What Is ABA Therapy? A Clear Guide for Parents

What is ABA therapy? In short, it is a treatment that uses the science of learning to teach useful skills, like communicating, playing or getting dressed, and to reduce behaviors that get in the way of daily life^{2, 3}. It is one of the most common supports for children with autism, and most evidence-based autism treatments are built on its principles¹. Research suggests it can help, but the quality of the studies is still limited, and a good program should fit your child and your family^{1, 4, 5}.

What is ABA therapy?

ABA stands for Applied Behavior Analysis. It is a science that uses learning principles to improve people's lives³. It looks at how the environment affects behavior, assesses before it intervenes, and makes decisions based on data³.

In practice, ABA encourages behaviors that help a child and discourages behaviors that get in the way, and it tracks progress closely². A "behavior" is not just being good or bad. Asking for water with words or a gesture, waiting for a turn or washing hands are also behaviors that can be taught.

ABA is not a single technique. There are very different styles:

• Discrete trial training: the adult gives step-by-step instructions to teach a specific skill and rewards the desired response².
• Naturalistic approaches: teaching happens during play and daily routines, following the child's interests. One example is pivotal response training (PRT), which takes place in a natural setting rather than a clinic^{1, 2}.
• Naturalistic developmental behavioral interventions (NDBIs): these blend ABA with what we know about child development. They take place in natural settings, the child and adult share control of the activity, and they use natural rewards⁶. The Early Start Denver Model, for children 12 to 48 months old, is one of them; parents and therapists use play to teach².

In the United States, the Behavior Analyst Certification Board (BACB) certifies ABA practitioners at three levels: Registered Behavior Technician (RBT), Board Certified Assistant Behavior Analyst (BCaBA) and Board Certified Behavior Analyst (BCBA)³. ABA programs are usually designed and supervised by a professional certified in behavior analysis¹.

Signs of a good ABA program

Not all ABA programs are the same. These are signs a program is on the right track:

• It starts with an assessment of your child's strengths and needs^{1, 3}.
• Goals are chosen with you, and with your child when possible. The American Academy of Pediatrics (AAP) says the clinician works with the family and the child to decide which skills to target¹.
• It is individual. Treatment is adjusted to each child's age, strengths and challenges¹.
• It includes you. The AAP says comprehensive programs should include parents, and families should take part in every decision¹.
• It tracks progress with data and changes the plan when something isn't working^{1, 3}.
• It relies mostly on positive reinforcement, which means rewarding and motivating rather than punishing⁷.
• Your child seems comfortable with the therapists most of the time.

What research says about ABA therapy

The AAP notes that most evidence-based autism treatments are based on ABA principles¹. The Centers for Disease Control and Prevention (CDC) say behavioral approaches have the most evidence for treating symptoms of autism².

Still, the quality of that evidence matters. A Cochrane review looked at early intensive behavioral intervention (EIBI), a form of ABA with many hours a week for young children⁴. It found only 5 studies, and just one was a randomized trial⁴. Children improved in adaptive behavior, meaning everyday living skills, but the quality of the evidence was low. For autism symptom severity, it was very low⁴.

A larger 2023 analysis pulled together 252 studies of interventions for young children with autism⁵. It found that several types of intervention have positive effects, but in different areas. Behavioral interventions improved social-emotional skills or challenging behavior. Naturalistic interventions (NDBIs) were linked to gains in language, play, social communication and adaptive behavior⁵. The authors also warn that many studies are low quality and that possible harms were rarely monitored well⁵.

Concerns from autistic adults

Some autistic adults and neurodiversity advocates have raised serious concerns about ABA⁷. In one small study, 10 autistic adults looked back on their childhood ABA, and most described it as harmful⁸. Because the study is so small, it can't support broad conclusions, but it shares experiences worth hearing⁸.

The most common concerns are⁷:

• The use of punishment in older programs, including physical punishment.
• Rigid programs with about 40 hours a week for every child.
• Trying to stop harmless behaviors, like hand-flapping or rocking.
• Choosing goals without asking the autistic person.

Even authors who support ABA agree that some of these concerns are valid. They recommend favoring positive reinforcement, setting hours for each child, including the person or their family in choosing goals, and measuring quality of life, not just behavior⁷.

What you can do at home

1. Notice what your child loves. Favorite games, songs and objects are powerful tools. Naturalistic approaches use those interests to teach^{2, 6}.
2. Think about your goals. Write down three things that would make life easier for your child and your family, like asking for help, sleeping better or a calm trip to the grocery store. Bring them to the first meeting.
3. Prepare your questions. For example: Who designs and supervises the plan? How do you choose goals? How will I take part? What do you do if my child gets upset in a session? How do you measure progress?
4. Practice in daily routines. Ask the team to show you how to support the same skills at mealtime, bath time or play. Programs should include parents¹.
5. Listen to your child. Notice how they feel before and after sessions. Their well-being is an important signal.
6. Take care of yourself. Raising a child with special needs can be exhausting. Getting support for yourself helps your child too.

When to get help

Talk with your pediatrician or a specialist if:

• Your child isn't talking, pointing or responding to their name like other children their age.
• You are worried about their development, their play or how they relate to others.
• Your child already has an autism diagnosis and isn't getting support yet.

You don't need to wait for a definite diagnosis to start services for a developmental delay¹. If your child is younger than 3, they can get assessment and intervention through your state's early intervention program¹.

If your child is already in ABA, talk with the team and consider a second opinion if:

• You aren't allowed to watch sessions, or no one explains the plan.
• The goals don't make sense for your child or your family.
• Your child gets very upset before or during sessions, again and again.
• Months go by and the data show no progress.

To read more, see the CDC page on autism treatment.

How we help at Healthy Solutions

At Healthy Solutions for Children and Families, our ABA therapy starts with a detailed assessment and an individual plan that fits each child's skills, interests and situation. Family goals can be part of the plan, sessions can take place at home, at school or in the community, and progress is reviewed with the family regularly. If you have questions about ABA therapy or your insurance, contact us or visit our insurance and evaluations page.

Sources

1. Hyman SL, Levy SE, Myers SM; AAP Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics (2020). Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics (American Academy of Pediatrics). DOI: 10.1542/peds.2019-3447.
2. Centers for Disease Control and Prevention (2024). Treatment and Intervention for Autism Spectrum Disorder (Tratamientos e intervenciones para los trastornos del espectro autista). CDC.
3. Behavior Analyst Certification Board (2026). BACB Fact Sheet. Behavior Analyst Certification Board (BACB).
4. Reichow B, Hume K, Barton EE, Boyd BA (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD009260.pub3.
5. Sandbank M, Bottema-Beutel K, Crowley LaPoint S, Feldman JI, Barrett DJ, Caldwell N, Dunham K, Crank J, Albarran S, Woynaroski T (2023). Autism intervention meta-analysis of early childhood studies (Project AIM): updated systematic review and secondary analysis. BMJ. DOI: 10.1136/bmj-2023-076733.
6. Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, McGee GG, Kasari C, Ingersoll B, Kaiser AP, Bruinsma Y, McNerney E, Wetherby A, Halladay A (2015). Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-015-2407-8.
7. Leaf JB, Cihon JH, Leaf R, McEachin J, Liu N, Russell N, Unumb L, Shapiro S, Khosrowshahi D (2022). Concerns About ABA-Based Intervention: An Evaluation and Recommendations. Journal of Autism and Developmental Disorders. DOI: 10.1007/s10803-021-05137-y.
8. McGill O, Robinson A (2020). 'Recalling hidden harms': autistic experiences of childhood applied behavioural analysis (ABA). Advances in Autism. DOI: 10.1108/AIA-04-2020-0025.