How Many Hours Are Needed for Kids with Autism?

Dr. Mary Barbera

How Many Hours Are Needed for Kids with Autism?

A lot of people get confused when they hear the words intensive ABA therapy. I get questions all the time about how many hours kids should be getting with the BCBA and with a therapist. So today I want to give you some of my thoughts on what intensive ABA therapy entails and what you should be expecting for your child or clients.

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Today I’m talking about a question that I got during one of my live Q&A coaching sessions that I did within my private Facebook community. This question is about how much ABA is needed for kids with autism.

The question reads “What is intensive ABA? My kid’s BCBA said 3 hours per week by a BCBA is what most people get and is 4 to 6 hours per week is a lot. She also said 40 hours per week will make my kid a robot and she didn’t want to do that to him. Also is 40 hours of ABA therapy by a technician good enough or should it be 40 hours per week of a BCBA?” We’re going to roll all these questions into one. So one of the things I did in preparation for this Q&A session was I downloaded this 3-page handout that was compiled by Dr. Cheryl Tierney, who is a developmental pediatrician at Hershey Medical Center. She is a big advocate for ABA and is working on legislation in Pennsylvania. So she developed this handout and we have her permission to share it as widely as we want.

It basically says that research supports a range between 20 and up to 40 hours of intervention per week lasting at least 2 years or more. Then she has the references of number four and number eight in the back here, which number four is a Dawson and Osterling study in 1997 and eight is a 2000 study by Harris and Handleman. There are other studies, like the Lovaas study, that show 40 hours. So this is saying 20 to 40 hours. In my experience with kids like Jack and Cody those clients that are featured within some of the videos and were my early intervention clients, what I did was I started out in early intervention with them. I had a contract and I started just 3 hours a week of just me. In some situations, it was 2 hours of me, 2 hours of a speech pathologist, and 2 hours of an occupational therapist, and some combination of that. So it was basically between 3 and 6 hours of early intervention providers to start.

Then when I started, I trained the parents like Jack’s mom, Angela and Cody’s mom, Jenna. I trained mostly moms, but there were a few dads that were stay-at-home dads and I trained the dads too. I trained them to do the intervention daily. 15 minutes a day was kind of the goal and then we would expand that to up to an hour or more per session. At the same time, I was working with the families to get them to have insurance or medical assistance in Pennsylvania, pay for more intensive ABA therapy. Most of the kids like Jack and Cody got 20 hours a week. Some of the kids got 30 hours a week like Kurt, who had major headbanging with an open wound on his head that I don’t have video permission for and was one of my first clients. He got 30 or more hours a week, but he had a substantial opening on his head.

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I think 20 to 40 hours, especially with you, the parents implementing some of these techniques is a good amount. I know we have some early intervention professionals here and if you can get the parent to be basically taking these techniques and working on bath time and bedtime and going to the grocery store and incorporating all these errorless teaching strategies and pairing up and positive reinforcement because basically, kids need every waking minute. They need to be having positive reinforcement, and if not, you’re kind of digging a ditch. If you’re treating problem behaviors wrong, if you’re not pairing up the environment and everything, it’s like digging a hole. So even if you have people come in 2 hours a day or 4 hours a day and start filling in the hole, then all throughout the night if you’re doing the wrong thing and not applying the techniques, it’ll be like digging a hole again.

The best thing to do is to have you learn whether you’re a parent or a professional and then teach the parent or teach yourself with the courses and with other trainings, if you want, to learn how to do all of this both at the table, away from the table, and in the community, becoming the captain of the ship. So will 40 hours per week make my kid into a robot? No, not the kind of ABA that I promote. If you are getting rote responding and robotic language, that is not what my verbal behavior approach and type of ABA does. It’s very much based on their assessment, very slow-moving, and pairing up. It should look very natural but be very structured at the same time. 3 hours a week of a BCBA might be enough to oversee the 20 hours a week of a therapist.

No one I know ever has gotten 40 hours of ABA therapy by a BCBA, that would be extremely expensive. You would have to be a multimillionaire who would be able to afford that. So that’s why the BACB now has an RBT credential, which is a Registered Behavior Technician. You can train anyone to be that technician: the parent, a 14-year-old babysitter, or a volunteer from church. It doesn’t have to be somebody highly qualified. In fact, if they come highly qualified with a different flavor of ABA and they are very strict and keeping the demand on and having the kids scream, it’s going to just undo a lot of the work that I’m teaching you here.

I hope you enjoyed this short snippet about ABA therapy. Wherever you’re watching and/or reading this, I’d love it if you would leave me a comment, give me a thumbs-up, and share this video with others who may benefit, and for more information, you can attend a free online workshop at marybarbara.com/workshop and I’ll see you right here next week.

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How Many Hours Are Needed for Kids with Autism?

Dr. Mary Barbera