What ABA is, and what it isn't

Applied behavior analysis (ABA) uses what's known about how learning and behavior work to teach skills and to reduce behavior that is unsafe or gets in the way of daily life. A BCBA assesses the child, sets goals with the family and designs a plan. Therapists, often RBTs, carry out the plan, and progress is measured and reviewed regularly.

ABA is one of the most widely used services for autistic children in the US, and many insurance plans cover it. It can focus on communication, daily living skills, play, safety and more, at home, in a clinic, at school or out in the community.

• It isn't a way to make a child "not autistic." Autism is a lifelong part of who a person is. Good ABA aims to help a child communicate, learn and stay safe, not to erase who they are.
• It isn't one fixed program. ABA ranges from structured table work to play-based teaching in everyday settings. Two providers can look very different.
• It isn't something done to a family. You should help set the goals, and you can ask questions, disagree and say no.
• It isn't the only option. Speech therapy, occupational therapy, developmental and relationship-based approaches, and school services are all used, alongside ABA or instead of it.

Many autistic adults, and some researchers and clinicians, have criticized ABA. Parents deserve to hear these concerns directly.

• Some ABA has aimed at making children look less autistic, for example stopping harmless behaviors like hand-flapping or requiring eye contact, rather than at the child's own wellbeing.
• Early ABA used punishment, and some autistic adults describe the ABA they had as children as harmful or traumatic. Some studies have reported higher trauma symptoms among people who had ABA; that research is debated.
• Teaching that centers on doing what adults say may teach children to go along with adults even when something feels wrong. Critics say that can leave children less safe.
• Many hours of therapy at a young age can leave little time for play, rest and family.

Many behavior analysts say the field has changed and that good providers no longer work this way. Others say the changes don't go far enough. Both views are worth hearing, and you can raise any of these concerns with a provider.

General signs many families and professionals look for:

• Your child's comfort and assent matter. Therapists watch for signs your child is unhappy or wants to stop, and respond to them.
• Goals mean something to your child and family, such as communicating needs, staying safe or joining activities they enjoy, not just looking "typical".
• Harmless autistic behaviors, like stimming, are left alone unless they cause harm.
• Teaching uses play and your child's interests, and sessions feel mostly positive.
• You're welcome to watch, ask questions and take part, and parent training is offered.
• Progress is shared with you in plain language, and the plan changes when something isn't working.
• The BCBA supervises regularly, and you can reach them.

1. What would my child's goals be, and how do you decide them with us?
2. How do you tell when my child is unhappy or wants to stop, and what do you do then?
3. How do you approach stimming and other harmless behaviors?
4. Can I watch sessions, and how will you include me?
5. How often does the BCBA see my child, and how do I reach them?
6. How many hours a week do you usually recommend, and why?
7. How do you measure progress, and how often will we review it together?
8. Do you ever use restraint or punishment? When, and who decides?