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When considering ABA Services for Young Children (Applied Behavior Analysis), many providers offer services in the client’s home, while others offer clinic-based care or some combination of these two environments. Clinic-based care may be the right option for many individuals, but there are nuanced factors to consider when evaluating whether this environment fits your child’s needs. Whether in the clinic, home, or another setting, ABA therapy should always be individualized, assent-based, and autism informed.

ABA in the clinic or the home?

There are numerous reasons why home-based care is optimal for many learners, some of which include:

• A comfortable environment where individuals can access their preferred items and routines.
• Collaboration opportunities for caregivers and providers, supporting generalization of learned skills.
• An optimal environment for teaching self-care and daily living routines, such as dressing, grooming, and household chores.
• Teaching occurs in an environment where the individual uses learned skills most often.

 

While there are benefits to care within the home, a clinic-based setting may be a better fit for some as noted below:

• For children who have not yet started school, clinic-based services offer an environment in which they can develop comfort with routines outside the home.
• High-quality programs focus on building school readiness in addition to other individualized goals. Skills targeted often include:
  • Participation in group activities with individualized modifications (e.g., sensory tools, breaks, fidgets).
  • Cooperating with daily routines (e.g., snack, circle time).
  • Transitioning between daily activities.
  • Building relationships with peers and healthy boundaries.
• A clinic also offers an option for a child who has barriers to home therapy (e.g., home environment or schedule considerations).

 

A hybrid of environments can also be considered, with some hours focused on building skills in the home, while others allow the individual to build the earlier mentioned school readiness and social engagement skills in the clinic-based environment.

As a final note in discussing potential learning environments, a traditional preschool or daycare setting is at times the best option for a learner. In some situations, ABA supports can also be provided in these locations.

Intensity of Intervention

ABA Services for Young Children is typically an intensive intervention therapy and recommendations often range from 10-40 hours per week depending on the child’s needs and the provider service model. Individual factors matter and should be thoughtfully evaluated. Considerations include:

• Longer day: A longer day is contraindicated when individual support needs do not require this intensity of intervention.
• Fatigue: Often, younger children still take naps or benefit from a shorter day of therapy due to emotional and/or sensory needs.
• Shorter day: A shorter clinic day (e.g., half day) will allow more time with family, other therapies (e.g., speech therapy or OT), traditional preschool hours, or other extracurricular activities.

 

When does a longer day of care make sense? All of these factors are relevant to decision-making:

• When higher support is needed across skill domains.
• The child sustains energy and comfort throughout the day.
• The clinic offers a strong variety of routines and activities.
• The family has the scheduling flexibility to make longer hours a good fit.

 

Other considerations in quality ABA Services for Young Children:

• Goals are individualized based on areas of strength and needs.
• Care is assent-based. This means that compliance is not the focus. Rather, the environment fosters the child’s happiness, relaxation, and engagement. The child is taught to refuse and deny non-preferred activities and interactions, and these self-advocacy responses are honored!
• The day includes breaks, emotional and sensory regulation activities, and regular times to engage in preferred activities.
• Skill-building is embedded within natural routines and play.
• Visual supports are present and depict choices, routines, and safety expectations.
• Communication is provided to caregivers on the child’s daily activities, barriers, and progress.
• Programming includes consideration of preparation for fading services to a more inclusive environment such as a preschool or daycare setting.
• Home sessions and parent collaboration meetings are offered regularly to keep caregivers informed and to encourage generalization of learned skills.
• The supervising Board Certified Behavior Analyst (BCBA) is present often and collaborates with other service providers (e.g., speech therapists) to support continuity of care.

 

The Autism Society of North Carolina offers ABA therapy in the Triangle, Asheville, and Wilmington regions. We emphasize assent-based care, individualized goals, thoughtful intensity of intervention, and highlight self-advocacy, empowerment, and healthy boundaries. Please visit our ABA and Clinical Services page for more about our services, contact information, and where we offer both home and clinic-based care.

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