How Much ABA Therapy Does My Child Need?

Other Guidelines for Hours Recommendations

While the general categorization of ABA services into focused or comprehensive plans is helpful, assessing medical necessity based on health insurance providers’ requirements and recommending a specific number of weekly hours of ABA therapy can be tricky.  

According to the Behavior Analyst Certification Board, hours recommendations should be based on what is medically necessary for each individual client. The problem is that there is no universal formula to determine what is “necessary,” since every client, environment, and situation is unique. Strengths, preferences, needs, and environmental circumstances of each individual client and their caregivers all factor into the decision.  

Decision-making should not be based on the duration of previous ABA services, nor solely based on the client’s age (Ivy & Schreck, 2016). At the same time, hours should not be restricted solely based on age, cognitive level, or co-occurring conditions (Wong et al., 2015).  

Agencies like insurance companies, which approve coverage of costs associated with ABA services, often have somewhat more specific guidelines. In Ottawa County, Michigan—where Waypoints primarily operates—those guidelines are as follows: 

As noted above, one common concern when determining an appropriate amount of time spent in ABA therapy sessions per week is the intensity of even a “focused” program (as opposed to “comprehensive”). Even 20 hours per week is a part-time job! 

As such, it’s very important to balance ABA services with everything else that is going on in a client’s life. Children typically spend 30 to 35 hours per week in school, so a comparable level of ABA services could be appropriate if the client is not in school full time. Alternately, if a client is attending school full time, an ABA service provider could accompany the child at school to provide additional support.  

As Kristen Bottema-Beutel and Georgia Pavlopoulou note in their recent critique of certain practices within the field of ABA, “primary studies and quality-controlled meta-analyses … have not found a relationship between intervention intensity and child outcomes (Choi et al., 2021; Rogers et al., 2021; Sandbank et al., 2021).” In other words, a high number of hours per week does not inherently mean that a client’s treatment goals will be met more efficiently, and a lower number of recommended hours does not necessarily prevent achievement of clients’ goals.  

That being said, there is a point at which too little time spent working on a behavior-analytic program will render it ineffective, simply because of limited learning opportunities and a lack of consistency. The efficacy of each program and the ideal amount of time spent working on it must be individually assessed and monitored by the supervising behavior analyst, and discussed in an ongoing manner with the client and their caregivers.