Get the Best Behavioral Therapy for Your Child with Autism

Is Your Child Enjoying or Dreading Therapy?

ABA Therapy Session
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Most doctors and schools recommend behavioral therapy for children with autism. The most common form of behavioral therapy is called applied behavioral analysis (ABA).

Parents of children with autism may be familiar with ABA in the form of an approach called "discrete trials." This approach to therapy involves a therapist who sits across a table from a child with autism and ask for a behavior (give me the spoon). When the child complies, he receives a reward -- very often a bit of food. The the therapist asks for another behavior, and another -- sometimes for as many as 40 hours a week.

Training for this type of behavioral therapy is relatively brief (it can be as short as just a few weeks). But therapy at this level, even for many hours a week, is unlikely to be ideal.

According to Jim Partington, PhD, board certified behavior analyst and director of Behavior Analysts Inc. in Pleasant Hill, Calif., a child engaged in behavioral therapy should be having fun, responding to the therapist's facial expressions, and working not just at a table but also in natural settings (playgrounds, classrooms, and so forth).

If your child clearly dreads therapy, prefers not to engage during therapy, or is always seated at a table with a therapist, it may be time to intervene.

Know Your Therapist's Background and Training

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Professor Texbook. Getty Images

Some parents have the luxury of choosing and hiring their own behavioral therapist. Others have therapists selected for them by their child's school, early intervention agency, or other institution. No matter what the source of your child's therapist, though, you should be able to learn more about the therapist. Questions to ask include:

  • Does this therapist have Behavior Analyst Certification Board (BACB) certification? Most qualified therapists do have this certification. If yours does not, you can almost certainly find a qualified local therapist through the BACB database.
  • Has this therapist worked with children on the autism spectrum before?
  • What is your therapist's educational background? Behavioral therapists should have a college degree and (ideally) formal training in special education, child development, or a related field.
  • Does your therapist take part in continuing education programs?

    Is the therapist aware of your child's individualized education plan (IEP), and is he or she involved with team meetings and/or working closely with your child's teacher?

Ask About the Tests Your Therapist Used to Design Your Child's Program

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Assessment of Basic Language and Learning Skills Test Revised (ABLLS) is a well-regarded assessment tool that looks many different areas of development and learning, and helps therapists and teachers to design an appropriate program for your child.

Partington suggests that parents specifically ask for this test. He says, "If you don't know what a child knows and doesn't know, you can't teach them. What you want to do is ensure that the level of teaching is at the appropriate level. When you go to the IEP meeting, you know what the appropriate goals are.... Without such an assessment, [therapists] ... may choose activities based on age-appropriate expectations. [When this happens], a child may be working on "red" and "blue" [when he] should really be working on concrete object identification."

Without appropriate assessment, your child's therapist may spend months working on advanced ideas, depriving your child of the basic concepts he or she needs to progress.

Observe Your Child's Therapist in Action

swing therapy
swing therapy. swing therapy

Observing your child's therapy sessions is important for several reasons. Of course, you want to know that your therapist is doing a good job -- but it's also important to know what words, concepts and techniques the therapist is using. This way, you can build on the therapist's work. Ideally, you'll be meeting with the therapist on a regular basis to discuss your child's progress, but seeing the process in action is equally critical.

As you observe, pay attention to the process, the content, and the relationship. Ask yourself:

  • Does this therapist seem to like and look forward to working with my child?
  • Is my child's therapy specific to his developmental level, or is it identical to therapy provided to others in his group/class?
  • Is the therapist rewarding my child with real emotional engagement (smiles, praise, high fives)?If she does, does my child respond?
  • Is my child's therapy conducted entirely at a table, or does the therapist also work with my child in natural settings?

If you see issues with your therapist's ability to connect with, understand, and/or reach and teach your child, it may be time to take action.

Ask for Change As Appropriate

Confusing Conversation

If, after you've reviewed your child's therapeutic program, asked about his therapist, and observed his therapist in action, you feel the program is inadequate -- it's time to act.

If your therapist is working for you, and you're paying out of your own pocket, you're in the driver's seat. Ask for the changes you want, or ask for a change in therapists. If you don't get what you feel you need,find a different therapist with the qualities you're seeking.

If your therapist is provided by the school system, you can start with the same approach. Armed with your knowledge of the therapist's training, credentials, experience and approach, bring your concerns to the school administration and/or IEP team. Be sure to put all of your concerns in writing, and be sure to keep a copy for your files. If your school does not respond to your concerns, it may make sense for you to take the next step on your own.

Find Help In Improving Your Child's Therapeutic Experience

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If your school can't or won't make reasonable changes in your child's therapeutic program, you may choose to find a consultant who can help you to move forward. Ideally, you're looking for a trained and experienced behavioral therapist who has and will work with schools and parents. In some cases, school districts may be able and willing to bring in an acceptable consultant of their own; just as often, the parents are the ones to bring a consultant to the table.

"You have to find people who know what they're doing, not just people who have a degree in behavior analysis or speech or education," say Partington. "[Find someone who's] trained to pay attention to the details of what motivates this child right now...unless someone is sensitive to the learner's behavior, the learner won't learn well."

Depending upon your situation, you might ask your consultant to observe your therapist in action, and/or to meet with your IEP team. Your consultant may be able to do some troubleshooting, make suggestions, or even put together a more effective program for your child. Of course, it's best to do all this with the knowledge -- and ideally the support -- of the school administration and therapist.

Oversee Your Child's Program

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Once you have an appropriate assessment and a well-trained therapist in place, you can take a deep breath -- but you can't rest on your laurels. The most important aspect of any therapeutic program is progress, and it's up to the parent to be sure that appropriate progress is being made.

To stay on top of your child's program, you may need to continue to observe therapy sessions from time to time. Watch to be sure your child is having a positive experience and receiving good emotional engagement. Ask yourself, as you watch your therapist working with your child:

  • Is this an appropriate task?
  • Is the instruction appropriate?
  • Is the child really coming in contact with enough reinforcement?

According to Partington, often the plan is right, but the teacher doesn't know how to motivate your child. When that's the case, the parent can have a tremendous positive impact by serving as a consultant to the therapist. No one knows your child as well as you do, so you may be able to offer invaluable information about what really motivates your child.

Know That Failure to Progress Is Never the Child's Fault

anxious girl

It's important to remember that, when it comes to therapy for children with autism, failure to progress is never the fault of the child. If you hear from a therapist that your child doesn't progress because of his behaviors, attention span, intelligence level, or stubbornness, it's time to question the therapist's technique.

Partington explains:

  • The view of the behavior analyst should be that the subject is always right. If the child isn't learning, you need to know why. It's not that the child is defective, it's that the approach isn't working. The therapist needs to ask, "what do I need to do to teach this child?"
  • ...Being autistic shouldn't stop children from learning. It has nothing to do with their ability to learn. They just don't learn typically. But that doesn't mean we can't teach children with autism language and social interaction. They don't need us to have fun -- they can create their own reinforcers. The therapist has to find a reinforcer that's better than what the child can do on his own. That "better thing" should always have a social component.


Interview with Dr. Jim Partington, PhD, board certified behavior analyst and director of Behavior Analysts Inc. in Pleasant Hill, Calif., March, 2007.

Simpson, R.L. 2001. ABA and Students with Autism Spectrum Disorders: Issues and Considerations for Effective Practice. Focus on Autism and Other Developmental Disabilities 16(2):68-71.

Sundberg, M. L. & Partington, J. W. The Need for Both Discrete Trial and Natural Environment Language Training for Children With Autism. In Ghezzi, P. M., Williams, W. L., & Carr, J. E. Autism: Behavior-analytic perspectives. Reno, NV: Context Press. (1999)

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