The "Costs" of ABA Therapy

When initiating ABA therapy services, many families do not fully consider  the “costs” of therapy.

You may have heard before that its always recommended to weigh the costs and commitment required to do something before agreeing to take it on (Luke 14:28 NLT). This is very good advice. Beginning something without fully understanding what it will cost you can lead to disappointments or frustrations.

Think of starting a New Year exercise plan. Many people join gyms, buy workout clothing, alter their diet, etc. However after a few mornings waking up to stiff and sore muscles, or eyeing the doughnut box at work, many people abruptly discard these exercise plans. Why is that? Because the full costs weren’t considered.  While we all know the benefits of regular exercise, living that kind of lifestyle will also cost you something.

Similarly, making a decision to begin ABA therapy for your child can be quite different from actually living out that decision everyday.

As much as I support and believe in what ABA can do, I also meet and work with countless families who don’t really understand the commitment that ABA therapy is. The potential benefits of ABA therapy are so numerous I can’t even list them all here, but every day will not be peaches and sunshine.

The following advice is to help parents on the ABA fence make an informed decision. I’m definitely not putting ABA down, but please, know what you are signing up for:

•       $$$$$$$$$$- While talking about the “costs” of ABA, the literal cost must be mentioned. ABA therapy is expensive. Why is that? Well, it’s administered by highly trained professionals (more on that later), it’s intended to be intensive, it requires rapidly changing supplies and materials, and the funding sources have not quite caught up to the diagnosis rates. High demand and low supply combined with a credentialing process that takes years to achieve = a not so affordable therapy option. 

•      Time- ABA therapy could cost you time, spontaneity, and control of your calendar. Professionals may expect you to participate in the sessions, attend update meetings, collect data, practice behavior management strategies, etc. Some of my clients have rearranged family vacations, anniversary trips, doctor’s appointments, even moving, based on what works best for the therapy schedule. At most clinics, if you cancel more than 3 consecutive therapy sessions they can re-staff your case, or possibly place you back on the waitlist for services. ABA takes a lot of time; time that the professionals give to your child and time that you give to the professionals.

•       Standards/Expectations- So how could ABA therapy cost you your standards? Well, ABA is a unique field. The people who are the most experienced, seasoned, and qualified in this field are typically not the ones who will work directly with your child. Unfortunate, but true. ABA therapists have varying experience levels, and are the ones who work with the child 1:1 to teach skills. The BCBA or Consultant is the one who designs and writes up what the therapist is supposed to teach. So you may pursue ABA therapy thinking you only want the best, most degreed professionals working with your daughter. Then you realize in your area, no one pays for ABA,  the  best companies have 3 year long waiting lists, and that one Consultant you found can only offer 1 session a week. So now what? I hate explaining this reality to new clients, but unfortunately the people in this field with great experience and expertise are in super high demand. They either charge very high hourly rates, or their schedules are completely booked. This is an unfortunate reality.

•      A little thing called privacy- So-0-0, no one talks about this part, but it’s true. You may need to develop a new definition of the word “privacy”. The ABA team will see your house messy (if you receive homebased therapy). They will see you answer the door in curlers and a torn pink robe. They will see you hit the peak of frustration when dealing with your child, as well as explode with joy when your child shows amazing progress. They may see or hear things about you and your family that even your closest friends don’t know. Speaking of…….

•       Marital Stress- It can be stressful on a family to  participate in intensive therapy services. Everything can become scheduled and regimented, and making a simple decision such as “Should I take my spouse on a Florida vacation this summer?” has to be discussed with a team of people. Things  get even more awkward in situations where one parent is on board with treatment, and the other parent is not.

•      Pride- This could be a big one, just depending on the type of person you are. ABA can be a pretty young field, as far as the professionals working with you and your child.  As a parent it might be humbling to have a little whippersnapper explain to you exactly what you should be doing differently, and then darn them, actually be right!

•       Remember your other kids??- As an ABA therapist, I used to show up to my clients homes with toys, gadgets, edibles, DVD’s, you name it. I would work 1:1 with my client, clapping and shouting and blowing bubbles….while their siblings would peek into the room wondering when THEIR therapist would show up. It may be hard for you rother children to ease into the new demands on your time, the sudden influx of professionals entering the home, the changes made to the house (visual schedules, sensory toys, etc.). This can be a hard thing for siblings to navigate.

•      Social life-  Beyond the time commitments, lack of spontaneity, and financial crunch ABA may cause, you may find yourself interacting and spending more time with the ABA team  than with your closest friends. You may find yourself using “ABA speak” like mands, target behavior, trip training, or prompt dependency, which your friends may find just downright odd. It’s hard to answer simple questions from your friends such as “So, how’s that ABA going?”, yet when the BCBA asks you for a progress update you are bursting with news to share. Your friends may think it’s weird if you call them at 9 am because your son just independently peed in the potty, but the ABA team will clap and cheer with you! It can be difficult to have a social life, when so much of your social interaction is with a team of behavior geeks. :-)