In the early ABA programs there are a few variables that can be controlled by the family to have the program progress quickly past the assessment phase and start acquiring some useful skills as soon as possible. One of the variables is the amount of preparation that a child and family can do before the direct services begin. This can affect a child’s ability to tolerate pairing as well as the quality of the baseline data that is being collected during the assessment phase.
What families can do before the first session
Typically within a 2-4 week time frame around the time of the child’s and family’s intake for direct services, there is time to prepare the child and family for the child’s and family’s participation in sessions of direct services. Within this time frame the child should be able to be responding to the therapist(s) within the sessions of direct services (i.e., within the sessions of ABA therapy) as opposed to being distracted by and/or responding to the unfamiliar setting of the therapy room, a new and unfamiliar schedule, and to a stranger(s).
Routine and environment adjustments that pay off
- Shift sleep and meal times gradually toward the session schedule rather than changing everything on the first morning.
- Identify a consistent, low-traffic space at home if services will be delivered there, and clear it of high-value items that will later become sources of conflict.
- Introduce photographs of the clinic, the building entrance, or the therapist so the arrival itself is not the first surprise.
- Practice short, structured transitions, such as moving from a preferred activity to a table task and back, so the demand of stopping something enjoyable is not brand new.
The information families should bring
A parent can assist in the assessment process by arriving at the first meeting with a two week log detailing the child’s sleep, bowel movements, times of illness, medication (and dosages), etc. As well as the times of day when challenging behaviors occur. A parent can also complete a preference inventory listing the child’s preferences for items and activities that the parent would prefer not to use as reinforcers. This would allow for the development of a program that is consistent with the parent’s values.
Choosing a provider and reading the fit
Finding a program for a child with an Autism Spectrum Disorder (ASD) diagnosis can be a long and arduous process. In most cases, families of children with autism spectrum disorders are left to their own devices when searching for quality programs, so it is worth touring an established clinic such as this ABA therapy Danvers MA center before comparing options elsewhere in the country. Therefore, families should make sure to ask for certain criteria when searching for programs for children with autism.
Questions that reveal clinical practice
- How many supervision hours per week of direct service does each client receive, and who delivers them?
- What is the process when a technician and a child are not a good match?
- How are goals selected, and how does the family contribute to that selection?
- What does the provider do when a program stalls for three consecutive weeks?
- How is progress communicated between formal reviews?
Pay attention to how the provider answers your questions about supervision and how they determine when a child can stop receiving ABA therapy. A good provider will be able to outline their decision-making for these types of issues.
What the first three months typically look like
By clearly outlining what the family can expect to happen in each stage of their child’s skill acquisition, families can be better prepared for what is to come. This will allow families to have a better understanding of what is happening in sessions, even if their child is not progressing as quickly as they had hoped.
| Stage | Typical duration | Primary focus | What parents should expect to see |
| Assessment | 1 to 3 weeks | Skills and function-based measures, preference sampling | Observation, few demands, questionnaires and interviews |
| Pairing | 1 to 2 weeks | Building the therapist as a source of reinforcement | Play-heavy sessions with minimal instruction |
| Program launch | Weeks 3 to 6 | Initial acquisition targets and behavior reduction plan | Structured teaching, first data trends, some protest |
| Adjustment | Weeks 6 to 12 | Refining targets, generalization, parent training | Goals added or dropped, home practice begins |
Parent training as the active ingredient
Generalization refers to a child’s newly acquired skills not being generalized to outside of the therapist’s hour long sessions of work with that child. The family’s work outside of the sessions with the therapist is what aids in a child’s skills being acquired and also generalized. Thus, in preparation for a child and family’s work together, it would be wise to prepare the family for the work that they will be doing outside of the therapist’s sessions with that child, as well as for the data that will be required for the purposes of that work.
Making home practice sustainable
The real volume of skill acquisition will come as you are able to increase time in existing routines (i.e. 10 minutes of good quality time) to eventually establish a schedule of increased volume. For now, ask families for one goal, one procedure, one time of day, and one measure. The volume will then increase from there.
Preparing siblings and the wider household
In addition to the child with autism, the siblings of children with autism can also be affected by the child’s behavior. Preparation of siblings can occur by having therapists explain the purpose of their being there and the expected behavior of their brother or sister during the session. In addition, extended family members and other caregivers of children with autism who enforce different rules and respond to situations in different ways should be informed by the child’s analyst and therapists of a few shared responses to common situations. For example, how to make a demand on a child with autism and how to give a child with autism preferred items.