ABA question

bliss611

Hi everyone. I'm hoping some of you give me guidance about ABA.

Quick background - DS got his ASD dx in late Feb - his symptoms are closest to PDD-NOS except that's not a dx any longer (?). It was an educational dx from CPSE/ BOE. He has been receiving PT, OT, SLP since mid-March which have made huge difference. He will continue those therapies plus a bit of counseling with a psych when he starts pre-K in Sept - in an integrated classroom. I also have him in a social group at his speech therapy place over the summer.

The thing is all his problematic behavior 4-5 months ago was very much related t speech and sensory issues so everything improved a LOT after OT and SLP started. So, I didn't really consider doing anything else at the time. But recently there has been new behavior issues - feeding (I posted about that a few days ago), aggression, oppositional behavior. So I am considering ABA now. From what I am reading, ABA should help with all of the new issues I am dealing with.

My first question is who prescribes that? I have an appointment with a dev-pedi in early September. Will they decide about that? Or should I be going to an ABA center for evaluation and services?

Also, it seems like it is very intensive therapy - 20-40 hours per week seemed to be the range. He will be in school 9am-3pm everyday. That will be a big adjustment for him already. And I'm afraid of taking away all his "being a kid" time for ABA therapy. How much ABA is normal for someone with mild ASD?

I'd love to hear about general experiences with ABA as well.

TIA!!!

greyt00

I think the dev pedi should be able to prescribe ABA.  We got orders for services (documentation for medical necessity) including ABA, speech therapy, and occupational therapy from a neurologist.  

ABA centers will vary with their intake process.  We turned our paperwork over and they did not do their own "evaluation" of DS1.  I mean, nothing that was an extra step before he started in the program or cost extra money.  The BCBA did various assessments with him once he started attending  (I am not nearly as well versed as others here, and I don't remember what "protocols" they use).  There was another ABA center in the area that wanted money up front (a few thousand just to walk in the door) for their own evals, including something with a psychiatrist.  

I would describe DS1 as moderately affected, though he is verbal and quite smart according to every single professional we have ever consulted in regard to his behavior.  However, he has lots of echolalia and perseveration, and right now, extreme rigidity issues with lots of tantrums at home.  We have insurance coverage and are able to put him in 32.5 hours of ABA per week.  

They are saving our lives with feeding.  I truly believe that nothing else on God's green earth would expand this child's diet.  Feel free to PM me if you want any more specifics.  He has a program in place for feeding as well as a medicine program that I devised on my own and they are executing. 

DS1 was just under 3 years old when he started.  He has been in for 6 months.

bliss611

Thanks greyt00. Our boys sound very similar. Very verbal & smart. Echolalia and preseveration are definitely the major concerns for DS as well.

Rigidity not so much - occasionally with certain things but doesn't seem too far off of other non-SN kids I've seen. Tantrums are becoming an issue now. And you already responded my feeding issues post...

hopecounts

We have no insurance coverage for ABA, we are doing 8 hrs working up to 10 starting in the fall, if we
It has been amazing for DD and has helped her significantly.
We have addressed behavior issues, speech, learning (colors, letters, numbers), play skills, etc
I love our ABA team.

Junebug060609

The dev pedi prescribed DSs ABA.

bliss611

Thanks JuneBug

bliss611

As always auntie - super informative answer. Thanks!

-auntie- said:

bliss611 said:

Quick background - DS got his ASD dx in late Feb - his symptoms are closest to PDD-NOS except that's not a dx any longer (?). It was an educational dx from CPSE/ BOE. He has been receiving PT, OT, SLP since mid-March which have made huge difference. He will continue those therapies plus a bit of counseling with a psych when he starts pre-K in Sept - in an integrated classroom. I also have him in a social group at his speech therapy place over the summer. 

Why an integrated class? 

They (evaluating psych and his current nursery school teachers) didn't think he would be able to attend a regular pre-k program. At the time, he was having trouble sitting through group activities (circle time, etc) and he had a lot of anxiety in large groups. A lot of that behavior has gone down with OT/SLP but not completely.

Is this a clinical psych doing counseling or is it a school psych/MSW? TBH, most school psychs are OK for doing MFEs to develop IEPs, but I don't know that I'd let one do therapy with my cat. Does you district have ABA settings at the preschool level? This might get your son intense behavior interventions without requiring additional time from your family life.

He works for the school but is not a MSW - a licensed psych. I do really like him. My big concern is it's not enough counseling - just 30min 1x per week. It's all  they would do.

The school district does not offer any ABA services at all. So whatever I do will have to be outside of that.

The thing is all his problematic behavior 4-5 months ago was very much related t speech and sensory issues so everything improved a LOT after OT and SLP started. So, I didn't really consider doing anything else at the time. But recently there has been new behavior issues - feeding (I posted about that a few days ago), aggression, oppositional behavior.

A lot of times, younger kids in the 2-3 age bracket  get a dx and then develop new and challenging behaviors closer to 4-5. Some dysfunctional behavior requires more bandwidth than a toddler/young preschooler has available to work with.

Definitely seeing evolving nature of the dx. Some things get better, others pop up - we've been seeing that on the sensory side a lot.

 So I am considering ABA now. From what I am reading, ABA should help with all of the new issues I am dealing with. 

ABA is the gold standard for teaching new skills and behaviors while fading dysfunctional stuff.

My first question is who prescribes that? I have an appointment with a dev-pedi in early September. Will they decide about that? Or should I be going to an ABA center for evaluation and services?

Where I live, many of the kids getting ABA do it in special day classes. 

Also, it seems like it is very intensive therapy - 20-40 hours per week seemed to be the range.

40 is the accepted gold standard. But a lot of kids who are less atypical and impaired can do reallya well with half that or a bit more.

 will be in school 9am-3pm everyday. That will be a big adjustment for him already. And I'm afraid of taking away all his "being a kid" time for ABA therapy. 

What does "being a kid" look like? Does he do well with unstructured time? This is one of those things where you have to look at your own child, not one who is well developing and learning skills on their own through independent play on the fly. Most kids on spectrum do best with overt structure and rote instruction.

He does do well with unstructured time. He will play with his toys, do arts/crafts, "read" books, physical play. I do understand what you mean - he won't do well with 5 hours of unstructured time but he can self-direct for a couple of hours.

How much ABA is normal for someone with mild ASD?

What does mild mean to you? I know kids with an initial Aspergers dx, who have IQs above 140, who are reading and speaking like teenagers at 6 whose behaviors limit the sort of placements in which they can be included? Their parents wouldn't consider them "mild". I know kids who are mainstreamed but need a para to act as a buffer to keep them from harming other children. Their parents consider them mild. I know adults who were dx'd in their 40s and 50s, who have marriages and careers but are riddled with anxiety and depression. They are considered to have a mild presentation.

Mild is how the evaluating psych described him. I do understand high-functioning doesn't mean much. When I say mild, he is doing OK on self-care skills - was potty trained at 3, can help dress himself (some of it is a motor skills issue), can get himself a drink, feed himself, clean up minor messes (as much as a 4 year old is willing to).
Socially, enjoys playing with other kids, doesn't generally have any major issues getting along or with sharing or taking turns. Speech is most problematic in social interactions with his echolalia "scripted speech".
He is starting to show some aggression lately but haven't seen any  issues with other kids yet - at the park or summer camp.
Feeding is a new issue - extremely picky eating!

Short answer, he needs enough ABA to rein in the dysfunctional stuff that will impact his ability to be truly included. That could be 20, 15 or 8 hours. Ideally, ABA becomes a lifestyle.

I guess I will wait for the dev-pedi and see what happens. He will have had almost an entire month of his school schedule by the then so we can figure out where to fit it in.

I'd love to hear about general experiences with ABA as well.

You might want to get Patty Bashe's book on ABA for those with HFA and Aspergers-

https://www.pattyrbashe.com/

TIA!!!

Thanks!!

bliss611

Thanks ladies.
Great info to keep in mind as we move forward. His dx right now is from school board. And our insurance won't cover ABA with his ed dx.

I wish I had recognized his issues earlier and had him evaluated at 2.
Would have been so much easier to do ABA then- no school and I was SAHM.

With school, it's going to be so hard. And to make matters worse, I'm going back to work in September (home for 3 years dealing with what we thought was severe separation anxiety) so everything will that much harder to accommodate.

bliss611

Thanks auntie. Will look into those resources.

I'm thinking if the dev-pedi can prescribe the ABA, I'll wait until that appointment in Sept - it's only 6 weeks away. If they do, insurance will cover it. Then I will try to find a place that can provide at least some of it in his school during school hours.

greyt00

If you feel pretty certain you will be doing ABA, you might want to start researching ABA service providers now.  If you have insurance coverage (yay!), find out who is in network (if applicable).  Get more info on those programs and set aside time to do introductory consults.  The second we got a diagnosis I went full speed ahead evaluating 2 different places.  Within 2.5 weeks, our first choice had received DS1's intake packet, but it took 4 months to start services started.  I've heard from others that the wait list is even longer now.  This is a large and highly renowned facility, though.  Our second choice would have gotten him in more quickly, I think.  Apologies if you've already started on some of these steps, I just didn't see it mentioned.  As a self pay or insurance pay, I don't think we even had to have the diagnosis/dr. orders to get on the list.  We only needed the diagnosis if we were going to use state funds (another wait list).  

hopecounts

Agree I would start researching ABA options now.
That way you are ready to go when you are ready. Many ABA providers have wait lists that can be months long for new clients.

bliss611

Thanks greyt00 & hopecounts. I will start that asap.

No, I have not done any of that. Thought we would need some sort of referral/recommendation to get ABA. That's why love this board