Below we've provide you with a list of questions and answers about our state-of-the-art Autism Program. We’ve also included questions suggested by Catherine Maurice, a parent of an autistic child and an advocate for effective services.
What kinds of services and interventions do you provide?
We provide services to improve the child’s’ speech, language, communication, social, self-care, and academic skills; and to reduce problem behavior. Our interventions are based on applied behavior analysis (ABA), which has been scientifically-proven and is the treatment of choice in treating individuals with autism. These services are also known as Early Intensive Behavioral Intervention (EIBI).
Where do you provide services?
We have therapy centers in Ft. Lauderdale and Miami, Florida. We also can provide services at the child’s home or school – anywhere in the world.
What is your philosophy on working with children with autism/PDD?
We believe every child can learn, no matter how severely impaired, when appropriate teaching methods are used. We also strongly believe that children should want to learn, so we emphasize positive reinforcement procedures. Both of these have been supported by a great deal of clinical research.
What type of language and communication procedures do you use?
We use procedures that have been scientifically-proven to be effective in teaching speech, language and communication skills to children with autism. Presently, we use a combination of Discrete Trials and Verbal Behavior therapy procedures. This is the most effective treatment known for improving speech, language, communication and behavior.
What is your success rate?
Our most recent program evaluation indicates that the average child in our program masters more than 110 new skills each month! This is an incredibly high number of mastered skills and we are confident it would rank among the best in the world, if such data were available from others.
How many hours per week do your services require and how much of this is one-to-one time?
We offer different programs designed to fit each child’s individual needs. Our 30-hour per week Early Intensive Behavioral Intervention program is for young children, 6 and under, who do not speak or who have very limited verbal repertoires. We also offer 20-hour and 10-hour per week versions of this program for children who do not require this level of intensity. All of this therapy is one-to-one. We also offer, at some locations, therapy in small groups of two students with one instructor and a school readiness program that mimics a typical (pre)school classroom schedule, staffing, and activities.
Why do you suggest so many hours of therapy?
Clinical research shows that many children with autism completely “recover” (function normally) with intensive behavioral therapy of 30-40 hours per week. Research, and our experience, shows clearly that this amount of therapy is necessary if the child is to make adequate progress.
Will you provide fewer than 10 hours per week?
Only for very young children for whom 2 consecutive hours of therapy would be clinically contraindicated. Even then, the duration of therapy would be systematically increased to at least two hours per day. Research and our own experience indicate that children do not make adequate progress when receiving less than 10 hours of therapy per week. We do not feel justified in providing therapy that has little chance of success.
Will you supervise my program if I hire my own therapist?
Yes, provided the person goes through our own therapist training program developed especially for this purpose. The skills learned in this training are absolutely essential for anyone who will be teaching children with autism. Without these critical teaching skills, the child does not progress or does not progress quickly, defeating the whole purpose of therapy. Our data also indicate that the overall rate of learning is considerably slower when using therapists that are not employed by Behavior Analysis, Inc.
Can you guarantee that my child will learn to talk or become indistinguishable from his or her peers?
No. Despite some agencies making these unethical and unsubstantiated claims, it is simply not currently possible to make such assurances. Although the large majority of children in our program have learned to talk, we will not mislead families by providing impossible guarantees.
What training and experience does the program supervisor have?
The program supervisor is the most critical factor in determining whether or not a program succeeds or fails. Our program supervisors are Board Certified Behavior Analysts with advanced training specifically in teaching children with autism and related disorders. Unlike many other agencies, the program supervisor is a true expert in applied behavior analysis. Individuals without this expertise simply do not have the formal education and training necessary to develop and maintain highly effective programs. This is supported by the Behavior Analysis Certification Board, the credentialing agency for Behavior Analysts.
What training and experience do your therapists have?
Our Therapists undergo extensive training in applying behavior analysis procedures to children with autism. This training is competency-based, meaning that they must actually demonstrate that they can properly carry out each teaching skill. They do not work with alone with children until they have shown they can apply all the teaching skills in real teaching situations, under supervision. All of our therapists undergo this competency-based training, even those who come to us with years of teaching experience.
What kinds of ongoing training does your staff receive?
Our program supervisors receive formal monitoring, feedback and training at least monthly. They also attend local, state, and national workshops and conferences related to applied behavior analysis, autism, and effective teaching. Our Therapists receive informal and formal monitoring, feedback, and training on a weekly basis.
Do you provide parent training?
Yes. Parent training is a vital aspect of our program and we encourage all parents to take advantage of these opportunities.
What type of involvement is expected from parents?
We encourage parents to take an active role in their son’s or daughter’s treatment. They may observe treatment sessions, ask questions and discuss progress daily with the Therapist, attend meetings and trainings. Of course, these are optional activities; however, we have found that children whose parents play and active role perform better in the long run.
Are parents welcome to participate in, or observe, treatment sessions?
Yes. As part of our parent training, we encourage parents to participate in actual teaching sessions, so they learn the same teaching skills our therapist use. We also have television cameras in each treatment room so that parents may observe their child’s therapy from another room without distracting the child (not available in all locations).
How is the child’s progress evaluated?
We clearly and objectively define every single skill that is being taught to the child and the criterion for mastery of each skill. This way, everyone knows exactly what skills are being taught and what is expected. Each day, progress data are collected on each of these skills. These data are reviewed at least weekly by the program supervisor. He or she then determines the appropriate course of action for each skill being taught.
How are parents informed of the child’s progress?
The Therapist discusses the child’s progress with the parents at the end of each daily session. Progress is also reviewed with the parents during periodic meetings. The parents may also review their child’s progress data, which are updated daily, at any time between meetings.
Do you work with other professionals?
Yes. We are happy to collaborate with other professionals.
What are your fees?
Our fees vary according to the child’s needs and the location of services. Please call us to discuss your child’s needs and our current fee schedule. We provide the highest possible quality at the most reasonable cost.
Do you accept insurance or other third party payments such as Medicaid, or Medicare?
Typically, these groups do not pay for behavior analysis services. Therefore, our services are usually paid for privately. However, some families have been successful in obtaining insurance payment for our services. These families pays us directly for our services and then attempt to receive reimbursement from the insurance company themselves.
What type of assessment do you conduct?
Our assessment is designed to clearly and objectively identify the child’s strengths and weaknesses. This allows us to determine exactly what skills need to be taught and in what sequence. It will not provide another diagnosis or an age-equivalent score. We have found that these types of evaluations do not provide information sufficient to make accurate treatment decisions. Different children with the same diagnosis or the same age-equivalent scores can differ widely on the specific skills they need to learn. The assessment involves working directly with the child and asking parents to complete a written questionnaire regarding the child’s skill level in various functional areas. Presently, we utilize the Assessment of Basic Language and Learning Skills-Revised.
How is the treatment program developed?
The treatment program is developed by a Board Certified Behavior Analyst (BCBA) and is based on the comprehensive assessment described above. We develop a program that is individualized to meet the specific needs of the child; we do not fit the child into a pre-existing program. The treatment plan will usually contain 5 – 10, or more, goals. A data collection system and specific learning materials are also prepared at this time.
What happens next?
Once the child begins therapy, he or she is seen according to the schedule agreed to by the parent and program supervisor (behavior analyst). Because children in our program make dramatic progress, the supervisors monitors progress and program implementation frequently to ensure that the child continues to progress as desired. This usually results in changes being made to the treatment plan weekly.
Do you accept children with difficult behaviors?
Yes. We have extensive training and experience treating children with problem behaviors. Our results are impressive, often completely eliminating the problem behavior. This might require additional fees due to the need for additional behavioral assessment, treatment plan development, staff and parent training, and program monitoring and adjustments.
What techniques do you use to manage difficult behaviors?
Our primary method of managing difficult behaviors is to teach the child, using positive reinforcement, desired behaviors to replace the unwanted behavior. We may also use extinction – withholding the reinforcer that is maintaining the problem behavior in conjunction with positive reinforcement for appropriate behavior. In all cases, we emphasize positive reinforcement-based procedures.
Do you ever use physical punishment or any physically intrusive procedures?
No. We have found that we can deal effectively with problem behavior by reinforcing desired behavior and ensuring that undesired behavior does not get reinforced.
Will therapy be too demanding for children who already have busy schedules?
Typically, children prefer our ABA sessions to most other routine activities. We make learning fun and the children want to attend. Children often run into our therapy rooms and some even ask their parents to take them to therapy. These are good signs that the child is not “burned out” by too much therapy.
Am I required to make a long-term commitment?
No. However, we suggest giving the program 90 days to properly evaluate how well the child will progress. The large majority of children begin making progress within the first few days. However, some children need longer to get adjusted and for our staff to learn the most effective ways of teaching that particular child.
How long can I expect therapy to last?
There is simply no way to predict how long therapy will last for a given child. Even with our highly trained staff and special teaching methods, the children in our program progress at different rates, although every single child makes progress. There are many, many factors affecting therapy outcome (e.g., age, number of hours of therapy, parental involvement). Many of our students successfully leave our program in 1 – 2 years.
What is ABA?
ABA stands for Applied Behavior Analysis. ABA is an approach to understanding and improving behavior based on its environmental causes, rather than some inferred mental states. The science of ABA has shown repeatedly that behavior can be changed by identifying and changing the individual’s environment. This has been demonstrated in thousands of research studies to the point where this is simply beyond dispute. ABA is the treatment of choice for improving behavioral and learning problems in children, adolescents and adults.
What evidence is there for the effectiveness of the behavioral approach?
There is a great deal of clinical evidence for the effectiveness of Applied Behavior Analysis in treating individuals with autism and related disorders. This proof may be found in the form of peer-reviewed scientific investigations published in dozens of scientific journals. No other form of therapy has such a scientific research base.
I understand you use the Verbal Behavior approach. What is this?
Verbal Behavior (VB) therapy is based on the principles and procedures of Applied Behavior Analysis. One of the underlying assumptions (which has been proven clinically) is that a person’s verbal repertoire consists of several different classes of behavior. Furthermore, each of these classes is separate and distinct from the other classes, and occurs for different reasons. In typically developing children, the different classes are learned very quickly and without formal intervention. However, in children with speech delays, these difference classes become more apparent and each must be specifically taught, using special methods. For instance, there are several different “meanings” of the word “milk.” A child may say milk when she wants milk to drink. She may also say “milk” when her father holds up a glass of milk and says, “what’s this?” The child may also say “milk” when she’s asked, “What do you drink for breakfast?” In each case, the word “milk” is the same, however, it is said for different reasons. In order for the child to have meaningful language, she must be taught to say “milk” under each separate condition. In this way, the child not only learns to say “milk” when shown a picture or glass of milk, but also says “milk” when she wants milk or when she is asked what she had for breakfast. If each of these classes is not specifically taught, the child’s verbal repertoire may be very limited (e.g., only naming pictures but never asking for things). Other approaches teach children to name items and expect the child to “use” these words when ready. It is seen as the child’s “fault” if he or she never uses the words. By specifically teaching the child each of the different classes (and there are more than described above), the child’s verbal repertoire will become more complete and fluent. There is more to the VB approach but it is beyond the scope of this answer.
What is the difference between ABA, Lovaas Therapy, Discrete Trials Training, Verbal Behavior Therapy, and Early Intensive Behavioral Intervention?
All of the therapies mentioned above utilize the basic principles and procedures of ABA. However, there are be subtle, but important, difference between some of these approaches. Ask your behavior analyst for more information about these differences.
Are other approaches successful?
Some other approaches may have some limited success for some children with autism. However, Applied Behavior Analysis has the greatest amount of scientific evidence for it’s effectiveness with many children and is clearly the treatment of choice for teaching and treating children with autism and related disorders. If your resources are limited, put your efforts into finding an expert behavior analyst to design and oversee a treatment program. This will give you the greatest likelihood of success.
What is the role of sensory integration in your treatment program?
None. We believe that children with autism (and all others) should only be exposed to treatments that have been scientifically proven to be useful. To date, there is no scientific evidence that sensory integration provides meaningful changes in speech, language, communication, behavior or learning. Therefore, we do not provide nor recommend sensory integration therapy. Instead, we provide treatment that has been scientifically proven, again and again, to improve all the areas mentioned above.
Will your program work with children who are not diagnosed as being on the autism spectrum but may have speech delay?
Absolutely. Our specialized treatment is effective with children with and without formal diagnoses. We have successfully served many children with mild to severe speech delays but who have not been formally diagnosed as being on the autism spectrum. They progress quickly.
How do I determine if someone is qualified to oversee my child’s program?
There is clear evidence the principles and procedures of Applied Behavior Analysis are the treatment of choice in treating a child with autism. Therefore, the person designing and supervising the program must be a competent Behavior Analyst. However, just having some behavioral training is not sufficient. The Autism Special Interest Group of the Association for Behavior Analysis has established the following minimum standards for the person designing and overseeing a behavioral treatment program. This person must:
Remember, these are only the minimum standards. Difficult-to-teach children may require additional training and experience.
Are people allowed to supervise home programs without being certified?
At present, there are no laws restricting who may or may not supervise behavioral programs. As a result, there are a great many unqualified people supervising treatment programs. The consequences of this are often disastrous for the child and his or her family. Children may be in therapy and not progressing, wasting the child’s precious time and the parents resources; children developing behavior problems due to ill-conceived treatments and therapies; and, actual harm from aversive procedures. Unfortunately, some children will probably have to be seriously harmed by unqualified practitioners before something is done about allowing them to practice.
How can I find out if the person supervising my program is certified in behavior analysis?
The Behavior Analysis Certification Board maintains a registry of all persons it has certified at www.bacb.com. If the person’s name is not on their list, they are not certified and are not qualified to supervise your program. If they claim to be certified, you should ask them for a copy of their behavior analysis certification an then contact the certification board to inquire why there name is not in the registry. Do not accept certification in other areas as a substitute for behavior analysis certification.
The mother of an autistic child has offered to set up and supervise a program for my child. Is she qualified to do this?
Not unless she is also a Board Certified Behavior Analyst with formal training and experience under the direction of an expert behavior analyst in designed treatment programs for children with autism. Many people claim to have expertise because their child attended an ABA program or they attended a few ABA workshops. She is no more qualified to supervise a behavioral program than she is to remove your child’s appendix because her own child has his appendix removed and she watched a couple of appendectomies on the Discovery Channel. Find an expert behavior analyst to set up and supervise your program.
I’ve been searching for an experienced Therapist to run my home program. How much experience should he or she have?
Of course, the person delivering the therapy is a critical component of a treatment program. However, even more important is the expertise of the person supervising the home program. A therapist may have years of experience teaching children with autism, but unless they have all the other qualifications of a program supervisor (Board Certified Behavior Analyst, at least one year’s experience supervising programs under the direction of an expert behavior analyst, training and experience in specific competency areas), she or he is not qualified to run the program without an expert behavior analyst as the program supervisor. First find yourself an expert behavior analyst to supervise your program. He or she can then train one or more therapists, who may or may not have experience. Experience alone is not as important as good training and good ongoing supervision.
My child had ABA services when he was younger and he frequently cried and ran away from the therapist. Doesn’t this indicate he won’t benefit now from this approach?
No. Your program was inappropriately designed and/or poorly implemented. A well designed and implemented behavioral program typically creates teaching/learning situations that the child wants to attend and produces therapists that the child runs to, not away from. We don’t start any formal teaching until the child readily approaches the therapist. The child is not ready to learn if he or she runs and hides from the therapist or therapy situation. This should be the case for any therapy (speech, occupational, etc.) – if the child runs away from the therapist or tries to escape therapy, there is little likelihood of progress.
I’ve heard that ABA makes children behave like robot. Is this true?
No, not if the program is developed by someone with true expertise in applied behavior analysis. Unfortunately, many people designing and overseeing treatment programs do not have this expertise. This will result in many problems, one of which may be a child responding in a robot-like manner. This is not a problem with the behavioral approach itself; it is a problem with how the practitioner uses the methods of behavior analysis. Behavior analysis, like any treatment or therapy, can be misused. If the practitioner does not design and implement the procedures properly, the child will suffer. You must ensure that the person overseeing the program is a true expert.
I’ve been told the child must cry and tantrum before he or she can be taught. Is this correct?
Absolutely not. There myth of “breaking them down before building them up” has been suggested by people unfamiliar with the power of a positive reinforcement-based program. This type of approach is sure to create behavior problems where the child misbehaves to avoid or escape the teaching situation. We encounter this everyday from children who have been through more traditional programs. Children in our Verbal Behavior program actually want to be in therapy because they find it fun and rewarding. Obviously, the child who is a willing participant in the teaching/learning process will far outgain the child who is forced to participate.
My child can name more than 100 items when shown the item or a picture of the item. However, he does not use these words spontaneously. I’ve been told that he will use these words when he is ready. How long should I wait?
You’ve already waited too long. Your child will not just use these words when he is ready. He must be specifically taught to use the words under different conditions. He must be specifically taught how to ask for things he wants. He must be specifically taught to answer questions. He must be specifically taught to carry on conversations. The ABA/Verbal Behavior approach is your best chance of getting your child to talk. Don’t wait any longer.