The Unique Benefits of In-Home ABA

Have you ever wondered about in-home ABA?

Keep reading to learn why we love this option for kids with autism.

A few years ago our Regional Clinical Director, Valerie Jaramillo, BCBA, was working with one of our kiddos. He was a young child who struggled with communication.  His parents were deeply concerned about his ability in the future to advocate for his own needs. They worried how he would answer questions, make friends, and have relationships. How would he tell people what he needed? How would his behaviors reflect the frustration that came from his delay in communication? It wasn’t that he didn’t understand what he wanted. Instead, it was an issue of how to communicate in the way the adults and peers around him understood. 
The family had tried an ABA program once before for a short time but hadn’t yet found the right fit. Valerie created a team for him in his home and started the process of creating programs. The long-term goal was to teach him how to communicate in a much more effective way. His ABA program was designed specifically to meet his needs. First, his therapists worked to use visual prompts to teach him responses to simple questions and greetings. When his communication skills started to grow, so did his treatment programs. His team included the community in his programming to allow for natural environment training, NET for short. Sessions started to fade out of the home and move into the community. They would walk to the corner store and practice making purchasing decisions. Then they practiced how to pay for it. The child and his team also enjoyed daily trips to local parks to meet with family friends and other peers. Step by step, therapists facilitated as this young child practiced his new skills. He learned to make friends and play with others. He worked hard, extremely hard, and his therapists supported him the entire way.
Each child is different and what they work on varies. Valerie explains that there are certain moments that emphasize just how beneficial in-home ABA programs are. It is one thing to practice a skill in a therapy room. It’s entirely different to join in the activities right there when the skill is needed. For example, when a child is approached at the park by a new peer, his therapists can help him practice his communication skills. Sometimes, they can even support the development of a new friendship. At Key Autism Services, our teams have witnessed hundreds of inspirational moments like this as our kiddos grow up in front of our eyes.
After experiencing stories that showed us how incredible in-home ABA is, we put together a list of benefits. There are many different services for kids with have autism. Each child is different so the variety of programs is exactly what we need. The benefits below are some of the reasons we love in-home ABA.

The unique benefits of in-home ABA: 


A familiar environment

It isn’t uncommon for our kids to go through a period of resistance when they start a new program. Conducting therapy in a familiar environment reduces the time it takes to adjust. Home-based ABA eliminates the need for the child to spend time adapting to a new an unfamiliar environment. New environments are often scary or take added time to get used to.

Eliminate a transition

Transitions can be a challenge for many of the children we work with. In fact, transitions themselves are often a goal we are working on during ABA Programs. Home-based ABA eliminates any need for getting ready to leave the home, transportation, or entering a new facility. This means we can spend the entire time practicing skills instead of overcoming resistance to attend each session

Home-Based ABA Saves time

Home-based ABA saves time for the entire family! Parents aren’t tasked with the extra errand of drop off and pick up from yet another appointment. Instead, they have ongoing support throughout the day incorporated into their typical routing. We save valuable time to spend productively with the therapy team versus in the car.

A Comfortable Environment for the Child

When ABA is done in the home, the child has a chance build rapport with new team members in a comfortable and safe space. They can focus just on a new team member and not have to factor in outside variables. It can be both distracting and scary to adapt to new children and unfamiliar spaces. With a therapeutic team in the home, the first step is meeting the therapists and building a strong relationship with them. Then, they can begin working to bring their new skills into other environments, on step at a time.

Reinforcers – Using each child’s favorite toy and activity. 

Reinforcers are a key part of behavior analysis. But the best reinforcers are the ones that motivate the child by using what they already love to do. These toys and activities are usually already in the home. Therapy teams can use the access to these reinforcers to spark motivation.

Naturalistic teaching

Conducting therapy in the child’s natural environment will allow for practice of skills directly related to family concerns.
For example, many of the kiddos in Key Autism Service’s home-based ABA programs are working on interactions with siblings. Therapy teams can work on this directly in their natural setting. They create programs that are structured around real interactions. Together, they can practice and improve communication with siblings. It doesn’t end with siblings, ABA can address any relationship or daily response.
Another common example is setting boundaries around electronics. At home, it isn’t unusual for a child to prefer to spend time on their iPad, video game, or other electronics. The behavior stops them from engaging with family or doing their homework. ABA teams wan work with the child to set limits with these items. ABA therapists motivate kids and teens to mange their time.


Conducting therapy in the child’s natural environment will help to teach skills where the child needs them every day. When teaching how to brush teeth in a bathroom it may surprise you how important the bathroom setup itself can be. Imagine learning to find the toothpaste in drawers to your right then going home to find that they’re always in cabinets above you! Children may also need to learn how to use their specific appliances. Teaching these skills at home in the space and with the items that they will actually use can speed this up.

Parental involvement

Conducting therapy in the home promotes parental and family involvement. Parents are encouraged to sit in or observe sessions when possible. Many family members want to learn the goals and programs their child is working on. They can then incorporate what is learned to better assist with their child’s programming when the therapy team is not there

Sibling involvement

ABA therapy allows the incorporation of siblings into the therapy session. Time can be used to educate siblings, work on social skills, build a positive sibling relationship etc.

Involvement of other family members

Home-based ABA therapy can incorporate other relatives or caregivers present in the home. Can train nannies, grandparents, etc so that the whole team is on the same page with a consistent treatment plan.

With popular autism therapy, some skills take time to learn


The longer a child receives a popular autism treatment, the greater her gains in language, daily living, and other skills. The number of hours spent on the therapy each week is also important to its success.

That’s the upshot of an unusually large study of the therapy, applied behavioral analysis (ABA)1.

ABA therapy breaks skills and behaviors into discrete steps, rewarding success at each step. But it is expensive and may require up to 40 hours per week. The new work is the first to tease apart the effects of the duration of ABA and its intensity; both aspects together compose the therapy’s ‘dose.’

The findings could help clinicians maximize the therapy’s effectiveness and limit its costs.

“It’s really difficult to nail down how much is exactly enough: What is the actual dose that a kid needs in treatment, and what are the trade-offs?” says study leader Dennis Dixon, director of analytics at the Center for Autism and Related Disorders (CARD) in Woodland Hills, California.

The study also shows that certain types of skills routinely take children longer to master than other skills. For example, reliably remembering to turn in homework requires sustained practice over time, whereas language skills may develop more quickly with intense drilling.

“That’s a much more fine-grained or nuanced look at this than other people have done,” says Tristram Smith, professor of pediatrics at the University of Rochester in New York, who was not involved in the work.

More imore:

The researchers analyzed data from 1,468 children in eight U.S. states who were receiving ABA treatment that followed the CARD model. The children were between the ages of 18 months and 12 years, received at least 20 hours of ABA therapy each month and had been receiving the treatment for at least one month.

The team tracked the number of skills the children mastered in each of eight skill domains over 36 months. The domains range from academic skills, such as matching objects by color, to social skills, such as responding appropriately to greetings.

For every domain, the children who spend either more hours per week or more months in therapy learn more skills than those who do less in either dimension, the researchers found. Duration has a bigger effect than intensity. For example, children master 0.78 of a motor skill, on average, per additional hour of treatment per week. But they learn 2.01 motor skills per additional month of treatment. The precise relationships vary from one domain to the next.

Because the two components of dose are measured on different time scales, however, it is difficult to directly compare them, Dixon says. In short, both components matter.

Still, the importance of duration came as a surprise, he says. Most studies have focused on the role of the therapy’s intensity. And most, but not all, have found that more hours per week translates to greater benefit. The new work appeared 19 September in Translational Psychiatry.

Domain differences:

The researchers also assessed the relative importance of intensity and duration for learning different skill sets.

When working on adaptive skills, such as brushing teeth and getting dressed, or on executive function skills — attention, memory, and self-control — most children tend to make slow, steady progress. More hours per week leads to greater gains, but the effect is small relative to that of extending treatment length.

By contrast, dialing up either intensity or duration both greatly improve children’s mastery of language skills.

The results are difficult to compare with those of other studies, however, because they are based on data from CARD rather than on standardized measures, says Zachary Warren, director of the Treatment and Research Institute for Autism Spectrum Disorders at Vanderbilt University in Nashville, Tennessee. Warren was not involved in the work.

If the results hold up, they could help clinicians plan the parameters of the therapy to offer a child, Dixon says. For example, clinicians might choose to work on executive function in a child for only a few hours a week and continue to practice it for many months. And they might re-evaluate the treatment if the child’s language skills don’t progress rapidly despite spending many hours each week on them.

One of the study’s investigators, whose 8-year-old receives ABA therapy, found the results personally reassuring.

“I took comfort in the fact that empirically we can see that both intensity and duration are creating value,” says Erik Linstead, assistant professor of mathematics and computer science at Chapman University in Orange, California. “My child is spending hours and hours a week in therapy. This made me feel like, okay, I’m glad that we’re doing this.”


Autism Symptoms Rarely Isolated, CDC Researchers Say


Nearly all children with autism are dealing with at least one other condition — and often several — ranging from anxiety to attention deficit hyperactivity disorder, sleep, behavioral and gastrointestinal issues, a new study suggests.

In an analysis of records on almost 1,900 kids on the spectrum, researchers found that over 95 percent presented with at least one issue in addition to autism.

The findings come from a study published online this month in the Journal of Autism and Developmental Disorders led by researchers at the U.S. Centers for Disease Control and Prevention.

The study relied on data collected from five communities across the country on 4-year-olds and 8-year-olds through the 2010 Autism and Developmental Disabilities Monitoring Network. The surveillance program — which is used to establish the government’s rate of estimated autism prevalence — relies on health and educational records.

Researchers looked for evidence of the 18 most common co-occurring conditions or symptoms in the children with autism, including cognitive issues, regression, behavior problems, congenital or genetic conditions and language disorders.

On average, they found that each child had 4.9 of these secondary conditions, with a higher prevalence among 8-year-olds compared to 4-year-olds.

Moreover, the study found that kids with autism who had co-occurring conditions were more likely to be diagnosed with the developmental disorder at younger ages.

“While the reasons behind this high prevalence are still unclear, their presence contributes to the ASD phenotype heterogeneity, which is a potential barrier to a timely diagnosis of ASD and a challenge for studying ASD etiology because of difficulties in defining a single early ASD behavioral marker,” the study authors concluded.

The researchers said their findings support the need for a “comprehensive system of care” for those with autism and greater consideration of co-occurring conditions in order to enhance early detection of the developmental disorder.


Autism Insurance Mandates Trigger Influx Of Service Providers


COLUMBUS, Ohio — An Indianapolis company is bringing two autism therapy centers to central Ohio as part of a plan to ultimately open 20 sites and provide about 1,000 jobs across the state.

The Hopebridge centers, slated to open in late April in Dublin and Westerville, are among 10 the company plans to have to operate within a year, said chief executive Dennis May.

Four have already opened: three in the Cincinnati area and one outside Dayton. Other centers are planned for Akron, Cleveland, and Toledo. They join a network of 17 Hopebridge clinics across Indiana and Kentucky.

The expansion comes after an Ohio law went into effect last April requiring individual and group insurance plans to cover kids 14 and younger for autism-spectrum screening, diagnosis, and treatment. Advocates say a key element of the law is its inclusion of applied behavior analysis, or ABA, which uses techniques based on human-behavior principles, such as prompting a child to imitate and repeat the desired behavior several times, offering rewards each time it is performed correctly.

Similar law changes have happened in 45 other states, leading to spikes in service providers, particularly those offering ABA, which has proven effective but has long been denied by insurance companies, said Lorri Unumb, vice president of state government affairs for Autism Speaks.

“It’s such a wonderful thing,” Unumb said. “This not only expands access or creates access for children with autism and will change the trajectory of their lives forever, but it also spawns new business.”

Hopebridge, which offers ABA, factored the law change into its decision to expand into Ohio, May said. Access to care also was a consideration.

“There’s really a shortage of the number of providers for the number of children, the size of the state and the need in the state,” May said. “We’re excited to support those families that have needs.”

Marla Root of the Ohio Autism Insurance Coalition said the group works to introduce providers to Ohio.

“We definitely have already seen some providers from other states looking to come into Ohio, absolutely, and we’re hoping that’s the case,” she said. “We have a lot of need and, especially, we have a lot of underserved areas.”

Some providers, however, continue to hang back as Ohio works to include ABA as a Medicaid benefit, Root said.

The change in law also has led to an increase in demand, exacerbating the need for more providers, said Melissa Bacon of the Ohio Center for Autism and Low Incidence. There have been new providers, she said, but it takes time to obtain needed certifications and approvals.

“It’s not like you can just turn a switch on and have that happen,” said Bacon, who directs policy, strategic initiatives and stakeholder engagement.

The federal Centers for Disease Control and Prevention reports that 1 in 68 children has been identified as having autism spectrum disorder, a developmental disability that can cause social, communication and behavioral challenges.

May said the Hopebridge clinic-based model is different from other providers that offer in-home treatment because it gives kids the space needed for therapy as well as social interaction with other children. The centers also offer comprehensive, collaborative care, with one-stop access to speech, occupational and physical therapies as well as ABA, he said.

Speech, occupational and physical therapies were generally covered before law changes, Unumb said, but it is significant that ABA has been added.

She said Ohio is a bit different from other states because, since 2013, ABA coverage was required for individual and small-group plans provided under the federal Affordable Care Act, also known as Obamacare.

A child with severe impairment could require 20 to 40 hours of ABA therapy each week, services that could cost as much as $70,000 a year, Unumb said. The new laws open the therapy up to children from non-wealthy families.

“It’s absolutely life-changing,” she said. “We see all over the country children who had no access to ABA therapy before making remarkable gains.”

© 2018 The Columbus Dispatch
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