Ari, now a 16-year-old, shares his story:

Why ABA Therapy Alone Isn’t Enough

Ari was one of the many children I encountered in my work who on the outside may seem difficult or defiant, but inside just want to be like everyone else, and feel like failures when the expectations placed on them don’t account for their inner experiences. My concern grew, since many of these children were already receiving hours a week of ABA therapy, and were still being treated at a surface level, their behaviors corrected without ever considering the underlying reasons for them.

This leads to several problems. First, the child may learn the appropriate behavior in one situation but won’t know how to apply it to other situations. Second, without addressing the root cause, removing one problematic behavior often gives rise to other challenging behaviors. Finally, the child may feel like a failure and that something is wrong with them, and they will shut down or escalate their behaviors to protect themselves from further hurt.

I knew there had to be a better way, and I came across the groundbreaking work of Robert J. Bernstein, a leader in the autism field. In his book Uniquely Normal, he describes exactly what I felt was missing: a deep understanding of how these children actually think and experience the world. He also presents a cognitive approach built on that understanding, one that I was captivated by. I reached out to him directly for training, and we have been meeting almost every week for over five years.

Incorporating Rob’s work into my ABA practice, I developed a four-step framework, where each step builds on the one before it. To evaluate the model, Rob Bernstein and I developed a research study using parent surveys completed before treatment and six months later. We measured thirteen key areas of daily functioning, including making friends, succeeding in school, expressing needs, getting along with siblings, and listening to parents. In most cases, parents reported meaningful gains across multiple areas, which demonstrated real changes in how their children were functioning in everyday life, not just improvements in isolated behaviors.

A Four-Step Framework for Real Change

Step 1: Creating a Safe Relationship

The first step is creating a safe relationship with the child. This means approaching the child without judgment or criticism and viewing the challenging behaviors as something to be curious about rather than something that needs to be immediately corrected or fixed. We can learn so much about the child by just being curious and asking the question, “Why is the child acting this way, and what purpose is it serving him?” Many problem behaviors are self-protection strategies a child uses to cope with their challenges, so creating a safe environment is critical for the child to open up and be able to learn.

Does the child feel safe enough to engage?

Step 2: Engaging the Child

The second step is to engage the child by looking for what excites and motivates him. Children learn and develop in their natural state of interest and engagement. Once a child is engaged, we can embed learning opportunities and challenges to promote growth. In addition, children that struggle often need someone to reach into their world to make the connection happen.

Am I entering the child’s world, or pulling the child into mine?

Step 3: Targeting Cognitive Development

The third step is to target a child’s cognitive development. Many challenges can be traced to gaps in how a child understands himself and the world around him. As a child’s understanding develops, they grow from the inside out rather than just copying appropriate behaviors that are expected of them. Learning how the child thinks and relates to the world is a critical part of this step and allows us to customize learning opportunities that directly address those gaps in understanding that the child struggles with.

For example, a child who struggles with moving from one activity to the next may lack the ability to plan for the next activity. Instead of forcing him to switch activities, ask him during the current activity, “After this, what will we do next?” — challenging him to think about what will come next. Over time, he begins to internalize the process of planning the next activity on his own.

From the child’s point of view, does he truly understand what is being taught and expected of him?

Step 4: Building Independent Functioning

The fourth step, and how we measure real success, is a child’s progress towards independent functioning. For this, we need to actively gain a child’s buy-in to the process and teach them to take responsibility for their success. A child can’t succeed by just being taught the correct behaviors. They need to understand and internalize how those behaviors actually work for them and help them in their world.

For example, a child that understands that people don’t like to be ignored will naturally respond to greetings, instead of needing parents or therapists to constantly remind him.

Are we creating a dependent child, who always needs someone else to teach him how to behave, or is he learning to behave from within?

What Changed for Ari

After working together, Ari’s perspective on himself shifted profoundly. He learned that he isn’t flawed, and that despite the challenges he faced in school, he possesses so many unique talents and abilities that needed the right intervention to flourish.

Stories in this series are based on real accounts, but many details have been altered to protect the subjects’ privacy.

If this story feels familiar, you can read more about our approach or get in touch to talk it through.