How much behavioral therapy does an autistic child need?
Updated: Sep 2, 2020
40 Hours per Week
"The best outcomes have been attained when a child receives 40 hours per week of behavioral treatment. Intervention should always be individualized, and some factors, such as a child’s age and current skill level, will influence the number of hours recommended. But, 40 hours per week remains the standard from which to deviate."
The success of ABA therapy relies on repetition in order for a child with Autism to learn and demonstrate new skills. Research has shown that 40 hours of therapy for a child is the crucial number in order to see significant improvement. That being said, studies have shown that 20-40 hours of therapy can be optimal for a child needing comprehensive intervention. If there are only a few specific skills or deficits that need to be worked on 10-20 hours may be effective.
Often young children will start with a full-time comprehensive therapy program and as they make progress the hours will be reduced. After a full evaluation with your child’s therapy team, suggestions will be made on what intensity of ABA therapy is best suited to them.
Comparing ABA to other Interventions
Today, there are as many choices in therapy as there are degrees of Autism. For parents, sometimes these options can be overwhelming. Despite the variety, when parents compare different therapies, the overwhelming evidence is almost always in favor of ABA.
For example, the Association for Science in Autism (ASAT), states:
Because ABA currently has substantially more scientific support than any other behavioral or educational intervention for children with ASD, ASAT recommends that families and professionals strongly consider implementing ABA and be cautious about other approaches. ASAT further recommends that professionals describe other behavioral and educational interventions as untested and encourage families who are considering these interventions to evaluate them carefully.
Given the great heterogeneity among children with autism, it is unlikely that all children require the same intervention, or even the same amount of an intervention.
Long-term studies indicate that about half of all children with autism make significant progress with early intensive interventions that require at least 20 hours per week. Other children make slower progress, with about 30 percent remaining minimally verbal at school age despite intensive treatment.
We might improve these numbers if we can home in on the active ingredients of a therapy, including dose, and how these factors vary by autism severity or traits9.
As we move toward greater personalization of therapy, we could apply a modular approach whereby some children receive one type of treatment (for instance, discrete trial training) for some treatment goals and another (perhaps a naturalistic, developmental method) for other goals.
Some children may need high intensity at first and then lower over time as they improve. A more economical approach would be to start all children at low intensity, assess each child’s response at a prespecified time and step up the intensity if the response is slow.
New research methodologies allow us to test these adaptive models.
Ultimately, these models may enable us to provide effective early therapy to all children who need it, including those with few resources or who live far from specialists.
Connie Kasari is professor of human development and psychology at the University of California, Los Angeles.