A child uttering a single syllable might seem inconsequential, but to the clinicians who work at University of Michigan’s Autism Consultation and Treatment Services (UM-ACTS) program, the little moments often trigger the biggest celebrations. “It is really rewarding when a five-year-old says something for the first time ever,” said Kristen Kalymon, Ph.D., Board-Certified Behavior Analyst (BCBA-D), and UM-ACTS program manager.
Breakthroughs like these in language acquisition and social interaction are the result of Applied Behavior Analysis (ABA) — a type of therapy provided by the UM-ACTS program at the University Center for the Child and Family (UCCF). ABA therapy is a specific approach to helping children with Autism Spectrum Disorder (ASD), and other developmental challenges, develop life skills.
According to Dr. Kalymon, ABA therapy is the only therapy endorsed by the U.S. Surgeon General to treat behaviors often associated with autism spectrum disorders. UCCF clinicians work with families to create specific treatment plans for each individual child using an empirically based system. ABA stands out from other forms of therapy because of its emphasis on setting tangible, measurable goals. The clinical care team at UCCF offers clients and their families a helping hand every step of the way – before, during, and after an autism diagnosis.
What is ABA Therapy?
According to Lawrence Kowalski, M.S., BCBA, supervisor of ABA services at UCCF, ABA practitioners use behavioral theories to encourage appropriate behaviors while also lessening negative behaviors. Researchers who study behavior see behavioral actions as three consecutive parts:
- Antecedent – the trigger of the behavior
- Behavior – the action itself
- Consequence – a positive or negative response to the behavior
In an ABA session, the behavior analyst will use different combinations of antecedents and consequences to reinforce each behavior. Each skill is repeated many times in one session.
Although the child works on skills during a therapy session, Dr. Kalymon said the ultimate goal is translating those behaviors to real-life situations. The clinical environment serves as a jumping-off point where the child can practice skills. UCCF will also pilot an in-home therapy option in the near future.
How Does ABA help?
ABA therapy at UCCF is highly individualized and each client goes through a detailed assessment before a treatment plan is devised. When setting goals, the family and clinicians work together to determine what skills are necessary for their child. Dr. Kalymon emphasized that every child is different, but some common intervention goals may be: the ability to communicate so basic needs are met; decreasing aggression; and understanding the norms of social interaction. For all children, learning is based on the ability to listen and imitate – skills that children with autism may struggle to acquire..
“Some children have delays in social skills, language development, or self care, so those are the primary things we would focus on,” said Dr. Kalymon. “If they don’t have the existing repertoire of listening and imitating, then we teach those skills first.”
Once the foundational skills of listening and imitating are mastered, the child can begin to build on them and practice using them in everyday life. Early intervention — seeking ABA therapy as soon as possible after an autism spectrum disorder diagnosis — is recommended as the best approach.
“There are a million opportunities per day to access those skills in a natural environment when you start earlier,” said Dr. Kalymon. “All of the research suggests the earlier and more intensive the treatment, the better.”
The UCCF Process – From Assessment to Pre-Therapy Consultation to Treatment Plans
UM-ACTS offers diagnostic evaluations for children and young adults from 12 months to 25 years old. Our Approved Autism Evaluation Center (AAEC) offers a gold standard approach to autism diagnosis. Following diagnosis, ABA may be one of a variety of recommendations made by our clinical team. Families interested in obtaining ABA services at UCCF meet with a clinician in a pre-therapy consultation, where families share their concerns and learn about UM-ACTS and ABA therapy.
After the pre-therapy meeting, ABA clinicians use the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), across multiple sessions, to comprehensively assess the child’s baseline skills. Part of the process is also taking the time to make sure a child is comfortable with the clinicians to get the most accurate representation of their skill level.
“We are assessing the child’s skill level across multiple domains – language, communication, adaptive functioning, and social skills,” Dr. Kalymon said.
UCCF clinicians look at how the child uses language, their social and play skills, and their ability to ask for what they need, and then connect their abilities to the corresponding developmental stage. Clinicians also use an adaptive behavior measure to measure the child’s daily life skills.
“All of that information we collect, plus talking with the parents, goes into developing the child’s treatment goals,” Mr. Kowalski said.
If ABA therapy is the recommended course of treatment following a pre-therapy consultation appointment, UCCF clinicians work with clients and their families to navigate the often complex world of insurance coverage.
The intensive nature of ABA is one reason it is so effective at helping children acquire new skills. Families should be ready to commit to multiple, 2-3 hour sessions per week. Time spent in therapy can range from 10 to 30 hours a week, depending on what is best for the child.
During every session, clinicians record data in order to track the progress each child makes. The plan can always be refined because there is a clear picture of what is working and what isn’t. This data-driven approach to therapy means it is clear when goals are met. The child continues to add new goals that build on each mastered skill.
“We set clear, measurable, observable goals,” Dr. Kalymon noted.
The UCCF Difference
Both families and children benefit from the access to UCCF services that accompanies their participation in UM-ACTS. Parents are involved in the therapy process, both clinically and at home, and the UCCF team is sensitive to the experience of the siblings of a child with autism. “We are able to combine traditional, behaviorally-based ABA with a family- and child-centered model,” Dr. Kalymon said. “We look at the development of the child and the needs of the family as we develop our goals and make sure their needs are met.”
One therapy session per week is designated for parents to attend so they can learn how to implement ABA techniques at home. Practicing with parents helps children become comfortable using their new skills at home or at school.
“Consistency, especially across parents, helps kids learn because we do the same thing every single time to try and promote a certain behavior,” Mr. Kowalski said.
Although it can be difficult to spend so much time away from home for therapy, UCCF clinicians believe the benefits of a center-based model outweigh the drawbacks. Center-based ABA is especially beneficial for children who will soon be transitioning into daycare or school because it helps them understand how to behave in those public settings. UCCF clinicians help them learn what those public expectations are and how to effectively deal with them.
What Happens Next? Life After ABA
Children stay in therapy as long as it is a beneficial fit for them. As they continue to meet their goals, they are often able to decrease the amount of time they spend in ABA sessions. Often children transition to a less intensive form of therapy, like a social skills group. If a child has mastered the skills they came to UCCF to learn, parents often feel comfortable continuing to practice appropriate behaviors at home on their own.
“ASD is a lifelong disorder so it becomes a conversation between the therapist and the family about whether they have achieved enough goals,” Dr. Kalymon said.
Whether you have questions about insurance, the assessment process, or just don’t know where to go next, UCCF is ready to help you take the next steps. UCCF is an Approved Autism Evaluation Center for Blue Cross Blue Shield (BCBS) and Blue Care Network (BCN).
What To Do Next:
If you recognize signs of an autism spectrum disorder in your child — or are in need of a re-evaluation or therapy for a child diagnosed with an ASD — please contact us so we can help you with next steps. We are here to help!
If you’re not sure what the signs of autism are, the National Autism Association provides age-specific guidelines.
Call (734) 764-9466 for more information or to schedule a pre-therapy appointment. Some services may have wait lists.