According to the BACB in the second edition of Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers, (Behavior Analyst Certification Board, 2019) in order to develop, support or restore functioning for those with ASD, each client and caregivers strengths, needs, preferences, and the environmental circumstances must be assessed to make the decision if a focused or comprehensive treatment plan should be utilized. Throughout the client’s treatment, there should also be room for flexibility to change the treatment plan based on changes to the above considerations (BACB, 2019).

When choosing between a focused or comprehensive treatment, the following are considerations assessed during the intake (and throughout treatment) (BACB, 2019):

• The client’s interaction with the environment and the resulting context and value to the client, family and community
• A provider- or client-directed treatment plan which is dependent on the involvement of peers or caregivers
• The number of recommended goals is dependent on the client’s needs and their caregiver’s response to treatment

Client age, diagnosis or the duration or nature of previous ABA services is NOT a consideration when assessing clients for current treatment intensity (e.g., Hassiotis et al., 2011; Ivy & Schreck, 2016; Wong et al, 2017).

The intensity of treatment is the dosage of ABA recommended and is categorized into focused or comprehensive treatment.

Focused ABA treatment focuses on a limited number of chosen skill targets specific to a client’s goals. The intensity of services can range from 10 – 25 hours per week.

For example, a 12 year old who has difficulty making friends and regulating their emotions may receive 10 hours of ABA per week with goals surrounding social skills and emotional regulation.

Comprehensive ABA treatment focuses on multiple areas of functioning including cognitive, communicative, social, emotional, adaptive, and maladaptive behaviors. Intensity levels of weekly services include 30 – 40 hours per week are required to see positive outcomes in those targeted skill areas.

For example, a 3 year old with delays in requesting, imitation, social skills, , tolerating non preferred activities,and eating, would receive 40 hours of ABA per week with goals surrounding communication, imitation, social skills, behavioral support, listener receptive skills, and adaptive behavior skills. 

Research has established that utilizing a comprehensive ABA treatment model for children with ASD is the most effective to develop, support or restore functioning:

• Comprehensive ABA produces the largest improvements in functioning for those with ASD (Klintwall et al., 2015).
  
  • At least 36 hours of direct ABA treatment per week for at least two years is associated with clinically significant, reliable changes in cognitive and adaptive skills (Eldevik et al., 2010).

• Low-intensity ABA treatment produces smaller improvements than high-intensity ABA treatment (Eldevik et al., 2006).

• Eclectic treatment comprising some ABA treatment plus a mixture of other therapies or methods is ineffective (at best) for most children with ASD, even when it is individualized and intensive (Eikeseth et al., 2002).
  
  • Eclectic treatment is defined as a combination of TEACCH, sensory integration therapy, and some applied behavior analysis method (Howard et al., 2014)

Therefore, determinations as to whether ABA treatment should be focused or comprehensive and the intensity of treatment should be based on the medical necessity of the treatment for each individual client rather than the client’s chronological age, duration or nature of previous ABA services, or the like.