ABA Concerns and Experiences

[Anonymous]

I am interested in experiences with at-home ABA therapy. My child was scheduled to begin ABA this month, but I have postponed the start date because I have concerns. We had an assessment and created a schedule a few weeks ago. A supervisor called me last week to set up a start date and to share the technician's name. I asked about the person's experience/background and was told that the person was new to the company, new to ABA therapy, and had previously worked in transportation. The person is also still in training and not yet a RBT. I asked about supervision and was told that a RBT would come with the technician on the start date and then the person would come alone. A BCBA would provide virtual supervision each week. Of course, I asked to meet with the technician before the start date. The supervisor said a meeting would be set up, but the start date would have to be pushed back. He said that the technician may change too because the assigned person would not start getting paid until they started working with a client and may not be able to wait for the new start date. See what happens when you start asking questions.

Another supervisor/coordinator contacted me this week with the name of a new technician and a new start date. I asked about the individual's background/experience and was told that the person has been with the company for 6 months, is in training, not yet a RBT, and previous background is not childcare or therapy. I have now requested that services be provided by an actual RBT and am on the wait list. My child is in preschool, speech therapy, and OT. I don't want to introduce another person/therapy into our lives without careful consideration (ABA wants us to do at least 20+ hours a week). I chose at-home over center-based services because I didn't like the centers that I visited.

Is my experience with this company typical for ABA therapy? Are most ABA technicians new, inexperienced, and not yet RBTs? I know there is high turnover. What are some good companies or providers in the DMV? Thanks.

[Anonymous]

Just don't do it. RBTs are inexperienced. ABA is based on "evidence" which basically aims to make kids look NT when they are not. Do speech and OT. Music is great. Outdoors are great.

[Anonymous]

We’re in a similar boat - do SP and OT and introduced ABA but only a few hours a week at school and at home. We only went with a BCBA and I’d avoid the whole RBT model and these “companies” that require 20 hours…I bet they take insurance and that’s why? We pay out of pocket and get reimbursed a portion back. Does your child require 20hours? Are their needs very severe?

I’d be super wary of the RBT model - hire a BCBA that can work for your family, and mentally & goals match your family. ABA can be intrusive so trust is a big component. I’d keep looking for other companies or private BCBAs you can hire.

[Anonymous]

Look at Capital ABA LLC. The owner is quite supportive and he’ll link you up with whichever BCBA is available and matches best with child's needs. It is out of network though for all insurances I believe.

[Anonymous]

In ABA you have to mesh very well with the BCBA, and with a new RBT there needs to be adequate supervision by either a very experienced RBT working towards a BCBA or BCaBA. If neither are available then the BCBA should provide direct supervision to the RBT.

I would not accept any program that only provides virtual supervision by the BCBA unless you also have a BCaBA assigned to your case. I would hold out for an RBT and in-person BCBA or BCaBA supervision. I would expect supervision to be weekly for inexperienced RBT or new program and at least monthly for a very experienced RBT and established program.

I think fit with your child is most important regarding the RBT more than there experience. If the BCBA provides good programs, supervision, and training then the experience of an RBT is not typically problematic. If you ever feel they aren’t working out though talk to your BCBA about it immediately.

If they can’t offer you more than they already have offered I’d look somewhere else. The virtual supervision of a new RBT would really turn me off. I would not accept anyone that hasn’t completed RBT training.

[Anonymous]

I would really look at a center. My dc has sever social delays so being at the center has been amazing. She’s also at a preschool but at the ABA center part of it is taught in a group format like a preschool but each child has a one on one therapist. They’re not being forced to do things, they’re being given the skills to do what they want to. My child was in speech and it for years w/ no progress. A dr at Georgetown pushed us to add ABA, and we’re finally seeing progress. It’s like it’s giving her practice in situations to know what to do. I like the extra hours of her being around kids her age. She’s silent at preschool but at ABA she’s not intimidated and actually initiates social things. It’s been amazing to watch

[Anonymous]

RBTs start relatively inexperienced, but background and experience can vary greatly. I’ve worked with some inexperienced RBTs that quit after a month, and other inexperienced RBTs that just picked everything up really quickly. I’ve also worked with very experienced RBTs that were basically learning to do BCaBA work. The model is set up such that as they learn they are also trusted with more responsibility and become able to help with training those less experienced.

[Anonymous]

We've had a good experience with Alliance Pediatrics. They come to our house but will also go to schools. They are expensive, but we don't need that many hours. I know there is a lot of variety in what ABA looks like for different providers, and honestly I would definitely not use anyone who isn't at least an RBT. I'd be worried that insurance wouldn't reimburse for those sessions. Our bills have the provider's licensing numbers on them. Without a certification of any kind, I don't know what our insurance would do.

[Anonymous]

We work with Brighter Strides for our mild-moderate DC who needed behavioral support. Amazing. We had two different RBTs who were great. But our child needed help with behavior- he was so disinclined to break focus and switch attention that it created a lot of dysfunction. When people say ABA just tries to make their kids act like “normal people” they are saying “my kid didn’t need ABA so we didn’t see the value.” Your kid might not need it… but if they do, keep looking.

[Anonymous]

Your initial post reminds me of my experience with ABA - but I didn't ask questions. We got lousy RBTs, and it was a huge waste of time and money. I wish I had really vetted the people better. A lot of the ABA companies out there are terrible - and just in it for the $. Years later, my son cried and asked why I let the mean people come to our house. He remembers it all and said one time, he wanted to come upstairs from the basement but that the lady (RBT) kept blocking him and wouldn't let him come find me. He was tired, not feeling well, and wanted me - but at that time couldn't figure out how to express himself or even realize how to call out for me.

[Anonymous]

We have had a very good experience with Brighter Strides ABA for the last 3 years. The RBT is very dedicated and our child really loves her. The BCBA supervision is also excellent and we have as many parent check-ins as we want.

[Anonymous]

Anonymous wrote:We work with Brighter Strides for our mild-moderate DC who needed behavioral support. Amazing. We had two different RBTs who were great. But our child needed help with behavior- he was so disinclined to break focus and switch attention that it created a lot of dysfunction. When people say ABA just tries to make their kids act like “normal people” they are saying “my kid didn’t need ABA so we didn’t see the value.” Your kid might not need it… but if they do, keep looking.

I'm curious, why is ABA being offered/recommended if it's not needed? The person who diagnoses shouldn't recommend it and the provider shouldn't accept the patient if it's not appropriate for the patient.

[Anonymous]

A lot of ABA companies have been acquired by private equity outfits which obviously does not care about your kid. I think there is real research showing that aba can help kids on the spectrum. However, what you frequently get is not what is supported by that research. Most RBTs are not good and people who aren’t even RBTs are even worse. Most companies also have a ton of turnover and will have your child introduced to a revolving door of people. My kid did aba for 2+ years and had maybe three decent RBTs that whole time for less than nine months each. Also virtual bcba supervision is a joke. We did that for awhile because our excellent bcba moved out of the area and it worked until we had a newer rbt and then it did not. And this bcba was great so if she couldn’t do it I doubt anyone could. It’s just not a WFH job.

[Anonymous]

If you are even a tiny bit uncomfortable—run away. You are your child’s advocate and safety person. You know what feels right. At its best, some ABA helps some kids. It should never be used as OT or speech therapy. Never. Most ABA is not done correctly anyway. Best bet if you want aba? Study it at home and adapt a curriculum that suits your style and your child. Keep in mind—-aba “results” pretty much fade away very soon after you stop doing it. So it’s not a permanent result.

[Anonymous]

Anonymous wrote:If you are even a tiny bit uncomfortable—run away. You are your child’s advocate and safety person. You know what feels right. At its best, some ABA helps some kids. It should never be used as OT or speech therapy. Never. Most ABA is not done correctly anyway. Best bet if you want aba? Study it at home and adapt a curriculum that suits your style and your child. Keep in mind—-aba “results” pretty much fade away very soon after you stop doing it. So it’s not a permanent result.

You don’t learn ABA through just adapting your own curriculum. There’s a whole underlying science behind ABA that takes years to learn and even longer to perfect. This is like saying playing Operation makes you a surgeon.

ABA is not a substitute for OT or SLP but plenty of ABA programs effectively teach both language and motor skills. You may want to research verbal behavior, first discussed in 1957 by B.F. Skinner in this book:



Here’s a very brief summary of verbal behavior: https://howtoaba.com/what-is-verbal-behavior/

You may also be interested in learning more about the ABLLS-R and VB-MAPP.

New skills acquired using ABA do not mysteriously fade away. This idea is so far fetched I’m not even sure where you came up with it.

The only thing I agree with you on is that a parent is the child’s main advocate. As with everything in life caregivers should always do their due diligence and find professionals that are experienced and trustworthy.