How Much ABA Therapy Does My Child Need?
Many caregivers and clients pursuing applied behavior analysis (ABA) services worry about how much time might need to be spent in sessions, especially considering that these sessions are often scheduled in addition to time already spent in school and potentially other therapeutic settings.
It’s important to understand that, while ABA does often require a significant time commitment for both clients and caregivers alike, there’s no one perfect amount that applies to everyone. Some will benefit from more support in pursuit of reaching their goals, others will require less, and the ideal number of weekly hours will likely change over time. Recommendations are made based on factors such as the age of the client, the kinds of goals they’re interested in working toward, and how much time they realistically have to devote to ABA sessions.
Part II, Section 3 of the Practice Guidelines for Healthcare Funders and Managers provided by the Council of Autism Service Providers, starting on page 13 here, suggests models of hours recommendations based on either “focused” or “comprehensive” ABA services. Let’s take a closer look at each.
Focused ABA typically includes 10-25 hours per week, and is considered appropriate for working on a limited number of behavioral targets or key functional skills.
Key functional skills may include areas such as social communication, task follow-through, self-care, safety, and independent leisure (Virués-Ortega, 2010). Higher-intensity focused intervention may be warranted if the client’s or others’ health or safety are at risk, or if quality of life is inhibited.
Other priorities during focused intervention may include adaptive, social, or functional skills that allow for maintained health, social inclusion, and increased independence (e.g., toileting, dressing, feeding, and compliance with medical procedures).
Beyond the scope of focused ABA, comprehensive ABA requires more intensive treatment, defined as 26-40 hours per week of one-on-one support (Cohen et al., 2006; Eikeseth et al., 2002; Eldevik et al., 2009).
Comprehensive ABA may be more appropriate for clients who are struggling with multiple different developmental domains (e.g., cognitive, communicative, social, emotional, adaptive functioning). Addressing environmental factors influencing highly prevalent severe or dangerous behaviors (such as aggression, self-injury, or property destruction) is also typically the focus of intervention.
How Long Will My Child Need ABA?
It’s difficult to estimate the overall duration of an ABA program. Specific discrete goals might be met to a client’s satisfaction within a single year or less, or services might evolve over time and be maintained across many phases of a client’s life as they begin school, plan for college, begin their first job, or pursue independent living. Each individual client has their own personal needs, goals, and preferences.
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:
Ottawa County Medicaid Treatment Hours Guidelines
Treatment Recommendation Age Range Guidelines
10-20 hours 1-21 years of age – Enrolled in full-time school
– Social, communicative, restrictive/repetitive defects
– Low to no challenging behaviors
25+ 1-21 years of age – Enrolled in part-time school or does not attend school
30-35 hours Typically for 1-5 years of age – Enrolled in part-time school or does not attend school
– Significant or dangerous challenging behaviors
– Significant communication delays
35+ hours Typically for 2-5 years of age – Must have significant cognitive impairments/delays and/or demonstrate significant or dangerous challenging behaviors
– Enrolled in part-time school or does not attend school
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.
Recommended Hours at Waypoints
All of the above information is included in Waypoints’ Treatment Hours Recommendation Guidelines provided to all employed clinicians, formalized as part of our process of pursuing accreditation from the Behavioral Health Center of Excellence.
One of the accreditation standards is that “the organization provides treatment recommendations by relying on best practices such as decision models, research, and professional judgment,” and every company providing ABA services should have clear policies and procedures in alignment with that standard.
While we’re a young company that has only been in operation since early 2021, I can report that we’ve recommended an average of 20 hours per week for our clients, with a range between 18 and 25. Part of our initial assessment process includes documentation of whether clients and caregivers agree to our recommended number of hours per week, and if not, the program plan is adjusted before authorization from an insurance provider is sought.
If you’re interested in pursuing ABA services and would like to get an idea of the level of services that might be appropriate, I hope you’ll reach out to us at firstname.lastname@example.org!
Waypoints currently operates in Ottawa and Kent Counties, and one of our recent blog posts covered some great autism support
Get in Touch With Waypoints
Whether you’re looking for diagnostic testing, one-on-one in-home ABA therapy and skill-building resources, or simply want to learn more about our unique approach, please don’t hesitate to reach out! (We love getting mail.)