In Home ABA Therapy vs. ABA School: Which is Better?

Transcript for Podcast Episode: 01
In Home ABA Therapy vs. ABA School: Which is Better?
Hosted by: Dr. Mary Barbera

This is a question I get a lot is: which is better? Home ABA or school ABA, center based and or should I home school? And there's so many variables. People from all over the world, literally, who have different circumstances, different funding streams, good options, bad options. I don't care what you call it. So that's why I decided this morning to write out some of the variables that can help us decide what the best situation is.

Hi, I'm Dr. Mary Barbera. Autism mom, board certified behavior analyst, online course creator and bestselling author of the Verbal Behavior Approach. Each week I provide you with some of my ideas about turning autism around. So if you haven't subscribe to my YouTube channel, you can do that now. So Anna got me thinking this morning about home versus school programing. And I don't know how old her son is now, but he is in an ABA program, approved private school or private ABA program that's funded by her district. And she's had involvement with a lawyer and she is trying to make a decision about a non-ABA school versus home program. She's wondering about using a completely different approach.

Maybe a good thing, but maybe a disaster. And on Friday, we have an IEP and the district told us that home-based instructions will be implemented if he's not accepted to the new school. So she's just really it sounds like leaving him in the current ABA placement is not an issue. It sounds like now she has potentially a choice between a non-ABA school versus a home. And I guessing the age is around 12. OK, so this morning I started thinking of it, and this is a question I get a lot is.

Which is better home ABA, or school ABA, center-based ABA or should I homeschool? And so many variables, people from all over the world, literally, who have different circumstances, different funding streams, good options, bad options. I don't care what you call it, whether you're calling the center or the school. This program, ABA, a non-ABA, I don't care what you call it. I don't care if it's called life skills or artistic support or inclusion. It doesn't matter. Typical, preschool. There are certain variables that make it so complicated for each individual.

So that's why I decided this morning to write out some of the variables that can help us decide what the best situation is, home versus center or school. First of all, we have to look at the child age in most states in the United States, children birth to three are serviced in their home or at daycares, wherever they are naturally going. But then for, really for funding reasons, that switches three to five may switch in the United States, the funding stream usually switches to center-based school programing. Very few places really do quality ABA programing.

And then you have in the United States, all 50 states now mandate insurance carriers to cover ABA. So then we got, you know, home ABA versus school ABA that's not through the education system. So that muddies the water, too. But we're never really talk about, like, ABA. versus non-ABA. We're going to talk about programing in general in the home or at a center slash school will kind of put those together. So if you think about typically developing kids. And we're talking about the whole day, we're talking about a six-hour chunk. We're not talking about, you know, if we talk about a six-hour chunk of time, if you think about the age that the child is at.

Where would he be? If he were typically developing. That's is usually where I would start. So under age five, under eight, the age of kindergarten, a child would be mostly at home or in daycare. And or at home with preschool, three mornings a week, three days a week, you know, very few like full time six-hour day every single day, preschools. That would be an option if they�re typically developing. So my thought is for kids under five. That's usually home and kids over five. It's usually school is where normal nor typical kids would be would be placed.

So the other variables and there's several variables. And then we're going to talk about after we talk about home versus school, order to talk about how to tell if a center or school is appropriate. But in addition to the age of the child, we also have to think about the work status of parents, grandparents and other care providers. So if a parent works full time and there if the child were typical, he'd be a daycare. Or maybe they have siblings and siblings are in daycare or preschool. Or maybe the grandparent watches the kids. The parents work, and the grandparents watch the kids. So what options are there?

I know a couple of my clients, moms, their dads worked a full time and then their moms also worked, you know, between the commute and everything, like nine hours a day. And so in one case, the child was being watched by both cases. The child was being watched by a relative when I first started. And one of the cases, I trained the grandmother, Jacob's grandmother, to deliver the therapy and to be the center of the child's programing. And I also trained mom to do it in the evenings and everything. And the other situation, the relative that was watching the child know that there were a bad person or abusive or anything, but they just were not into anything extra that they would have to be delivering.

So in that case, Mom decided to pull the child back to her home, stay working nine hours a day, but hire a nanny to be the center. And to, you know, have the speech therapist come in, have the behavioral therapists come in and have me come in to run the program. So I think that's a really important variable. Is there one parent or caregiver in a home situation that has the time but also has the interest in learning and being open and being the little boy that was being watched by a relative? This little boy was banging his head on soft and hard things three hours out of the nine hours a day. We didn't know that, but we did know that when I started he had an open lesion on his head that we had to fix.

And so when I was interviewing and assessing, when was he banging? How hard was he banging and what, you know. OK. He's in a highchair. He's banging on the high chair. OK. Can we get a shorter chair with a booster seat? OK. We can do that. He was banging in the pack and play in the crib. Because he was expected to take two naps a day and he was banging before he fell asleep, banging when he woke up. OK, we need to switch that. We can't have this child banging his head. Like he can't have two naps. He needs one nap. It needs to be short. No banging. Soon as he's awake, he needs to be picked up and engaged.

So those are those are two big things. Our funding is another big, big variable. But just because something's funded like in Kelsey situation on podcast number three, MaryBarbera.com/3. Kelsey had funding to take her son Brentley an hour away. Driving him an hour away. To a center. An ABA center run by a behavior analyst. But even though that was funded, that was not what her child needed. So just because it's funded, like when Lucas was supposed to go to the three to five program, that whatever was recommended was not appropriate. We're going to talk about why that wasn't appropriate.

So we'll save that. But just because something's funded doesn't mean it's right for your child. And then there's other factors. Are there siblings? You know, what's the functioning level? What are the other diagnoses? I had a client once with autism. He was two. He also had severe diabetes with a pump. I've had kids with severe anaphylactic allergies. I've had kids with other syndromes that they need a nurse. These are all factors that could make center-based programing or something, not in the cards. I do think that functioning level is something that I would consider as well.

So if it's a matter of, I remember when Lucas when I was in my second due process case, when Lucas was like nine or 10 years of age, he had transitioned back from na approved private school to our public school. And the teacher went out on our side in pregnancy and nobody knew what they were doing. And like, I wasn't gunning for perfection. It was just like a disaster, like all of a sudden. And of course, they didn't want me to see the disaster. So they like didn't let me in the classroom and were rude, and so we ended up, you know, in due process anyway. But when I was in my due process, what he was about nine or 10, I remember another behavior analyst that knew me pretty well, and was working with me in the Verbal Behavior Project, said, "You know what to do. Why don't you just homeschool Lucas?".

And I was adamant. I was already working as a behavior analyst. And I was like, no, I do not want to home school. I'm already working. I'm already becoming a leader in the field. There's a lot of kids to help. And I need Lucas to go somewhere for six hours a day so that I can do my life and have my goals and have, you know, it's a lot of time to have a child to home. Now, if it meant Lucas was, you know, very high functioning and this when he was 10, it would mean the difference between him going to college or being, you know, very disabled. And I knew it was like a shorter-term thing where I could fix it and then I could get him somewhere else like I would have. I would have probably considered it.

But I knew by age 10 that Lucas had moderate to severe autism, had a mild intellectual disability. He was not going to progress to college. To be fully conversational, most likely to, you know. So if you've taken my intermediate learner course in module one, I talk about the three profiles of intermediate learners. And for me, I'm not saying like, I gave up on Lucas or anything. It's just a factor. If I have a profile, a kid who I if I didn't think that I could really, you know, under age eight, I would last as hard as possible, especially if you have a child that's making pretty good gains. And I did when Lucas was under eight. I blasted full, full tilt.

But when children get older, you know, that was kind of my experiences. I always wanted somewhere for Lucas to go for six hours a day. And it didn't have to be perfect, but it had to be appropriate. So those are the factors age, the work status of parents and caregivers. The funding streams or whether parents are, you know, independently wealthy and can do whatever they want. Hire nannies, hire round the clock care. You know, like there are differences between, you know, even hiring a lawyer, which, you know, I went through many of our parents have gone through.

And then really thinking about, you know, is this going to be pivotal in changing the trajectory of where my child's going to be? So for Lucas, at age 10, is this really me home schooling? Is that going to change his trajectory of where he's gonna be at 12 or 18 or twenty-five? And I didn't think it would. And now he's twenty-three. And again, he goes to a center six hours a day.

And I have friends who don't have that for whatever reason, their adult kids can go to the center-based program. And so you end up I think in a difficult situation where, you know, your kids at home all day. It's a lot of hours to fill with meaningful activities.

OK, so let's switch gears pretty quickly and then I'm going to get to the rest of the questions. I know this is kind of long. Let's switch gears to how to tell if a center or school is appropriate, no matter what you call it. Whether you call it ABA, verbal behavior, non-ABA, floor time, whatever. Typical school. How do you tell if a school or a center is appropriate? Those variables that I talk to about home versus center still absolutely apply the h the you know, the age. The funding. All that stuff. However, when I'm really looking at a school or center, I am mostly looking at my big three. Is a child safe? So let's talk about safety first.

As I say in podcast one with my journey and I have a whole podcast episode on my legal battles over the years and I have an interview with Gary Mayersen as one of my podcast interviews, both, you know, excellent podcast interviews and episodes. But when Lucas' was when he turned three, Brett's right when he got the diagnosis and right when he was ready to go to the three to five programing, the program that was recommended was in the middle of the city. Lucas had just finished a year of two-year-old preschool at our neighborhood preschool that was, you know, had an excellent reputation. So he already had that. He already got the diagnosis of autism. I had developed a home program in my house in the suburbs.

And the program that was recommended with the three to five-year-old program was in the middle of the city in a gun zone so they could not do any outside playground time because it wasn't a gun zone. And then I had a choice to get him to this center. It was either I would drive him, but I also had Spencer, who was 18 months younger. So I would have taken my 18 month old and my three year old essentially nonverbal child, drive both of them into this gun zone, middle of the city, park or I don't know what I would do. Maybe they would come and get Lucas out of the car and swiftly move him into the building.

And then at the center that was proposed, I think it was 15 minutes a week of one to one time. I mean, we were talking about studies showing kids needed 40 hours a week of one to one time. And this was going to give him 15 minutes a week in a classroom where he couldn't even go out to recess. And then every six weeks, because of funding, they would take like a two-week break. So they didn't take summers off, but they had this scattered schedule.

So right there, it wasn't a safe situation. Or he could stay at my home with his 40-hour week program, which was proven. We had a yard with a fence. He could go outside. He could return to his typical preschool with one of his behavioral therapists. Like which part of this would even make sense for him to go to this other option? So safety is huge in Kelsey's situation in podcast three. She was driving him. He was banging his head on hard surfaces 100 times a day. He was eloping from the center, running out of the door three blocks away when Kelsey was trying to drop him off. It's just not safe. So if it's a safety issue, then it's not appropriate.

In addition to the center or school having safety and it doesn't you know, you might have to put things in the IEP to make it safe for your child. A one to one, a one to one during recess time, which would with the one to one being within arm's distance of your child the entire time because there's no fence. You may need, you know, whatever you need, but you have to make sure that the center of the school has enough safety considerations to make your child safe.

You also want to make sure that the time during the school day isis appropriate. They're going to be working on skills that your child needs, not skills he already has, not skills that are too hard, skills that are functional. And this is, again, depending on the age and the ability level. And I think as your child gets to be 10 or 12 or 14, we have to be thinking, no matter what the functioning level is, where are they headed? What skills are really going to be appropriate?

I remember one, we had au pairs, which is how we kept Lucas safe. And I got to work and earn a PhD and travel, was we hired au pairs for a good 10 years of Lucas' and Spencer's lives. And I remember one of our au pairs coming back after not seeing us for three or four years. And Lucas was probably eight when she was here and 12 when she came back. And she said, like, his independent skills with like chores and showering and all that stuff just really improved. She didn't see a ton of gains with language.

And it wasn't because we weren't trying and we weren't working on that. Like the other, last week, Lucas answered his first why question spontaneously. We were walking in a parking lot at a restaurant after we ate and I had been trying. I work with him a little bit on why questions like why is the pool closed? And he knows to say, because. And so I go, oh, oh, be careful. It's slippery. It had snowed a little bit. I said, be careful. It's slippery. And I go, Why is it slippery? And he's like, because it snows. And, you know, because he could see the snow.

But it still was his first spontaneous answering why question. So I don't want you to think like I'm not working on language. We teach him new people that he comes in contact with, new tasks at work and all that stuff. But I think at this point, you know, his language, he's not fully conversational. I think it would. But we can work more, more on independence, keeping him safe. Working on independence with everything and working on keeping him happy. So that's the other thing is, is your child happy to go to a center or school or do you think they'd be happy if it's just a possible.

What kind of things do they know? Do they know about pairing? Do they know about the power of manding or requesting? Is it set up so that the kids look happy? Like if I were picking a day care for a typically developing kid and I went in to day care A and this teacher was like, Johnny, stop that. All right. The jump rope is going away because you guys can't share and blah, blah, blah, blah. If that was, you know. Stop. Keep your hands yourself. I told you, you know, sit criss cross applesauce like nobody's listening today.

Or and then I went into daycare B, and it was like, I like the way you're sharing. That's so awesome. You know, give me a high five. If it was like all these 8 positives to every negative. I don't care what you call it, I would pick the positive environment.

So when you're assessing potential places for your child to be, whether that's a a center or school or classroom, look for people that are positive. Look for people that know enough to talk to you about how they program for happiness, how they keep the child safe and what kind of skills they work on and see if they are in line with what you think your child needs.