My neighbor’s son wouldn’t make it through breakfast without a complete meltdown. Not because he’s being difficult, although sometimes he can be. But mostly because the spoon is on the wrong side of the bowl. This tiny change to what he expected for breakfast would send him into a complete downfall. His mom told me this the other day at dinner time. She said it almost casually, as if it was no big deal. But to me it was huge. It’s huge because it describes so perfectly how life is for so many kids with autism. Every day is a minefield of the unexpected. And it is very difficult for them to learn to deal with all of the normal skills of daily life such as tying one’s shoes, asking for help when needed, reading a room, and taking turns.

Why a child with autism needs more patience in daily life than most people realize and how ABA therapy can be a valuable tool in helping a child with autism learn daily living skills, like tying shoes, asking for help, reading a room and taking turns.

Before we delve into more specifics, it’s worth clarifying just what we are talking about in regards to ABA Therapy and its specific application for children with autism and its resultant benefit to their treatment.

It’s more about moments than milestones

For the child with autism, skill building can happen in the smallest of moments. Often, a child with autism will engage in play in order to practice the skills he or she needs to have in order to deal with the world. These skills can include communication, waiting, sharing attention, and coping with frustration. In the example above, the child and the therapist played with a toy train for twenty minutes. Trains don’t matter in this scenario. What matters is the play. Here is how the therapist could have used that play as a way to practice all of these different skills.

Skills that can be affected and then learned by children with Autism Spectrum Disorders (ASD) in ABA include:

• Communication: Requesting wants and needs, learning to say “I don’t understand,” building vocabulary that goes beyond labeling objects
• Daily routines: Brushing teeth in sequence, getting dressed independently, sitting through a meal without the morning falling apart over a misplaced spoon
• Play skills: Taking turns, engaging with peers in a back-and-forth way, tolerating when a game doesn’t go as planned
• Social awareness: Reading facial expressions, understanding why someone might be upset, initiating conversations without a script

These are not little things to learn for children with Autism Spectrum Disorders (ASD) and other Developmental Disabilities (DD). These are the very building blocks of life, and the support of ABA therapy can be pivotal in developing these foundational skills.

What does “routine” actually mean here?

Consistent routines are a staple of ABA programs for children with autism. The child’s nervous system is constantly working to manage the world around him or her. By establishing a consistent routine, it can help alleviate some of that stress allowing the child’s brain to focus on more important things. Of course, the routine itself is not the end goal of a child’s ABA program. Instead it serves as a framework within which the child can develop new skills. A building under construction needs a framework in order to stand. Children with autism need a consistent and predictable set of events in order to learn and grow.

So what do good ABA programs do with all of this teaching of routine? While many programs only teach children to follow through on routine after routine after routine, good ABA programs also teach children to be flexible within the routines. So, when the small disruption to routine, such as a spoon being on the wrong side of a bowl, does arise, the child who has been through a good ABA program will be able to handle the situation. He or she will have been taught within the contexts that are most relevant to the child how to practice dealing with disruptions of all kinds until he or she can handle them without becoming significantly overwhelmed. As one can see, this is a far cry from mere compliance and is actually a rather sophisticated way of teaching.

The research — honest version

I am not going to go into great detail about the “bad old days” of ABA, or most of the techniques that were utilized by many programs in the past, because some of them were truly awful and caused a great deal of harm. However, I also do not want to give the impression that everything that falls under the umbrella of ABA today is equally laudable. As with any field, there are many approaches that are not supported by current research and should be avoided. In addition, as with any field, there are programs that use techniques that are less common, but not necessarily outside the bounds of current practices or models, and are not representative of the quality of ABA programming that is available to families today. I am not referring to these programs or techniques. I am referring to outdated models and practices of therapy in general.

Here is a general overview of the research and a comparison of the good and the bad of ABA Therapy:

 

Older ABA approaches	Modern, naturalistic ABA
Highly structured, desk-based drills	Play-based and natural environment teaching
Compliance as the primary goal	Meaningful skill development and independence
Rigid correction of behaviors	Understanding function of behavior before responding
Adult-directed at all times	Child-led learning integrated throughout

The biggest distinction between the old way and the new way is the focus.

Finding support that actually fits

My frustration with most online advice about ABA is that they portray ABA as a monolithic program and give families the false impression that they have only two choices: ABA or nothing. As with any approach to working with children, there are many ways to practice ABA, and there is wide variability in the quality of programs. When looking for a program, families would do well to focus on the characteristics of the therapists and how the program fits into the family’s life. Therefore, families should look for programs that ask good questions during intake, such as: How do the therapists interact with each other, and with my child? How does the program view and support the families of children who receive services there? What are the staff members’ orientations to ABA, and how do they put ABA into practice with the children and families in their program?

When searching for an ABA provider for your child there are many things to look at and consider. A good place to start is by visiting a program, watching the therapists interact with children, and asking questions of the potential providers and the staff of the programs you are considering. If a program allows it you should watch how the therapists respond when they think no one is paying attention to them and their interactions with the children in the program. This will help to give you an idea of the type of work that the therapists in the program are willing to do to support the children in the program. You should also watch how the therapists in the program handle children who are having a very bad day. The type of work that the staff of the program does on those days will give you the best idea of the type of work that they will be doing with your child on the days when your child is having a very bad day. The program should also treat your family with respect and kindness and establish a good working relationship with your child’s other therapists. For these reasons, I highly recommend Bierman Autism Centers if you are looking for aba therapy needham ma, particularly their Needham location. All of the children in the programs at Bierman Autism Centers are treated differently and all of the families in the programs are treated differently. The programs at Bierman Autism Centers are very flexible and the staff at Bierman are willing to do a great deal to support each child in the program and each family in the program.

The part nobody talks about enough

Work in ABA can be slow and grueling. But it can also be good. And the progress is so fine that by the time you’ve noticed it, it’s been months and the child can do something they couldn’t do before. And that’s true for any learning by any person. The brain reorganizes itself to learn new things. And it’s hard. And it takes a long time. And we’re not really willing to grant that sort of time to learning to read or to learning to ride a bike. But for some reason, we’re willing to grant that sort of time to a child with autism to learn the most complex of social and emotional skills. And we want them to do it in a pretty short amount of time. I don’t get it.

(And here’s what I keep coming back to: we extend this patience readily to learning to read or ride a bike, but somehow expect social and emotional skills to follow a tidier timeline. Why? Those are infinitely more complex.)

I have been saying lately that small steps are great steps, and this morning brought home that point in a really wonderful way. My neighbor’s son is one of the kids who really struggles in the mornings when things aren’t just right. But this morning, despite things not going just right, he made it through most of the morning. Not all of it, but most. Which, if you have lived through the hard mornings with this kid, is everything.