Early Behavioral Treatment Helps Kids with Autism

With applied behavior analysis, an intensive but costly treatment program, many autistic kids can lead normal lives. Here’s what parents should know.

When Susan and Joe Butler’s son, Collin, was born, he seemed normal and healthy. By the time the South Carolina boy was 14 months old, his parents were worried. Something seemed terribly wrong.

The toddler was talking less, no longer using words he’d known a few months earlier. Instead of communicating verbally, Collin threw tantrums. It took multiple visits to a pediatrician, and testing by a specialist, for the diagnosis — autism spectrum disorder (ASD).  

When parents hear that news, they sometimes begin a frantic search for solutions, grabbing at straws. “There are a lot of unproven, fad treatments that supposedly can help autism,” says Michael J. Morrier, PhD, assistant director of the Emory Autism Center in Atlanta. He recommends a therapy known as applied behavior analysis (ABA), which, he says, is backed by research and evidence.  

Collin Butler is an ABA success story. After several years of therapy, his communication abilities and social interaction improved dramatically. By the time he entered third grade, he was functioning appropriately in school and no longer needed it. Collin graduated from the University of South Carolina and has since founded Autism Wishes, helping to fulfill the dreams of children with autism.

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What is autism spectrum disorder?

The autism spectrum covers a range of complex neurodevelopment disorders, and children and adults with the diagnosis have very different levels of functioning. It’s characterized by communication difficulties, restricted and repeated patterns of behavior, and, especially, impaired social interaction. According to the Centers for Disease Control and Prevention, it now affects one in 44 children in the U.S.

A baby with autism may not respond to people nearby and focus intently on one item for extended periods of time. Some children, like Collin, appear to develop normally for a while before showing signs of autism. Researchers haven’t figured out what causes autism, but it’s likely that both genetic and environmental factors play a role.

What is applied behavior analysis?

ABA can help youngsters with ASD improve basic skills like looking, listening, and imitating. It also helps them develop complex skills necessary for success in school and adult life — including reading, conversing, and understanding another person’s perspective. The therapy is based on understanding behavior and how physical and environmental influences can change behavior.

While there are various forms of the therapy, all use basic principles and techniques. They reward appropriate speech and interactions and withhold rewards for inappropriate activities and avoidance behavior.

A 2020 review of the evidence for early intensive ABA to treat children with ASD concluded that it improved parents’ assessment of their child’s behavior after two years and improved cognitive skills after one year.

After diagnosis, medical providers often recommend ABA and provide resource information about the therapy. Emory’s Morrier also advises checking out Autism Speaks (a non-profit advocacy group for people with ASD) and its guide to understanding the therapy.

Starting the therapy as soon as possible after a child is diagnosed is important. “If a child with autism has ABA before the age of five, when they leave treatment about one-third of them will be indistinguishable from their peers,” Morrier says. “They will still have little traits of ASD but, for the majority, most people wouldn’t know they have autism.”

The therapy starts with an evaluation to pinpoint the autistic child’s specific strengths and needs. Afterwards, therapists develop a plan to focus on ways to work with the youngster individually on developing appropriate behavior.

“For example, if a child with ASD is not talking, the way to teach him may be a little different with various forms of ABA, but all reinforce communicative attempts and don’t reinforce no communicative attempts,” Morrier explains.

“An ABA therapist may hold up a flash card with the word ‘ball.’ If the child says the right word, he gets the ball. In another form of ABA, the child may be playing with a ball, and a therapist will hold the ball until the child says the correct word to get it back.”

Depending on the needs of both the family and the child with autism, a therapist may come to the home to work with a child for seven or eight hours most days of the week. A child may also go off-site for therapy. Some off-site programs embed treatment within normal childhood activities.

At a daycare center within the Emory Autistic Center, two-thirds of children have a diagnosis of autism while another one-third are developing normally. By having normal youngsters in the same daycare setting as kids with autism, therapists can work on teaching the autistic youngsters how to interact with normal peers in typical preschool activities. The children remain in the program for 12 months, until they leave for kindergarten and public school.

For some families, a therapist may come daily and work with the autistic child and a parent within the home. When both parents work, this approach may not be practical. “However, all good ABA programs involve parent participation and give parents strategies they can use with their child at home and in the community,” Morrier says.

ABA therapy typically lasts for several years. At the Emory Autistic Center, some autistic children may respond after one or two years, while others take three or four. “Every child is different,” Morrier explains. “No one knows why some kids respond better and faster than others.”

Paying the bill

Because ABA involves so many hours of therapy a week, often for years, it is expensive. One study found that it costs an extra $1.4 to $2.4 million to raise a child with ASD over a lifetime, on top of the usual costs of raising children.

For those who qualify for Medicaid, benefits for autism treatment are now mandatory, and all 50 states require that private insurers cover ABA. Some employer plans, which operate outside state rules, may not. There may be free services available through public schools, however.

The bottom line: There’s hope for people with ASD to interact with the larger world. They can learn to behave like other children, Morrier notes, and might not seem to qualify for the diagnosis when retested.

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