Written by Luis Vera

 

At The SEED Center, our mission is to provide positively impact the lives of individuals with autism spectrum disorder, ​therapeutic services that both across the spectrum and across their lifespan.

Whether this is your first time researching an ABA provider or your fourth or fifth time (we hope and believe this we’ll be your last stop), a frequent question that comes to mind for a lot of caregivers is “how much ABA is enough? How many hours of ABA does my child need?” The answer to that, as with many things in life, is: it depends. What I can tell you though, without hesitation, is that in the majority of cases, anything less than 10 hours a week of ABA treatment, say 1 hour a week, could/should be considered glorified babysitting.

Why do I say that? Well, think about it, if your child has multiple goals that need to be worked on across various developmental domain​s and​ for just ​one ​of those goals it could honestly take hundreds of learning trials for your child to achieve true mastery of that skill. It is very unrealistic that 1 hour a week of ABA could achieve that level of progress. Essentially, determining the ideal treatment dosage of ABA therapy for your child is a complex decision, composed of many factors that have to be considered.

Per the Behavior Analyst Certification Board (BACB), “ABA treatment programs for ASD incorporate findings from hundreds of applied studies focused on understanding and treating ASD published in peer-reviewed journals over 50 years. Treatment may vary in terms of intensity and duration, the complexity and range of treatment goals, and the extent of direct treatment provided. Many variables, including the number, complexity, and intensity of behavioral targets and the client’s response to treatment help determine which model is most appropriate. Although existing on a continuum, these differences can be generally categorized as one of two treatment models: Focused or Comprehensive ABA Treatment.”

According to the guide ‘​Applied Behavior Analysis Treatment of Autism Spectrum Disorder​’ published by the BACB, the attempt to answer how many hours of ABA therapy is described as “an analysis of multiple variables, such as the intensity of treatment goals, client needs & severity of deficits, and client response to treatment. A range of 10-25 hours/week for focused treatment and 30-40 hours/week for comprehensive treatment is recommended.” In other words, treatment dosage is based on medical necessity.

What’s the difference between Focused and Comprehensive Treatment, besides how many hours my child is being serviced?

According to the BACB, determinations as to whether ABA treatment should be focused or comprehensive and the intensity of treatment should be based on the ​medical necessity​ of the treatment for each learner rather than the individual’s chronological age, duration or nature of previous ABA services.

The following is an excerpt from an update to the guide published in February 2019 by the BACB that highlights the distinction between Focused and Comprehensive treatment.

 

INTENSITY OF TREATMENT

The Guidelines note that treatment intensity (sometimes referred to as dosage) typically comprises both the number of hours of direct treatment per week and the total duration of treatment. The comments that follow focus primarily on the number of hours of treatment per week.

Focused ABA Treatment is described in the Guidelines as”…treatment provided directly to the client for a limited number of behavioral targets[functional skills, problem behaviors].” Intensity levels in a range of 10-25 hours per week are mentioned, with the caveat that the intensity may need to be higher depending on the nature of the target behaviors and other considerations, individualized to each client. For instance, behaviors that put the client and/or others at risk of harm may well warrant high-intensity focused ABA treatment for some period of time. Those may include maladaptive behaviors to be reduced and/or adaptive behaviors that need to be developed or strengthened in order to enhance the client’s health, safety, and overall functioning.

Comprehensive ABA Treatment  is described as “…treatment of the multiple affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning” as well as maladaptive behaviors. The Guidelines state that intensity levels of 30-40 hours per week are common and necessary to achieve meaningful improvements in a large number of treatment targets. The Guidelines emphasize, however, that the intensity of comprehensive treatment must be individualized to the client’s characteristics and other factors. To expand on those points, we note that analyses of data from multiple studies of comprehensive ABA treatment for children with ASD show that

Whether ABA treatment is focused or comprehensive, the guidelines make it clear that treatment is comprised of services delivered directly to the child based on medical necessity which is pinpointed to the needs of every individual. In circling back to the original questions of “how much ABA is enough? How many hours of therapy does my child need?” the answer is not that simple, it depends…..on the medical necessity of your child.

 

References:

BACB Guidelines