When your child is diagnosed with autism, their doctor or therapist will likely recommend evidence-based behavior treatment with an applied behavior analysis (ABA) provider.
Once you meet with the therapist and set up the first session, your child’s ABA treatment plan will be created based on the length of time the therapist believes your child needs intervention. This is based on the severity of the autism diagnosis, whether complementary medical treatments are employed, your child’s educational support system, and other factors.
This might mean they need up to 40 hours of ABA therapy per week. While this treatment timeline is intensive, it often decreases in intensity over time until the child ultimately no longer needs the therapy.
It is important to keep your child in treatment for as long as the ABA therapist recommends. ABA therapy is well known to improve the lives of people with autism, and those who participate in intensive treatment see better outcomes.
Determining the Length of Treatment Is Part of a Personalized Plan
Children with autism need intervention early in their lives to help them reduce maladaptive behaviors, develop positive behaviors, and manage issues around communication, socialization, and cognition. There is no cure for autism since it is a developmental disorder, but there are several supportive therapies that can ease symptoms, especially when they are part of an early intervention treatment program. One of the leading treatments is applied behavior analysis (ABA) therapy.
ABA therapy is an evidence-based treatment, according to medical specialists, the American Psychological Association, and the U.S. Surgeon General. An ABA therapist gathers information about your child’s behavioral needs, related to the severity of their autism diagnosis. Severity level is based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and determined by information that you provide as well as assessments of your child.
The therapist will create a treatment plan with specific goals and measurable steps. If your child struggles to meet one of the goals, the therapist can adjust their approach so positive behaviors are implemented.
Since ABA therapy is based on your child’s individual needs, the length of each therapy session and the number of sessions they need per week will be unique. While there are some standard practices for judging how many hours are needed, the exact protocol will be adjusted for your child’s needs and availability.
Autism Severity Level Determines ABA Therapy Duration
For most children with autism, ABA is recommended as a long-term, intensive treatment program. This means the child will attend therapy sessions on a regular basis, for many hours each week, for several years. This often looks like 25 to 40 hours of therapy every week, which will be divided across several days in the week.
The overall treatment regime often lasts for one to three years. The number of years recommended will depend on your child’s age and the severity of their autism diagnosis.
- Level 1: Also called “requiring support,” this is the least severe level for people on the autism spectrum, but the diagnosis can still mean that the person struggles with communication in social situations, and that can lead to anxiety or stress. They may be inflexible in certain contexts and have trouble switching between different activities. They may struggle to organize or plan, which hampers some aspects of daily life. With appropriate therapy and other interventions, however, they often lead typical, balanced lives.
- Level 2: Also called “requiring substantial support,” inflexible behaviors, communication deficits, and social impairments lead to struggles with work, education, and relationships. Even with supports in place, someone at this level may have limited social interactions due to isolating, struggles with verbal communication, obsessive interests, and outbursts. Behavior therapy helps a great deal, but the person will still need consistent support in several areas of life.
- Level 3: This level is defined as “requiring very substantial support,” which means more than just behavior therapy. The individual will need medical interventions like physical therapy and occupational therapy. They may need a caregiver because of motor skills problems and neurological issues. They will have a hard time maintaining focus, avoiding repetitive behaviors, and communicating, both verbally and nonverbally. Behavior therapy can help to manage many of the social and communication issues, but this therapy will be one of many treatments. It may not be the primary focus of the treatment plan, depending on the specifics of the individual case.
Children diagnosed at Level 1 may only need one or two therapy sessions per week, especially if the therapist can work with parents or school administrators to educate them on maintaining specific ABA practices outside of therapy. However, children at Level 3 may need up to 40 hours per week of ABA therapy, which means they should be enrolled in a special education program.
Scientific Research Supports Long-Term, Intensive ABA Treatment
There are many studies on the effectiveness of ABA treatment, but one recent study examined the direct impact of both hours of treatment per week and the duration of treatment over months. The goal was to understand how well participants responded to long-term, intensive treatment versus short-term or limited treatment. The study looked at eight domains of treatment to determine how the amount of therapy access determined improvement.
The study found that more time spent in therapy improved behaviors in each of these eight domains for study participants. Academic and language domains were especially improved with more access to ABA therapy. There were also moderate, but still positive, impacts on nonverbal IQ, daily life skills, and social functioning.
The study also found that treatment duration was important for gaining skills in the executive function domain, but clients would benefit from clinicians lowering the intensity of these sessions. Spending less time per week, but adding more weeks throughout the treatment plan, helped children with autism learn executive functions better and maintain the behavioral changes for longer.
This study suggests that limiting the number of treatment hours your child receives could be detrimental.
Managing the Financial Picture
Understandably, you might be concerned about the costs of such intensive treatment. The good news is that insurance significantly offsets the cost of ABA therapy in most cases. This means reduced out-of-pocket costs for families dealing with autism.
Work with your pediatrician and ABA therapist to get your health insurance involved. Most states require some health insurance coverage for autism treatment, and ABA therapy meets the standards of most insurance companies.
The important part is that your child gets the number of ABA therapy hours per week that is recommended for their specific situation. There isn’t a set answer on the number of hours a child will need, but an ABA therapist can make a recommendation once they assess your child.
- Understanding Behavioral Therapy for Autism. (July 2016). Psychology Today.
- Treatment and Intervention Services for Autism Spectrum Disorder. (September 2019). Centers for Disease Control and Prevention (CDC).
- Applied Behavior Analysis. Autism Speaks.
- DSM-5 Diagnostic Criteria. Interagency Autism Coordinating Committee (IACC).
- An Evaluation of the Effects of Intensity and Duration on Outcomes Across Treatment Domains for Children with Autism Spectrum Disorder. (September 2017). Translational Psychology.