If you have recently heard the term ABA therapy – from your child’s pediatrician, a diagnosis report, another parent, or your own research – you have probably also discovered that it comes with a lot of opinions attached. Some families describe it as the most effective support their child has ever received. Others have concerns about older approaches. And most parents in the middle of it all are simply trying to figure out what it actually is before they decide anything.
That is exactly the right place to start.
ABA therapy is one of the most widely recommended and most frequently misunderstood therapies in pediatric care. ABA stands for Applied Behavior Analysis, and it is the “only autism intervention that is approved by insurers and Medicaid in all fifty states.” ABA first planted its roots in the early 20th century through the emergence of a newfound systematic approach to understanding human behavior known as Behaviorism. Behaviorism focuses on external stimuli, as opposed to internal mental states, as a means of determining behavior and was first introduced by American psychologist John B. Watson. Later, another American psychologist, B.F. Skinner, built on this idea of Behaviorism and introduced the theory of operant conditioning. Operant conditioning poses the idea that behaviors are influenced by the events and consequences that follow them: reinforcements increase the likelihood of a behavior, while punishments decrease the likelihood of a behavior. Applied Behavior Analysis emerged from these schools of thought surrounding the relationship between behavior, reinforcers, and punishment. It was not until the 1960s that ABA was applied to children, particularly children with autism, by Dr. Ole Ivar Lovaas. Dr. Lovaas developed many of the crucial foundational aspects of ABA still used today, including the early intervention approach, which found that children who receive intensive, individualized plans earlier in life demonstrate dramatic developmental gains.
Controversies
ABA is a discipline that has made a tremendous impact on the lives of many autistic children and adults. However, that is not to say that people do not have differing experiences and opinions.
Many autism activists criticize ABA as a form of suppression of neurodivergent children and their forms of expression. Anti-ABA advocates argue that redirecting a child away from a behavior that is not harmful, such as stimming, amounts to the erasure of self-expression and an attempt to make autistic children conform to a societal standard.
While these criticisms of ABA reflect legitimate concerns, they are tied to an era of ABA that is no longer practiced. In other words, ABA has undergone extensive development over the years, and the kind of therapy children receive today is significantly different from what was established in the 1960s.
Andjela Avram, BCBA and clinical director at Little Tesla, explains:
Clinical Perspective from Little Tesla
“This is such an important conversation, and we genuinely appreciate when families and communities push us to reflect on our practices, because that is how the field grows.
“We want to be transparent about how we approach this at Little Tesla: we do not work on reducing or eliminating stimming unless it is directly dangerous to the child or significantly interfering with their ability to learn and access their environment. Full stop.
“Stimming serves a real and valid neurological purpose. It helps children regulate their nervous system, manage sensory input, express emotion, and stay grounded. We recognize that, and we respect it. Our goal is never to make a child appear “more normal” or to strip away behaviors that are simply different from neurotypical norms.
“The criticism you are referencing reflects a very real history in ABA. Older, more punitive models of the therapy did prioritize social conformity over the child’s wellbeing, and that was harmful. We take that history seriously. Modern, ethical ABA has moved away from that approach, and practices like ours are committed to a neurodiversity-affirming model.
“What we focus on is helping children build skills that increase their independence, communication, and quality of life: goals that the child and family actually want.
“We ask: is this behavior getting in the way of something this child wants to do? Is it causing them harm? If the answer is no, it is not a target.
“The goal is never to change a child. The goal is a child who has more tools, more access, and more ability to show up in the world in a way that works for them.”
What ABA Looks Like for Children Today
So with this history in mind, what does ABA look like for children today?
One of the most common misconceptions about ABA is that it looks like a child sitting at a table for hours, repeating tasks on command. For most children receiving ABA in a contemporary pediatric clinic, that is not what it looks like at all.
For young children, sessions are typically play-based. A therapist works alongside the child using toys, games, books, and activities the child is naturally drawn to. Learning opportunities are embedded into those activities rather than presented as separate drills. If a goal is to build requesting language, the therapist creates natural moments during play where the child is motivated to communicate.
For older children, sessions may involve more structured activities alongside naturalistic approaches, particularly when working on skills that require explicit practice: social scenarios, problem-solving, or navigating specific situations that come up in school or community settings.
Sessions are typically conducted by a registered behavior technician working under the supervision of a board-certified behavior analyst, known as a BCBA. The BCBA designs the treatment plan, sets the goals, and provides ongoing oversight and adjustment based on how the child is progressing. Parents are involved throughout, because what happens between sessions, in daily life at home, is a critical part of how skills develop and generalize.
How ABA Goals Are Set
This is one of the most important things to understand about quality ABA practice: goals are not standardized. A good ABA program does not apply the same goal list to every child. It starts with a thorough assessment of the individual child, their current skills, the areas where they need support, and what matters most to their family, and builds a treatment plan from there.
Parent input is clinically essential. A BCBA needs to understand what a family’s daily life looks like, what they find most challenging, and what outcomes would make the most meaningful difference, because those things shape what gets prioritized and how success is measured.
Goals are typically reviewed and updated regularly as a child makes progress. Effective ABA is not a fixed program. It is a responsive one, adjusted based on what is working and what the child needs next.
ABA therapy is not a single thing. It is a framework with a complex history and a contemporary practice that looks genuinely different from what many parents expect when they first hear the term. Understanding what it actually involves, how goals are set, what sessions look like, who it is for, and what it is not, is the most useful thing you can do before making any decisions about whether it is right for your child.
If ABA has come up in your child’s care and you want to understand what it would actually look like for them, an evaluation is the clearest way to find out. Little Tesla’s team is here to walk you through that process and answer your questions at whatever pace feels right.
