At Community Behavior Consulting, we do not diagnose children with autism or any other disability. The reason is very simple: diagnosing a child and then referring the child to yourself for treatment can lead to ethical issues because there are financial incentives for children to receive ongoing treatment. Due to this, we have seen many different diagnostic reports and recommendations that talk about ABA. Often, it does not appear like the recommendation is customized for the client. Here are some pointers when trying to figure out what the recommendation for ABA treatment means:
Recommendations often include hour ranges for how much ABA treatment is needed. First, there is a difference between direct treatment with certified professionals and implementing ABA interventions in home and at school. Direct treatment hours should be based on how much need the client has. The Behavior Analysis Certification Board has guidelines that explain the difference between focused and comprehensive treatment. Focused treatment ranges from 10-25 hours a week and looks at a limited number of behavioral targets. A child that has needs, but not in every domain, would be a good fit for this type of treatment. These targets may include communication and social skills. Comprehensive treatment is typically 30-40 hours and involves treatment across multiple developmental domains: cognitive, communicate, social, emotional, adaptive functioning, etc. Not every child needs dozens of hours a week of ABA and at times, too much ABA treatment can have negative effects if it removes the child from other opportunities that support their development: such as play time with peers and napping. There is even research to conclude that there is not a large difference in treatment effects between 15 and 25 hours a week of treatment.
If a recommendation report does not include referrals to a variety of service providers in the area, ask why not. Even worse, if a recommendation report does not include recommendation to a variety of service providers and does not have immediate openings to start servicing the child with the recommended treatment hours, there is an ethical problem with the company. Children with autism need access to speech therapists, occupational therapists, special education experts, and sometimes other services providers and the diagnostician should be including those experts in their reports.
Recommendations for ABA treatment should include some information about how the ABA service should be delivered. ABA treatment ranges widely in how it is delivered. It is important that children that specifically struggle the most with social skills are not engaged in only one-on-one treatment with adults, but have opportunities to be with their peers to work on their skills. Because we know that a characteristics of autism includes struggles with generalization, only receiving cookie cutting ABA treatment is not going to help the child reach their potential.
If you received a recommendation for ABA treatment, consider talking to a wide variety of professionals and families that have received the treatment to determine how to best move forward. Local parent support groups often can refer you to parents that have had good and bad experiences and many professionals will share pros and cons that they have experienced.