What is ABA Therapy and How Does it Work?

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ABA (Applied Behavior Analysis) is an evidence-based therapy that has been widely accepted as the primary form of therapy for children and adolescents with autism.

What is ABA used for at Circle Care?

ABA therapy is used to improve behaviors like social skills, reading, academics, and communication as well as learned skills like grooming, hygiene, fine motor dexterity, job proficiency, and even simple things like a child keeping his room clean.

The Goal:

To establish or increase socially acceptable behaviors and diminish or extinguish socially unacceptable behaviors that would cause the child to feel excluded from social settings and peers. 

How is this accomplished?

At Circle Care Services, one of our Board Certified Behavior Analysts, (BCBA) will:

• Analyze atypical behaviors
• Identify the triggers that bring on each one.
• Outline a plan to alter the child’s experience.
• Break down long term goals into bite-sized achievable steps which are then
  • Practiced
  • Reinforced
  • Mastered

For example:

Daniel’s mom says “he tantrums all the time” but upon analysis, his BCBA identifies that his tantrums occur when attention is being diverted from him to others. Now, the BCBA will outline a step-by-step plan to reach the desired long-term goal; developing a more appropriate way of getting attention. The plan is then implemented and skills are practiced, reinforced, and mastered.

Beginning ABA Therapy Services for your child

First, a Circle Care BCBA will set up an interview with you and your child to gather all the information needed for successful therapy sessions. 

Your child’s likes and dislikes are important for creating positive reinforcement, both through fun activities and prizes and treats.

The BCBA will then perform a Functional Behaviour Assessment (FBA). 

What is this?

• Observing and collecting data about your child’s behavior
• Identifying which behaviors to target in therapy
• Create a treatment plan for the Registered behavior tech (RBT) who will actually be working with your child.

What does it look like when my child is in therapy?

Once you’ve decided to pursue ABA therapy for your child, the process can seem a bit scary. You’re not sure what to expect when starting ABA, and you don’t know what a session will entail. Though this can look a little different for every child, your ABA agency will be sure to go over the treatment plan with you.

Once the treatment plan is in place, it’s time for your child to meet one of our Registered Behavior Technicians (RBTs) who will provide the individualized ABA session at each visit. 

Our RBTs work under the close supervision of our board-certified behavior analysts (BCBA) with an occasional visit to update the treatment plan when your child masters skills and new programs are added.

Our ABA therapists work towards establishing a good working and playful relationship with your child. ABA sessions should be something that your child looks forward to!

If your child is dreading the arrival of the therapist, it could be concerning, but don’t jump to replace the therapist immediately. Sometimes it takes some time for your child and the therapist to “pair” for the first couple of sessions. In ABA therapy, we call this process “pairing”.

Our therapists are good with children: energetic, playful, and creative enough to integrate the treatment plan into playful activities so that the work doesn’t feel like work – it feels like fun! 

This is included in what we call natural environment training: taking a skill that has been worked on in therapy and applying it to a more natural setting, like playtime. This helps your child to generalize a skill in more than one area, rather than learning it only while sitting at a desk with the therapist.

Learning Pivotal Skills In ABA Therapy

In the beginning stages of therapy, some of the most essential skills to establish are the pivotal skills that all other skills will hinge from. Pivotal skills include:

• Motivation
• Self-initiation
• Self-management
• Responding to multiple cues

Without pivotal skills, it is hard for a child with autism to focus. 

These skills are foundational, and when mastered through praise and reinforcement, your child will be likely to repeat and use them in other areas.

Children with autism who master pivotal skills are able to sit and listen and have the motivation and the self-management to work to improve communication and language skills.

This helps them grow academically and socially.

What a Circle Care ABA Session Looks Like & The Treatment Plan

How long is a session?

• This will vary depending on the age of your child and the number of hours that are required to reach the decided-upon goals.
• Every child is approved for a specific number of hours per week up to forty hours per week, depending on need.
• On average, most sessions in your home will run for no less than two hours. 

Where do sessions take place?

Our RBT will choose a space to start the session based on your wishes, the child’s interest, and their own assessment of where they can be most successful to accomplish the goals of the day. 

With playful interaction, your child will warm up to the idea of spending time together at the table, in the playroom, or anywhere where your child will be able to achieve the desired outcome.

Our RBT has the tasks of keeping your child focused while running the program, entering real-time data as it occurs, and delivering reinforcement when your child responds appropriately. 

The behavior tech will also keep your child’s motivation high to keep working. The best way to do this is to be prepared by having materials ready for the session and having the work environment as distraction-free as possible. 

It is the job of our RBT to team up with the caregivers to accommodate therapy in a manner that works well for your whole family. Some of the challenges that may need to be addressed are:

• Find a distraction-free setting where your child can be attentive.
• Finding a place for siblings to hang out while the session is going on.
• Figuring out if it is best for the parent or caregiver to be present or not while the RBT is working with the child. 

At Circle Care, maintaining a respectful and professional openness to accommodate each other is a very important priority.

A meaningful conversation between you and our therapist will help result in an arrangement that will be practical for your family members and productive for your child with autism. 

Discrete Trial Training and Natural Environment Training

If a child with autism has communication skills deficits, Discrete Trial Training is commonly used to start teaching them the skills that they need.

It is an extremely repetitive type of teaching and it can be difficult to keep the child motivated without a heavy schedule of reinforcement. For example, the RBT might present a picture of a cat and say “cat” and then ask the child, “What is it?” 

When the child answers “cat”, the RBT reinforces the child with praise and smiles and whatever other reinforcers have been identified.

How do our RBTs know what keeps your child motivated? Is it a certain toy? A minute on the tablet? Coloring? Tickles? Bubbles? A Skittle? If it is unclear what motivates your child, the RBT or the BCBA can conduct an informal preference assessment and get an idea that way.

It can be tricky because what works one week may not work the following week. Our therapists realize the importance of remaining flexible and being ready to conduct some quick informal preference assessments when a child with autism switches things up.

As your child builds upon those pivotal skills and reaches some of the goals in communication and social skills, our RBTs will help the child to transition those skills to more natural situations. For example, a child may be able to say “ball” each time a picture card is held shown, but will the child say “ball” if the RBT holds one up and waits for the child to request it? That is the goal! To generalize the skill to give it meaning!

No Two Sessions Are Alike

Every session will be different. There will be days that are filled with successes and other days that are filled with frustration. The RBT will take careful data and detailed notes that the BCBA can look over and discuss with the RBT to make improvements, add or delete programs or change direction on something that was previously discussed. 

Because each child’s therapy is so unique, parents must receive one on one training to carry over what is being taught and practiced with the RBT. The BCBA is responsible for parent training and will steadily educate parents about what they can do to contribute to their child’s overall success. ABA is most successful when parents are willing participants in the therapy that their child is receiving. The more that parents know about how ABA works, the more successful the child with autism will be because there will be consistency in the way that everyone is communicating with each other and with the child.

Sessions can take place at home, in our clinic, and even at school. 

The most important aspects of therapy are a skilled RBT who is:

• Keeping your child-focused
• Taking accurate data 
• Following the treatment plan as written by the supervising BCBA.

Our therapists are flexible, provide frequent breaks and get to know your child well enough to avoid anything that triggers negative behaviors or escalations. 

At Circle Care, we aim to make ABA a positive and fun experience for your child with ASD; one that they look forward to on those days during the week that are dedicated to therapy. The more positive reinforcement that is tied to the experience the greater success that there will be overall with the treatment plan.