Starting ABA therapy often comes with a lot of hope. Parents are told things like, “You’ll see huge progress!” or “Just give it time!” But what happens when days, weeks, or months go by and things still feel off? When and how do you distinguish “getting used to things” from a poor fit in staff, company, or ABA in general?

If that’s where you are right now: take a breath. You are absolutely not alone. In fact, I think this is a lot more common than what is publicly talked about, and many providers do a poor job of preparing parents for this side of starting ABA.

It may be helpful to know that the therapy program not feeling effective does not automatically mean your child is “too severe,” that you’ve failed, or even that ABA itself is the problem. Sometimes therapy needs adjustment. Sometimes expectations need recalibration. Sometimes the fit just isn’t right.

So, let’s look at 5 of the most common signs it may be time to pause, ask questions, or make changes…and how exactly to do that without hitting the off switch prematurely.

Concern #1: Behaviors Increasing/Not Improving

One of the most common reasons families worry therapy isn’t working is when behaviors get worse or simply don’t seem to improve at all.

But behavior change is rarely perfectly linear.

Temporary increases can happen for several reasons:

• New expectations are being introduced (or, even if they seem like the same expectations, are being introduced by someone new)
• Adults are responding differently than before
• Your child is learning new ways to communicate frustration and needs
• Sessions are unintentionally increasing stress and/or anxiety as “demands” increase

All of this can be normal adjustments, and a responsive BCBA (supervisor) will recognize that modifications to session procedures are needed to help keep your child happy, relaxed, and engaged in order to promote learning and behavior change. That said, if behavior is consistently worsening, staying unchanged for long periods, generalized across settings, or creating safety concerns, it’s more than reasonable to ask to chat more with the BCBA on what may be triggering this and what can be added, removed, or changed to overcome barriers.

Some great questions to ask include:

• What function does the team believe the behavior serves?
• How are we measuring progress?
• What changes have been attempted?
• Are goals realistic?
• Could medical, sleep, sensory, anxiety, or environmental factors be contributing?

Concern #2: They Don’t Seem to be Doing Much

I’ve heard this concern several times from parents, and it has always had a bit of a different nuance to it.

Sessions might look like sitting in the same spot at the table much of the time, or playing the same game the whole time. They might look like long or frequent breaks. They might include repetitive questions or flashcards you know you heard your child respond correctly to last Tuesday. They might look like little engagement between your child and the adult who’s supposed to be teaching them.

All of this can be a concern and none of it. I know–but hear me out.

For a learner who strongly, strongly prefers playing with slime over any other activity, sitting at table with slime might truly occupy much of the session as a reinforcer (reward) between work tasks or as an activity paired with these tasks simultaneously, like how some learners might fidget with a small toy at their desk.

For a learner new to ABA, particularly sensitive to tasks others assign them, or other challenges to continuous learning, long or frequent breaks may be the first phase or two toward reducing these breaks over time as tolerance increases. Or these breaks may come as appropriate reinforcement for making a request for a break rather than throwing items, hitting, or other potentially harmful behaviors.

The repetition in ABA may seem unusual, especially if you know you have heard the right answer from your child. But the same goal or target may be worked on even after the first correct response because we need multiple datapoints providing they can continue to respond correctly, even when new materials or situations are added, and across multiple people.

For learners easily overwhelmed by a lot of interactive play and talking, engagement may look different. Staff might sit nearby and watch their activity with occasional quiet comments, might quietly model play activities for them, or give the learner the choice between interaction and playing alone.

Or…it’s an actual problem, with staff not necessarily implementing how they’ve been trained to teach and engage with your specific child. And that can come from ineffective or unclear guidance, technicians applying what worked with a different child, or other causes. If a BT appears disengaged, overwhelmed, unsupported, or unclear on expectations, that’s often a systems issue, not necessarily a character issue.

While your child’s technician (the one working directly with them every session) should understand the “why” behind procedures, some struggle to articulate this well. I recommend talking directly with their supervising BCBA.

Questions worth asking of the BCBA:

• What are the current goals and what does teaching look like?
• How often should they be doing [whatever activity you may be concerned about]?
• Is there a specific schedule they should be following?
• How do we decide when pairing shifts into instruction?
• What should progress look like in the next month?

Concern #3: You Child is Still Stimming, Choosing to Play Alone, or Behaving Differently Than Peers/Siblings

It is completely understandable to, as a parent, be afraid of what impact being visibly different can have on your child. But it’s absolutely imperative that parents know and understand that the goal of ethical therapy isn’t to erase autistic identity. The goal should never be masking, or looking “less autistic.” The goals should instead be focused on giving them the skills to access what they want in a safe and effective way.

I frame ABA to parents as building a tool box. I want to be able to give a child tools for their box in case they want or need them in the future. Take introducing yourself to a new person, for example. They may choose to use that tool every time they meet someone new, to never use that tool, or to use it in only some situations. All are perfectly valid as long as they are safe. I just want them to have that tool in their box in case they want or need it–that’s all. That’s all any of us want when guiding our own children or teaching students.

Your child may continue to hand-flap, script, line things up. He may continue to choose to play alone on the playground or opt out of family game nights. She may continue to talk at length about something that seems boring or odd to someone else. Your child may continue to do, say, and choose different things than her brother or sister did at her age and than your friends’ kids the same age.

When not having the skills at their disposal limits safety and fair, equal access to opportunities, that’s when we intervene and treat. For everything else, we support individual expression.

But I must also point out that there are situations where a BCBA may miss the bigger impact of a behavior. For example, a child who squints through almost-closed eyes for self-stimulation may miss an oncoming car when about to cross the street. A child who chooses to play alone may not tolerate required group projects in school. A child with very specific interests may insult well-meaning listeners when they try to change the subject, ask questions, or misunderstand bits of information, then suffer from poor self-esteem due to struggling peer relationships.

In those situations, again, speak with the BCBA. Help them to understand your concerns regarding the bigger potential harm of the behavior and how it interferes with learning, communication, health, etc. They will be able to discuss further whether an intervention is needed, what skills should be taught, and how.

Concern #4: Your Child Still Isn’t Talking

This one is emotional. And understandably so.

Communication growth can happen in many forms. For some kids, teens, and even adults, spoken language can emerge and grow. For other learners, gestures, pictures, signs, speech-generating devices, typing, and other modalities are just as valid and in no way inferior to speech.

Speech development timelines vary dramatically. A child being minimally speaking does not automatically mean therapy is failing, and the same goes for a seeming lack of progress with other methods of communication. In ABA, we celebrate the baby steps: the learner reaching for the device on their own for the first time, saying, “buhbuh” for bubbles, pointing instead of hitting, showing someone else what they’re doing even if they can’t yet comment on it.

We all know talking opens so many doors. But, figuratively, you have to take the smaller individual steps, one at a time, to scale the full flight of stairs. Progress takes time.

But, if you want some more concrete reassurance of that progress, here are some things you can bring up with their BCBA:

• Reviewing met (mastered) communication goals so far
• Current goals and how they are being worked on or taught
• How you can support progress outside of direct sessions
• Next steps or future communication goals
• How readiness for the next goals will be determined

Concern #5: You Just Don’t Mesh With the BT or BCBA

Sometimes nobody did anything wrong. Sometimes communication styles clash, personalities don’t click, expectations differ. Your child seems tense, like they don’t trust or enjoy being around a person. Sessions feel draining, like a chore, for both of you. You feel unheard.

Therapeutic relationships matter. And you don’t owe anyone endless chances because they’re nice or are trying. You and your child deserve the right fit.

But, that being said, the right fit can only be found if you are able to articulate what you need, just like any relationship. If you need more communication, for a technician who is more quiet and reserved to avoid overwhelming your child, for a BCBA who is in-person rather than virtual (telehealth), or another need, identify this for your provider as soon as you are aware, even as early as the intake. If conflicts arise later during services, bring this to your BCBA or, if needed, your operations point of contact, like a director.

Keep in mind that not every company or provider is willing or able to accommodate your wants and needs. That’s just fact. If there are “wish list” items–a BCBA with 20+ years of experience, a BT who loves all the same video games your son does so they can bond, an RBT able to change a weekday appointment to a weekend when last-minute conflicts come up–consider whether those are truly make-or-break items to access therapy. But also feel that you are able to voice what your family needs in order to participate fully. Sacrificing something you or your child needs (language services, more frequent caregiver training, physical management training for severely unsafe behaviors, etc.) is not only unfair, but often unsustainable. If one provider can’t or won’t provide this, another may.

Not Working, or Not Yet?

ABA therapy isn’t successful because hours happened. It’s successful when life gets easier; when communication improves; when your child gains skills, confidence, flexibility, safety, autonomy, or simply more opportunities to participate in the world in ways that work for them.

And if therapy isn’t doing that?

You’re allowed to ask questions, to advocate, and to change course.

ABA may truly not be the best fit for your child or family, or maybe the current team or company or setting or schedule aren’t promoting what you hope to achieve. But as a valuable part of the team yourself, you play a key role in determining whether you can afford to give it more time or it’s time to try something else.

As long as you are continuing to strive for what’s best for your child, you can’t fail.

by Britt Bolton, BCBA