How Much ABA Is Enough for Children With Autism

You've weighed the pros and cons and decided that applied behavioral analysis (ABA) is the right therapy for your autistic child. Now, you get down to brass tacks to figure out when, where, and how much therapy your child really needs.

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40 Hours per Week

The literature recommends 40 hours a week. But so much therapy is very expensive and hard to find. Is it really necessary for a child to have 40 hours of ABA each week to be successful?

Both the Lovaas Institute (which launched the use of ABA for autism) and the Behavior Analyst Certification Board (which trains ABA therapists) say "yes." According to the folks at Lovaas:

"The best outcomes have been attained when a child receives 40 hours per week of behavioral treatment. Intervention should always be individualized, and some factors, such as a child’s age and current skill level, will influence the number of hours recommended. But, 40 hours per week remains the standard from which to deviate."

Lessening the Number of Hours

On the other hand, both do say that the number of hours can be lessened for children with fewer challenges and should be lessened over time as the child gains skills. They also say that ABA should be provided in a variety of settings, both individually and in groups.

Research conducted by non-ABA organizations seems to suggest that fewer hours might be helpful. But even then, the amount of time spent in therapy is extraordinarily high. The numbers usually mentioned are 25-40 hours per week, every week, for up to three years.

Says the Lovaas Institute:

"The purpose of 40 hours of therapy is to provide a child with structured intervention throughout the day. During structured intervention, the environment is systematically manipulated to help a child remain successful while also teaching new skills quickly. In addition, parents are empowered to continue intervention throughout the child’s waking hours. Typically developing children learn from the natural environment all of their waking hours. The purpose of an intensive program is to allow a child with autism to learn how to learn in the natural environment and ultimately catch up to his or her typically developing peers."

Do children really catch up to their typically developing peers with intensive ABA?

The reality is that this is rare, but it does happen. Generally speaking, those children who actually "catch up" were the highest functioning to start with, and while they may be able to function well as young children, they may develop new challenges as they face more complex social challenges in later years.

In most circumstances, however, children with autism don't "catch up." While children with autism can certainly learn (in many cases) to gain new behaviors and "extinguish" others, they are usually left with significant challenges. And, of course, when a child is receiving such intensive ABA, he has little "extra" time to devote to ordinary childhood pursuits, personal interests, or relationships. He is also living in a highly structured world that is quite different from the usual chaos of daily life. This can mean that a child with autism, unlike his typical peers, may have little experience with activities such as team sports, after-school activities, and other interactions that are important for social acceptance. It can also limit a child's experience with flexibility, improvisation, and other important skills.

Another concern that parents do need to consider when looking at intensive ABA is the cost. The good news for families who choose ABA is that it is quite often covered (at some level) by schools and/or insurance. In some cases, schools will provide students with ABA-based classes in the school setting. In other cases, private health insurance or Medicaid will pay for at least some of a child's ABA therapy. At 40 hours a week for three years, however, the "leftover" costs for families can be significant.

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  • ABA Guidelines for ASD. Behavior Analyst Certification Board.

  • Lovaas ABA Treatment for Children with Autism. Lovaas Institute.

  • Lovaas OI. Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol. 1987;55(1):3-9. doi:10.1037//0022-006x.55.1.3

  • Mceachin JJ, Smith T, Lovaas OI. Long-term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard. 1993;97(4):359-72.

  • Sallows GO, Graupner TD. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard. 2005;110(6):417-38.

  • New York State Health Department Recommendations

By Lisa Jo Rudy
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.