Parents are told by the pediatrician and by other parents that their chid recently diagnosed with autism should be receiving ABA Therapy as soon as possible. Should it be Verbal Behavior, Pivotal Response Training or “Lovaas” Therapy or exactly what? Equally important are questions about the qualifications of the therapy team. That is what this article is about. What questions should parents ask the Early Intensive Behavioral Intervention provider during your first meeting or when talking with the intake person over the phone?
1. What degree or degrees does the person with ultimate clinical responsibility for your child have and from what institution(s) of higher education? Who was their primary mentor and what experience did that person have with autism ABA intervention, and what were their professional qualifications (e.g. PhD, MA, Licensed Psychologist, Certified Behavior Analyst, MEd?). How much experience is expected? Any other questions to think about?
a. Professionals holding doctorates from accredited universities in behavior analysis, psychology or special-education with an emphasis on applied behavior analysis, are among the most qualified to determine your child’s appropriateness for ABA services and to develop and supervise intervention plans. An academic degree alone is insufficient to determine a professional’s qualifications but is a prerequisite. Most doctoral level supervisors have spent 4 or more yea
rs in graduate school and at least one year in a supervised practicum, plus often one year of post-doctoral fellowship. One would hope the supervisor has had at least 3-5 years of experience evaluating and developing intervention programs for young children with autism spectrum disorders for a significant portion of their time.
b. If the supervisor has completed only an on-line MA or BCBA in applied behavior analysis, knowing more about the person who trained them is essential information in estimating their qualifications. An MA or BCBA who was trained by a another MA or recently certified BCBA will generally have less high quality training and experience than a person with such a degree who graduated from a more traditional MA program in an accredited bricks-and-mortar university or college whose mentor had considerable academic and clinical experience. It may be helpful to look up the supervisor's mentor on the college or university website to explore their qualifications. It may also be useful to visit one of the review websites in evaluating the training of Supervisors who graduated from on-line commercial educational programs http://www.onlinedegreereviews.org which provides comments by program participants or graduates.
c. Ask the person with overall clinical supervisory responsibility where they did their internship or practicum training, the populations with which they worked and their clinical supervisors. Someone graduating from a bricks-and-mortar doctoral program in behavior analysis or psychology with well established clinical supervisors with extensive experience with children with autism will likely be better prepared to oversee your child’s services than a supervisor lacking such training. Supervisors that worked primarily with adults or older children (rather than pre-school age children), or mainly in residential settings, or children with other developmental delays or disabilities, would have much less relevant experience. If the person supervising your child’s services has appropriate academic training and gained relevant experience after completing their formal course training, they may be highly qualified, depending on the nature of that experience.
d. A supervis
or who graduated with an MA/BCBA from a commercial on-line university in which part or most of their supervision was on-line, by telephone or only occasionally face-to-face is likely to be considerably less qualified and should be a cause for concern.
e. Ask the supervisor how often s/he will be in the home or at the center observing your child’s therapy and providing supervision. Weekly or every other week is a minimum. Ask how often there will be team meetings including all team members including parents and hands-on therapists. Meetings less than every two weeks are usually inadequate until toward the end of therapy when less frequent meetings are appropriate.
f. Ask the provider how they provide differential services to higher functioning children with some langauge, versus children with more severe autism symptoms, shorter attention span and more limited skills.
A competent provider should be able to describe how they individualize intervention tailored to the child, using more Discrete Trial methods with children with more severe symptoms and more incidental teaching or naturalistic methods with children who are higher functioning. If you are unclear, ask for concrete examples.
g. Ask the Supervisor their approach to dealing with challenging behavior, such as meltdowns, aggression, repetitive stereotyped behavior, self-injury, destructiveness or other problem behavior.
If they mention “required relaxation,” “over correction,” “restitution,” squirts in the face of water mist, placing lemon juice or vinegar in the child’s mouth contingent on biting or spitting, or a spanking on the thigh combined with a stern "no," used as a contingent aversive, placing the child alone in a locked room without direct adult observation as an aversive event, or physically restraining the child for more than a few seconds to avoid immediate injury, parents and policy makers are urged to look more carefully into the program. Any mechanical physical restraint (such as belts, straps, or posie restraints, arm guards) should never be used unless ordered by a physician for medical reasons. The first respon
se to a child’s challenging behavior should be to attempt to understand the reasons for the behavior problem, and to make it unnecessary for the child to engage in challenging behavior through conducting a thorough functional assessment and implementing intervention accordingly. Proactive positive approaches can be combined with mild brief time outs, such as looking away from the child briefly, or placing the child on a chair away from a rewarding situation when they hit, or delaying access to a preferred item, or seating the child in their room with the door open for a few minutes, can be entirely appropriate, but more severe aversive procedures are always suspect except in specialized treatment centers.
g. Ask if they hold any elected or appointed positions in state or national ABA or autism or other professional organizations.
Having been elected an officer or appointed chair person of a state Task Force or a national Committee usually means the person is held in high esteem by their peers for their training, experience and leadership skills. After they tell you about their honorific position, ask them to explain what that post entails. That will often tell you a great deal about the person’s competence, sense of balance and humility.
2. Ask what degree or degrees does the person with day-to-day supervisory clinical responsibility for your child has, and from what institution(s) of higher education? Where did they receive their didactic training (e.g. classroom or on-line) and who were their instructors? What were their instructors’ qualifications? What clinical supervision did they have (i.e. setting, diagnoses, age groups) and by whom?
Most on-site ABA therapy supervisors have MA/MS degrees and some are Board Certified Behavior Analysts. Some BA/BS trained supervisors with many years of relevant experience, including experience with supervision, can also be highly qualified for on-site supervision depending on the specific training they have received. Preference is for persons trained by bricks and mortar academic institutions with established behavior analysis or psychology degree programs. It is appropriate to ask such individuals how much of their didactic training was face to face versus on-line. Generally, face-to-face mentoring is more effective. Ask the names and degrees of their favorite instructors and where they received their academic training. If they don’t recall their names, or are unaware of their instructors’ qualifications, that is often a red flag. The hand-on-supervisor should have had at least 3-5 years of experience working with children with autism, at least two doing hands-on one-to-one intervention and up to three years of supervisory experience. Ask the supervisor how much experience they have had working with families and parents, the more the better. If this is their first supervisory experience that is not usually a good sign unless the top supervisor is planning to spend considerable time with them on site over the first 3-6 months.
3. Ask what degree or degrees and experience the persons or persons who conduct your child’s day-to-day hands-on ABA intervention have and from what institution(s) of higher education? If they have not had formal academic training in ABA or autism, where did they receive such training, and from whom and for how long?
While it is possible for some high school graduates to do a credible job of hands-on ABA therapy with young children with autism, that is less likely to be effective than a person with at least 2-4 years of education from an accredited college with relevant academic training (e.g. child psychology, education, behavior analysis). While some aspects of ABA therapy are relatively routine and can be carried out by persons with less training, many skills require judgment on-the-fly, which must emanate from a combination of firmly understanding the basic principles and experience-based learning. Preferred are people with a BA or BS in psychology, child development, education, special education or speech language pathology and at least one year of experience working wit
h pre-school age children in an educational or clinical setting.
4. Ask the hands-on therapists’ supervisors how much pre-service training hands-on therapists receive.
If they say “none,” that they learn on the job that is often not a good sign. That basically means the first month or so of your child’s therapy will be spent teaching the new therapist. Ask what kind of daily data the hands-on 1:1 therapist will be recording and how much of their time will be devoted to data versus intervention. Tell the supervisor you plan to review the data at the end of shifts periodically.
5. Ask the supervisors how they handle situations in which you as a parent or a visitor are uncomfortable with, or disapprove of interactions observed between a therapist and the child.
If they say the problem should be resolved directly with the therapist and fail to mention that they welcome any feedback or concerns the parents may have, that is a serious problem. Parents should never feel that they are hostages to a given therapist, and unable to report their concerns to supervisors.