Question: How Much ABA (Applied Behavioral Analysis) is Enough?
The literature recommends 40 hours a week of Applied Behavioral Analysis (ABA). But so much therapy is very expensive and hard to find. Is it really necessary for a child to have 40 hours of ABA each week to be successful?
Answer: Short Answer from the Lovaas Institute:
Typically, yes. The best outcomes have been attained when a child receives 40 hours per week of behavioral treatment. Intervention should always be individualized, and some factors, such as a child’s age and current skill level, will influence the number of hours recommended. But, 40 hours per week remains the standard from which to deviate.
Long Answer from the Lovaas Institute:
In 1987, Dr. Lovaas published a peer-reviewed article in Journal of Consulting and Clinical Psychology demonstrating remarkable progress for children with autism using behavioral treatment. Close to half (9 out of 19) attained a normal IQ and tested within the normal range on adaptive and social skills. Follow-ups have shown that these children can now succeed in life without costly special education and residential services. The children received an average of 40 hours of behavioral treatment each week for two years, with an additional year devoted to decreasing the hours of behavioral treatment while increasing the number of hours in school.
Between 1987 and 2005, a number of attempts were made by independent practitioners to replicate these results. While some children in the other studies made gains, none of the studies included treatment approaching 40 hours per week, and none of them were as successful as in 1987. While there may be a variety of reasons the other studies were not as successful, the hypothesis that the number of hours of treatment will affect treatment outcome makes sense. Imagine rephrasing the question as follows, “Is it really necessary for a child to attend first grade all year to be successful and pass on to second grade or can she just attend school for half the year?” Studies between 1987 and 2005 that only provided 20-25 hours of treatment to children with autism in effect reduced their schooling by half. Is it any wonder the treatment was not as successful?
The purpose of 40 hours of therapy is to provide a child with structured intervention throughout the day. During structured intervention, the environment is systematically manipulated to help a child remain successful while also teaching new skills quickly. In addition, parents are empowered to continue intervention throughout the child’s waking hours. Typically developing children learn from the natural environment all of their waking hours. The purpose of an intensive program is to allow a child with autism to learn how to learn in the natural environment and ultimately catch up to his or her typically developing peers.
Attention is often devoted to those children who reach the best outcome. While this is understandable and remains the goal of intervention, there are other children who make great gains. While they may not reach all criteria for best outcome, their quality of life is greatly improved from what they learn. In this sense, many children have been successful making gains to improve their quality of life in behavioral treatment programs with less intensity than 40 hours per week. However, there are still some general guidelines. A 1999 report from the New York State health department recommended a minimum of 20 hours per week of individualized behavioral interventions using ABA techniques, based on strong evidence in the research. And, the 1987 Lovaas study found that children receiving 10 hours of therapy per week fared no better than those who did not receive treatment at all.
References:
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372.
Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), 417-438.
New York State Health Department Recommendations
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