There are a few things that take parents by surprise when we discuss the possibility of starting a new therapy program, one of them being the number of hours required for best outcome. Although research shows that 40 hours a week are most effective in overcoming deficits associated with autism, different providers will probably recommend a range of hours that can go between 6 to 40 hours a week depending on the child’s age and the significance of the symptoms. So, inevitably, and rightfully, parents will ask: “Why does ABA require so many hours?” The simple answer to this question is: because the research shows that 40 hours are most effective in reducing deficits associated with autism. But parents still ask why such a big difference between traditional therapies (Speech Therapy, Occupational Therapy) and ABA when it comes to recommended number of hours. Well, for many reasons but I will emphasize the most important ones below.
First, if we look at if from the perspective of areas targeted, ABA addresses deficits in all developmental areas, while speech therapy and occupational therapy address only one area.
Then, we have to keep in mind that we are teaching NEW skills that are spread across various developmental areas. In order to be able to this we have to present materials consistently and systematically and we have to “teach” it for a certain amount of time in order to document progress. The ABA model is not different than any other learning model that children are required to attend. For example, when children enter school (where they go to learn new skills) they are required to be at school M-F from 8-3 because they need the consistency and repeated exposure to materials to learn a variety of skills, concepts, organization, etc.
But, the most important reason we require a lot of hours is the unique approach ABA takes in order to address the deficits associated with autism. When a child is referred to us for therapy he/she already has documented delays in 2+ developmental areas. With ABA we address those deficits, we teach skills that a child struggled learning from the natural environment. Children don’t learn from the natural environment when they are overwhelmed by sensory input, by the amount of information, by the amount of irrelevant information that they have to filter out, and because of the extremely fast pace, and chaotic way information is happening around them. In ABA, we control all/most those factors and modify the environment to make it easier for the child to learn and to set them up for success. So, initially we identify skills to be targeted, and we break them down into little components, and then we create a plan that systematically teaches each one of those components. For example, if a child cannot point to pictures of objects in books, we may start with working on looking at a book first (just looking at the book not through the book), then we may work on pointing (just the fine motor action), then we isolate and teach one picture at a time, then we work on pointing at that picture in a book format, then we look at generalizing that skill to different books, and so on. So, each skill is broken into little steps to make sure that the child has enough support for a successful outcome. Further more, when something new is introduced, repeated exposure is required for learning. In the natural environment children may be shown the cow once or twice and they will remember that the name cow goes with that object. Most children with autism require more repetition in order to learn those skills. Some children need to be exposed to a target for 10 times while others need to be exposed for 50 times before learning it. So, Johnny may need to be shown what a cow is for about 10 times before he can point to it while Matt may need to be shown the picture 50 times. In ABA we systematically and consistently teach one target until mastery in order to avoid confusion and ensure success. So we will work on identifying the cow until it’s learned before we move to identifying the picture of a pig.
So, teaching each step within a skill separately, and exposing children to each step for a multitude of times requires a lot of time. Further more, the number of repetitions, skills and steps within skills increase tremendously depending on the amount of delay documented. For example, if a child has a documented delay of 1 year in each developmental area then we may be looking at hundreds of skills to be isolated, broken into little steps and repeatedly presenting them, and this adds up to A LOT of hours of therapy. A lot of times the initial assessment shows delays of 2, 3 or 4 years and that means more time needed to work on catching up.