Association for Behavior Analysis International

Although there is strong support for the use of interventions based on applied behavior analysis (ABA) for autistic individuals, there is also evidence of heterogeneity in response to treatment. Treatment intensity or dosage (i.e., hours of treatment) may be a key predictor of ABA treatment outcome, however; little is known about what informs treatment intensity recommendations. Although historically it has been accepted, based on a considerable body of research, that higher intensity treatment leads to greater improvements in targeted skills and behaviors, recent research has suggested otherwise (e.g., Sandbank et al., 2024). Recommendations regarding the specific intensity of treatment should be based on the medical necessity of the treatment for each individual patient (CASP, 2024). Treatment intensity recommendations are part of the careful individualization of behavior analytic treatment and should be adjusted based on individual needs and responses to therapy. However, this is an aspect of clinical practice that is not well understood. This symposium will explore the nuances of medical necessity and present recent applied research regarding treatment intensity and dosage recommendations for ABA therapy for autistic individuals.

Practitioners in the field of behavior analysis interacting with autistic learners in center or home-based therapy covered by insurance

An integral component of an Applied Behavior Analysis (ABA) treatment package is determining the medical necessity for ABA services, as well as appropriately allocating treatment hours to patients. However, each individual payor (e.g., insurance companies and local Medicaid funding programs) develops its own criteria for ABA medical necessity, making this process challenging for providers. Although the Council of Autism Service Providers (CASP, 2021) provides guidelines for both providers and payors, additional details may be needed when crafting an individualized treatment plan. It is necessary to ensure that treatment hours (a) align with the integrity of behavioral interventions, (b) take into account the learner’s individual and environmental factors, and (c) are sensitive to the overall well-being of the learner (e.g., Berg et al., 2024). This review will explore medical necessity through both a medical lens (i.e., Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM–5; American Psychiatric Association, 2013]) and the recent behavior-analytic literature.

Common guidelines recommend 30-40 hours per week of ABA-based treatment for young children with autism, but recent evidence suggests this dosage may not be necessary. This study aims to examine the effect of hours on the effectiveness of applied behavioral analysis in young children with autism (n = 387). We compared the impact of four dosage levels of ABA on adaptive behavior, measured by the Vineland-3, at three different time points. A two-way mixed ANOVA indicated a significant effect of time, with adaptive behavior scores improving compared to baseline. There was no significant effect of dosage. Additionally, children were grouped into Low, Moderately Low, and Adequate or Above groups based on their baseline Vineland Communication and Socialization scores. Two-way mixed MANOVAs revealed that children in the Moderately Low communication group made more significant gains on all Vineland subscales compared to the Low or Adequate and Above groups. At the same time, no differences were found for baseline socialization groups. This study demonstrates that current recommendations for high weekly hours of ABA may not be necessary to achieve positive results. This study is consistent with other research demonstrating baseline cognitive abilities are a useful predictor of treatment progress for autistic children receiving ABA.