Questions about Autism Behavioral Therapy

Trauma Columnist · Jul 19, 2019

I totally get your frustration as I have an autistic child in my life too. However, we can't provide specific recommendations. Have you considered:

Easter Seals for evaluation and they can usually point you in the right direction

A private advocate (we use one and its been a great help in navigating the school system)

State-run programs for autistic children. In Illinois we have this and I would hope other states do also

PeakRN · Jul 23, 2019

I can't speak to the Pennsylvania aspect, but there are many therapy modalities that can be utilized for kids with autism.

Speech-Language Pathologists are one of the most underutilized in my opinion. I think even healthcare providers don't fully understand their role and how much they can do for many of our patients. Some kids may also benefit from a referral to audiology or ENT if there is an auditory disease component and not just neurological. Physical and occupational therapy may also be helpful.

Also on the non-psych tangent make sure you keep up on your kid's GI health. There is a fair bit of GI disease associated with ASD, especially constipation. As much as diet can be hard to manage trying to manage constipation only becomes more challenging the worse it becomes.

I do think parents need to have some very real conversations with their BCBA about how their behaviors are looking, and you should be able to look at their actual data. Not all BCBAs end up working well will all kids, and that doesn't necessarily mean that they aren't a good therapist.

Behaviorism in general doesn't necessarily have the greatest efficacy in the literature. There are certainly many kids that respond well to behavioral therapy, but I do think we need to remember that these kids still have feelings and higher level thought processes and we can't ignore the role those play, nor extinguish our humanity when treating kids with autism. I do think that the role of ABA is greatest in the very young kids and slowly diminishes over time, and that higher functioning adolescents and older school age kids begin to see far less benefit from it.

As kids transition from pre-operational to concrete and then formal they will benefit more and more from what we would consider to be more modern psychological therapy approaches. A good state licensed doctoral prepared psychologist is invaluable in this transition.

I also think that most kids should see a good pediatric psychiatrist. While I generally dislike the use of medications in autism for some kids there is a role either in the short term or on an ongoing basis in which medication therapy may make other therapies more effective. On the same note I don't really like treating kids for things like ADD or ADHD with medications, however for kids with more significant disease process their ADD or ADHD can detract from the effectiveness of therapy sessions. That specialized medical evaluation can really help to bring some insight and good recommendations for our kids care.

On of the most frustrating things is that the literature has shown many times the most important determinant of outcome is the number of hours we can get kids in therapy a week (especially for ABA), and yet the vast majority of insurances will not approve even close to the recommended number of hours. While it certainly isn't all the same, more hours in therapy can make a huge difference in kids outcomes.

I do think it is very important to make sure that your BCBA, Psychologist, and Psychiatrist communicate and form a good plan together regarding your kids care. They should be sharing this plan with other therapists who seek your kid (SLP, OT, PT), or any other medical providers who see your kid regularly.

If your kid is on a schedule, token board, or other things at home I would make sure to take this with you especially if you get admitted to the hospital. We may not be able to stick to it as much as would be ideal but the more consistency we can keep typically helps with behavior and maintains the improvements that you and you kid work so hard on.

I do think on of the more difficult things comes with schools. Again I would involve your BCBA, psychologist, and psychiatrist in IEP meetings as much as possible. While I think that the majority of educators want to do what is right, a background in education is not the same as a background in pediatric psychology. I have seen many times where a school decides to take an approach completely different from the rest of the care team and has derailed months and even years of therapy.

Having parents who are involved and invested are one of the most valuable resources your kid can have. As much as healthcare providers sometimes don't like 'difficult' parents, you have to be your child's advocate and don't be afraid to speak up. Clearly you are already trying to do the right thing and care a lot about your kid. I wish y'all the best.

CamMc · Aug 9, 2019

I have my master's in Applied Behavior Analysis, although I'm not currently working in ABA, it was getting to be too much and the pay was not good until you become a BCBA, I did have a client who's family were in contact with Kennedy Krieger in MD. I feel like while I was in school I remember people in my classes talking about there being a lot of resources in PA or maybe another state in the area. I went through an online program through Ball State, so a good majority of students were in the mid-west or on the east coast. I am currently working on taking my pre-reqs to go back to nursing school, but I would love to continue working with the neurodiverse peds population and would be very interested if you do find any research that is going on. I would agree with speech therapy being a great tool to add, as well as occupational therapy. I butted heads with my supervising BCBA because I was very interested in incorporating what my clients were doing in their OT sessions as part of our ABA therapy.