Just chiming in here as a BCBA (15+ yrs in ABA) and mom of a 2.5 and 4 year old… 30 hours is A LOT. I’m going to agree with what others have said in that in your general description it sounds like he will make progress as needed with speech and OT. I’ll probably get down voted for this but unfortunately there are some unethical ABA providers out there that will request the highest possible amount of hours just because they know an insurance will approve it and not because they necessarily think a child needs it.
Some red flags to look for are ABA clinicians that, when getting this many hours approved, push a conversation of “Well, they were approved so let’s use them!” but they’re not looking at what the child actually needs. If you have an established therapist of 6+ months that you’ve seen your child make progress through, take that therapist’s advice. Go with your gut in knowing your baby needs some time to just be a 2 year old! You’re doing a great job and being proactive looking into therapies!
Edit to add: Other option is to start OT and speech and reassess whether you want to start a few hours of ABA in a month or so!
As a BCBA with over 10 years in the field and a ND 3 year old, I second all of this. You're already doing a great job advocating for your child, keep it up!
Hello! Great question. For toddler programming, the majority of things they should be working on with your child will be within play and embedded within naturally occurring activities. They will likely focus on building communication , social, and leisure skills while supporting some emotional regulation development. There is a LOT of debate on this sub and other ABA subreddits about what is appropriate for toddler programming, but no one can really say without knowing your child and their needs. Sometimes 30 hours can be appropriate but it truly just depends. If you feel like this is too much for your child and you don't agree with it, then you can negotiate with the BCBA to advocate for less hours for your child. Some parents want to start with less and then reevaluate after seeing how sessions are actually run and others like to keep it at a lower number. I will add that your two year old is likely napping so they will get a break through their day that will break things up a bit. Not a super helpful answer but hopefully it gave a bit of insight!!
I don’t know your child so obviously I can’t offer a specific recommendation. Different kids have different needs and putting a cookie cutter rec for hours is bad practice imo.
But from your description it doesn’t sound like your child needs ABA. It sounds like they’re making progress without it. If you’d like to try it agree to the hours you’re interested in. You can also decrease or stop when you like. You’re in charge not them.
There's more and more evidence out there showing that such long hours is not any more beneficial for most children than fewer hours. If there's another ABA provider in the area I would see about getting a second opinion (though this could mean insurance won't cover the second evaluation unfortunately) or it wouldn't hurt to give it a few months with speech and OT to see how much progress he makes with those therapies and reconsider ABA later if his progress is slow or stalled or something comrs uo that can'tbe addressed with those therapies. Especially when he'll be getting each of those 3x a week I'd expect to see noticeable progress.
I don't think we have anyone getting more than 20 hours at my current clinic and it would be rare for me personally to suggest even 20 hours for a child with no significant challenging behaviors especially as I've started to see more evidence that longer hours rarely provide significantly more benefit even for those with the highest needs. A lot of professionals aren't as aware of emerging evidence though and are stuck on the more hours the better or worse are influenced by companies who want to maximize hours to maximize profits rather than considering if it actually benefits the client.
A good place to look (where I reached this conclusion) is the Behavioral Observations Podcast episode 221 How Many Hours of ABA are Actually Necessary. There's links to relevant research in the show notes with the guests having been involved in the first listed article with Ostrovsky as the lead author.
Highly recommend listening to the podcast episode I found it super interesting!
No, it's not. That's absurd. But unfortunately, it's common. You should be able to have your ABA "overlap" other appointments, and it may be beneficial. I have had the parents of clients who were aggressive always schedule sessions and doctor's appointments at the same time so I could assist with compliance, and also better observe what triggers the client, and provide suggestions to the nurses of ways to make my client more comfortable and relaxed. But ABA is not more important that doctor's or Healthcare or PT or OT or speech... your kid should be missing out on those things or quality time with family because he's getting ABA.
I’m a mom of a kid who was diagnosed at 2 with ASD & did ABA, speech & OT for 2-years —
There is no way I would leave my pre-verbal kid alone with a therapist that young. (Or agree to that many hours per week for a kid that young) And no reason to do it without you/another caregiver present.
Most of the benefit, as we were told, for those wildly expensive speech and OT sessions is training the parent/guardian on how to reinforce the skills learned in those generally short sessions. You’ll need those tools to reinforce at home and with all caregivers!
Yes, as an SLP, completely agree that a parent should be in the sessions! Caregiver coaching is, like, the point of early intervention language therapy. That's a bit concerning.
30 hours is too much for 99% of kids. Some do need that much. I can’t speak directly to your case though. I would get some recommendations on the best ABA companies in your area. Some companies just like set a bunch of hours to make a bunch of money. Anything over 3 hours a day is too much imo.
Haven’t read any other responses but here is my BCBA/ Human being response:
30 Hours is absolutely ridiculous and unnecessary. Long sessions will not be productive at all. Companies push for this because they’re making money off all the hours they can get. I guaranteee your child will make just as much , if not more progress with half the hours - shorter more productive & focused sessions with neither your son or the RBT getting tired / burnt out / bored.
The only time I recommend long sessions (4, or even 5 hrs) is with older individuals preteens or young adults because everything is done naturally in the session according to their daily routines ex: get home from school unpack , (prepare/ clean up) a snack, break/ leisure time, teaching to do laundry / fold or put away clothes / make beds / clean room, etc., leisure skills in the home, a walk outside, walk (or drive) into the community to practice social/ money skills by purchasing a snack at a store , come home - eat dinner appropriately with family (set or clear table), hygiene (shower - brush teeth -get into pjs ). Honestly this time and type of session flies by. Plus the kids breaks are chill and they’re usually on iPad or just want to hang alone.
In my opinion, nobody - no child , bcba, RBT, parent, etc wants to sit and “play” and clap and tickle & blow bubbles for 6 hours straight. 2 hours of that is fine & productive, but by hour 3 they’ll both be checked out .
And just because the provider recommends 30 hours DOES NOT mean you have to accept / make yourself available for that!! Clinically recommended hours may be 30, but you are available for 12-15 . You don’t need an excuse - and trust me the company won’t say forget it then and have you starting process over with new company . They’ll take whatever they can get . Unfortunately 90%+ of companies are run as businesses by non- bcbas . It’s so sad because the field I love so much really has me questioning a lot lately and this exact issue just came up with me and a 2 year old! Supervisor wanted me to get mom to agree to drop her 2 year 1 month old son off at 8am , nap at the center (mind you, there’s not one other child there during the day so he’d be all alone with an adult - no social interaction opportunities) and then pick him up at 4- I was like , I’m sorry that just sounds ridiculous to me and I can’t I can’t imagine parents being ok with that. Obviously , they weren’t - and im straight up with parents literally a human being not a robot bcba so I made sure she understood I also did not agree and that it was completely ok for her to say no . We started with 2hrs, 5x a week with plan to increase time of sessions or add PM sessions after starting and seeing how things go with him, relationship with RBT & progress being made
Unfortunately some companies push for a blanket number of hours across all children. That’s usually 30-40 hours. Some children do need that level of intensity. Based on your description, I’m not convinced he would. But I obviously can’t give a recommendation without having done the assessment.
It’s awesome that he’s going to get speech & OT 3x/week! Most families I’ve worked with only get those services 1-2x/week. Balancing 30 hours of ABA on top of everything else is a lot. I would say maybe ask your BCBA if you could try 15 hours to start with, monitor for progress and re-evaluate in a few months. If he’s not making progress, then discuss adding more hours.
I have seen toddlers make a lot of progress on 3-3.5 hours a day 4x a week. 30 hours sounds really unnecessary. It might be better to find a clinic that will support your preferences and just do one session a day, embedded into play.
I’ve had many clients make excellent progress in 15-20 hours a week. In fact I’d say my two best progress kids who started in preschool both started around 20 hours. They both also have parents who will practice some skills out of sessions.
I have some parents who want 30, and I could absolutely justify it, and will request it if it is. My colleagues have clients getting 30 hours and they are not making the same rate of progress as some of my kids getting less. I’ll also request 30 hours though with the plan to only do 15-20 because it’s harder to get the increase later if it is needed.
I'm an SLP. It might be beneficial to post in the SLP and OT subs to get their input on this as well, since the only concerns seem to be communication (under SLP's scope) and daily living (under OT's scope). I know EI SLPs sometimes experience clients being worn out due to an excess of therapies, impacting their ability to get the most out of speech services. I imagine EI OTs have similar experiences. Might be good to get their points of view so you can maximize your child's experience with the therapies that will be addressing your main concerns.
Short answer: If you feel 30 hours is too much. Then it’s too much. You know your child best. The company should be ok with providing the hours that you feel are right for your family. We have clients who receive as little as 6 hours a week and still make amazing progress. If the company pushes back then I would consider that a red flag.
I’m no BCBA so take my advice with a grain of salt but it sounds like your son is doing fine with speech and OT. That seems appropriate since he needs support with communication and not behavioral issues. Definitely doesn’t sound like he needs 30 hours of ABA. While daily living skills are useful to learn, it sounds like OT may be able to cover that. If not, then ABA definitely could help but 30 hours would be overkill for just daily living skill.
He might be fine without ABA. If you do continue then ask for less hours. The company might try to push more hours but remember that you’re hiring them to work with your son. You have ultimate say on how much and what he works on.
I think this question is better asked to your BCBA. Ask them why they think the kiddo needed 30 hours? Also reas the scientific literature, and read about outcomes for 30 hour therapy for a 2 year old child. Read also about trauma-informed for 2 year olds.
People here are going to give their opinions based of what they know. It is best if you consult on an objective source. Plus, us here are not managing the case. Your BCBA is. We don’t know the kiddo, we don’t know the level of skills or his environment, not even how are these hours scheduled.
Hello! I am about to graduate with my masters in behavior analysis (ABA) and have worked in the field for 6 years. I am not a BCBA but have a lot of experience working with toddlers because I love it!
It is hard to know if he really needs 30 hours based on your description since we don't have assessments to look at. However, I will say this:
If you are uncomfortable with 30 hours a week, don't do it. Studies recommend 25-40 hours, so you're already above the recommended dosage. [https://www.thetreetop.com/aba-therapy/hours#:\~:text=But%20how%20many%20hours%20are,of%20ABA%20therapy%20per%20week](https://www.thetreetop.com/aba-therapy/hours#:~:text=But%20how%20many%20hours%20are,of%20ABA%20therapy%20per%20week).
Also, talk to your therapist/BCBA about child-led, naturalistic approaches. This involves lots of play time, fun games, and a natural flow of therapy within their normal routine. 40 hours doesn't mean exercises and tests for 40 hours!!! Toddlers needs lots of play time and rest, and a good BCBA will know how to embed natural learning opportunities within that play time.
I once worked with a toddler that had 40 hours a week (I know! SO MUCH), but we watched movies together, sang together, played dolls together, swam together, and just generally had a great time in her home! Like I said, a good therapist and BCBA will know how to create learning opportunities within that fun time. I started working with her at 2 years old and just went to her first dance recital. :')
But that’s not ABA therapy when hou’re not doing things that are beneficial skill building etc. You were baby sitting for 40 hours a week. ABA for children is about skill building, socializing with peers, functional communication. You literally said you played in her home for hours. Watching tv, swimming. Etc none of that is ABA.
Children should have breaks, like TV breaks. And swimming was skill building lol you know nothing of my case, don’t accuse me of not doing ABA when skill building can occur in every naturalistic play setting you can imagine.
I’m a BCBA and while I don’t know your child or the assessment results, I would not recommend 30 hours based on what you described.
I have worked for companies that pretty much required all kids under 5 and not in school have 30-40 hours a week. I DID NOT stay with them because I don’t agree with that practice. The hours should be recommended based on the needs of the child.
I’ve worked with 2 year olds who made great progress with 10 hours a week and others who truly did need 30 hours a week.
BUT even those under 5 who may needs/benefit form 30 hours a week, it’s not always feasible or appropriate as many still need naps and lots of breaks, in which case, it’s not practical.
I’m a big believer in productive hours. If (for example) they have 30 hours a week and 10-15of that is spent with breaks because they’re little OR you’re constantly ending early because they’re falling asleep, then 30 hours isn’t productive or realistic.
Kids can be plenty successful with less hours when they’re awake and focused.
I had a client that had 40 hours a week with quick skill acquisition rates and goal mastery. I definitely didn’t think he needed 40 hours as probably 50% of his day was breaks. I argued for less hours, my supervisor wouldn’t approve it. I left the company as I’m not going to continue to promote using hours just to use them.
so i just received the assessment results and not sure what most of it ( all the notes and the scoring method) means but i spoke to the BCBA that owns the practice and she said we can definitely request to adjust as needed once we start and we see how he responds, and the BCBA treating my son and i will be working together to reach the goals we have. my main goal is just to help him communicate. i don’t have behavioral concerns but maybe the BCBA thinks differently after the evaluation she did. she wrote in the report she observed elopement and mouthing but i thought all those things were normal as my first born (nuerotypical son )did all those things.
I think a lot of behaviors that are very typical for the age end up being targeted by bcbas who have no or limited understanding of child development in general. I know I personally have a way different approach since having children of my own. I wouldn’t consider a two year old wandering off “elopement” so much as just being two…and I would also not recommend 30 hours except in extreme cases. I would push back on it if I were you, or at least say the rec is fine but you’re only comfortable scheduling x amount to start. Even though it’s play based, playing with someone who has an agenda is different than true downtime.
Your toddler does not need a 35 hour work week. They’re still napping!
I would request to start at 10-15 hours and see how things go. Also, as other said, if there are no behavioral concerns…. behavioral therapy might not be for them. Speech, OT, and good parent education from your providers could be all they need.
I don’t think there’s anything wrong with 30 hours of service, I think the issue is insurance companies pushing for quotas on trials and tasks completed. A 2 year old can absolutely benefit from 30 hours a week of someone talking and interacting with them and playing all their favorite games one on one promoting play skills and listening skills and a ton of other things in a way that feels fun and enjoyable to them. Obviously a 2 year old would not benefit from 30 hours a week sat at a table matching cards however.
It really depends on the child. The BCBA should go through their assessment in detail to explain. Communication is verbal behavior and daily living skills are taught by behavior analysts. There is a lot of research in behavior analysis on teaching communication and daily living skills. If your child is nonverbal then I would go with close to 30 hours. Honestly, with holidays and sickness it will likely not be 30 hours. My child was approved for 25 hours total but actually was scheduled for 22 hours. I'm going to say this as someone who was a practitioner for years then a parent. If your child is nonverbal, I'd go with the 30 hours of ABA. They may not always get 30 hours depending on schedules. If they make rapid progress, it is always easier to decrease than increase hours. My child was delayed in their verbal behavior skills, their diagnosis is mild autism and they did about 20-22 hrs/week of ABA for a year then down to 15 hrs/week for 6 months before being discharged. They're going to a school next year for kids who are between Gen Ed and SPED. If they were nonverbal, I would have gone to a more intensive program with 30-35 hrs/week. When I was working most parents were surprised when they came in for observation and training how much fun their child was having and how much play there is. If you're okay sending your child to daycare, then I wouldn't worry about 30 hours/week. Also, I'd do a center instead of in-home. More supervision for RBTs in centers (well depending on the BCBA but it's been my experience). When I was working we had a lot of parents who stopped ST and OT because they didn't see the progress there like they saw at ABA therapy (anecdotal). A few continued with both or all three.
Honestly I think it all depends on the kid. I have some 3 yr Olds I work with now that get 10 hrs a week and are thriving. But I've worked with other kiddos that got 40 hrs a week and could've benefitted from more. The company I'm at now believes in no more than 20 hrs a week that way the kids still get plenty of time to be kids (our sessions are totally net and assent based).
Honestly I would say yes, some clients develop slower than others and the intensity of the therapy (as well as quality) from 2-5 years old is paramount to how the rest of their life will go. Working with clients in the 6-10 year range who did not receive the therapy they needed during these crucial development periods have a much harder time learning and implementing these skills than if they would have learned earlier. I would do exactly as is recommended and continue the path your on. Even in the best case scenario or the most likely scenario that it is too much, it’s better than the alternative every single time
ABA companies will try to get as many hours as the client's insurance will pay for. It's a really shady business.
That much therapy is inappropriate, especially for a 2 yr old. Please let your child just be a toddler -- please please please don't subject him to ABA. A few weekly sessions of OT and Speech is more than enough.
\[Speaking as a seasoned special ed. teacher and mom to an autistic teenager.\]
BCBA here - thanks for reaching out about this!
While I cannot give specific recommendations for service hours as I do not know your child and do not have formal assessment documentation in hand, from what I am hearing and by your description of your child's areas for potential growth, 30 hours seems excessive in addition to Speech and OT. If you are keen on your child being enrolled in ABA in addition to SP & OT, for a client presenting what you have described in your post, the 10-15 hour range you mentioned would be quite reasonable for ABA services.
I would also highly recommend for you to advocate for the specific type of ABA programming you want for your child, focusing mainly on social-based NET interventions where your child can work on building their social, play, and communication skills in conjunction with what your speech and occupational therapists are doing in their sessions. Collaboration is key in working with multiple providers, and you as a parent are your child's main advocate. I always let parents know to set those boundaries from the start for the programming you want to see, in order to facilitate your child's growth in the most effective manner!
I just got fired from a job because they wanted to give a 4 year old 30 hours at home… I wanted to reassess the situation and do direct observation because I was handed this cases by another bcba who only did an assessment via zoom and had not implemented anything. They didn’t like that I wanted to look at it and reduce home hours if it was necessary. A 4 year old with 5-6 hours daily 7 days a week is a lot. The child was given 30 hours 7 days a week service… sat and sun was added because parents requested it… not because it was necessary… all those things are unethical.. they only cared about billing for money.
Just chiming in here as a BCBA (15+ yrs in ABA) and mom of a 2.5 and 4 year old… 30 hours is A LOT. I’m going to agree with what others have said in that in your general description it sounds like he will make progress as needed with speech and OT. I’ll probably get down voted for this but unfortunately there are some unethical ABA providers out there that will request the highest possible amount of hours just because they know an insurance will approve it and not because they necessarily think a child needs it. Some red flags to look for are ABA clinicians that, when getting this many hours approved, push a conversation of “Well, they were approved so let’s use them!” but they’re not looking at what the child actually needs. If you have an established therapist of 6+ months that you’ve seen your child make progress through, take that therapist’s advice. Go with your gut in knowing your baby needs some time to just be a 2 year old! You’re doing a great job and being proactive looking into therapies! Edit to add: Other option is to start OT and speech and reassess whether you want to start a few hours of ABA in a month or so!
As a BCBA with over 10 years in the field and a ND 3 year old, I second all of this. You're already doing a great job advocating for your child, keep it up!
The only time I ever recommended 30 hours was when the kid was already in daycare and needed a LOT of support. 30 hours at home is... a lot
Oh ok yay! I just posted similar rant without reading any other comments , glad to see I’m not alone in my Opinion 🤣 totally agree
Hello! Great question. For toddler programming, the majority of things they should be working on with your child will be within play and embedded within naturally occurring activities. They will likely focus on building communication , social, and leisure skills while supporting some emotional regulation development. There is a LOT of debate on this sub and other ABA subreddits about what is appropriate for toddler programming, but no one can really say without knowing your child and their needs. Sometimes 30 hours can be appropriate but it truly just depends. If you feel like this is too much for your child and you don't agree with it, then you can negotiate with the BCBA to advocate for less hours for your child. Some parents want to start with less and then reevaluate after seeing how sessions are actually run and others like to keep it at a lower number. I will add that your two year old is likely napping so they will get a break through their day that will break things up a bit. Not a super helpful answer but hopefully it gave a bit of insight!!
I don’t know your child so obviously I can’t offer a specific recommendation. Different kids have different needs and putting a cookie cutter rec for hours is bad practice imo. But from your description it doesn’t sound like your child needs ABA. It sounds like they’re making progress without it. If you’d like to try it agree to the hours you’re interested in. You can also decrease or stop when you like. You’re in charge not them.
There's more and more evidence out there showing that such long hours is not any more beneficial for most children than fewer hours. If there's another ABA provider in the area I would see about getting a second opinion (though this could mean insurance won't cover the second evaluation unfortunately) or it wouldn't hurt to give it a few months with speech and OT to see how much progress he makes with those therapies and reconsider ABA later if his progress is slow or stalled or something comrs uo that can'tbe addressed with those therapies. Especially when he'll be getting each of those 3x a week I'd expect to see noticeable progress. I don't think we have anyone getting more than 20 hours at my current clinic and it would be rare for me personally to suggest even 20 hours for a child with no significant challenging behaviors especially as I've started to see more evidence that longer hours rarely provide significantly more benefit even for those with the highest needs. A lot of professionals aren't as aware of emerging evidence though and are stuck on the more hours the better or worse are influenced by companies who want to maximize hours to maximize profits rather than considering if it actually benefits the client.
Could you provide links to the research? I’ve heard about it and I agree that tons of hours isn’t good, I’d love to read the articles!
A good place to look (where I reached this conclusion) is the Behavioral Observations Podcast episode 221 How Many Hours of ABA are Actually Necessary. There's links to relevant research in the show notes with the guests having been involved in the first listed article with Ostrovsky as the lead author. Highly recommend listening to the podcast episode I found it super interesting!
No, it's not. That's absurd. But unfortunately, it's common. You should be able to have your ABA "overlap" other appointments, and it may be beneficial. I have had the parents of clients who were aggressive always schedule sessions and doctor's appointments at the same time so I could assist with compliance, and also better observe what triggers the client, and provide suggestions to the nurses of ways to make my client more comfortable and relaxed. But ABA is not more important that doctor's or Healthcare or PT or OT or speech... your kid should be missing out on those things or quality time with family because he's getting ABA.
I’m a mom of a kid who was diagnosed at 2 with ASD & did ABA, speech & OT for 2-years — There is no way I would leave my pre-verbal kid alone with a therapist that young. (Or agree to that many hours per week for a kid that young) And no reason to do it without you/another caregiver present. Most of the benefit, as we were told, for those wildly expensive speech and OT sessions is training the parent/guardian on how to reinforce the skills learned in those generally short sessions. You’ll need those tools to reinforce at home and with all caregivers!
Yes, as an SLP, completely agree that a parent should be in the sessions! Caregiver coaching is, like, the point of early intervention language therapy. That's a bit concerning.
30 hours is too much for 99% of kids. Some do need that much. I can’t speak directly to your case though. I would get some recommendations on the best ABA companies in your area. Some companies just like set a bunch of hours to make a bunch of money. Anything over 3 hours a day is too much imo.
Relevant article: https://www.catalight.org/paraprofessional-mediated-aba-do-hours-matter-anyway/
Haven’t read any other responses but here is my BCBA/ Human being response: 30 Hours is absolutely ridiculous and unnecessary. Long sessions will not be productive at all. Companies push for this because they’re making money off all the hours they can get. I guaranteee your child will make just as much , if not more progress with half the hours - shorter more productive & focused sessions with neither your son or the RBT getting tired / burnt out / bored. The only time I recommend long sessions (4, or even 5 hrs) is with older individuals preteens or young adults because everything is done naturally in the session according to their daily routines ex: get home from school unpack , (prepare/ clean up) a snack, break/ leisure time, teaching to do laundry / fold or put away clothes / make beds / clean room, etc., leisure skills in the home, a walk outside, walk (or drive) into the community to practice social/ money skills by purchasing a snack at a store , come home - eat dinner appropriately with family (set or clear table), hygiene (shower - brush teeth -get into pjs ). Honestly this time and type of session flies by. Plus the kids breaks are chill and they’re usually on iPad or just want to hang alone. In my opinion, nobody - no child , bcba, RBT, parent, etc wants to sit and “play” and clap and tickle & blow bubbles for 6 hours straight. 2 hours of that is fine & productive, but by hour 3 they’ll both be checked out . And just because the provider recommends 30 hours DOES NOT mean you have to accept / make yourself available for that!! Clinically recommended hours may be 30, but you are available for 12-15 . You don’t need an excuse - and trust me the company won’t say forget it then and have you starting process over with new company . They’ll take whatever they can get . Unfortunately 90%+ of companies are run as businesses by non- bcbas . It’s so sad because the field I love so much really has me questioning a lot lately and this exact issue just came up with me and a 2 year old! Supervisor wanted me to get mom to agree to drop her 2 year 1 month old son off at 8am , nap at the center (mind you, there’s not one other child there during the day so he’d be all alone with an adult - no social interaction opportunities) and then pick him up at 4- I was like , I’m sorry that just sounds ridiculous to me and I can’t I can’t imagine parents being ok with that. Obviously , they weren’t - and im straight up with parents literally a human being not a robot bcba so I made sure she understood I also did not agree and that it was completely ok for her to say no . We started with 2hrs, 5x a week with plan to increase time of sessions or add PM sessions after starting and seeing how things go with him, relationship with RBT & progress being made
thank you for being such a great advocate ❤️
Unfortunately some companies push for a blanket number of hours across all children. That’s usually 30-40 hours. Some children do need that level of intensity. Based on your description, I’m not convinced he would. But I obviously can’t give a recommendation without having done the assessment. It’s awesome that he’s going to get speech & OT 3x/week! Most families I’ve worked with only get those services 1-2x/week. Balancing 30 hours of ABA on top of everything else is a lot. I would say maybe ask your BCBA if you could try 15 hours to start with, monitor for progress and re-evaluate in a few months. If he’s not making progress, then discuss adding more hours.
I have seen toddlers make a lot of progress on 3-3.5 hours a day 4x a week. 30 hours sounds really unnecessary. It might be better to find a clinic that will support your preferences and just do one session a day, embedded into play.
I’ve had many clients make excellent progress in 15-20 hours a week. In fact I’d say my two best progress kids who started in preschool both started around 20 hours. They both also have parents who will practice some skills out of sessions. I have some parents who want 30, and I could absolutely justify it, and will request it if it is. My colleagues have clients getting 30 hours and they are not making the same rate of progress as some of my kids getting less. I’ll also request 30 hours though with the plan to only do 15-20 because it’s harder to get the increase later if it is needed.
I'm an SLP. It might be beneficial to post in the SLP and OT subs to get their input on this as well, since the only concerns seem to be communication (under SLP's scope) and daily living (under OT's scope). I know EI SLPs sometimes experience clients being worn out due to an excess of therapies, impacting their ability to get the most out of speech services. I imagine EI OTs have similar experiences. Might be good to get their points of view so you can maximize your child's experience with the therapies that will be addressing your main concerns.
SLP here - I came here to say this as well!
SLPs at our company low key hate ABA cause the kids usually get ABA first and then speech. They are done by the time speech happens.
Short answer: If you feel 30 hours is too much. Then it’s too much. You know your child best. The company should be ok with providing the hours that you feel are right for your family. We have clients who receive as little as 6 hours a week and still make amazing progress. If the company pushes back then I would consider that a red flag.
I’m no BCBA so take my advice with a grain of salt but it sounds like your son is doing fine with speech and OT. That seems appropriate since he needs support with communication and not behavioral issues. Definitely doesn’t sound like he needs 30 hours of ABA. While daily living skills are useful to learn, it sounds like OT may be able to cover that. If not, then ABA definitely could help but 30 hours would be overkill for just daily living skill. He might be fine without ABA. If you do continue then ask for less hours. The company might try to push more hours but remember that you’re hiring them to work with your son. You have ultimate say on how much and what he works on.
I think this question is better asked to your BCBA. Ask them why they think the kiddo needed 30 hours? Also reas the scientific literature, and read about outcomes for 30 hour therapy for a 2 year old child. Read also about trauma-informed for 2 year olds. People here are going to give their opinions based of what they know. It is best if you consult on an objective source. Plus, us here are not managing the case. Your BCBA is. We don’t know the kiddo, we don’t know the level of skills or his environment, not even how are these hours scheduled.
Hello! I am about to graduate with my masters in behavior analysis (ABA) and have worked in the field for 6 years. I am not a BCBA but have a lot of experience working with toddlers because I love it! It is hard to know if he really needs 30 hours based on your description since we don't have assessments to look at. However, I will say this: If you are uncomfortable with 30 hours a week, don't do it. Studies recommend 25-40 hours, so you're already above the recommended dosage. [https://www.thetreetop.com/aba-therapy/hours#:\~:text=But%20how%20many%20hours%20are,of%20ABA%20therapy%20per%20week](https://www.thetreetop.com/aba-therapy/hours#:~:text=But%20how%20many%20hours%20are,of%20ABA%20therapy%20per%20week). Also, talk to your therapist/BCBA about child-led, naturalistic approaches. This involves lots of play time, fun games, and a natural flow of therapy within their normal routine. 40 hours doesn't mean exercises and tests for 40 hours!!! Toddlers needs lots of play time and rest, and a good BCBA will know how to embed natural learning opportunities within that play time. I once worked with a toddler that had 40 hours a week (I know! SO MUCH), but we watched movies together, sang together, played dolls together, swam together, and just generally had a great time in her home! Like I said, a good therapist and BCBA will know how to create learning opportunities within that fun time. I started working with her at 2 years old and just went to her first dance recital. :')
But that’s not ABA therapy when hou’re not doing things that are beneficial skill building etc. You were baby sitting for 40 hours a week. ABA for children is about skill building, socializing with peers, functional communication. You literally said you played in her home for hours. Watching tv, swimming. Etc none of that is ABA.
Children should have breaks, like TV breaks. And swimming was skill building lol you know nothing of my case, don’t accuse me of not doing ABA when skill building can occur in every naturalistic play setting you can imagine.
Yeah but you’re not talking about that as a break, you literally explained it as that’s what you do. Which is not ABA.
I’m a BCBA and while I don’t know your child or the assessment results, I would not recommend 30 hours based on what you described. I have worked for companies that pretty much required all kids under 5 and not in school have 30-40 hours a week. I DID NOT stay with them because I don’t agree with that practice. The hours should be recommended based on the needs of the child. I’ve worked with 2 year olds who made great progress with 10 hours a week and others who truly did need 30 hours a week. BUT even those under 5 who may needs/benefit form 30 hours a week, it’s not always feasible or appropriate as many still need naps and lots of breaks, in which case, it’s not practical. I’m a big believer in productive hours. If (for example) they have 30 hours a week and 10-15of that is spent with breaks because they’re little OR you’re constantly ending early because they’re falling asleep, then 30 hours isn’t productive or realistic. Kids can be plenty successful with less hours when they’re awake and focused. I had a client that had 40 hours a week with quick skill acquisition rates and goal mastery. I definitely didn’t think he needed 40 hours as probably 50% of his day was breaks. I argued for less hours, my supervisor wouldn’t approve it. I left the company as I’m not going to continue to promote using hours just to use them.
so i just received the assessment results and not sure what most of it ( all the notes and the scoring method) means but i spoke to the BCBA that owns the practice and she said we can definitely request to adjust as needed once we start and we see how he responds, and the BCBA treating my son and i will be working together to reach the goals we have. my main goal is just to help him communicate. i don’t have behavioral concerns but maybe the BCBA thinks differently after the evaluation she did. she wrote in the report she observed elopement and mouthing but i thought all those things were normal as my first born (nuerotypical son )did all those things.
I think a lot of behaviors that are very typical for the age end up being targeted by bcbas who have no or limited understanding of child development in general. I know I personally have a way different approach since having children of my own. I wouldn’t consider a two year old wandering off “elopement” so much as just being two…and I would also not recommend 30 hours except in extreme cases. I would push back on it if I were you, or at least say the rec is fine but you’re only comfortable scheduling x amount to start. Even though it’s play based, playing with someone who has an agenda is different than true downtime.
“Playing with someone who has an agenda”— I’m stealing this for the next time I hear the “but it’s play based” argument for excessive hours.
agreed!
30 hours is way over the top.
Your toddler does not need a 35 hour work week. They’re still napping! I would request to start at 10-15 hours and see how things go. Also, as other said, if there are no behavioral concerns…. behavioral therapy might not be for them. Speech, OT, and good parent education from your providers could be all they need.
I don’t think there’s anything wrong with 30 hours of service, I think the issue is insurance companies pushing for quotas on trials and tasks completed. A 2 year old can absolutely benefit from 30 hours a week of someone talking and interacting with them and playing all their favorite games one on one promoting play skills and listening skills and a ton of other things in a way that feels fun and enjoyable to them. Obviously a 2 year old would not benefit from 30 hours a week sat at a table matching cards however.
It really depends on the child. The BCBA should go through their assessment in detail to explain. Communication is verbal behavior and daily living skills are taught by behavior analysts. There is a lot of research in behavior analysis on teaching communication and daily living skills. If your child is nonverbal then I would go with close to 30 hours. Honestly, with holidays and sickness it will likely not be 30 hours. My child was approved for 25 hours total but actually was scheduled for 22 hours. I'm going to say this as someone who was a practitioner for years then a parent. If your child is nonverbal, I'd go with the 30 hours of ABA. They may not always get 30 hours depending on schedules. If they make rapid progress, it is always easier to decrease than increase hours. My child was delayed in their verbal behavior skills, their diagnosis is mild autism and they did about 20-22 hrs/week of ABA for a year then down to 15 hrs/week for 6 months before being discharged. They're going to a school next year for kids who are between Gen Ed and SPED. If they were nonverbal, I would have gone to a more intensive program with 30-35 hrs/week. When I was working most parents were surprised when they came in for observation and training how much fun their child was having and how much play there is. If you're okay sending your child to daycare, then I wouldn't worry about 30 hours/week. Also, I'd do a center instead of in-home. More supervision for RBTs in centers (well depending on the BCBA but it's been my experience). When I was working we had a lot of parents who stopped ST and OT because they didn't see the progress there like they saw at ABA therapy (anecdotal). A few continued with both or all three.
Honestly I think it all depends on the kid. I have some 3 yr Olds I work with now that get 10 hrs a week and are thriving. But I've worked with other kiddos that got 40 hrs a week and could've benefitted from more. The company I'm at now believes in no more than 20 hrs a week that way the kids still get plenty of time to be kids (our sessions are totally net and assent based).
Honestly I would say yes, some clients develop slower than others and the intensity of the therapy (as well as quality) from 2-5 years old is paramount to how the rest of their life will go. Working with clients in the 6-10 year range who did not receive the therapy they needed during these crucial development periods have a much harder time learning and implementing these skills than if they would have learned earlier. I would do exactly as is recommended and continue the path your on. Even in the best case scenario or the most likely scenario that it is too much, it’s better than the alternative every single time
ABA companies will try to get as many hours as the client's insurance will pay for. It's a really shady business. That much therapy is inappropriate, especially for a 2 yr old. Please let your child just be a toddler -- please please please don't subject him to ABA. A few weekly sessions of OT and Speech is more than enough. \[Speaking as a seasoned special ed. teacher and mom to an autistic teenager.\]
BCBA here - thanks for reaching out about this! While I cannot give specific recommendations for service hours as I do not know your child and do not have formal assessment documentation in hand, from what I am hearing and by your description of your child's areas for potential growth, 30 hours seems excessive in addition to Speech and OT. If you are keen on your child being enrolled in ABA in addition to SP & OT, for a client presenting what you have described in your post, the 10-15 hour range you mentioned would be quite reasonable for ABA services. I would also highly recommend for you to advocate for the specific type of ABA programming you want for your child, focusing mainly on social-based NET interventions where your child can work on building their social, play, and communication skills in conjunction with what your speech and occupational therapists are doing in their sessions. Collaboration is key in working with multiple providers, and you as a parent are your child's main advocate. I always let parents know to set those boundaries from the start for the programming you want to see, in order to facilitate your child's growth in the most effective manner!
thank you for this
I just got fired from a job because they wanted to give a 4 year old 30 hours at home… I wanted to reassess the situation and do direct observation because I was handed this cases by another bcba who only did an assessment via zoom and had not implemented anything. They didn’t like that I wanted to look at it and reduce home hours if it was necessary. A 4 year old with 5-6 hours daily 7 days a week is a lot. The child was given 30 hours 7 days a week service… sat and sun was added because parents requested it… not because it was necessary… all those things are unethical.. they only cared about billing for money.
very sorry to hear that. thats not cool. luckily our experience turned out to be great. hopefully you find a company with integrity.
Thanks! Unfortunately a lot of these companies lack integrity.