Saturday, March 1, 2014

The "Costs" of ABA Therapy





The benefits of ABA therapy are well documented and cover varying functioning levels, ages, and methodologies, with supporting research that spans decades. Don’t quite believe that yet? Have a look here, here, here, or here. The “pros” of ABA are numerous.

If you have come across information online about ABA haters, or the “cons” of ABA, they tend to be categorized into bad experiences with a company or person, inaccurate or outdated information, or people who feel ABA is wrong because it tries to “normalize” individuals with Autism. I’ve already addressed those criticisms of ABA on my blog, so no need to do that again.  

So am I saying there are only advantages, or benefits to ABA therapy? Is it all great, ALL the time?

Well, since the name of this blog is “I Love ABA”, clearly my opinion of ABA is positive. :-) 
However, what I think many families do not fully consider  are the “costs” of ABA therapy.

You may have heard before that its always recommended to weigh the costs and commitment required to do something before agreeing to take it on (Luke 14:28 NLT). This is very good advice. Beginning something without fully understanding what it will cost you can lead to disappointments or frustrations.

Think of starting a New Year exercise plan. Many people join gyms, buy workout clothing, alter their diet, etc. However after a few mornings waking up to stiff and sore muscles, or eyeing the doughnut box at work, many people abruptly discard these exercise plans. Why is that? Because the full costs weren’t considered.  While we all know the benefits of regular exercise, living that kind of lifestyle will also cost you something.



Similarly, making a decision to begin ABA therapy for your child can be quite different from actually living out that decision everyday.


As much as I support and believe in what ABA can do, I also meet and work with countless families who don’t really understand the commitment that ABA therapy is. The potential benefits of ABA therapy are so numerous I can’t even list them all here, but every day will not be peaches and sunshine.

The following advice is to help parents on the ABA fence make an informed decision. I’m definitely not putting ABA down (have you seen the name of this blog??), but please, know what you are signing up for:


  •       $$$$$$$$$$- While talking about the “costs” of ABA, the literal cost must be mentioned. ABA therapy is expensive. Why is that? Well, it’s administered by highly trained professionals (more on that later), it’s intended to be intensive, it requires rapidly changing supplies and materials, and the funding sources have not quite caught up to the diagnosis rates. High demand and low supply combined with a credentialing process that takes years to achieve = a not so affordable therapy option. 
  •      Time- ABA therapy could cost you time, spontaneity, and control of your life. Professionals will come into your home multiple times a week, and expect you to participate in the sessions, collect data, practice behavior management strategies, etc. Some of my clients have rearranged family vacations, anniversary trips, doctor’s appointments, even moving, based on what works best for the therapy schedule. ABA takes a lot of time; time that the professionals give to your child and time that you give to the professionals.
  •       Standards/Expectations- So how could ABA therapy cost you your standards? Well, ABA is a unique field. The people who are the most experienced, seasoned, and qualified in this field are typically not the ones who will work directly with your child. Unfortunate, but true. ABA therapists have varying experience levels, and are the ones who work with the child 1:1 to teach skills. The BCBA or Consultant is the one who designs and writes up what the therapist is supposed to teach. So you may pursue ABA therapy thinking you only want the best, most degreed professionals working with your daughter. Then you realize in your area, no one pays for ABA,  the  best companies have 3 year long waiting lists, and that one Consultant you found can only offer 1 session a week. So now what? I hate explaining this reality to new clients, but unfortunately the people in this field with great experience and expertise are in super high demand. They either charge very high hourly rates, or their schedules are completely booked.
  •      A little thing called privacy- So-0-0, no one talks about this part, but it’s true. You may need to develop a new definition of the word “privacy”. The ABA team will see your house messy. They will see you answer the door in curlers and a torn pink robe. They will see you hit the peak of frustration when dealing with your child, as well as explode with joy when your child shows amazing progress. They may see or hear things about you and your family that even your closest friends don’t know, such as how often you argue with your spouse. Speaking of…….
  •       Marital Stress- It can be quite stressful on a family to have a special needs child who is not getting proper services. However it can also be stressful on a family to adjust to a commitment to ABA. Everything becomes scheduled and regimented, and making a simple decision such as “Should I take my spouse on a Florida vacation this summer?” has to be discussed with a team of people. In the course of doing my job, it isn't unusual for me to have parent meetings that dissolve into heated hubby/wife arguments, sit and observe a family eating dinner,  or be put in the middle of tense or awkward family dynamics. It gets even more awkward in situations where one parent is on board with treatment, and the other parent is not.
  •      Pride- This could be a big one, just depending on the type of person you are. Not to toot my own horn, but I look pretty young. I also don’t have any kids. So imagine me giving parenting tips to a parent who is twice my age, and has 4 children. Definitely a situation that can be a hit to the ol’ ego. Many ABA therapists are 20-something college students, and many BCBA’s are also pretty young. This just tends to be a young field….I think its all the energy we need to do this :-) Regardless, as a parent it can be painfully humbling to have a little whippersnapper explain to you exactly what you should be doing differently with your child, and then darn her, actually be right!
  •       Remember your other kids??- As an ABA therapist, I used to show up to my clients homes with toys, gadgets, edibles, DVD’s, you name it. I would work 1:1 with my client, clapping and shouting and blowing bubbles as reinforcers….while my clients siblings would look on in amazement, not understanding why no one showed up to play with them for 3 hours. This can be really tough, but as a parent ABA may definitely cost you some interaction time with your other kids. It’s almost like your child with Autism is now lead singer of a pop group, and your other children are the back up singers. ABA is very time intensive and labor intensive, and many parents tell me that after a day of collecting data, managing behavior, or meeting with the Consultant, they are just too exhausted to meaningfully interact with their other children.
  •      Social life- Lastly, ABA may cost you a social life. Beyond the time commitments, lack of spontaneity, and financial crunch ABA may cause, you may find yourself interacting and spending more time with the ABA team and Consultant than with your best friends. You may find yourself using “ABA speak” like mands, target behavior, trip training, or prompt dependency, which your friends may find just downright odd. It’s hard to answer simple questions from your friends such as “So, how’s that ABA going?”, yet when the Consultant asks you for a progress update you are bursting with news to share. Your friends may think it’s weird if you call them at 9 am because your son just independently pooped in the potty, but the ABA team will clap and cheer with you! It can be difficult to have a social life, when so much of your social interaction is with a team of behavior geeks.

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