ABA Therapy

[Stephenie]

My son was recently diagnosed as being on the autism spectrum (Asperger's) and the developmental ped suggested a minimum of 20 hours a week of ABA therapy, combined one on one and group therapy. Does that seem like a lot to anyone but me? He'll also be doing OT , probably 2 hours a week. We have experience with OT, but not with ABA. I have looked into a few centers around here and it seems like most of them require about that 20 hours as a minimum and one was 35 hours a week. My son has never been away from me like that. No daycare, no preschool. Just Sunday School once a week. We plan to homeschool in part because he has huge anxiety over being in group settings with other kids. I tried to talk to him about going to a group ABA program and it upset him. He does not want to go where there are other kids and does not want me to leave him. 

He's three and will be four in April, by the way. 

What exactly happens in ABA therapy? I don't know a whole lot about it, but I do know the doctor said it would help him learn to make eye contact better, pick up social skills etc.

Thanks 

[AnalogWife]

Sorry, see below....

[AnalogWife]

Wow that sounds like a lot of ABA!  4 hours a day/5 days a week.  My DS is one month younger than yours and in preschool 15 hours per week which includes OT, ST, and PT, but no ABA.  His Dev Pedi indicated that he wasn't in dire need of ABA and I selected a preschool that doesn't mandate it (some do, at least in this area), but I'll be interested in results because I sometimes do wonder what ABA would do for my DS.  There are some ABA vids on Youtube that might give you an idea of what goes on.  FWIW, my DS has gained social and eye-contact skills just by being in the Special Purpose room of his SN preschool, before that he was in an integrated class and it was a bit too fast for him.  GL! :hug

[Altair]

ABA is behavioral, whereas some other interventions (RDI, Floortime, Social Thinking for older kids) are cognitive and/or relationship based.  It is not something you *have* to do by any means and there are many other options.  I'm extremely fluent in the 3 listed above and use them daily...  though every kid I work with also gets 1-1 speech and OT (and sometimes additional PT and counseling).  It might be worth your while right now to just take some time to really explore what your options are in your area, esp. in terms of what your school district and insurance offer. 

[Linda on the move]

Originally Posted by Stephenie 

My son has never been away from me like that. No daycare, no preschool. Just Sunday School once a week. We plan to homeschool in part because he has huge anxiety over being in group settings with other kids. I tried to talk to him about going to a group ABA program and it upset him.

Look into it and research it, and then decide what to do based on what you think with give your child the most control over his life long term. IMO, this is NOT a decision that a child with autism should get a vote on.

Sometimes what is best for our kids upsets them. It's not our job to make them happy today. It's our job to attempt to figure out what will make them happy in the long run, and then make it happen.

Sometimes what has been best for my DD has been very difficult for her and very heartbreaking for me. But she is 14 and doing really well. She's still on the spectrum, but she goes to school, has hobbies, does volunteer work and is considering going to college. (some have programs for kids with special needs).  If we stuck with what she always wanted to do, she'd be hiding in her bedroom, refusing to interact with the rest of the world at all, and would have no future other than to live like a child in our home forever and never grow up. Because we've done some tough things, she can create her own future.

[Stephenie]

The doctor thought he'd be a poor fit for the sn preschool provided by the school district. He's quite bright in addition to having AS and it gets complicated when you have a 3 year old reading on a 2nd grade level in any preschool. He is really, really stubborn and gets mad when anyone tries to show him anything he already knows. And he's got SPD as well, so sitting still is a challenge as well as crowds.. I know they'd be trained to work with all of that. Unfortunately, my district is known to have a poor program and I have prior bad experience with them... so we'll be staying away from that for now. 

Insurance says they will cover OT, ABA, PT, ST, prescriptions, supplements, just about anything relating to autism until he's six, 100% with no caps. So we're ready to use that benefit to the fullest. Funny how a diagnosis can change that so much, with SPD as his only DX, we could only get $1500 of OT. 

There are several programs around, the one that looked more appealing in terms of time was more speech focused and at this point, speech is not an issue. I am wondering if trying one on one ABA and doing social skills groups a few times a week would be better? At least to start, so it's not so overwhelming to him. To just start dropping him off somewhere 20 plus hours a week seems like it would be too much change for him at once. Change is not something he tolerates well. 

I do think I will ask the doctor about that recommendation. When we spoke, he just recommended a few centers and said that he thought what would be best was the combination of one on one and group, since he has such a hard time socially, but he wrote 20 hours minimum on the letter to insurance. I don't know if he really thought for sure that was what he needed or if he wanted to be sure insurance would give us what we asked for. 

I am  fortunate to live in an area with many options, but that also makes it a bit overwhelming. Do I want horse ABA? Does he need a music based autism playgroup? 35 hours a week of ABA? 6? 20? And what about OT... there's a whole center with a similar OT program to the ABA ones I was talking about. I am a bit overwhelmed with it all.

As for him having input, I am not letting him decide, I was trying to prepare him. And was sad at how much it upset him. 

Thanks for the input, I have a lot of research to do and a lot of thinking to do as well. 

[nayma]

stephenie, i have no personal experience with aba (and i know it is an amazing tool for many families), but i don't think you should just go with exactly what the dr. recommended.  every child needs so something different, and i sometimes don't believe dr.'s have the time to accurately address that fact.  aba seems like a great fit for a lot of families, and it might be a great fit for yours, but i would also encourage you to inform yourself before jumping into any one approach.  look around at rdi, floortime, etc., and see if those seem like a good fit, also.  as someone else mentioned, aba is a behavioral technique, whereas rdi is a developmental approach - two different apprpoaches that suit different children. 

one other comment -and it's not meant to offend anyone - but during all my reading by adults on the spectrum, many of them mention that maintaining intense eye contact is downright painful.  it is certainly not my goal to get my dd (with AS) to look at me, especially when it makes her feel uncomfortable. 

okay, i lied - more comments (lol)!  in the beginning, i read, "targeting autism," and i thought it was a nice mix of adults experiences, the perspective of a special ed professor, feedback from parents, etc.  i would recommend it!

also, in response to the idea that it's out job to push kids - whether it's always comfortable or not- i have to both agree and disagree with this.  you have a *little* one.  what your gut tells you is probably right, imo.  i have argued with my dev. ped and ot plenty of times, and ultimately, always done what felt right for me as my dd's mom.  as in any relationship, there are times to push and times to step back and rest.  it's so hard to figure out what works when.  i wish you good luck during all these decisions.  xxx.

[PikkuMyy]

I am an ABA therapist, and you'll find that there isn't a single format for ABA therapy that prescribes what all therapists do. So you'll really need to go and observe the program to see what it is like. It's hard to describe it in a very short way but:

Much of ABA therapy might be what is called Discrete Trial Training, which is the breaking down of skills into tiny steps, with modeling and positive reinforcement. However, ABA involves much more than that. It involves therapists being able to examine minute details about a person's particular behaviors to figure out the purpose for them, what happens before and after the behaviors occur, and whether they are appropriate or not. Then we can figure out a more appropriate behavior to teach if it isn't appropriate, and reinforce the behavior if it is appropriate.

However, how this will look can vary quite a bit based on the therapists. At our center, we put our relationship with our students first, which means developing a close relationship with them. That means that we do a lot of programs with our students that don't fit into the discrete trial format, and build emotional and social development in a natural way. We teach eye contact through games that teach the children to make eye contact with us in order to communicate what they want, and as a way of connecting as we have fun. We don't sit them at a table and force them to make eye contact for a certain number of seconds in order to get a piece of cookie, which is what people often think of when they picture ABA therapy.

We have students who are non-verbal and have very low understanding of language and social skills, and also students who can speak very well, read well, but are struggling socially. So ABA therapy is appropriate for a wide range of children. 20 hours a week isn't a lot - it depends on what your son will be learning there. I've had a lot of students who had 40 hours a week.

[Stephenie]

Thanks for the input..

We're touring a center on Wed. It would be four days a week 5 hours at a time, which feels like a lot to me, but we're trying to be open minded about it. They do groups, but always have a therapist with each child and there are only 3 kids currently in the program. They have ABA most of the day but have OT, ST and PT available. It seems pretty good from what I can tell. I am mostly unsure about the amount of time. I want him to have play time, family time, time to run around outside etc. 

[sbgrace]

Wow! That's great insurance.

Someone else mentioned but there are other options/approaches to autism instead of ABA. The relationship based ones fit really well into family time. I do think things can get unbalanced.

We homeschool. We have been using RDI since my son was diagnosed and I'm really happy with that choice. Insurance does cover it like they cover any autism treatment (not 100%/like any other medical treatment so subject to our deductibles but still I feel fortunate our State mandates insurance coverage).

ABA may be the right choice but I'd encourage you to at least look into other approaches to see if they might fit your son and family better. They might not. But ABA isn't your only or necessarily best option.

[PikkuMyy]

Originally Posted by sbgrace 

Wow! That's great insurance.

Someone else mentioned but there are other options/approaches to autism instead of ABA. The relationship based ones fit really well into family time. I do think things can get unbalanced.

We homeschool. We have been using RDI since my son was diagnosed and I'm really happy with that choice. Insurance does cover it like they cover any autism treatment (not 100%/like any other medical treatment so subject to our deductibles but still I feel fortunate our State mandates insurance coverage).

ABA may be the right choice but I'd encourage you to at least look into other approaches to see if they might fit your son and family better. They might not. But ABA isn't your only or necessarily best option.

I wasn't as clear as I could be in my post, but although our center would generally bill itself as providing ABA therapy, we do a lot of RDI and Floortime because there are many communication and other interpersonal skills that you simply can't teach in a discrete trial format.

So I would talk to the staff when you are visiting about how they support the students emotional and relationship growth.

[Stephenie]

There's a law in TX that insurance companies  must cover and can not cap certain autism services for ages 3-5.  It includes:

• Evaluation and assessment services
• Applied Behavior Analysis (ABA)
• Behavior training and behavior management
• Speech therapy
• Occupational therapy
• Physical therapy
• Medication or nutritional supplements used to address symptoms of autism spectrum disorder.

Our insurance was already 100% coverage after the deductible, so once we pay that off it seems we won't have to pay much, if anything. It seems ST has a copay, but that's not a priority as he's really verbal. 

I am not sure if RDI would fit into that. Unfortunately, we can't afford anything our insurance does not cover. I will ask if they use any other approaches when I check out the center. 

[Stephenie]

Well we toured what seems to be a great center today. He'd make the fourth child in the program, they are all boys within a few months of each other in age. They are really flexible and will let him start slow and they have an open door policy so I can be there if he needs me in the beginning. They also have two way mirrors so I can watch most activities without him knowing if I want. They go outside or to the gym every day and if he needs more running around time they will take just him outside if need be.

As long as everything works out how we want it to for insurance, we are going to try it. 

Thanks everyone for your input. 

[Linda on the move]

I hope it works out well for you guys!

[lywells]

Hi Stephanie,

 I am an ABA Therapist and I would be willing to answer any questions that you have about!! Please feel free to talk to me because I would love to be of some help!!!

[Cinder]

My 3 year old gets 12 hours of pre-school in an autism class room a week.  in those 12 hours he gets 3 hours of OT(all sensory, no fine motor) and 3 hours of ST(he is 100% non-verbal).  At home he gets 8 hours of 1:1 ABA therapy/floortime model with a private therapist...so about 14 hours a week of therapy and 20 hours of week total for everything.  I definitely think at times it is too much for him...but it's less than our now almost 7 year old got at 3, and at 6 he lost his autism diagnosis (well the educational label part of it), so I definitely think lots of intensive therapy works, I'm just not sure it's right for TRAVIS even though it was obviously right for Kincaid.  Kincaid now has a global dyspraxia diagnosis and is in 1st grade and gets 3 hours of OT (all fine motor now) and 4 hours of ST(for articulation) and 2.5 hours of conductive education (artic. issues effecting his ability to sound out words) and they wanted to do 2 hours of PT per week as well for gross motor, but I said no, he is already pulled out of class enough as it is.