Why is ABA Therapy so expensive?

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Imagine you’ve just been told your child has autism spectrum disorder. You rush home and start googling. You find that Applied Behaviour Analysis or ABA Therapy is the gold standard treatment for autistic children. You’re sold. That’s what you want for your child. You call some providers. You make a few appointments. At the first consultation, you ask about the cost of therapy.  The therapist explains that the fees are per hour and the total cost depends on the number of hours of therapy per week.  Oh, and don’t forget the cost of supervision (wait… what’s supervision?). At the second consultation the therapist explains the same thing, but adds on an ‘administrative fee’ that’s paid yearly. You rush home and start googling… again. Why is ABA Therapy so expensive? 

Mother researching ABA Therapy for autistic child.
Photo by Anastasia Shuraeva on Pexels.com

Here are 6 reasons ABA Therapy is costly:

Federal & Provincial reasons:

  • To begin with, Ontario doesn’t regulate Applied Behaviour Analysis.  Most of the other disciplines that work in autism treatment have regulatory colleges (Psychology has the College of Psychologists of Ontario, Speech has the College of Audiologist and Speech-Language Pathologists of Ontario, OT has the College of Occupational Therapy of Ontario etc). Nothing similar exists for Behaviour Analysts. Because there’s no regulation, getting services for your child can be like the wild west. There is the Behaviour Analyst Certification Board, but they’re not a regulatory body. 
  • Moreover, ABA isn’t considered a medical intervention and isn’t covered by OHIP or private health insurance. Again, this goes back to the lack of regulation. Considering ABA Therapy as medically necessary would mean that the government would fund it and insurance companies would pay for it. There is a movement to make autism therapy medically necessary. This change would mean that the federal and provincial governments have to fund autism therapy (ABA, as well as others like Speech, OT, Physio) at the prescribed dose. The prescribed dose would be different for each child, depending on their needs.
  •  Lastly, there aren’t enough clinicians for all the children who need them. System capacity is a big problem in Ontario. We’re in a bit of a catch 22. There aren’t enough clinicians. However, lowering the training standard for future clinicians isn’t an option. Children and families deserve the best therapists possible and that takes time and investments in education and training from the province. 

Structural Reasons

  • Many ABA Therapy programs are 1 on 1. You could be paying one person’s entire yearly salary. Group programs are less costly because the salary of the clinician is divided between the people paying for services. Some children can learn in a group setting and some just can’t.  
  • There’s more than just the therapist who works with your child. In most cases, an Instructor Therapist (IT) /Registered Behaviour Technician (RBT)  is doing the direct treatment with your child. One or two levels of clinical supervisors guides the ITs work: a Senior Therapist (ST) and a Board Certified Behaviour Analyst (BCBA) or Psychologist. Most Instructor Therapists have a college diploma or a bachelor’s degree related to ABA. Also, most Senior Therapists are working towards becoming BCBAs and have many years or experience doing ABA in a variety of settings. To become a BCBA you need to have a masters degree in ABA, complete 2000 hours of work experience and write a board certification exam. Having the layers of supervision is a way of cutting down the cost to the family (as backwards as that sounds). Most Instructor Therapists do not have the skillset to assess and design the intervention plan. However, most families do not want to spend their money on having the BCBA deliver the intervention. This is because the BCBA’s hourly rate is often 3 times higher than an Instructor Therapist. 
  • In addition, every ABA Therapy program is individualized for the child. This takes time and expertise. The basis of ABA is data analysis. And the IT, ST and BCBA should be spending time analysing the data, finding trends and making changes to ensure learning. Also, many therapists make teaching materials that are specific for the child. For example, if teaching colours and the child really likes the movie Cars, perhaps using pictures of the characters would be motivating. This individualization helps increase the rate of learning.  

Conclusion

There are a number of reasons that ABA Therapy costs as much as it does. These are just a few. Changes are needed. They will benefit the field and the children and families that access ABA services. Financial means should not be a barrier to receiving the best treatment. 

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