What does it mean to say child is done with ABA?
The two main reasons a a parent or behavior analyst would have for saying a child is done with ABA are:
- The behavior analyst is not trained to work on the skills the child needs
- The child is where he/she needs to be and the parent is adequately trained
1. Behavior analyst is not trained to work with the skills the child needs
I have seen numerous situations where a program or individual behavior analyst will "graduate" a client saying that the child no longer needs ABA. The child still has deficits typically in social skills and more advanced language/academic skills. The parents typically have no idea how to work on these skills and unfortunately the behavior analyst thinks he/she doesn't either. Rather than tell the parent that the behavior analyst has gone as far as he/she can with the child based on his/her training, the behavior analyst tells the parent that the child has graduated and can be done with ABA. This happened so many times at a previous place I worked and the parents were so upset. Then they were left wondering what to do to help their child continue to make gains and mistakingly thinking that ABA could no longer help them.
Some programs recognize that their main training is with early learner skills and will tell parents when starting that they only work with children of certain ages. There are early intervention programs that only work with a child to age 3, and then there are some programs that only work with a child to age 6, etc. When children are done with these programs, it is the duty of the program based on the behavior analysis code of ethics, to recommend options for the parent so that the child can continue to develop skills. If a behavior analyst has not told a parent that they will end services when their child reaches a certain age, but the child reaches a point where the behavior analyst is not adequately trained to work on the skills the child needs, the behavior analyst should not just end services but either receive training and research how to teach the skills or recommend other behavior analyst who are trained to work on the more advanced skills.
A lot of behavior analyst also use the ABLLS or VB MAPP to develop programming for a child. Often, once the child has completed all or most of the programs in these assessments, a behavior analyst might say that the child is done with ABA but the child still has deficits in language, social skills, academics, academic skills, etc. So what is the next step? Typically in this situation the behavior analyst ends services and the parent seeks out other types of programs. Some examples are relationship development intervention, brain training, other social skills curriculums, social skills groups, tutors, etc. Will these programs be helpful for the child? It is hard to say because it will depend on: if the programs address the child's areas of deficit and whether or not the programs make use of behavior analytic techniques. A child might make progress using these other programs without the input of a behavior analyst but the most effective method of incorporating these programs is to use the curriculums while incorporating the principles of behavior analysis. In this situation there are three options:
1. The parent can find someone whose main training is in the areas that the child still has deficits but is not in behavior analysis
2. The parent can find the person mentioned previously and have the behavior analyst consult on how to incorporate behavior analytic principles
3. The parent can ask her behavior analyst to incorporate curriculums that are needed for the child and/or to recommend another behavior analyst who has experience with the deficits.
No matter which solution is chosen, the best results will always be achieved when the principles of behavior analysis are incorporated. So the best solution would be either number 2 or number 3. A lot of other curriculums/approaches will say that behavior analysis isn't used but when you break down what is done during the sessions, the programs incorporate many principles of behavior analysis. Whether a program wants to admit it or not, or even know it or not, effective programs are always incorporating the principles of learning. I could go into more detail but that is a topic for another blog.
2. The parent is adequately trained
The other situation I have seen where services are ended with the behavior analyst are when the parent is adequately trained. This means the parent as learned through direct training and experience with the child how to incorporate the principles of behavior analysis into everyday life and apply them when necessary with the child. Typically, in these situations the parent will remain in contact with the behavior analyst and consult as needed. Otherwise, the parent continues to determine the curriculum and programs needed for the child and incorporates the principles of behavior analysis. The parent might hire a tutor or someone to help determine the curriculum but the parent directs the tutor on how to work with the child. The parent also continues to follow the principles of behavior analysis when responding to inappropriate behaviors and throughout the daily routine.
Behavior Analysis is Technically Never "Done"
While services with a behavior analyst might be done, incorporating the principles of learning and behavior analysis should never be "done." Even if someone intentionally ends their formal ABA program, if the child is still learning and making gains, principles of learning are still at play. The most progress will be made though if those principles are intentionally incorporated.
Principles of behavior/learning never go away. The field of behavior analysis aims at identifying in real life what factors, methods, techniques result in behavior change/skill acquisition. Making use of this knowledge can result in changes not just for autistic children but in schools, colleges, work places, nursing homes, and society in general. Whether the parent is interested in trying RDI, Brain Training, Social Skills Training groups, etc when any curriculum or programming effectively incorporates principles of behavior/learning you will see more progress than when the program does not make use of these principles.
A behavior analyst may always be needed to some extent for a child on the spectrum if a parent does not know or does not feel comfortable with applying these techniques/principles. It will also depend on the extent that a child needs to have these techniques effectively applied. Even for typically developing children, parents or teachers who make use (either knowingly or just by natural tendencies) of principles and techniques of learning will have children who acquire skills faster than parents who do not have this knowledge and might not be effectively teaching their children. This holds true for professors, bosses, etc anyone in a position of requiring behavior/learning.
If a parent acquires the necessary skills to know how to prompt, reinforce, and adjust the environment when necessary (among other techniques), then their child will not always need a behavior analyst. This of course will depend on the child’s deficits and behavior. Even for a child who has a lot of deficits or intense behavior, if the parent or others working with the child are trained well enough, the level of input needed from a BCBA may be minimal.
So the point here is even if you end your formal programming, it is always best to still incorporate the principles of behavior analysis/learning so that your child will make the most progress.
Ending a formal ABA program
I am not sure if there is any research on this topic but my preferred way to end a formal ABA program is to fade the behavior analyst out of the situation and remain consultation on an as needed basis. If the parent typically receives services a few days/week, services are dropped to 1x/wk, then 1x/2wks, 1x/month, 1x/3 months (if needed), 1x/6 months (if needed), and 1x/year. Using the fade out procedure ensures that a child/parent really is ready to no longer receive input from a behavior analyst. A lot of times a child will do well so the services are just ended and then all of the old behaviors/issues arise again. Fading out the behavior analyst allows the parent to receive training and feedback on how to continue to achieve results with their child. Even during the less frequent times, the behavior analyst or a behavior analyst should always be available for a consult when necessary.
Examples of situations:
Here are some examples of situations where a parent or behavior analyst might decide to end formal services.
A student possesses most necessary skills to succeed academically and socially. The student is staring soccer and art classes. Does the behavior analyst need to be involved?
If the parent is able to provide training and guidance to the coach and art teacher, then the behavior analyst is most likely not necessary. If the parent does not feel comfortable or is unable to provide guidance, then the behavior analyst might be involved initially and then fade out. A trial soccer practice/art class might also be done to see if the coach or art teacher even need input from the parent/behavior analyst. It is possible that the child will do so well that no guidance is necessary.
A Student is advanced academically but lacks social skills. The BCBA lacks training in social skills and the parent does not feel comfortable being the person responsible for teaching these skills. Should the BCBA continue to provide services?
There are several options for this situation. The parent could enroll the child in social skills groups. When doing this, the parent should find groups that incorporate the principles of behavior analysis to promote learning and acquisition of the skills. If the group does not incorporate principles of behavior analysis, the behavior analyst can provide consultation on how to teach the child. If a group does not exist, the behavior analyst can either research social skills curriculums and develop programs for the child based on the child's deficits or refer the family to a behavior analyst who has training in teaching social skills.
A Student is advanced academically, possesses social skills, but still engages in intense outbursts/aggression occasionally for different reasons. The parent adequately implements behavior reduction programs with the guidance of the BCBA but needs assistance when the behavior changes. Should the BCBA continue to provide services?
For this situation, the BCBA might not be needed on a frequent basis but should still provide consultation services to the client. If the child still engages in intense outbursts/aggression and the parent is not always capable of responding appropriately, the behavior analyst can develop plans and provide training when needed.
A Student has completed ABLLS-R but struggles academically and with certain skills such as language comprehension and auditory processing. The BCBA's training is mostly with using the ABLLS-R but the BCBA is willing to research other curriculums/programs. Should the BCBA continue services?
There are a couple of options for this situation as well. If the BCBA is willing to research other curriculums and programs, the services should be maintained because they will be able to effectively incorporate the principles of behavior analysis to help the child gain skills. If the parent is unsure of the BCBA's ability to determine new programming, the parent might want to seek the input of a provider with experience addressing these skills and have the BCBA consult on how to teach the child.