Why Adherence to Your Behavior Analyst’s Clinical Recommendation is Critical to Success

Parents and caregivers will do just about anything to provide for their children’s needs and requirements.  Unfortunately, for those whose children require additional supports and services, this can feel nearly impossible. For parents and caregivers of children on the autism spectrum, who are already struggling to meet the demands of their schedules and responsibilities, the added time and energy required to support intensive weekly ABA therapy hours can be difficult and overwhelming. The result is quite often a compromise on therapy hours which can seriously impact the child’s progress.

What commonly occurs in autism services is parents will seek ABA therapy for their child, knowing that it is considered the gold standard for autism intervention with decades of research and evidence to support its efficacy. As part of this process, the ABA provider will observe and assess the child, as well as interview the family to determine their recommendation for weekly hours of ABA services based on the child’s needs, age, and other determining factors. What we commonly see, however, is families not making their children available for the recommended hours. While not being able to reach the clinically recommended hours is affected by multiple factors such as family schedules, staffing issues, sickness, weather and other extenuating factors, lack of access to the child often accounts for anywhere from 5-40% of weekly clinically recommended hours not occurring.

Families who do this are typically trying to compromise between their child’s needs and the demands of their other responsibilities—and managing and navigating the needs of a child with special needs alongside all the competing needs and requirements of daily life is challenging. However, if one looks at this objectively, it is akin to getting a prescription from a doctor and telling the pharmacist to only give you part of it. Most families assume that with fewer hours per week, their child will still progress and learn new skills but at a slower pace. Unfortunately, this is not necessarily the case.

It is true that ABA therapy is unique in its intensity, but this is a core component of why ABA is so effective. ABA is effective at helping a child catch up to and develop alongside their chronological age when the recommendation for frequency and intensity of services is adhered to. There are decades of research to support the efficacy of ABA at teaching the skills necessary for communication, social interactions and self-management. In a recent research study which included 1,468 children with autism ranging in age from 18 months to 12 years old, treatment intensity and duration were both significant predictors of mastering learning objectives and goals across eight domains of functioning (academic, adaptive, cognitive, executive function, language, motor, play and social). Similar findings have been reported from other researchers over the decades. Overall, studies have strongly indicated that treatment intensity has significant positive effects on individual progress and the acquisition of skills.

Intensity or “dosage” of treatment will vary by client and should always be individualized to the child’s needs and goals. Generally, for children under the age of 5, more intensive hours are recommended to capitalize on the intensive brain growth during the first 5 years of age and to stimulate a child’s brain before children enter Kindergarten. Once a child is engaged in learning at school at least 3 hours per day, treatment recommendations generally include 15-20 hours per week. Again, recommendations for intensity and duration of intervention should always be based on a detailed assessment of your child’s needs, level of functioning compared to other children of their current age, and your child’s individual goals.

It’s very important that parents and caregivers of young children with autism spectrum disorder understand that ABA is the gold standard of treatment but is only most effective when the program recommendations are adhered to entirely. The structure and design of an ABA program is essential to its outcomes. While it is understandable that parents are trying to do their best to meet the demands of their family’s schedule, it is vital to consider the research when making decisions regarding how to prioritize interventions. Finding that extra time every week to ensure that your child is receiving their recommended amount of ABA can make a huge difference in their life and yours.