Questions to Ask Your Child’s ABA Provider - SBH Specific Responses

I’ve heard a lot of parent concerns and autistic individuals voicing their negative experiences with ABA. Can you tell me more about this? 

• • Autistic individuals who have encountered traumatic experiences in ABA are becoming more vocal about those experiences, and the ABA community is being challenged to listen to those concerns to ensure no further trauma is caused. Additionally, parents who have children who have had negative experiences with ABA have expressed their apprehension and negative association with ABA. At SBH, we want these individuals to know that their experiences and concerns are valid, heard, and heavily considered as we provide our services. Many ABA procedures, such as escape extinction, physical prompting, and intervention on stereotypy have gotten a lot of attention from the autistic community, as these individuals have experienced trauma from their previous service providers. We are always looking to grow and learn at SBH, and we want our learners to feel safe and free to be themselves while in our care. We strive to never cause any physical, mental, or emotional harm to our learners, and we are dedicated to furthering our professional development to make certain that we are providing compassionate care.

What is your stance on escape extinction?

• • At SBH, we value listening to the autistic community and consulting the most recent research. Applied behavior analysis has changed drastically over the past few years, and we want to ensure our services are the highest quality and do not cause any harm to our learners. Escape extinction has been a popular topic in our field, and at SBH, we choose to prioritize teaching functional communication, appropriate refusal skills, and self-advocacy skills over teaching compliance with demands. While complying with demands is an important skill for success in a school or work environment, we want our learners to learn that their voices have power, and that they are allowed to appropriately refuse a task, ask for a break, or choose which task they would like to do instead. 

Do you utilize hand-over-hand prompting in your facility?

• • Hand-over-hand prompting, or full-physical prompting, has also been a popular topic within our field. We strive to respect our learners’ bodily autonomy and freedom of movement, so unless the learner needs to complete the task for his or her own safety or personal hygiene (cleaning up after a bathroom accident or cutting with scissors, for example), we refrain from full-physical prompting to the best of our abilities and instead utilize other effective prompting methods. 

In what setting does teaching occur? Are children mainly at the table, or is there a heavier emphasis on teaching through play?

• • Our teaching occurs across settings and is individualized for each learner based on current skill levels and developmental appropriateness. Many learners will have a variety of teaching at the table, in the natural environment, and in group settings. Others may not have as much table time and may spend more time in play. Learners who are working on social skills or school readiness skills may spend more time in a group setting. 

Do you intervene on self-stimulatory behaviors?

• • At SBH, we only intervene on socially significant behaviors. This means that unless a behavior heavily impedes learning, we will not intervene. For example, if your child engages in hand flapping but is still able to engage with toys and complete tasks, we will not intervene on hand flapping. If the self-stimulatory behavior is at all dangerous or highly disruptive, we will consider intervention utilizing functionally appropriate replacement behaviors.  We also strive to educate families and other service providers on why self-stimulatory behavior occurs and the reasons to or not to intervene. 

Tell me more about how you utilize reinforcement and how I know my child will perform these skills without needing candy, a toy, etc., afterwards?

• • The use of reinforcement is paramount in delivering effective ABA services. Oftentimes, parents are concerned that their child will remain dependent on an extrinsic reinforcer (candy, a toy, etc.) in order to engage in a certain behavior or skill. While we do utilize extrinsic reinforcers in order to teach new skills, we are also focused on, first, fading those extrinsic reinforcers, and second, pairing those extrinsic reinforcers with intrinsic ones. For example, if a child is earning a Cheerio for appropriately walking down the hallway without engaging in flopping behavior, our RBTs and BCBAs pair the Cheerio with social praise such as, “I love the way you’re walking!”, giving a high-five, etc. Over time, we will fade the Cheerio, and the child may engage in the behavior without relying on that additional reinforcement. Some learners are more dependent on extrinsic reinforcers, and we take this dependency into consideration when developing these learners’ programs and when choosing which reinforcers to use (ensuring we’re not choosing a reinforcer that would be harmful if delivered too frequently or in too large of a quantity).

How do you incorporate or consider my child’s specific likes or interests in their therapy session?

• • Your child’s interests are of utmost importance in ensuring our services are successful. Our therapists are well-trained on utilizing teaching strategies while following the child’s lead during play. We want our learners to enjoy coming here and use their interests to enhance their success in ABA. 

There are rumors that ABA makes children robotic. Tell me more about that and how you ensure that is not occurring in your clinic. 

• • Autistic individuals and their families who have experienced poorly implemented ABA services have voiced their concerns about ABA making them feel like they were trained to be “robots.” This is a valid concern, and we want to listen to and consider those experiences. This concern likely comes from a heavy emphasis on compliance with demands and a lack of teaching of functional communication, giving choices, or generalization skills. At SBH, we place higher value in teaching communication rather than teaching compliance. Our learners will, of course, contact demands in their environments (school, a job, etc.) in which they will need to comply; however, we want to equip our learners with the skills necessary to complete a task, which often means teaching appropriate refusal, asking for a break, explaining if something is too hard, asking for help, etc. We also want our learners to generalize their skills. This means that while we do consider it a success if our learners learn one correct answer or skill in the clinical environment, we want our learners to expand on that knowledge by practicing these skills in other environments, be able to provide a variety of answers to questions, and respect each learner’s individuality. 

What is an RBT, BCaBA, or BCBA? What are their roles, and who will be spending the most time with my child?

• • An RBT is a registered behavior technician. RBTs receive a minimum of 40 hours of training and must pass a competency assessment and pass a certification exam. RBTs provide 1:1 services to their learners and implement the plans written by the BCBA. A BCaBA is a Board Certified Assistant Behavior Analyst. These are practitioners who hold a bachelors degree, have taken courses in behavior analysis, acquired at least 1,000 experience hours, and passed a certification exam. BCaBAs can supervise RBTs, write goals and behavior plans, perform assessments, conduct parent trainings, etc., but must work under the supervision of a BCBA. A BCBA is a Board Certified Behavior Analyst (BCBA). BCBA’s have a masters degree, have completed courses in behavior analysis, acquired at least 1,500 experience hours, and passed a certification exam. A BCBA conducts assessments, creates protocols and behavior plans, writes goals, and supervises RBTs and BCaBAs.

Tell me more about the assessment process and how you determine what to work on with my child.  

• • Prior to your child’s assessment, we will review intake paperwork and evaluate information you provide regarding strengths, weaknesses, developmental history, challenging behaviors, and goals for treatment. Based on that information, we will choose an assessment that is most appropriate for your child. This may mean that more than one assessment will be used. During the assessment, our goal is for your child to have fun and not feel like demands are being placed on them. Once the assessment is complete, the BCBA will write goals for treatment and review the assessment results and goals with you prior to beginning services.

What is my role in my child’s treatment?

• • You have a vital role in your child’s treatment. We offer parent training services in order to ensure consistency of care within the clinic and in the home environment. During parent training meetings, we will discuss any specific protocols we implement in response to challenging behaviors, communication needs, or adaptive skills. We will also be available to answer any questions you may have and provide a safe space to discuss any further concerns. 

How often will I receive progress updates or how will I remain informed on how my child is performing in ABA therapy?

• • A re-assessment will be conducted every six months, and you will be provided with a formal progress report so you can see how your child has been performing on each individual goal. You will also have access to your child’s profile on our data collection system to see which goals he or she is currently working on and how they’re performing. Additionally, at the end of each session, your child’s RBT will provide you with a brief summary of the session, and your BCBA is readily available to discuss your child’s progress or needs as well. 

How do you determine how many hours of therapy my child receives?

• • The amount of therapy hours your child will receive is based on a variety of factors. In order to make our clinical recommendation on the amount of hours we feel are needed for successful services, we will consider your child’s age, any additional therapies your child is receiving, whether or not your child is currently in school, severity of challenging behavior, communication needs, and assessment results. 

If my child is successful in ABA, how and when will hours be faded? Tell me about your transition services. If my child is unsuccessful, how will the decision be made to either increase hours or discontinue services?

• Our goal is for your child to be as independent as possible. As your child masters his or her treatment plan goals, your child’s BCBA will provide a recommendation to gradually fade either the number of hours or number of days your child receives services. Services hours will systematically be faded, and we will provide guidance and support as your child transitions from our clinic to school, work, etc. If your child is not showing as much improvement as we would like after receiving our services, we will assist you in finding another reputable service provider so your child can achieve as much growth and success as possible. 

What services do you provide at your facility, and what ages do you serve?

• • We currently provide applied behavior analysis services to individuals between the ages  of 18 months to 18 years.

My child engages in aggressive or self-injurious behavior. Is your staff well trained to address these behaviors and ensure my child’s and their own safety? Tell me about your crisis management training and the criteria for when to use it.

• • Our staff is adequately prepared to address aggressive and/or self-injurious behavior while ensuring your child remains safe and his or her dignity is protected. If your child engages in behavior that is at all harmful to him/herself or others and we feel we are not equipped to ensure his or her safety, we will work with you to find another service provider in the area to assist you with those challenging behaviors. 

Do you and your staff have any training or experience with AAC devices?

• • While we do not currently have an SLP at our clinic, our staff has familiarity with various communication devices. If your child uses a device to communicate, we will ensure he or she is placed with a BCBA and RBT who is fluent with using and teaching the device.

My child has a dual diagnosis and/or does not have an autism diagnosis. Do you and your staff have experience treating other diagnoses (ADHD, OCD, ODD, conduct disorder, epilepsy, etc.?)

• • We do provide services to individuals who have a dual diagnosis. However, it should be noted that if your child does not have an ASD diagnosis, your insurance company will not cover services. If you wish to still receive our services, we will work with you to find a potential solution. If we feel your child’s diagnosis is beyond our scope of competence, we will assist you in finding another service provider to best meet your child’s needs.

Do you collaborate with other service providers (teachers, SLPs, OTs, PTs, etc.)?

• • If provided with parental consent and a release of information form, we will happily collaborate with any service provider to ensure consistency of care.