured, rigid, adult-driven, and sometimes, aversive, meaning treatment could involve unpleasant techniques to alter maladaptive behavior.(1)

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In 1960s, as ABA has expanded and become more common, it has also acquired critics among parents and autism advocates, who took issue with its methods and the way they were used by some practitioners. One source of criticism stems from the fact that the earliest form of ABA was not wholly based on positive reinforcement for desired behaviors; the therapist used principles of both positive reinforcement and punishment to reduce self-injurious behaviors, treating severely impaired persons by applying some aversive reinforcement methods. Such methods would involve both shock punishment—administered through a shock room for those who don't respond to less intense methods—and a reward system that used food and affection to encourage positive behaviors. 

To learn more about the historical context, early methods and the level of controversy surrounding ABA, you can explore the following articles:

Screams, Slaps and Love (Life Magazine, 1965)

America’s Most Popular Autism Therapy May Not Work — and May Seriously Harm Patients’ Mental Health

Reinforcement Therapy: Obedience Training of Children with Autism

Evolving Practices 

Since the early 1970s, however, the world of ABA and the application of the principles of ABA have evolved enormously. Like many areas in healthcare, advancements in research have led to the development of new strategies and approaches. Today, ABA is characterized by a more naturalistic, engaging, play-based, and child-centered form of intervention; a therapy often occur within the context of everyday activities—such as mealtimes, playtime, bath time, and community outings like grocery shopping. This approach contrasts sharply with the rigid, clinical settings of the past, emphasizing real-life teaching experiences.

Contemporary ABA programs are designed to be flexible and responsive to the diverse needs, values, and cultural contexts of each child and family.

According to the Behavior Analyst Certification Board (BACB), current standards emphasize the importance of individualized treatment plans that respect the unique circumstances of each client. ​​

Nevertheless, Dr. Leaf from Autism Partnership Foundation thinks that current ABA practices can still be too rigid, which may not help children with ASD as much as possible. He believes therapists should be more flexible and adapt their approaches to fit each child’s individual needs. "It is essential to prioritize real-life outcomes instead of strictly adhering to procedures. To achieve this, new therapists require high-quality, extensive training that equips them to implement ABA effectively and truly benefit their clients."(2)

The Principles of ABA

The fundamental principles of Applied Behavior Analysis (ABA) guide the treatment process, emphasizing the following key ideas:

  • Behavior Development through the Environment: ABA recognizes that children learn from their surroundings. Behaviors evolve over time in response to various stimuli.

  • Changing Behavior through Reinforcement: Different forms of reinforcement are employed to modify behavior. Praise and rewards encourage desired actions, while differential reinforcement involves withholding praise for undesired behaviors.

  • Effectiveness of Positive Reinforcement: Positive reinforcement is the most effective method for encouraging desired behaviors. It is generally more impactful than punishment, which can have adverse effects. 

  • Consistency for Meaningful Change: ABA is an ongoing process requiring continuous reinforcement and monitoring. Regular reassessments help the therapy evolve alongside the child’s progress.

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These points highlight the key concepts of ABA. First, children learn from their environment, and their behaviors change over time based on their experiences. To encourage positive behaviors, ABA uses rewards and praise, while it also addresses unwanted behaviors by withholding praise when needed. Positive reinforcement—rewarding good behavior—is an effective way to promote change, as it tends to be more beneficial than punishment, which can lead to negative outcomes. Finally, ABA requires ongoing support and regular check-ins to ensure the therapy adapts to the child’s growth and progress.Interestingly, the foundational principles of ABA were inspired by early experiments with pigeons, where researchers demonstrated that reinforcing specific behaviors could lead to remarkable changes—a concept that has since transformed how we approach behavior in children and other areas of life. 

ABA principles are based on learning theories and include the following key approaches:

Natural Consequence

Natural consequences are the direct results of behavior. For example, if you touch a burning candle, you will burn your fingers. This immediate connection between behavior and consequence helps individuals learn from their actions.

Reinforcement

Reinforcement refers to the follow-up to a specific behavior, which can either increase or decrease the likelihood of that behavior happening again in the future. If a behavior improves, it’s often because something or someone is providing positive reinforcement. This can include rewards like praise, candy, extra playtime, or fun activities.

  • Positive Reinforcement: This occurs when a reward is given after a desired behavior is demonstrated, encouraging its repetition.

  • Negative Reinforcement: This involves the removal of an unpleasant stimulus after the desired behavior is achieved, motivating the individual to continue the behavior.

Punishment

Punishment is a consequence that follows a specific behavior, making it less likely to occur again. It serves as a penalty for mistakes or rule violations. For instance, a teacher might assign extra work during recess to a talkative child as a consequence for not following classroom rules.

 

Shaping

Shaping is a technique used to teach new behaviors by rewarding successive approximations toward the desired behavior. For example, when teaching a child to brush their teeth, they receive praise for completing each step, increasing the likelihood that they will continue to perform the behavior correctly.

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Fading

Fading involves gradually reducing reinforcements and prompts while maintaining the desired behavior. This process helps ensure that the individual can perform the behavior independently over time.

7 Dimensions of ABA.

The seven dimensions of ABA therapy outline the essential components that Board Certified Behavior Analysts (BCBAs) and Registered Behavior Technicians (RBTs) utilize to create engaging and effective treatment plans for children.

1. Applied

The applied dimension emphasizes implementing learned skills in real-life contexts. BCBAs collaborate with children to identify specific, relevant goals such as communication, social skills, and self-help skills. This focus on functional skills ensures that children can apply what they learn across various environments.

2. Behavioral

The behavioral dimension involves analyzing and modifying behaviors. BCBAs assess children's behaviors to understand their functions, triggers, and consequences. Through systematic observation and data collection, they design treatment plans to enhance positive behaviors and reduce maladaptive ones.

3. Analytic

The analytic dimension highlights the importance of data-driven decision-making. BCBAs collect data through observations and reassessments to evaluate the effectiveness of strategies. Continuous data analysis allows therapists to adjust treatment plans and track progress, ensuring optimal outcomes for each child.

At Wellspring Learning Centers, data is vital to a child’s programming, enabling behavior analysts to identify progress or challenges in task performance. We make data-informed decisions to guide our interventions.

4. Technological

The technological dimension focuses on precisely documenting all treatment strategies used during therapy. BCBAs provide clear and detailed descriptions of their techniques, allowing RBTs to replicate successful methods and maintain consistency across sessions, facilitating effective teamwork among caregivers.

5. Conceptually Systematic

This dimension emphasizes the use of established principles and research-backed theories in behavior analysis. BCBAs develop treatment plans based on evidence-based practices, ensuring that RBTs implement high-quality and effective techniques.

6. Effective

The effective dimension prioritizes achieving meaningful change. BCBAs collaborate with families and other caregivers to set goals that positively impact the child's quality of life. Whether focusing on improving communication, fostering independence, or promoting social inclusion, ABA therapy aims to enhance the child's overall development and well-being.

7. Generality

The generality dimension emphasizes the transfer and maintenance of learned skills across different settings and situations. RBTs aim to teach skills that children can use in various environments, such as home, school, and the community.

The seven dimensions of ABA create a structured framework for developing effective treatment plans for children. The applied dimension focuses on teaching skills that are meaningful in real-life situations, such as communication and social interactions. This ensures that children can use what they learn outside of therapy sessions.

The behavioral dimension involves analyzing and modifying behaviors by understanding their triggers and consequences. By systematically observing behaviors, therapists can design targeted strategies that enhance positive actions and reduce unwanted ones.

Data-driven decision-making is central to the analytic dimension, where therapists continuously collect and analyze data to assess the effectiveness of their strategies. This allows for ongoing adjustments to treatment plans based on the child’s progress.

All treatment methods are clearly documented by a BCBA (a therapist)- that helps maintain consistency and ensures that caregivers can effectively collaborate. The conceptually systematic dimension emphasizes using established research-backed principles, ensuring that interventions are based on proven techniques.

The effective dimension aims for meaningful changes that improve a child's quality of life. Therapists work closely with families to set goals that foster communication, independence, and social inclusion. Finally, the generality dimension highlights the importance of teaching skills that can be applied across various settings, such as at home, in school, and in the community, enabling children to generalize their learning and thrive in different environments. Together, these dimensions form a comprehensive approach to supporting children’s growth and development.

When to Start and When to Stop ABA

Literature consistently suggests that the optimal age for ABA therapy generally falls between the ages of 2 and 6, with starting at age 2 (or even earlier) being particularly advantageous for developing communication skills, following directions, and preparing for preschool. In many cases, early intervention can significantly alleviate the challenging symptoms and behaviors associated with autism. This enables children to learn to manage various triggers that complicate everyday life, such as sensory overload from loud sounds, bright lights, or crowded places; it also helps them to learn how to cope with transitions between activities and navigate social interactions, among other everyday challenges.

Many parents begin ABA therapy for their children during early childhood or while they are in elementary school. They often wonder when therapy should cease, especially after their children have mastered some of the essential skills and achieved significant milestones. Questions may also arise about whether to continue therapy into adulthood.

 

Deciding when to end ABA therapy is a nuanced process. Professionals suggest considering termination of therapy when:

  • The child has completed 2-3 years of intensive therapy, followed by an additional 2-3 years of focused interventions

  • The primary goals of the therapy have been achieved

  • The child no longer shows common symptoms of autism

  • Progress has slowed or plateaued over several weeks or months

Research suggests that the earlier a child starts ABA therapy, the better the outcomes. Most children affected by a NDD can be diagnosed by the age of 24 months, with advancements in health science allowing for a reliable diagnosis as early as 12 months. Initiating early intervention as soon as autism is diagnosed is recommended, as it provides the opportunity for learning and progress during a critical period of neuroplasticity. Studies using the Early Start Denver Model have shown significant improvements in children with autism between the ages of 18 to 30 months, focusing on social interactions, play, and communication skills.

Several key indicators can help parents, caregivers, and therapists determine when it’s important to continue ABA therapy for children with autism. These include:

  • Children requiring direct instruction to learn in a natural environment.

  • Parents, caregivers, and teachers struggling to manage problem behaviors without the support of a Board Certified Behavior Analyst (BCBA).

  • Difficulty implementing behavior or teaching plans effectively by parents, caregivers, and teachers.

  • Children not thriving in different educational settings.

  • Children failing to meet their goals in ABA therapy efficiently and on time.

  • Challenges in adapting to or applying new behaviors in unfamiliar environments without additional teaching.

  • A lack of spontaneous skill development without direct instruction or intervention.

These criteria can help guide parents and caregivers in making informed decisions about their child's therapy journey.​ However, there is no one-size-fits-all answer. The duration and intensity of ABA therapy each child requires depend on their unique progress toward established goals and milestones. Some children may only need short-term therapy and can transition away from it after a few years, while others may benefit from continued support throughout childhood and into adulthood to foster ongoing development.

Ultimately, the decision to start or stop ABA therapy should be based on the child's individual needs and progress, in collaboration with professionals who understand the complexities of autism.

Unveiling the Financial Burden

Families with children on the autism spectrum face an average of $60,000 in costs per year. These expenses include medical care, therapy sessions, specialized education, and additional support services. The costs associated with managing a neurodevelopmental condition can vary depending on several factors, such as location, severity of symptoms, and the availability of resources. 

The cost of ABA therapy can vary widely, typically ranging from $100 to $200 per hour. This variation is influenced by several factors, including the intensity of the therapy program, the qualifications and experience of the therapist, and geographical location. For example, families in urban areas may encounter higher rates due to increased demand and living costs compared to those in rural regions. At the same time, medical centers in larger cities often have a greater availability of well-experienced therapists, which can enhance the quality of care and improve outcomes for children receiving therapy.

The structure of an ABA program is another critical factor influencing overall costs. Intensive ABA therapy typically involves multiple sessions per week, ranging from 20 to 40 hours of one-on-one sessions (with a minimum of 10 hours per week).(3,4) This level of commitment can result in substantial annual expenses for families.  The total costs can range from $30,000 to $100,000 annually, depending on the number of hours of therapy required and the specific needs of the child. These figures highlight the significant financial commitment that families must be prepared to make to access effective treatment.

One of the most important considerations for families is the availability of insurance coverage for ABA therapy, as it can vary significantly. Some countries have provisions for ABA therapy under public health insurance, while others do not. In the US, Canada, UK, Australia, New Zealand and some EU countries many insurance plans now cover ABA services, largely due to legislative mandates requiring insurers to provide this coverage for autism-related treatments. However, the specifics of coverage can differ greatly between plans. In the Middle East, coverage for ABA therapy varies by country and is often limited or nonexistent, which poses significant challenges for families seeking effective treatment.

The long-term financial implications of ABA therapy must also be considered. Research suggests that early and intensive intervention can lead to better outcomes for children with ASD, potentially reducing the need for ongoing services later in life. However, the reality for many families is that ABA therapy may be required for several years, contributing to a substantial lifetime cost associated with autism treatment.(5) Estimates indicate that families may face lifetime costs that range from $1.4 million to $2.4 million for individuals with ASD, depending on the presence of comorbidities and the level of intellectual disability. Moreover, the economic impact of autism extends beyond direct treatment costs. Families often incur additional expenses, including specialized educational programs, assistive technologies, home modifications, and logistical arrangements—each tailored to meet the unique needs of their child. This compounding of costs can place significant stress on family finances, affecting their overall well-being and stability.

Quality Matters: The Negative Implications of Low-Quality ABA Therapy

The quality of ABA therapy is heavily dependent on the qualifications and experience of the therapists delivering the intervention. When ABA therapy is conducted by low-quality or inexperienced therapists, several significant problems can arise, ultimately compromising the effectiveness of the treatment and the well-being of the individuals involved.

Inconsistent Treatment and Outcomes:

One of the primary issues associated with low-quality ABA therapy is inconsistency in treatment implementation. Effective ABA relies on a structured approach that includes data collection, individualized programming, and the consistent application of behavioral strategies. Inexperienced therapists may lack the skills to develop and adapt these individualized programs, leading to generic and poorly tailored interventions. As a result, children may not receive the targeted support they need, leading to stagnation in progress or even regression in behavior and skills.

Lack of Evidence-Based Practices:

Quality ABA therapy is rooted in evidence-based practices that have been rigorously tested and shown to produce positive outcomes. Therapists who are not well-trained or lack sufficient experience may apply outdated or ineffective techniques. This misapplication of strategies can result in minimal gains for the child, wasting precious time and resources that could be better spent on proven methods. Without adherence to evidence-based practices, the potential benefits of ABA therapy are severely diminished, and families may feel frustrated and disillusioned with the therapeutic process.

Ethical Concerns and Unintended Consequences:

The ethical implications of low-quality ABA therapy cannot be overlooked. Therapists who lack experience may not fully understand the ethical considerations involved in working with vulnerable populations, including informed consent and the importance of building trusting relationships with children and their families. Inappropriate or poorly delivered interventions can lead to negative consequences, such as increased anxiety or behavioral challenges. Moreover, families may feel pressured to comply with strategies that are not in their child's best interest, further eroding trust in the therapeutic process.

Emotional and Financial Burdens on Families:

The impact of ineffective therapy extends beyond the immediate outcomes for the individual; it also places significant emotional and financial burdens on families. Parents often invest considerable time and resources into securing therapy for their children, and when that therapy falls short, it can lead to feelings of hopelessness and frustration. Families may find themselves needing to seek additional services or change therapists frequently, leading to increased costs and stress. The emotional toll can be profound, as families grapple with the challenges of supporting their child while navigating an inadequate therapeutic landscape.

Finding a Good ABA Therapist

Choosing an experienced ABA therapist is crucial because they have the skills to effectively support your child's unique needs and help them develop important skills. However, experience alone isn't enough; the therapist must also be personable and capable of building a strong relationship with your child. Trust and rapport are essential, as they enhance engagement and motivation, enabling more effective learning. Without this connection, even the best techniques and strategies may fail to lead to meaningful progress.

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  • Do Your Research: Start by looking for ABA therapists in your area. Check online directories or ask for recommendations from your doctor, your friends or local autism support groups.

  • Check Qualifications: Make sure that the therapist holds a master’s degree or higher in behavior analysis, psychology, or education, and is certified in Applied Behavior Analysis by the Behavior Analyst Certification Board (BACB). Additionally, they should have experience working specifically with children with autism. Look for credentials like BCBA (Board Certified Behavior Analyst), as this indicates a high level of expertise and training in the field. Do not hesitate to ask the therapist to share their credentials- therapists without the necessary qualifications may avoid discussing their credentials or become defensive when asked. In contrast, those who have completed the required studies and hold the appropriate certifications will likely be proud of their achievements and will willingly share their credentials.

  • Ask About Experience: Inquire how long they have been practicing and what types of cases they have worked on. It's helpful if they have experience with your child's specific needs.

  • Observe Their Approach: Ask about their therapy methods. A good therapist should use positive reinforcement and tailor their approach to fit your child’s unique personality and challenges.

  • Schedule a Meeting: Arrange a time to meet the therapist in person. This is an opportunity to observe how they interact with your child and to ask any questions you may have. A good professional with strong ethics will be open and willing to answer your questions and explain their approach clearly.

  • Talk to Other Parents: Reach out to other parents who have worked with the therapist. Their insights can help you understand what to expect.

  • Trust Your Instincts: Pay attention to how you and your child feel about the therapist. It is important that both of you are comfortable and feel understood.

  • Set Clear Goals: Once you choose a therapist, work together to set specific goals for your child's progress. This helps keep everyone on the same page.

References:

  1. Molko, R. ABA History: Applied Behavior Analysis Therapy Evolution. (2024) https://learnbehavioral.com/blog/understanding-the-evolution-of-aba

  2. Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Ala’i-Rosales, S., Ross, R. K., Smith, T., & Weiss, M. J. Applied Behavior Analysis is a Science and, Therefore, Progressive. (2016) Journal of Autism and Developmental Disorders, 46(2), 720–731. https://doi.org/10.1007/s10803-015-2591-6

  3. Choi, K., Bhakta, B., Knight, E., Becerra-Culqui, T., et al. Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder. (2022) Journal of Developmental & Behavioral Pediatrics 43(1):p 9-16, January 2022. | DOI: 10.1097/DBP.0000000000000995

  4. Granpeesheh, D., Tarbox, J., Dixon, D. Applied behavior analytic interventions for children with autism: A description and review of treatment research. (2009) Annals Of Clinical Psychiatry, 2009;21(3):162-173. https://www.researchgate.net/profile/Jonathan-Tarbox/publication/26816222_Applied_behavior_analytic_interventions_for_children_with_autism_A_description_and_review_of_treatment_research/links/0fcfd4fff0bcab12ab000000/Applied-behavior-analytic-interventions-for-children-with-autism-A-description-and-review-of-treatment-research.pdf 

  5. Kogan, M. D. et al. The financial burden of autism spectrum disorder on families: A comparison of families with children with ASD and those with typically developing children. (2018) Autism, 22(4), 489-498.

  6. Bernero, C. Parental Experience with Applied Behavior Analysis as an Autism Intervention. (2023) University of Texas at Austin. Retrieved from:  https://www.proquest.com/openview/9ecfa2623e55c68b867c7746a2786206/1?pq-origsite=gscholar&cbl=18750&diss=y

  7. Garey, J. The Controversy Around ABA:  Why some autism parents and advocates find fault with the therapy. https://childmind.org/article/controversy-around-applied-behavior-analysis/ 

Insights from Parents of Children with Autism: Expert Perspectives on ABA

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In the field of neurodevelopmental intervention, Applied Behavior Analysis has long been recognized as one of the most effective and evidence-based therapies. However, as with any field of study, there are diverse opinions on its application, effectiveness, and overall impact, especially when it comes to real-world experiences. Parents' perspectives on ABA are not only shaped by the clinical research but also by the lived realities of raising a neurodiverse child.

In this regard, experts who are also parents offer a unique and invaluable point of view by bringing both professional knowledge and personal experience to the table, offering insights that reflect the complexities of neurodevelopmental disorder. While some experts firmly support the use of ABA as a cornerstone of autism treatment, others question its broader application or suggest modifications based on the individual needs of the child. These differing perspectives reflect the ongoing evolution of the field and underscore the importance of considering the scientific advances, clinical evidence and the nuances of each child's needs when selecting interventions.

Ekaterina Men and Peter Lloyd-Thomas are two such figures whose opinions and experiences reflect the diversity of thought within the neurodiverse community. Both are parents of children with autism and have dedicated much of their professional lives to advancing the field of intervention practices- Ekaterina as a President of the Center for Autism Problems (Russia), content curator and a leading advocate for high-quality ABA intervention and Peter, the founder of Epiphany ASD, an independent researcher and a proponent of personalized medicine and personalized education for improving lives of children affected by ASD. While their experiences with ABA may differ, their viewpoints also highlight the challenges and complexities involved in its implementation. Their perspectives, shaped by years of personal involvement and professional expertise, offer valuable contributions to the ongoing discussion about the role of ABA in autism treatment.

Ekaterina:

''I don’t think there’s a more troubled professional field than Applied Behavior Analysis ABA. How did it happen that such a necessary, logical, humane, intelligent, and well-thought-out therapy for children with autism and other developmental disorders became the target of so much misinformation, hysteria, and fraud? On the other hand, the louder the attempts to discredit it, the more they highlight its true value. Good tools are worth their weight in gold. No one goes to great lengths to discredit something that’s clearly worthless—its value speaks for itself.

For some, money knows no bounds. My colleagues and I conducted a quick survey of “ABA therapy” courses that pop up through ads. They’re cheap, and yet it’s nearly impossible to identify who’s actually teaching them. These courses, often promoted by commercial “education” vendors, offer a poor substitute for genuine, professional training, misleading an audience that genuinely seeks to understand behavioral science and theory.

It would be easy to disregard the actions of fraudsters— “not our problem,” as the saying goes—if fraud didn’t have another side: the deceived victims. It’s one thing when the victim is an adult who can make their own decisions, but quite another when vulnerable children suffer under the guise of ABA therapy. After attending courses promoted through Google Ads, these children end up subjected to therapy that is, at best, ineffective, and at worst, harmful. 

Another issue is with those who discredit ABA therapy without truly understanding it, confident that their degrees in fields like medicine, law, or even acting can be easily applied to a completely different field of science—one that has earned multiple Nobel Prizes. Let me share just a couple of examples to illustrate the consequences. A mother is seeking treatment for her child at a trendy clinic, where she’s told ABA therapy isn’t necessary until her child transforms into some kind of “superman” (here implies to becoming ‘’perfectly healthy’’). They assure her this will happen because they are the "greatest" experts, while everyone else is apparently illiterate in the field of autism. She believes that eventually, her child will overcome autism, shatter his limitations, and become a well-adjusted, social member of society—perhaps even with a career in banking.

With this rosy picture in mind, the mother continues on. But something still nags at her. She instinctively senses, even if she doesn’t fully understand it, that raising a child is a long, tedious, and exhausting process. She knows that well-adjusted people don’t just appear out of nowhere. So, secretly, she begins taking her child to therapy sessions. And thank God for that, you might say. If only it weren’t for one thing: she can’t handle the child.

As you can see, even the most advanced treatment isn’t a magic trick. It doesn’t transform a child overnight. It never has, and it never will. Even in movies, when it happens, such films are rarely taken seriously. A child who receives help remains complex, temperamental, and sometimes exhibits maladaptive behavior. While this behavior may lessen in frequency and intensity, progress is always gradual. You can be thrilled with a pointing gesture that suddenly appears, or the fact that the child finally solved a math problem they were struggling with or managed to put on their pants when before they would just fall down. These are real achievements that are worth celebrating. But overall, the child remains challenging. Even highly restored teenagers, excelling academically or in complex hobbies, still struggle with social adaptation. Their social age often lags behind their biological age, and if you haven’t learned how to manage this, you won’t succeed.

You might have excellent test results; you might feel that your brain’s protective mechanisms are functioning well. But life is about the daily interactions with your child's process of growing. The mother I mentioned earlier sometimes resorts to physically punishing her "progressing" son. Not because she’s a bad mother, and not because the therapy is ineffective, but because she’s a real person. No one is born knowing how to raise atypical children (or even typical but troubled ones). These skills need to be learned, just like knitting, driving, or playing the trumpet.

The basic skills of ABA—understanding the laws of behavior—can literally save lives. ABA teaches you how to respond to crises in ways that prevent escalation. Behaviors that exhaust you don’t always involve extreme actions like head-banging; they could be endless whining, repetitive nonsense, or handling household items in ways that frustrate you but can’t be changed. The more inappropriate your reactions, the higher the chance the behavior will persist, draining you to the point of suicidal thoughts. Meanwhile, the child may be physically healthy. Even if the autism level or neuro-trauma was mild, and developmental delays have been reduced, trauma still exists. And trauma doesn’t disappear without a trace. Even a broken finger, if healed properly in childhood, will remind you of itself at 60. A bullet that didn’t kill you still passed through your body—and you’re not the same as someone who’s never been shot.

But as I said, restorative treatment, even when a child has strong compensatory resources, never transforms a child from a "little devil" into Oscar Wilde. “Bad” behavior, formed in the context of illness, doesn’t just vanish on its own. The child will improve—his stomach pain will stop, the fog in his mind will lift—but the behavior will remain. It was his way of interacting with the world and getting what he wanted. He didn’t know any other way. But even when you finally realize that the idea of your child with ASD suddenly becoming a perfect, well-adjusted person is just a fantasy, and not your reality, you still won’t know how to handle it.

There are many cases where mothers, with the best of intentions, seek treatment (which is absolutely necessary!) but are misled into thinking their child is just a collection of proteins and metabolites, rather than a complex system of interacting physical and emotional needs. Without a basic understanding of behavioral principles, these mothers end up physically punishing their children. And, of course, those who resort to violence—whether through their own actions, medical arrogance, or exploiting misinformed parents—will face their own reckoning.

All of this still needs to be addressed. But for now, rely on the trusted tools that are available. First and foremost, professional training should only come from courses approved by the IBAO commission—a reputable institution that evaluates ABA training programs. If it’s about improving parental literacy—learning how to avoid reinforcing negative behaviors due to improper reactions and ineffective behavioral management—seek training from those affiliated with IBAO-approved educational materials. Don’t trust online ads or anyone offering advice on complex matters like space while specializing in digging holes. Such advice is clearly irrelevant. Focus on treating your children without resorting to physical punishment.''

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Peter:

"From my personal experience, behavioral intervention has been very beneficial as a teaching method, but it does not make autism go away.

Why did ABA catch on in the first place? People are naturally drawn to hope, and the more expensive something is, the more appealing it becomes. Forty hours a week of ABA therapy is costly, and it is nice to have, if someone else is paying.

Many parents are looking for curative treatments for autism. Lovaas, the "father" of ABA, claimed that ABA could cure autism and that children who undergo it would become like typical kids. Unfortunately, this is an exaggeration.

 

Is two years of ABA cost-effective for severe autism? It likely depends on who’s paying for it. Will two years of ABA be life-changing for a person with severe autism? Unfortunately, even after 20 years of ABA, a person will probably still have severe autism unless their underlying biological issues are addressed.

Children with mild autism need a different kind of therapy. These children often need to learn social and emotional skills that they may not naturally acquire. They need to know how to make friends, how to avoid conflicts, and how to prevent being bullied at school. This kind of therapy is most effective when started at a young age, before social struggles become ingrained. 

For cases of severe autism, if you can afford intensive (and expensive) 1:1 intervention of any credible kind, it makes sense to use it.  It should improve skill acquisition and will make the parents feel better.  However, it's important to recognize that none of these interventions are curative—the child will still have autism. Once the funding for 1:1 intervention stops, the effects will likely fade away.

Don’t mortgage your house to pay for ABA. Nothing stops you making your own 1:1 intervention program using family, friends and volunteers.  This does not cost much and is sustainable over many years; it is likely to be much more effective that 2 years of "professional" therapy.

Our last ABA consultant was highly experienced. She told us that, in her experience, all children with autism benefit from ABA, but the level of progress varies widely. If a child doesn’t respond to ABA, it’s likely that the therapy isn’t being implemented correctly. ABA should be fun, not like a punishment. If your child hates ABA sessions, they have little chance of success."

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