Do you provide assessment?
We do not diagnose autism, although we do provide a comprehensive behavioral and language-based assessment once a qualifying diagnosis is made by a neuropsychologist.
Do you provide counseling?
We do not provide counseling, talking therapy, or mental health services. Please seek the services of a Psychologist, Clinical Social Worker, Clinical Professional Counselor, Marriage and Family Therapist, or similar. We treat children, teens, and adults diagnosed with Autism Spectrum Disorder (ASD) ages 1-22 using applied behavior analysis (ABA). While we work with individuals that also have other diagnoses (e.g., ADHD, OCD, ODD, etc.), ASD must be indicated as a qualifying diagnosis for purposes of insurance coverage.
Where can I go to obtain a comprehensive report specifying an ASD diagnosis that will be accepted by most insurance?
A prescription or note from an M.D. (e.g., a Developmental-Behavioral Pediatrician) that specifies ICD-10 code F84.0 Autism Spectrum Disorder is a great first step. Many insurance companies require additional documentation to justify the diagnosis, in the form of a more comprehensive assessment that incorporates a battery of diagnostic tests. These reports are frequently done by a Neuropsychologist or a Clinical Psychologist. There may be long wait lists for a diagnostic evaluation by a Neuropsychologist, so it is best to call around.
Where do I go to find resources (e.g., Neuropsychologists, Speech Therapists, Occupational Therapists, etc.)?
While we do have good working relationships with multiple providers from a variety of disciplines, it is best to determine which providers are in-network with your insurance company, and take the time to reach out and speak with the provider to determine best of fit with the needs of your child. Sources Magazine, UNLV Resource Guide, FEAT of Southern Nevada – among many others – provide a local list of community resource providers.
What does ABA therapy look like?
1:1 ABA therapy will be delivered by a Registered Behavior Technician (RBT) under the supervision of a Board Certified Behavior Analyst (BCBA) and/or a Board Certified Assistance Behavior Analyst (BCaBA). Therapy may look fun and similar to play early on, as the therapists pair themselves with reinforcement and make it more likely for the child to want to work for them. The therapists will incorporate task demands and current programming goals into their instruction so the child may be unaware they are “working.” We do this to prevent ratio-strain whereby task demands are too high in relation to reinforcement provided. This may result in challenging behavior and damage the therapeutic rapport with the therapist. When teaching language and communication, the RBT will help the learner to request for things the child may want, vocally label, receptively identify, echo sounds/words/phrases, and teach conversational speech. All goals and programming are developed in conjunction with the family.
Are all of your staff certified, registered, board-certified, and licensed?
Yes. We do not employ any clinical staff who are not certified. The state of Nevada further requires all BCBA’s be licensed as LBA’s and all BCaBA’s be licensed as LaBA’s. The state ABA board requires RBT’s also be registered with the state of Nevada (double registration).
Why are there different approaches to ABA and what is best for my child?
- There is not a specific set of procedures or protocol when implementing ABA. The reason for this is to first understand that we teach each child as an individual using the science and methodology of ABA. For instance, there is not a recipe to treat aggression since aggression may be maintained by attention, escape from demands, or denial of a preferred item or activity. If a child has a tantrum at school so he can escape the work tasks presented, sending him to the Principal’s office would reinforce that behavior since the child does not want to be in the classroom. Therefore, we must understand the function of each behavior we target and have interventions that match the function.
- There are several approaches in the field of ABA that include a Lovaas approach, Early Start Denver Model (ESDM), Pivotol Response Training, Verbal Behavior, among many others. These approaches use behavior procedures such as discreet trials, natural environment teaching, chaining, and many other techniques. Specific procedures selected are empirically validated and well researched and published in the field of ABA. There are differences in how therapy is delivered across the various approaches.
- Achievable Behavior Strategies modifies our approach to the needs of the individual learner with flexibility to use the best empirically validated procedures specific to the learner. We utilize discreet trials but may apply it in the natural environment. Therapy may occur at the table or on the floor – every moment is a teachable moment. We follow the child’s motivation when teaching to make learning fun, but may also work on compliance training procedures keeping a high ratio of reinforcement and quickly fading out prompts. We pair the use of edibles with social reinforcement and quickly fade out so that social praise alone will eventually become a potent reinforcer. We do not wait to establish learning to learn behaviors before teaching necessary skills, since we embed our behavior intervention into our procedures so that we can demonstrate progress with skill acquisition targets immediately, while addressing challenging behaviors in the moment. We focus on teaching the various verbal operants and functions of language since acquiring vocal speech is important for most of our learners. We use positive interventions and always use the least restrictive procedures. Reinforcement is abundant and we use behavior momentum and antecedent strategies to gain compliance quickly minimizing the likelihood of challenging behavior.
Will my child learn to talk?
We can not make promises, guarantees, or predict the future as there are variables well beyond our control (e.g., age of learner, intellectual disability, apraxia, learning history, rate of acquiring skills, etc). However, we have lots of success teaching language and communication to our learners who previously had limited speech or no speech at all. For some learners with no vocal speech, we may initially use augmentative communication (e.g., PECS, Sign, an iPad with Proloquo, etc.) but always pair vocal speech with its usage (total communication). We use behavior analytic language assessments well established in our field (e.g., ABLLS-R, VB-MAPP, etc.), and empirically validated strategies to teach the language-based goals derived from those assessments.
What is the Behavioral Health Center of Excellence (BHCOE) and why is that important?
The BHCOE is an international accrediting body specific to the delivery of ABA. The process is rigorous and includes an analysis of all agency policies/procedures and internal processes, a clinical interview, satisfaction surveys of parents and employees, on-site observations of sessions with fidelity check and review of clinical files. A provider with BHCOE accreditation adheres to the best standards of practice in our field, so you can be rest assured the provider has a focus on delivering top quality behavior analytic programming. Visit their website to learn more: https://bhcoe.org/
How long are sessions and how many hours of ABA are recommended?
- Treatment intensity varies for each child. Typically, the younger the child the higher the intensity since early intervention is well-supported in the literature. It may also depend on the type of treatment plan being developed (i.e., comprehensive treatment versus a focused treatment). Comprehensive treatment often involves an intensity level of 30-40 hours of 1:1 direct treatment a week. This is based on research findings required to produce good outcomes. For focused treatment, we have a minimum requirement of at least 15 hours a week of direct 1:1 treatment a week.
- Duration of treatment is managed by evaluating the learner’s response to treatment. Session duration can range from two hours to six hours. Sessions may also be broken up (e.g., a morning and afternoon session) depending on the child (e.g. the child requires a nap in-between sessions).
How much can I participate in my child’s treatment?
We highly encourage parent participation. In fact, most insurance companies require it along with working on parent goals. Parents are encouraged to watch sessions so strategies can be incorporated and generalized to the home since the parent is the one who works with the child for most of the day. Our state of the art clinic has patient observation cameras with full audio capabilities in the event that a parent’s presence in session escalates certain behaviors in the child.
Do you provide services in the home?
Our services are primarily clinic-based and school-based (for charter or private schools that allow us to provide ABA therapy). We do not provide home-based services; however, we may temporarily on a short-term basis, work in the home environment depending on the situation. For example, we may conduct toilet training in the home to generalize this skill that was acquired in the clinic. We may teach a teenager functional life skills that may involve bathing or cooking that can only be taught in that specific environment. However, these situations are rare and most skills are successfully taught in the clinic. In fact, we have found faster skill acquisition and decreased challenging behavior when delivering ABA in the clinic where children have access to a huge selection of teaching materials and stimuli, other children they can interact with in an controlled environment, and ongoing support from other RBT’s and BCBA supervisors.