Is My ABA Provider Any Good? Red Flags For Bad ABA

Recent laws requiring insurance plans to fund ABA have caused an explosion of new providers across the United States. Unfortunately, this rapid expansion has produced agencies that vary dramatically in clinical experience and competency. Check for these red flags when you are evaluating your current provider, or potential new providers. 

Recommended service levels differ from evidence-based levels. For example, if you have a three-year old child with significant delays in communication, social and self-help skills, and your provider recommends a 10-hour per week program, be concerned. Current evidence suggests that a 10-hour-per-week program for a child with these issues will have no measurable long-term effects on standardized tests of cognitive, communication and functional adaptive skills. On the other extreme, if your provider recommends a 40-hour-per-week program for a 15-year-old, you should also be concerned. There is currently no long-term outcome research on intensive programs initiated for children over six years old. If your program is inconsistent with evidence-based procedures, consider a different provider. 

The most senior clinician on your case has less than 36 months of experience. Effective intensive early intervention programs involve a curriculum of hundreds of programs delivered over the course of 2-4 years. The person responsible for the weekly management of your child’s team needs years of experience. 

Staff have eight-hour shifts at your house. Agencies do this to maximize their billable hours (no drive time to pay for!), despite the fact that it invariably burns out both kids and staff, and causes lousy therapy. These agencies may also bill when clients are napping, and ask staff to skip or bill through breaks and lunch. As you might have guessed, this is illegal.

Your provider has arbitrary clinical rules that are applied to all children. For example, “We do not integrate kids into preschools during the first 12 months of treatment.” Rules like these are generally implemented to maximize billable hours, and may cost children valuable treatment opportunities.

Your child has 25-40 (or more) programs currently on acquisition. This typically means you have an inexperienced supervisor or behavior analyst. Too many concurrent programs slow down children’s acquisition rates, and make it almost impossible for supervisors to effectively manage each program. 

Your staff does not have instructional control of your child. If your staff spends 50% of their time trying to coax or persuade your child into cooperating, your 40-hour-per-week program is now a 20-hour-per-week program. Skills learned under these conditions are unlikely to generalize to real-world settings. 

Programs are consistently on acquisition for 2-4 months, or longer. This may indicate that the programs are simply not being done, not enough time is spent on each program, that an appropriate task analysis has not been completed, or that the skills are not developmentally appropriate to the child’s current level of functioning. 

Your program list gradually drifts into all play-based, nonverbal activities. This suggests that your team is losing reinforcement control, and is consequently reducing the demand level of the program to prevent noncompliance and tantrums. 

Your child has a tantrum when he/she is told “no.” This may be an indication that insufficient rewards are being used, children are being allowed to repeatedly fail within programs, or appropriate goals have not been set.

Your child knows what a quadrilateral is, but can’t tell you what he/she had for lunch. This suggests that intervention has focused on memorization skills (e.g., moving from 100 expressive object labels to 500 expressive object labels), rather than on increasing the complexity of communication skills (e.g., moving from one-word verbalizations to full-sentence verbalizations). 

You are sticking with your current provider because you like your behavior techs. It’s a common mistake. Don’t overlook concerns about your program’s content and direction, simply because you are fond of the personnel who work directly with your child.