My first disclaimer that we have an older child with moderate autism co-occurring with Down syndrome and complex medical conditions. My second disclaimer is to look for the links. I don’t get paid for any of them or anything, I’m just trying to help you out if you don’t know the terminology. This post is part of a series about what to expect with in-home ABA.
We chose in-home ABA (Applied Behavior Analysis) for a variety of reasons. The first is Ben’s age. At 13 there just aren’t many options, especially when you live in a rural area. We have two ABA options and both are in-home. The other advantages of in-home therapy are that we can work on family relationships which have suffered, and tackle the concerns that arise in Ben’s normal environment. The cons are that with up to 25 hours/week of therapy, we have an ABA tech in our space much of the time Ben is home. I haven’t mentioned it lately, but I’m introverted to the point of reclusive, with a large side of awkward.
Therapy started with a process called pairing. Ben’s ABA tech (she’s fabulous!) is a woman just a few years younger than me, which I think is a huge advantage. She spent a couple of weeks developing a rapport with Ben and getting familiar with our family and routine. I used this time to work on a rapport with her as well. I’ve said it a million times and I’ll say it a million more. As the mother of children with developmental and medical needs, I am a professional parent. I see myself as 51% of any professional team that works with my boys, and as such, I conduct myself according to reasonable professional standards as far as communication, demeanor, and overall way of functioning. Though I don’t hold to it for the entirety of a professional relationship which takes place in the home, for at least the first visit I wear business casual attire as well.
The ABA technician is responsible for the nuts and bolts of day to day therapy, and the BCBA (Board Certified Behavior Analyst) is the guru who writes programs to address the specific behaviors of concern, and analyzes the outcomes and continuously tweaks the program. They spend a certain percentage of the therapy time with the ABA tech and recipient of the therapy and communicate with the recipient, family, and tech regarding all things related to the therapy. The success of the process depends upon the functioning of this team, which brings me right on back to my professional parent point above. Since I want this to work, I consider it my job and view myself as just as essential as the rest of the team.
After the period of pairing, demands ramp up, and so does the behavior, but there’s a plan for that.
We have programs in place for Ben to learn daily tasks like put on his own shirt, ask for items using more than one word, and wait (hallelujah on that one!). There’s a lot of timing. Timing of non-compliance, timing “waits”, and a visual timer to let him know when he needs to move on to the next activity. In fact, visuals are a big part of this. As someone who is predominantly auditory in functioning, the visuals are something I have never been great at incorporating on my own, but are so valuable for Ben, so this is a huge bonus.
We use a simple first/then board with most of Ben’s normal daily activities as simple thumbnail icons.
Used with the timer, this should help Ben navigate transitions, which can get pretty rocky.
Coming soon we’ll have a simple visual calendar for Ben to make the flow of his day more predictable.
Though it’s still early in the game, Ben is getting more demands placed on him by the technician, and that means lots of noise, non-compliance, and mini-meltdowns. (I think our tech thinks they’re actual meltdowns, I’ve warned her, but seeing is believing).
Change is uncomfortable for us all, and the discomfort I have with this gives me a sense of camaraderie with Ben. We’re all growing here, and since we’re off to a late start, it’s a bit jarring. We’re holding on tight for the ride, as usual. At least we have that part mastered.