Teens, Adults, & ABA

Most clients receiving intensive ABA treatment in the home, school, or clinic setting are young children between the ages of 2-10. This is the typical age range for ABA services, and for many clinicians the age group we serve the most. 

But why is that? Does this mean ABA therapy isn't effective if the client is a teen or an adult? 

It can be difficult to find ABA providers who serve older clients, to access ABA services for adults, or to obtain funding for services across a lifetime. Meaning that if a child begins ABA therapy at 3 or 4, they probably are not still accessing the same intensity of services at 13 or 14. Doesn't mean they no longer NEED the services, just that it can be a challenge to keep obtaining funding, or to stay with one provider for that long.

This information will be especially relevant for people in rural areas, or locations with limited services/providers. If an area only has a handful of ABA providers, I have found that the handful tends to focus on very small children. The less diversity of providers, the less diversity of clients served.

Even in school systems that provide ABA services, the ABA classrooms may be for the younger children. Most of my clients attended Autism Pre-K programs. But I have heard of very few high school level programs of the same intensity or quality. 

So does all this mean that ABA therapy is only for toddlers or school-aged children? Definitely not.

It’s important to understand that ABA is a broad science that can include a variety of methodologies, different teaching styles, and varying techniques or strategies. Doing DTT with a small child to teach her to communicate is ABA. Implementing a visual schedule in my home to increase my own time management is ABA. A mother using positive reinforcement to get her son to clean his room more consistently is ABA. ABA can be a strategy, a technique, or an entire curriculum. 

Once you understand what ABA really is, it’s easy to see how placing an age cutoff on ABA treatment is ridiculous. It’s amazing the progress that can be made with quality ABA services, regardless of age or ability level.

Two big barriers to securing ABA treatment for an older child or adult can include safety concerns and lack of funding.

An Autistic 15 year old may have more significant and potentially dangerous problem behaviors than when they were 5. The child is bigger, stronger, and the problem behaviors have been occurring for years and years. Not all ABA professionals are equipped or trained in working with significantly aggressive or violent clients, or (to flip it) may not be trained/equipped to treat non-dangerous, subtle, or more introspective issues such as a 35 year old man who wants help with job skills/disclosing his diagnosis to potential employers. 

Like physicians, BCBA's have specialties. No one BCBA knows everything.

An ABA provider might not serve older clients simply because this is not part of their clinical expertise. Or, if the provider is based out of a facility, the facility could be an inappropriate setting to accept highly aggressive clients.

ABA funding varies by location and setting, and available funding for treatment strongly impacts what services are available. For example, in my local area there are very few social group programs available. The reason why? Very minimal funding options. 

In other areas or states, ABA treatment may have age cutoffs. This means the child can only access ABA until age 9, or until they enter school. Many families simply can't afford ABA therapy if their insurance won't cover it. 

In some states, teens or adults may qualify for ABA services with certain restrictions. Intensive, in- home treatment each week may not be covered but behavior reduction services may be available.  In other words, the ABA provider can come in monthly to extinguish a challenging problem behavior. Unfortunately funding sources often don’t understand that without a systematic plan to modify the environment and train caregivers, behavior plans can have temporary effects. New behaviors and skills must be taught, in addition to maladaptive behaviors being reduced.

If you are the parent of an Autistic adolescent, teen, or adult, I encourage you to see what ABA services or providers are available in your local area. ABA therapy doesn’t have to stop just because your child has entered middle or high school, or graduated from high school. I encourage you to advocate for your child's needs, and consider starting a program, class, or social group if you cannot locate one. Everyone needs community and to belong, and there are probably other families in your area struggling with the same issues you struggle with, who would love to connect.

Here are some helpful tips to help you locate quality ABA treatment for older individuals:

• The company/provider should have experience working with older children or adults (however this may be difficult to find depending on where you live). ABA providers do not all have the same clinical training and experiences, so ask direct questions about the providers background.
• The staff should have Physical Management Training if dangerous or aggressive behaviors are occurring. PMT includes specific training techniques that teach professionals what to do in the event that a client becomes physically aggressive or dangerous to themselves, property, or others. If the staff are unsure what to do in a dangerous situation then they may unintentionally harm your child, or the staff could get injured.
• The format of the ABA therapy sessions should be appropriate for the age and ability level of the client. In most scenarios, teens and adults have more naturalistic, community- based instruction, focused on practical life skills.
• Program goals must be highly practical--think "What does this individual need to learn to function as independently as possible in society RIGHT NOW?" 
• Understand that frequency of services may be minimal, the older the individual. Again, this is largely due to funding. While a 4 year old may receive 20 hours of therapy each week, a 24 year old may only receive 4 hours of BCBA consult per month. Be prepared that this will require a high level of career/parent involvement to have any effect on problem issues.

** Resources about ABA & older individuals:

https://asatonline.org/research-treatment/clinical-corner/does-aba-work-for-older-children/

http://www.lovaas.com/meetingpoint-2007-06-feature-02.php

http://www.act4autism.com/aba-with-older-children/

http://autismallianceofmichigan.org/wp-content/uploads/2013/03/ASEAC_Autism.pdf


* Video Clip explaining why it can be difficult to locate ABA providers who work with teens/adults