What to Expect: Considerations for Ongoing Applied Behavior Analysis
Now that your Applied Behavior Analysis (ABA) journey has begun, you are beginning an important and significant process. Initial assessments have been conducted and now the work begins, but how can you make sure you are smooth sailing through treatment?
As a caregiver and parent, it is vital for you to ask questions throughout this entire process. It is your right to be fully informed on every aspect of treatment, so questions should be welcomed by any ABA provider. While yes, your provider is technically the expert in ABA therapy, you are the expert in knowing your loved one. The parent/caregiver insight is valuable for helping with the direction and course of treatment. It is important you ask for rationales of anything and everything within the treatment being implemented for your son or daughter.
We want you, the child’s support system, to reap all the benefits of ABA therapy — and see the growth outside of therapy hours, in our absence. Below are important things to consider as you are making your way through this next step in the process.
Communication & Commitment
Communication is key to staying informed and up to date with what is happening in treatment. This includes communicating with everyone on the child’s treatment team. Once a treatment plan is put in place, assessment should never stop. The BCBA is constantly assessing program progress, reporting on goals, assessing teaching strategies, and problem behaviors. The BCBA should be contacting you to discuss any major changes in the child’s goals — whether it’s regarding a skill building goal or a behavior reduction goal, you should be informed, and your consent should be obtained prior to any changes. We can’t stress the importance enough in asking why the changes are being made. Be sure to ask the questions! Your BCBA should give you rationale of the suggestive change in understandable, non-technical language.
Effective treatment is not enough, when looking for significant clinical outcomes and changes in ABA therapy. Parent/Caregiver involvement is paramount to the effects of treatment, which is why communication is so critical. During the initial caregiver interview, the BCBA will begin to understand what every-day routines need changing. By understanding these every-day routines, the BCBA can begin to help impact the home environment to become less stressful. Since your opinion and recommendations matter, it’s important for caregivers to not only approve, but be in alliance with carrying out the suggested treatment strategies. As a united front, we are far more likely to be successful.
Generalization and Maintenance
Generalization is an ABA term that refers to a behavior change that is durable across time, different environments (therapy, home, school), or if the behavior changes spread to a variety of related behaviors (Baer, Wolfe, & Risley, 1968). Maintaining ongoing communication with the BCBA to stay informed is critical to generalization and maintenance.
Socially significant goals are designed out of collaboration with the parents/caregivers and BCBA, to determine what concerns to target within the home, community, and school. Ideally, the whole team (ABA staff and family) should be on the same page for determining the child’s treatment success. The goal for ABA therapy for your son or daughter is to
increase learning opportunities for your child to work on acquiring new skills
maintain previously acquired skills, and
promote learning across people, settings, and times throughout your child’s life
If your child is doing well in the ABA setting, but caregivers and teachers not seeing changes in your child’s behavior, it is very likely to be the result of failed generalization.
Simply put, how useful is it for your child to be able to (insert any skill here) in therapy, if they are not able to do so at home, school, or in the community? If a skill fails to generalize across environments and it’s no longer worked on within therapy, it will also fail to maintain. In other words it will disappear. Let’s use the example of a child learning to use their words to communicate their wants and needs in the center. It is a similar thought to working out at the gym. In therapy, a specific muscle is the focus and the data begins to show the muscle has grown to reach a certain size. Because the team is happy with that, they move on to a new muscle in therapy. Meanwhile, that first muscle never was worked on at home or the community — only in a therapeutic scenario. So now what? Muscle atrophy (the muscle reduces in size).
For skills to maintain and flourish across settings and people, we must give the child opportunities to utilize the skills and benefit from it. Keeping the child at the center of the therapy is vital because all of the skills worked on should result in a meaningful change in the child’s life. When looking at each goal and skill set, it’s important to consider the following: is this a skill that will be worked on every day in this child’s life (toilet training, washing hands, communication), or it is a smaller component of a larger bigger picture (expressive labeling is a component skill for conversation/socialization)? This is yet another reason for the parents/caregivers to ask those important questions:
“Why are we working on this skill?”
“Is this a short-term goal?”
“What are the long-term goals we are working on?”
“Does this skill benefit a long term goal?”
Even while we encourage you to ask the questions, parent training is something you should expect within treatment. You should be learning along with your child during therapy. ABA should sharpen your skills and expand on your parent tool-box. The child’s success- whether it be a child in ABA therapy or a typically developing child, is more probable when caregivers are involved (Levy et.al, 2005).
Collaboration: What should this look like?
You should have expectations for your BCBA to be in collaboration with other professionals that make up your child’s treatment team (teachers, speech therapists, OT). The lack of collaboration, or poor collaboration, can hinder the treatment team’s ability to develop and carry out interventions with high treatment integrity. There is research that demonstrates parents and teacher’s active involvement has proven to result in an increase in social skills (Kelly & Tincani, 2012). BCBA’s have an ethical responsibility to initiate and maintain collaboration with other professionals involved in the coordinated care of the child, in order to maintain treatment integrity and better facilitate generalization. Collaboration allows us, as professionals, to better serve the client. BCBA’s should not be hesitant in collaborating with other professionals, they should make it a goal to build good rapport in order to serve more efficiently on the same team. Make it a point to ask the BCBA questions on how they will approach collaboration with other professionals. Will they be visiting the child’s school? Will they be coordinating to have other professionals observe the child in ABA therapy?
At the end of the day, ABA is an enormous investment in your life and the life of your child. It is so important to ask the questions, and ensure you are getting the most of what ABA has to offer.
Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough. Journal of applied behavior analysis, 33(3), 373–391. doi:10.1901/jaba.2000.33-373
BAS videos
Baer, D. M., Wolf, M. M. and Risley, T. R. (1968), SOME CURRENT DIMENSIONS OF APPLIED BEHAVIOR ANALYSIS1. Journal of Applied Behavior Analysis, 1: 91-97. doi:10.1901/jaba.1968.1-91
Gresham, F. M., Gansle, K. A., & Noell, G. H. (1993). Treatment integrity in applied behavior analysis with children. Journal of applied behavior analysis, 26(2), 257–263. doi:10.1901/jaba.1993.26-257
Kelly, A., & Tincani, M. (2012). Collaborative Training and Practice among Applied Behavior Analysts who Support Individuals with Autism Spectrum Disorder. Education and Training in Autism and Developmental Disabilities,48(1), 120-131.