Applied Behavioral Therapy - Is it worthwhile, how to pay?

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Has anyone had any experience with Applied Behavioral Therapy? There is one place in the region here that does this as an Asperger's or Autism therapy. Does it have a decent success rate? Have people found it actually helpful? Is it significantly different than other behavioral therapy?

The one provider here said it isn't covered by insurance and shied away from telling me how much it would cost.

My son is on behavioural therapy for almost a year. He is not much improved. Still not communicating verbally ,still loves running in circles, flapping his arms, and do step dances.

It can be quite helpful, but I would monitor the treatment carefully if you go that route. Don't let them force him to make eye contact or stop stimming (as long as the stims don't interfere with him responding). Also, 20-30 hours a week is better than the usual recommendation of 40 hours a week, because kids getting 40 hours tend to get too overloaded to learn a lot of the time. And if you notice any changes in his behaviour you don't like, don't let them convince you it's no big deal - pull him out.

But if you take those precautions to avoid the potential problems of ABA, it can do wonders to help a kid learn to communicate and be more independent.

I don't have any personal experience with ABA as my daughter was diagnosed too old, but I have read blog posts from some autistic adults who were traumatized by ABA as children. Whether the "ABA" they had was correctly performed or not I can't say, but it would appear that there are some "ABA therapists" out there using borderline abusive tactics to get children to do what they want. So if you decide to go ahead with it, be very very careful. Find a provider you like and trust and build a relationship with them. Sit in on the sessions if possible and make sure they aren't stopping him from doing harmless stims or anything like that.

Also, remember that your child is a child. They need to be able to learn, grow, play, outside of therapy like all other children their age. I personally wouldn't make a child do any kind of therapy for longer than a few hours a day (depending on the age), regardless of what kind of developmental condition they had. I don't think children are able to concentrate for much longer than that, and I think they need to be allowed to be kids without spending the equivalent of a full-time job in therapy.

I grew up in an era before Applied Behavioral Therapy / Analysis was called such. When I was a child, all such therapies were simply variations of "reparative therapy", but they were structured the same and used the same techniques as today's ABA.

I was taught that autistic behaviors were not acceptable, and which behaviors were acceptable. I learned to look people in the eye, listen carefully and respond appropriately. I was taught to explicitly make rules for my behavior and base my words and actions on constant observation of the person I was interacting with. I have a good career, a loving spouse, healthy kids and enough trappings of modern life for my childhood to have been considered a "success".

But there is a price, you see. Most all such therapies work on the basis of repression. A person's normal, healthy (for them) reactions are forced to never exhibit in favor of ones that are deemed socially acceptable. And while this is possible it creates amazing amounts of stress as well as damage to the person's sense of Self. Essentially they are told until they believe it that their automatic coping mechanisms are "bad", but given no alternate ways to cope. Of course, once the skills are learned it can work without too much damage if the person has forewarning, sufficient decompression time afterward, and an 'escape' should they become overloaded. But that's actually quite different from ABT/ABA. To think of it as a cure is folly; like all reparative therapies the key is to teach the person they are broken and must conform, even at the cost of their sense of self worth.

A few other perspectives:
http://smallbutkindamighty.com/2015/06/ ... d-consent/
(with sublinks to: https://unstrangemind.wordpress.com/2014/10/07/aba/
https://sociallyanxiousadvocate.wordpre ... -left-aba/
http://www.speakforyourself.org/uncateg ... tic-child/
)

May I ask how old your child is? Also, what is your assessment of where s/he lies on the spectrum?

She is 17 and considered high functioning. Much of her problems have to do with executive functioning and environmental triggers and over-stimulation. She is on track to finish school in about 1.5 years. She is doing all of her school work at home on a semi self directed program. Right now she is still making up quite a bit of work due to bouts of depression and challenges with executive functioning.

Basic things like organizing herself, remembering to do things are at times incredibly challenging. But at the same time she is doing a zoology course using college textbooks and is flying right through it.

My personal opinion (and my daughter had ABA when very young and it helped), is that I have doubts that strictly applied ABA therapy in a 17.5 year old will help with executive functioning issues. There may be some components of ABA that could be lifted to target some behaviors, but I would be very hesitant to spend money on this.

For organization and prompting, I think I would look more into using technology effectively.

You may also want to read Smart but Scattered. It may prove to provide some insights into her exact executive functioning issues. I see there is a version for teens. Note to self: get this and review it with my son.

It's tough. I have EF issues that clearly prevent me from reaching my full potential. But that doesn't mean I haven't learned to compensate enough to have a successful, full life (mom, professional, etc). Part of the trick is to not focus on what you have the potential to do, and to focus on what you can reasonably do and do that well. That helps with depression. When I was younger, I suffered through a lot of less-than-healthy emotional states because I was so...frustrated, angry, depressed, embarrassed, etc...by recognizing the gap between what I knew I was my "potential" and what I was actually able to do.

The bottom line is that with any compensatory strategy that an atypically wired person employs, there is a cost. Let me try to explain. When I compensate effectively for my EF issues, it makes certain things much easier. So it seems great. But the truth is, it does not come naturally to me, so maintaining it requires constant effort. That constant effort is taxing, so although the implementation of the compensatory strategy makes some thing easier, it drains me in other ways. That's why I say to focus on what you can reasonably do and do that well. Find the balance between the cost of compensating and the benefits. When I am functioning at my "best," it isn't the most that I am capable of. It is the place at where the benefits of compensating and the costs are in balance. The effort that I put in to compensatory strategies (and the associated drain) is cancelled out by the benefits that I am getting.

It may be that the trick for your daughter is to learn ways to compensate for her EF issues (ideas found in referenced book), and then to find the balance between how much they tax her and how much they help. For me, a system of routines, organization tools, and downtime seems to work. Well enough for me to have a mid-level management job, a healthy relationship with my kids, a decent home environment, and a sense of sanity.

I do know that I have the capacity to have finished a doctoral program and probably done some pretty interesting/great things. I still have faint echos of past mentors who told me I was brilliant and gifted and going to do amazing things (in my field). But had I gone that route, I would not have my kids nor my sense of sanity. The compensating that it would have required would have burned me out into a highly educated, and perhaps published or maybe even "known," shell of a person. To attain that degree of intellectual/professional success would have cost me everything else.

I am happy with my choice.

If she's 17 and high functioning (& obviously intelligent) rather than ABA/ABT she would likely do much better learning workarounds for everyday problems. The difference is that they are conscious efforts on her part that she *chooses* to utilize when she needs them to get through a situation, with the knowledge that she's going to need to compensate afterwards with whatever unwinding she learns works best for her. For many that even holds true for seemingly simple executive function deficiencies, not just overstimulating social interactions.

As a side note, many who do this notice that setting up a "small goal" ahead of time works well. Something like, "I need to get laundry done, so at 11:00 am I will stop what I'm doing and do two loads" actually engages things like OCD and rigidity of expectations and uses them to advantage. That (in a nod to ABA/ABT) rewards the person for getting the task done, but it does so in a way that works with their limitations rather than try to beat/ignore them into submission.

Oh, in that case, ABA will do absolutely nothing for her. Everything they teach in ABA programs is probably below the level of a typical 8 year old. The only 17 year olds who would get any benefit from ABA are low functioning.