ABA therapy is an accepted form of treatment for ASD, and it's often given in the home. COVID-19 prompts the use of more tools, such as masks and gloves. Learn more about how in-home ABA therapy sessions have changed during coronavirus.
Why Invest in Therapy Right Now?
ABA therapy is a commitment. Insurance companies often cover some or all of the cost, but families must make time and space for the sessions. And they must reinforce key concepts when the therapist isn't there.
Families are under intense pressure now, and their to-do lists are long. But making space for ABA therapy makes sense.
Discussions around ASD often focus on behaviors. We look for autism signs such as:
• Cognitive impairment.
• Language or communication difficulties.
• Repetitive behaviors.
• Social impairment.
But some parts of ASD remain hidden. The Anxiety and Depression Association of America says, for example, that 40 percent of young people with ASD have clinically recognized forms of anxiety.
A child with ASD may not talk openly about fears and worries, but they remain. And those concerns can grow during these uncertain times. Children with ASD may not appreciate the schedule changes that come with COVID-19. And they may hear worrying bits of data about the situation on television or radio.
Routines are comforting for people with ASD, experts say. That's especially true if the routines are structured and measured.
An ABA therapist can contribute through:
• Routine appointments. The child will have therapy on a set schedule that's built into the family's weekly habits.
• Structured conversations. ABA offers real, tangible steps that can help a child progress to a larger goal. The therapist and child may not talk directly about feelings, but a child may gain confidence in small tasks, and that could help overwhelming worries to fade.
• Family respite. Parents may need to participate in some forms of ABA. But during most sessions, they can rest and watch, rather than taking action. This could be a break that some stressed parents really need.
Adding anything to a family's financial or emotional budget is difficult during these trying times. But therapy could be an investment that's well worth the initial cost.
How ABA Sessions Work
ABA isn't meant to be prescriptive. Instead, it's a collaborative form of therapy between a mental health professional, a child, and that child's caregivers. Since the care is so personal and customizable, it can look very different from one patient to another. But a few fundamentals remain constant.
Typically, an ABA program involves:
• Goals. The team determines what the child should obtain from therapy. Common goals include stopping self-harm, communicating clearly, or reducing toilet accidents. Those big goals break down into small tasks the therapist tackles in sessions.
• Prompts. The therapist prompts an action, such as, "Put the yellow block on the table."
• Assistance. The therapist can help the child understand what the prompt means and how to accomplish the task.
• Reinforcement. When the task is complete, the therapist gives a verbal reward for a job well done.
• Repetition. This sequence happens again and again until the child has mastery of the concept and is ready to move on.
Research suggests that as much as 50 percent of kids with ADA can learn enough to return to mainstream classes if they receive intensive, frequent ABA therapy sessions.
These sessions can be given at home with tools the family has nearby. And they can be repeated as often as necessary for the child to learn. It's not uncommon for therapists to come every day to work with a child in need.
COVID-19 Changes In-Home Visits
The coronavirus poses a national health risk, and as a result, agencies have released strict guidelines about how individuals, businesses, and health care providers must respond to protect the common good.
All of those guidelines apply to ABA practitioners. They should not stop the therapy altogether.
The Centers for Medicare and Medicaid Services asked all health care providers to immediately review procedures to ensure infection control. That means most are examining their:
• Use of gloves and masks.
• Disinfection protocols.
• Social distancing requirements.
• Telemedicine opportunities.
Some cities and states have opted to enforce so-called "social distancing" measures. These prompt the cancellation of most large events, and they can close the doors of restaurants, movie theaters, retail outlets, and other non-essential businesses.
Social distancing, experts say, is designed to eliminate close contact between people. Six feet is considered the gold standard, and most people are encouraged to keep that space between them.
An ABA therapist and patient can follow that six-feet guideline. A professional can sit far from a child and still offer encouragement and support. Much of ABA's work is verbal, and it requires no touching at all.
For those students who do need touch, gloves and masks can protect the therapist, and that can keep germs from passing to the child.
After visits, experts say, families can further protect the family through a thorough disinfection of high-touch areas, such as:
• Door jams.
• Tables and chairs.
• Bathroom surfaces.
Families can ask the therapist to wash hands immediately upon entering the home. They can also offer a spot for shoe removal, so the therapist doesn't track germs into the house.
These steps do take time, and it can seem a little unusual to work with a therapist wearing a mask and gloves. But for many children, in-person therapy remains the best way to achieve results with ABA. Taking these measures is critical.
Other Options Are Available
For some people, no matter how many precautions are available, allowing someone into the home during COVID-19 is just too risky. Families are under intense pressure, and they should do what they feel is best.
Some medical providers are experimenting with telemedicine techniques. These approaches allow therapists and their patients to interact via a web camera or video chat, so they never share a physical space. Many insurance companies are relaxing policies regarding telemedicine reimbursement, so this model may gain traction as COVID-19 drags on.
This isn't the right approach for every family or every child. But if the choice is telemedicine or no therapy at all, it could be a good option.
Signs of Autism. National Autism Association.
Anxiety in Autism Spectrum Disorder. Anxiety and Depression Association of America.
Maintain Routines. Autism Focused Intervention Resources and Modules (AFIRM).
The Top 10 Reasons Children with Autism Deserve ABA. (2011). Behavior Analysis in Practice.
CMS Issues COVID-19 Guidance on Infection Control, Protective Equipment. (March 2020). American Physical Therapy Association.
Coronavirus, Social and Physical Distancing and Self-Quarantine. (March 2020). Johns Hopkins Medicine.
Coronavirus (COVID-19): Social Distancing With Children. (March 2020). The Nemours Foundation.
Practice Guidance for COVID-19. (March 2020). American Psychiatric Association.