Understanding ABA Programs

Photo source : www.thirtyhandmadedays.com, www.journeyofmylifendestiny.blogspot.com 

*Recommended post-- Writing ABA Programs

My last post on programming was really for professionals, but this one should help parents/caregivers understand the "why" and "how" of teaching new skills.

Typically with ABA treatment, intake/assessment is followed by treatment planning, which is followed by creating individualized programs, which is followed by teaching those selected programs. What's a program you ask? Basically, a program is what is being taught to the learner. If your child is receiving ABA services, they probably work on multiple programs every single therapy session.

I find that most parents/caregivers have a very vague understanding of what their child is working on and why, and how skills connect to each other. Due to this lack of understanding, some common problems that can arise include:
  • Expecting the ABA team to teach your child everything, all at the same time
  • Expecting skills to be taught in a matter of days
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on
  • Confusing a "Program" with a "Target"
These are the main problems I see, although there are many more that can pop up when parents don't understand how the teaching part of ABA therapy works (yes, ABA is far more than behavior reduction!).

I always recommend to parents to ask questions, observe therapy sessions, utilize the BCBA, and review/look at the data regularly. These components are like the blueprint of the building, or anatomy of the cells of your child's treatment. If you are confused about the services your child receives, I would ask: how regularly are you viewing that blueprint? How involved are you with the anatomy of it? It took the staff and BCBA on the case extensive training, years of experience, and college coursework to have a solid understanding of what they are doing. How much harder do you think it will be for YOU to understand what they are doing?

I love to remove confusion (just call me Confusion Off) so let's address each of the common problems I see, one at a time:

  • Expecting the ABA team to teach your child everything, all at the same time - Definitely the biggest misconception I see. Intake/assessment is usually the point where the BCBA discusses goals for treatment with you. From the assessment results and this conversation, the BCBA will prioritize goals based on a variety of factors such as: goals that can replace current problem behavior, goals that are needed for daily functioning, goals that address the most pervasive developmental delays, etc. What this means in plain English is we cannot teach everything, all at the same time. It's just not possible. Plus your child would hate that. The reality is other non- clinical factors must be considered too, such as how available is the child for therapy, how many hours of therapy a week can the family afford, how many hours of therapy a week can the ABA therapist provide, etc.. When you add up all these factors and weigh the highest priority goals, this does mean that some skills may not be targeted right away. Your suggestions to keep adding new goals are not being ignored, it's likely that the things you want to add are not priority, the child already has the maximum number of goals for the moment, or new goals won't be added until performance improves.
  • Expecting skills to be taught in a matter of days - When you start climbing a ladder, do you put your foot on the 5th rung? No, right? Teaching is very similar to that. When teaching a new skill, there is this thing called a "pre-requisite skill". This means there is something the child needs to be able to do before they can move on to more complex or advanced skills. For example, many play skills require the ability to imitate. Why? Well, if I am trying to teach a young child to play with a Barbie doll I am going to do this by sitting down with them.....and playing with a Barbie doll. I know, this is complicated stuff :-) But what happens if while I am enthusiastically playing, the child just stares up at the ceiling and drops their doll? The child needs to be able to watch my play and imitate it, in order for me to teach them to play on their own. So before I can tackle play skills, I first need to work on teaching imitation. Much of ABA treatment involves these kind of careful ladder steps. We have to work our way up that ladder, which depending on the learner can take days, weeks, or even months. But its super unrealistic to assume the learner will just fly through learning new skills. Expect it to take time.
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on - This may sound like it would never happen, but it absolutely does. A parent initiates ABA services, and during the intake makes statements like "I just want him to be normal", "I'm fine with whatever you think we should focus on", or "I just want her to be happy". Unfortunately, I don't have any curriculum for teaching "normal" or "happy". So in these kinds of situations what can happen is the ABA team puts together a treatment plan that is not functional for the learner. For example, the BCBA may decide the child should work on manners to improve their social skills. However the family isn't big on manners, and this is not an important goal to them. So when the ABA team is not around, who is practicing manners with the child and reinforcing this skill? Likely nobody. Which means the skill won't progress, and it probably won't  generalize. Think of the ABA team like a group of painters showing up to your home. We have our coveralls on, our paint, and our paintbrushes. But...what exactly do you want us to paint??
  • Confusing a "Program" with a "Target" - "I told you I wanted him to learn his body parts, why is he just playing with a Mr Potato Head toy?". If I did not have the knowledge I have, I would find much of what the ABA team does highly confusing.  It looks like we teach random flashcards, meaningless games, and senseless activities over and over again, that have nothing to do with the reasons parents initiated therapy. This could not be more inaccurate. Every "program" is like a menu at a restaurant. You open the menu because you want something to eat or drink. But you can't tell the waitress "I want to eat". You need to be more specific. So you read over the menu and see the hamburger section. But you can't tell the waitress "I want a hamburger". You need to be more specific. So you choose the exact hamburger, and the exact toppings and tell the waitress "I want a hamburger-well done- with no onions and extra cheese". Make sense? Bringing it back to ABA treatment: menu= overall objective, hamburger= program, specific hamburger= target. When a parent says to me "I want him to play with his brother". What I hear is "I want him to improve his social skills", which means breaking that down to improving and reducing behaviors, which means breaking that down to first learning to play with me, then learning to play with me and a peer, then learning to play with just a peer. Whew. Designing treatment is not quick, or simple. Rest assured, the issues you initially discussed with the BCBA are being worked toward, but we have to break the skill apart in order to teach it.

With any child, there will be skills that come easy and skills they struggle to learn. There will be things they should be able to do but cannot, and other things they do super early or super easily. Thats just part of being a human. It will drive you crazy if you look at your child with Autism as a collection of deficits and "not there yet's", and it will also cause you to overlook all the progress they are making right now.
Take time to appreciate those baby steps, sometimes baby steps are all we have.

*Free Resource: This simple handout helps explains common program names many BCBA's use (what the program is supposed to teach).

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