Applied Behavior Analysis, or ABA therapy as it is more widely known, has significantly grown in popularity in the United States as a leading intervention for children with autism. Based on the research of Dr. Ivar Lovaas, ABA therapy for children with autism was initiated in the mid 1990s and has grown to include multiple providers for thousands of children with autism across the United States. While this treatment is popular and is endorsed by the United States Surgeon General, it is not without its critics. One of the most prominent criticisms of this approach is that, while it is well researched and widely provided, it does not yet have a set of standards to regulate providers.
ABA therapy is usually provided to children with autism in their homes, where providers can work with children on every day skills, including communication, following directions, playing with peers, and completing daily self care tasks. The majority of children who receive intensive in-home ABA therapy are preschool age and therapy is provided 25 to 40 hours per week. Due to the intensive nature of the therapy and the number of hours required, ABA therapy is expensive and insurance coverage is not consistent, even with the implementation of the Affordable Care Act.
In view of the expense involved, some ABA therapy providers utilize paraprofessional staff to provide direct treatment to children with autism in their homes. Typical qualifications for paraprofessionals include a high school diploma, a valid driver’s license, and the ability to pass a caregiver background check. Experience with children or coursework in psychology or special education is often listed as a preference, but is not required. Paraprofessionals are supervised by staff members that have credentials including bachelor’s degrees in psychology or education. Some ABA providers require supervisory staff to also have certification in behavior analysis. Professionals who do have certification in behavior analysis direct the programs and set the standards for in-home therapy. Paraprofessionals receive training directly from their employers and supervisors. In-home therapy provided through this model may cost up to $20,000 per year, depending on the level of services a child receives.
Other providers require therapists providing services in-home to have a bachelor’s degree in psychology, education, or a relevant area. These therapists are supervised by professional staff members who have master’s or doctorate degrees in psychology and certification in behavior analysis. Therapy provided by professional therapy teams such as this may cost $50,000 or more per year, which is significantly more expensive than the paraprofessional model.
Currently the regulations regarding ABA in-home therapy in the United States are not consistent across the country. Standards set within the psychology profession mandate that professionals who supervise in-home therapy for children with autism be credentialed by the Behavior Analysis Certification Board (BCAB). This board is currently in the process of revising and standardizing criteria for behavior analysis certification. The Association of Professional Behavior Analysts also provides regulatory criteria for ABA in-home therapy programs.