too much ABA therapy?

[Anonymous]

Folks, I'm pretty sure I need a reality check. 3 1/2 year old DS was recently diagnosed with ASD by Children's. The neuropsych recommended 20 hours a week of ABA therapy. We just got his IEP (he's in PK3 in DCPS), and it covers (among other things) 2 hours a week of "Behavioral Support Services". So now it seems I have to make up the other 18 hours a week through private means. We are working on securing private ABA therapy for 10 hours a week to start because that's all we can afford until open season. My deep down gut feeling is that 20 hours a week for DS of ABA therapy is too much. His issues appear to worsen the more people/stimulation are around. At home, one-on-one, he's great much of the time (definitely has his tantrums and stimming moments though). With a playmate at our house, he's great. He can engage in play, talk, make eye contact, laugh etc. over a two hour period). Last week we had a bunch of folks over and he did really well with six or seven other kids running around his house (i.e., engaged, talking, side-by-side playing, no major hitting or meltdown). At school, though, he has his hardest time. He avoids eye contact, doesn't talk much, seeks sensory stimulation in inappropriate ways, doesn't understand personal space needs of other kids, etc). On the one hand, I know logically that the very experienced and smart neuropsych who evaluated him first-hand says 20 hours a week. On the other hand, I watch him talk and play and even engage with other kids and think its overkill. I want to be on board, but something in me hates the idea of weighing him down with all of these therapies and interventions. I need folks who have BTDT with ABA therapy to pull me back into reality. Thanks.

[Anonymous]

I agree with you. Start slow and ramp up if you want once you see how he responds. From your description, my son was much more severe than yours and was also recommended about 25 hours a week.

It took us a year to find an ABA therapist that clicked with my son and now he gets 5 to 6 hours of ABA a week.

However, we did have a training session for all the teachers, us parents, the nanny/shadow and the grandparents (all parties that work with our child) to go over interactions and expectations. We are all on the same page now. Examples of interactions and expectations: tell him what to do rather than what not to do (may be common sense to some but not to others), speak in simple phrases rather than multiply step instructions (at first), give him appropriate time to respond (wait 10 second rather than asking it again). These are just a few of the basic ideas we covered. It really helped to have everyone on the same page with how to interact with our child.

We have seen huge progress and I think a lot of that is due to the constant and common way we all work with my son based on our training.

[Anonymous]

I am of the mind that the more ABA you can do, the better. Admittedly, we were pretty extreme for our DC -- began ABA at age 2 and did at least 40 hours a week (7 days a week). But it absolutely changed his path. If it's done right, the program will be tailored to his particular needs and goals, so it will be very productive. Best of luck.

[Anonymous]

Anonymous wrote:I am of the mind that the more ABA you can do, the better. Admittedly, we were pretty extreme for our DC -- began ABA at age 2 and did at least 40 hours a week (7 days a week). But it absolutely changed his path. If it's done right, the program will be tailored to his particular needs and goals, so it will be very productive. Best of luck.

Do you mind saying who you used for ABA?

[Anonymous]

The fact that his behavior is so different at home (even under chaotic conditions) and at school makes me wonder if there's something wrong about the school setting. That was certainly the case for us at the first school we were at; a different school brought out the best, instead of the worst, in our child (although, of course, the ASD was still there).

[Anonymous]

Anonymous wrote:I am of the mind that the more ABA you can do, the better. Admittedly, we were pretty extreme for our DC -- began ABA at age 2 and did at least 40 hours a week (7 days a week). But it absolutely changed his path. If it's done right, the program will be tailored to his particular needs and goals, so it will be very productive. Best of luck.

That sounds financially out of reach for pretty much everyone though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am of the mind that the more ABA you can do, the better. Admittedly, we were pretty extreme for our DC -- began ABA at age 2 and did at least 40 hours a week (7 days a week). But it absolutely changed his path. If it's done right, the program will be tailored to his particular needs and goals, so it will be very productive. Best of luck.

That sounds financially out of reach for pretty much everyone though.

I agree... I am the PP whose child gets 5 to 6 hours a week. We also pay for the ABA therapist to train everyone and meet with teachers etc throughout the year. At $150 an hour, I have no idea who could pay for 40 hours a week...

[Anonymous]

OP here - the ABA therapy group we are talking to requires a minimum of 10 hours/week. Hoping we can get coverage during open season.

[Anonymous]

As a speech therapist I often see doctors offices, psychologists neuropsych's, etc propose inflated amounts of therapy. It doesn't mean necessarily that your child needs that much especially from what you described. Do what you can afford and supplement with things like play dates, a fun activity like gymnastics/karate, etc.
What is more concerning is the school. Is your DS just starting there? After he's had some time to settle into the school year it might be good to call a meeting to see how the placement is working out.

[Anonymous]

I think behavioral training was really helpful for my kid, but we didn't do ABA. We did a parent-led behavior therapy program. There is some evidence for this as a positive, cost-effective means of therapy. It's tough to do, though. Unless you are willing to hang on through a thousand and one meltdowns because DC is having ANOTHER extinction burst, it won't work.

Any behavior psychologist can help you develop this kind of program. You could see the behavior psychologist on a weekly basis to plan and to talk things over and to talk about more interventions to use. Even if you see the therapist weekly, it's going to be WAY cheaper than ABA.

[Anonymous]

We started with 8 hours a week, moved up to 10 or 12 after a month, then stuck with 16 hours. After while it becomes your new normal and the ABA person is basically an extension of the family. She went grocery shopping with us, out to playgrounds, to the mall, etc while also doing some work while in the home. At the same time it can be mentally exhausting for the kid, so you have to take a step back and analyze things every now and then.

I remember when DS was diagnosed and reading about the recommended 20 hours and thinking *holy sh--*, how is that going to happen? After a year of ABA now I see what a difference it has made for our family. DS gets most of his services during preschool hours now but we still keep one home session during the week.

There are good and bad ABA companies here. Good ABA won't feel like a horrid struggle and make your child stressed. If you question if it is the right fit, it probably isn't. Good ABA is supportive and positive.

[Anonymous]

Its really individual depending on the child, their severity and their needs. We were offered I forget how much but it was a huge amount. Maybe 30-40 hours. We could not find any providers who offered more than 2 hours a few times a week. Between ABA, speech, OT, special preschool and some activities we were beyond exhausted. Our child wasn't benefiting from ABA (the provider was great but she was basically doing speech therapy far more basic than the speech pathologist and the speech pathologists style worked better) so we dropped it. If my child had moderate or severe autism, I would probably start with 10 hours a week and see how it goes. You can adjust. Remember even though it feels like a lot and long term, many of these therapies for some kids may only last a few years so it is exhausting while you are doing them but in the long run worth it and you'll just need to find the right balance for your child and family. 10 hours is fine. I agree with the speech pathologist some offer the max amount so families can decide what is best for them. Do what you can afford too.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am of the mind that the more ABA you can do, the better. Admittedly, we were pretty extreme for our DC -- began ABA at age 2 and did at least 40 hours a week (7 days a week). But it absolutely changed his path. If it's done right, the program will be tailored to his particular needs and goals, so it will be very productive. Best of luck.

That sounds financially out of reach for pretty much everyone though.

I agree... I am the PP whose child gets 5 to 6 hours a week. We also pay for the ABA therapist to train everyone and meet with teachers etc throughout the year. At $150 an hour, I have no idea who could pay for 40 hours a week...

Insurance. Ours covered it and we just had a small co-pay per session (under $20). Otherwise, its for the very wealthy. Some counties also provide it. We have friends in Montgomery County and their child was getting it through Infant and Toddler. It surprised me so maybe it is a newer thing.

[Anonymous]

I am the poster who said the more the merrier. Our consultant charged about $125/hour, but we hired college students at $15/hour to actually do the instruction. It was still outrageously expensive, but the 40 plus hours were at $15/hour. The consultant only met with us every couple of weeks for a couple hours at a time. And she trained our instructors when they started.

[Anonymous]

Anonymous wrote:I am the poster who said the more the merrier. Our consultant charged about $125/hour, but we hired college students at $15/hour to actually do the instruction. It was still outrageously expensive, but the 40 plus hours were at $15/hour. The consultant only met with us every couple of weeks for a couple hours at a time. And she trained our instructors when they started.

That makes sense!! I am the pp whose child gets 5 to 6 hours. I think we may use the same person. We use the consultant for 5 to 6 hours a week direct with child and then have nanny/shadow, all teachers and family trained by consultant.