Your child has received an Autism Spectrum Diagnosis and is ready to start Applied Behavior Analysis (ABA) therapy. You may be flooded with mixed emotions like excitement, apprehension, uncertainty, and confusion, to name a few.

You have likely read countless books and articles about ABA therapy, and perhaps you have even talked to other families who have children in ABA therapy. Nonetheless, you are sure to have many questions as you are getting started. 

Get into the habit of writing your questions down as they come to you, rather than waiting until meeting with your child’s Board Certified Behavior Analyst (BCBA). It’s likely that at that point, you may struggle to recall all of the questions you have pondered over the last several weeks or months after receiving your child’s diagnosis.  

Read on to learn about 8 important questions to ask your child’s BCBA during the initial visits to ensure you are adequately prepared for what to expect! 

Asking these questions early on will help reduce frustration and confusion once your child’s therapy starts. 

1. What is expected of myself and my family during treatment hours?

This is a big one! ABA is a time commitment for families, with 20 or 30 hours per week often being prescribed. Especially if your child is receiving in-home therapy, you will want to know what is expected of yourself and other family members. 

• Will I be heavily involved during sessions? 
• What would this look like? 
• Should I continue with our typical day-to-day activities? 
• Should siblings be kept in a separate area of the home or will they be present and participate in the sessions? 

Your BCBA can help clarify all of those questions for you to ensure everyone is on the same page with what you and your other family members will be doing during the therapy sessions. 

2. What will a typical ABA therapy session look like? 

ABA therapy sessions will vary greatly from client to client and even potentially session to session. However, it’s valuable to get a general idea of what your BCBA envisions for the layout of sessions. 

Keep in mind that the answer to this question may change as the treatment team gets to know your child more and gets a better idea of how they learn best. Some things you may want to know include whether the session will be in one specific room, utilizing a table and chair, or if it will be more naturalistic teaching. 

The answers to these questions will also provide you with additional information regarding your BCBA’s therapeutic approach.  

3. How are goals determined?  

You may want to know more about how your BCBA develops goals for your child. Ideally, they would create goals that are of value to both your child and yourself, taking your concerns into consideration (and your child’s if they are able to communicate what they want to work on). 

Goals are also likely to be programmed based on assessments that the BCBA conducts. It’s great to have an understanding of the purpose of the assessment administered and how it will tie into goal creation. 

4. How often are goals re-evaluated?  

Watching your child make incredible progress, but not having goals moved on is sure to be frustrating. Ask your child’s BCBA how often they will be re-evaluating goals, how often goals are progressed and how often new goals are added. Progress should continuously be monitored and changes made to goals as soon as a need is identified. 

Realistically, when goal procedures need to be created or stimuli is needed, some time is expected between the identification of a new goal need and the introduction of the goal. 

It is crucial that changes are being made as soon as feasible to ensure that treatment is being provided consistently and all of the hours being provided are worthwhile to all who are dedicating their time and resources to receiving ABA services. 

5. Who will my child’s care team consist of?

Not every organization has the same care team organization. Some companies have a 2-tier structure, with the team consisting of the BCBA who supervises the case, and behavior technicians/registered behavior technicians who work directly with the child. 

Other companies have a 3-tier structure with a mid-level provider sometimes called a treatment therapist or senior therapist. It’s helpful to know who will be the main point of contact, especially if the organization has a 3-tier structure. 

Additionally, you likely want to know how many behavior technicians to expect on your child’s team. If they are receiving more than 15 hours per week, it is unlikely that they would only have one behavior technician, so the hours will be split among two or more behavior technicians. 

it is also important to note that there may be a “ramping up” period of time when your child first starts therapy as they build up your child’s treatment team. You may want to ask how long they expect until the team is full.

6. What consistency can be expected of our therapists?

Oh the dreaded turnover. Unfortunately, the ABA field is not immune to turnover and despite everyone’s best efforts, even the best providers will experience this. That awesome therapist your child has bonded with for a year may move out of state to be closer to family. Perhaps they graduated college and are starting on a new career path. It’s bound to happen. 

However, if turnover is significantly high, that may be a sign of red flags. Ask upfront what the company’s turnover is like and what they do to combat turnover. Many companies implement a policy requiring staff to commit to each new client for a minimum of 6 (or more) months. Ask if they have a similar policy. You can also ask if they have a “floater” position who would fill in when there are open sessions available, or if your BCBA would fill those hours directly when needed. 

7. Do you work on reducing stimming or forced eye contact?

The ABA field has made leaps and bounds in terms of ethical practices since the treatment’s initiation. Practices such as a focus on decreasing self-stimulatory behaviors that are not harmful, and forcing eye contact are outdated, unnecessary, and potentially harmful. 

Self-stimulatory behaviors that are not harmful to the child or others (arm flapping, spinning, vocal stims, etc.) may serve the purpose of helping the child regulate their body and/or emotions. Furthermore, ask about punishment procedures. Per the BABC’s ethical guidelines, reinforcement-based strategies should always be utilized and exhausted prior to the implementation of any punishment-based procedure. 

ABA sessions should be immersed with reinforcement, whereas punishment should be used extremely rarely. It is a good idea to make sure your treatment team is in agreement on that. 

8. What are the transition and discharge criteria?

When your child is first starting treatment, transitioning out of therapy may seem like an eternity away, so it will likely be the last thing on your mind. However, it’s vital to know what the criteria are for transitioning to a lower number of hours and ultimately transitioning out of therapy. 

As stated previously, ABA is often a major time commitment. While your BCBA can’t give any guaranteed timeline for when your child will progress to the point of reducing hours, they can tell you what the requirements for reducing hours and discharging would be. This should be clearly outlined in all of your child’s treatment plans as well. 

Knowing this information should help you monitor your child’s progress toward the ultimate goal of discharge and functioning in the most inclusive environment.

Final thoughts

Starting ABA Therapy for the first time can be a daunting process. So much time, energy, and resources are expected of you and your family. 

Asking all of the right questions at the onset of services (or before, if possible!) is the best way to ensure everyone is on the same page with what to expect over the course of treatment. Your child’s progress is of the utmost importance. 

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