Clinical Corner: Is ABA the right choice for my child?

After my child’s recent autism diagnosis, we were referred for therapy services, including applied behavior analysis (ABA). Since I was unfamiliar with ABA, I looked for more information online and encountered mixed perspectives, with some sources strongly supporting ABA and others raising concerns about its appropriateness for use with autistic children. How can I determine if ABA is the right choice for our child and our family?

Answered by Duaa Alzahrani, Phd, BCBA, and Reva Mathieu, EdD, BCBA
Duquesne University

Is ABA therapy the right choice for my family?

Photographed by Vitaly Gariev (pexels.com)

This is an important question as many families face many of the same concerns. It’s entirely natural to feel hesitant about a therapy that you don’t know much about or that you have only encountered through secondhand and contradictory information. As a parent whose child has been newly diagnosed, it can be overwhelming to make decisions about treatment rather quickly. Seeking information and guidance about therapy from credible and trusted sources is an important aspect of the decision-making process that you are about to embark on.

Applied Behavior Analysis (ABA) is one of the most widely recommended interventions for autistic children, yet, as of late its use with autistic children has become frequently misunderstood and debated (Leaf et al., 2021; Leaf et al., 2022; Reichow, 2012; Sandoval-Norton & Shkedy, 2019). When an autism diagnosis occurs, it may be common for families to be referred to ABA-based services. After this referral, caregivers may realize that they know little about what ABA services entail both for their child and their family. As a first line of information gathering, caregivers may turn to the internet to learn more about ABA and how it might help their child. Due to the sheer ability to access a wide variety of information online, caregivers may also be bombarded by hundreds of both science-backed treatments and pseudoscience approaches (Celiberti & Jaiswal, 2025). Caregivers may also receive mixed and sometimes contradictory messages about ABA. Some sources describe ABA as the gold standard, (e.g., Hourican, 2025) while others raise concerns based on historical practices, ethical issues, or personal experiences from autistic individuals who received ABA therapy (e.g., Wilkenfeld & McCarthy, 2020).

Positive and Promising Information

Despite the opposing opinions toward ABA, there is encouraging context worth highlighting. ABA is a well-established field with decades of published research, thousands of researchers actively contributing to the literature every year, and a large professional community that regularly shares data and outcomes at national and international conferences. The field of ABA continues to advance through ongoing research across a wide range of areas, including communication, daily living skills, caregiver training, and quality-of-life outcomes. In addition, behavior analysts are guided by a comprehensive ethical code and are required to engage in continuing education to maintain competence and ethical practice.

It has been said that “when you know one individual with autism, you know one individual with autism.” Fortunately, the very nature of ABA allows for substantial individualization. Goals, teaching strategies, and behavior-support approaches can be tailored to the unique strengths, needs, values, and preferences of each individual and family and this customization continues over time based on data, evolving needs, and client and family input. When practiced responsibly and ethically, ABA is not a “cookie-cutter” approach, but rather a flexible science designed to support meaningful, individualized outcomes.

Concerns and Responses

Concerns regarding ABA have been raised by some autistic self-advocates, including reports of practices that may emphasize compliance in ways that can limit individual autonomy. These concerns are not entirely unfounded in certain applications of therapy. Earlier models of ABA service delivery, particularly those developed decades ago, at times emphasized compliance, normalization, and adult-directed goals, with less consistent attention to assent (e.g., monitoring a child’s willingness to participate and pausing or modifying intervention in response to distress), autonomy (e.g., offering meaningful choices or honoring preferences), or the lived experiences of autistic individuals (e.g., incorporating perspectives from autistic self-advocates when selecting goals). For caregivers, these practices may present as rigid programming, expectations that a child “push through” distress, or limited opportunities for shared decision-making, which can understandably influence whether families feel hesitant, mistrustful, or unsure about engaging in ABA services. In response to these concerns, the field of ABA, like many human service and healthcare disciplines, has engaged in critical self-reflection and ethical examination of its practices, increasingly recognizing the importance of consumer responsiveness. Contemporary ABA practitioners are increasingly and more authentically listening to autistic voices, ethical critiques, and family feedback to guide more compassionate, person-centered, and culturally responsive approaches that prioritize dignity, collaboration, and quality of life.

Contemporary ABA Practices and Ongoing Evolution

As the field of ABA continues to evolve, so do its values, practices, and professional expectations. Contemporary ABA approaches are guided by comprehensive ethical requirements outlined in the Behavior Analyst Certification Board (BACB) Code of Ethics, which are frequently reviewed and updated. These include continued core values related to obligations toward the protection of client dignity, rights, and welfare, respecting client personal choice and self-determination, and prioritizing clients’ and caregivers’ rights and needs in service delivery. Practitioners are also ethically required to individualize services and ensure that goals, procedures, and outcomes are meaningful and beneficial to the client (BACB, 2020). These values and practices are not entirely new to the field of ABA. Historically, ABA has emphasized individualized, socially valid interventions for autistic individuals (Baer et al., 1987; Celiberti & Taylor, 2021). However, this renewed emphasis and reconsideration of compassion integration has strengthened the field’s capacity to more explicitly and foundationally integrate practices that increase effective collaboration with allied professionals, develop strong interpersonal relationships with clients, caregivers, and colleagues, and consider how neuro-affirming practices can be integrated into procedures and assessments with clients. In practice, this may look like collaborating with caregivers to prioritize goals that support autonomy and quality of life, actively monitoring assent and distress cues, offering meaningful choices, and flexibly modifying or pausing interventions when procedures are no longer beneficial.

An important part of this evolution is the growing emphasis on neuro-affirming (Allen et al., 2024; Mathur et al., 2024), person-centered compassionate care (Alzahrani & Mathieu, 2025), and assent-based treatment (Abdel-Jalil et al., 2023; Flowers & Dawes, 2023; Morris et al., 2024). Neuro-affirming care includes prioritizing understanding behavior within the context of a child’s communication, sensory needs, and lived experiences, rather than focusing more narrowly on compliance or behavior reduction only. Compassionate care within ABA involves the deliberate and systematic delivery of services that prioritize the dignity, emotional well-being, and personal values of individuals receiving assessment and intervention (Mathieu-Sher et al., 2024; Rohrer & Weiss, 2022; Taylor et al., 2019). This framework emphasizes empathy, collaboration, and a holistic understanding of the needs of clients, their families, and the interdisciplinary teams involved in their support. Assent-based ABA means that services are delivered in ways that respect a child’s willingness to participate, provide meaningful choices, and respond to signs of discomfort or withdrawal (Lipshin, 2025). Rather than using a one-size-fits-all approach, practitioners are expected to adapt interventions to the child’s preferences and needs while maintaining therapeutic goals.

Compassionate Care for Caregivers

ABA that emphasizes compassionate-based practices is reflected not only in intervention procedures but also in the quality of relationships and collaboration with families and colleagues. Core interpersonal skills, such as active listening, respectful and clear communication, and perspective taking promote flexibility and assist practitioners, validate caregiver concerns, respond to questions, and explain recommendations in accessible, nontechnical language. They also help practitioners adjust recommendations when strategies do not fit a family’s needs, context, or culture (Rohrer et al., 2021; Mathieu-Sher et al., 2024). Increased collaboration further positions caregivers as active partners in treatment, with meaningful involvement in goal selection, priority setting, data review, and shared decision-making throughout the assessment and intervention process (Rohrer et al., 2021). Compassionate ABA also emphasizes individualization and responsiveness to family needs, recognizing that services must be tailored to each family’s unique values, schedules, resources, and support systems rather than applying uniform approaches across clients (Dennison et al., 2019). Consistent with the foundational principle of social validity, treatment goals are selected to meaningfully enhance the child’s and family’s quality of life, rather than prioritizing convenience, compliance, or behavior reduction in isolation (Baer et al., 1987). Finally, culturally responsive ABA practices attend to families’ cultural and linguistic backgrounds by providing materials in preferred languages, respecting cultural norms, and adapting interventions to align with family beliefs and practices whenever possible (Martínez & Mahoney, 2022).

Person Centered Compassionate Care in Service Delivery

Although caregivers play a critical role in facilitating access to evidence-based treatment and ongoing services, the primary recipients of ABA therapy are the clients themselves. Neuro-affirming, assent-based compassionate care, therefore, centers the client as an active participant in intervention, with clinical decisions guided by the client’s preferences, communication, boundaries, and lived experiences. In practice, this approach prioritizes dignity and self-determination by offering meaningful choices throughout sessions, supporting voluntary engagement, and avoiding forced compliance, power struggles, or coercive strategies whenever safely possible. Clients are explicitly taught and supported to self-advocate by communicating needs, preferences, and refusals using accessible modalities (e.g., vocal language, AAC, gestures), with advocacy responses consistently recognized as valid communication rather than noncompliance. Therapeutic assent is continuously monitored through both explicit and implicit indicators, including approach behaviors, affect, avoidance, and signs of distress, with practitioners expected to pause, modify, or discontinue demands when dissent persists. ABA practiced compassionately further emphasizes strength-based treatment planning, ensuring that goals enhance quality of life while avoiding the suppression of identity, self-regulation strategies, or communication. When behavior reduction is necessary, functionally equivalent alternatives are taught proactively and ethically, with ongoing adjustments informed by the client’s responses and well-being. For caregivers, understanding these client-centered practices is essential for effective advocacy and for ensuring that services remain aligned with the client’s needs, values, and overall quality of life ((Alzahrani & Mathieu, 2026).

Questions to Consider If ABA Might be Right for Your Family

Every family’s priority, values, and circumstances are unique. When meeting ABA providers and exploring different centers and delivery options, it may be helpful to ask questions that can assist you in deciding whether a provider’s approach aligns with your family’s priorities, values, and your child’s overall well-being. Below is a list of questions you may want to consider as you explore the appropriateness of ABA as a therapy approach for your child.

What specific areas do we as a family want ABA providers to support most right now, or what few things might we want to prioritize (communication, independence, emotional regulation, daily routines, school success, family life)? What challenges and barriers are we facing?
Is there research that addresses these priorities?
How will ABA address these needs? What will intervention look like
What does ABA typically look like in practice for families whose goals are similar to ours?
How does ABA define meaningful progress, and how does that align with our family’s definition of success?
How do the goals selected for intervention focus on improving my child’s quality of life rather than just reducing challenging behavior?

Just as ABA approaches can vary, individual behavior analysts differ in their communication style, values, clinical priorities, and approach to collaboration. Because the relationship between your family and the provider plays a central role in your child’s experience, it can be helpful to reflect on whether a particular analyst feels like a good relational and professional fit. The following questions may support you in evaluating whether a provider’s approach aligns with your family’s expectations, comfort level, and goals for care.

Table 1

Questions to consider if a particular behavior analysis might be the right fit for your family

Possible questions to ask	What we hope to learn	Pause if you hear
Collaboration
How do you collaborate with families and other professionals to support consistency and generalization across settings? How will you share and explain my child’s progress in a clear and meaningful way with our family?	Describes how they share decision-making around goals, interventions, and ongoing care Emphasizes consistent, ongoing communication with families and other professionals Has a plan to actively seek family input and feedback Requests consent to collaborate with teachers, therapists, and other providers to support consistency across settings Offers multiple, accessible ways to communicate (e.g., meetings, written updates, messaging) Provides regular, balanced updates that include progress and strengths and not just challenges Explains progress in clear, non-technical language that is easy for families to understand Responds to feedback with openness, flexibility, and collaborative problem-solving Offers caregiver training that is individualized and directly connected to the child’s goals and skills. Uses non-technical language and ensure understanding.	States that goals are based on assessments without asking about your family’s priorities or goals Provides no clear or shared plans for consistent communication or limited ways to stay connected Uses technical language without ensuring understanding No identified plan to collaborate with other professionals involved in your child’s care Does not offer caregiver trainings, or only provides training that is general and not tailored to your child’s specific skills and needs
Goals
How are the goals chosen for my child, and how do they reflect what matters to our family?	Will explicitly ask you about your priorities and goals	Relies on standardized or preset goals without meaningful individualization
Preferences
How are my child’s preferences, strengths, and communication style incorporated into assessment and intervention planning?	Describes goals as individualized, strength-based, and aligned with family priorities Includes caregiver input and, when possible, the child’s preferences and communication style Uses assessment results to inform, but not to rigidly dictate, goal selection Prioritizes skills that support communication, independence, and meaningful participation in daily life. Will focus on identifying your child’s strengths and their preference to inform child-led instructions. Has plans to teach language acquisition across modes of communication. Recognizes challenging behavior as a form of communication and emphasize teaching functional, alternative skills	Neglects to ask about your goals and priorities or do that as a routine question without engaging in that area in depth. Prioritizes goals that primarily serve environmental expectations (e.g., compliance, sitting still) over the child’s needs Minimizes or overlook communication and independence as priorities Focuses primarily on reducing behavior without teaching replacement or functional skills Frames challenging behavior as a problem to eliminate rather than something to understand
Adapt services
How will you adapt services to our family’s culture, values, and daily routines?	Shows genuine interest in learning about your family’s cultural values, beliefs, and expectations Asks questions about how culture and routines should be reflected in goals and service delivery Adapts interventions to align with your family’s language, routines, religion, and cultural context	Shows disinterest in cultural variables Provides a one-size-fits all approach to intervention.
Assent, child comfort
How do you ensure my child’s assent and comfort during sessions, and how do you respond if my child shows signs of distress or disengagement?	Has established procedures in place to monitor and respect assent and dissent during sessions Has clear protocols for adjusting, pausing, or modifying sessions when a child shows signs of distress or disengagement Consistently prioritizes emotional well-being alongside skill development within their service model Maintains structured systems to support and ensure implementation of assent-based practices Provides ongoing staff training on recognizing and appropriately responding to assent and signs of distress	Does not mention assent or are unfamiliar with assent-based practices Places primary emphasis on compliance or rule-following Expects participation regardless of the child’s comfort or engagement.
Skill instruction
How are skills taught during sessions, and how is learning supported without forcing compliance?	Describes teaching as play-based, flexible, and responsive to the child’s interests and motivation Embeds learning opportunities naturally within play and daily routines Treats signs of distress as meaningful communication and respond with support Teaches self-advocacy and self-regulation skills (e.g., requesting breaks, asking for help, seeking comfort) Describes learning as collaborative rather than compliance-driven	Relies on “waiting out” distress or challenging behavior without teaching alternatives Does not address emotional regulation or self-advocacy Uses “child-led” language without clearly explaining what it looks like in practice Treats play as a reward rather than an integral part of learning Separates teaching from meaningful or motivating contexts
Solve problems
What happens if something is not working for our child or family?	Invites and encourages ongoing feedback from families Describes clear processes for modifying goals or interventions when needed Engages in collaborative problem-solving and offer alternative approaches Follows up to ensure changes are effective and acceptable for the family	Responds defensively to feedback Lacks a clear plan for adjusting ineffective interventions Continues strategies without considering family or child response.

Key Take Aways

ABA is not a one-size-fits-all approach, nor is it a static practice. It is, however, a well-established, evidence-based therapy supported by decades of rigorous scientific research demonstrating its effectiveness for use to support autistic individuals. At the same time, the appropriateness and impact of ABA depend on how assessments and interventions are designed and implemented, as well as how well they align with a family’s values and the client’s overall well-being. While some historical applications of ABA have raised valid concerns by contemporary standards, the field continues to seek feedback and evolve toward more compassionate, person-centered, and neuro-affirming practices that further prioritize dignity, assent, and autonomy. For families, the question should be less about whether ABA is inherently “good” or “bad,” and more about whether a specific provider’s approach meets the unique needs of the child and their family. Through informed questioning, careful observation, and ongoing advocacy, caregivers play a powerful role in ensuring that ABA services are responsive to their child’s unique needs and are holistically aligned with the individualized needs and values of the family.

References

Abdel-Jalil, A., Linnehan, A. M., Yeich, R., Hetzel, K., Amey, J., & Klick, S. (2023). Can there be compassion without assent? A nonlinear constructional approach. Behavior Analysis in Practice, 1-12. https://doi.org/10.1007/s40617-023-00850-9

Allen, L. L., Mellon, L. S., Syed, N., Johnson, J. F., & Bernal, A. J. (2024). Neurodiversity-affirming applied behavior analysis. Behavior Analysis in Practice. https://doi.org/10.1007/s40617-024-00918-0

Alzahrani, D., & Mathieu-Sher, R. (2025, May 26). Examining the effectiveness of a behavior analytic intervention conducted within multi-level person-centered compassionate care model. [Conference session]. 51st Annual Convention of the Association for Behavior Analysis International, Washington, DC.

Alzaharni, D., & Mathieu, R. (2026). From critique to compassion. In R. Mathieu (Ed.), The Compassionate Shift. Cognella Academic Publishing.

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Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Celiberti, D., & Jaiswal, A. (2025). Making sense of autism treatments. Science in Autism Treatment, 22(7). https://asatonline.org/research-treatment/making-sense-of-autism-treatments-weighing-the-evidence/

Celiberti, D., & Taylor, B. A. (2021, October 18). Heart of ABA: Harnessing existing capacities, recognizing new opportunities [Webinar]. Rethink Behavioral Health. https://www.rethinkbehavioralhealth.com/resources/heart-aba-harnessing-existing-capacities-recognizing-new-opportunities/

Dennison, A., Lund, E. M., Brodhead, M. T., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering home-supported applied behavior analysis therapies to culturally and linguistically diverse families. Behavior Analysis in Practice, 12(4), 887-898. https://doi.org/10.1007/s40617-019-00374-1

Flowers, J., & Dawes, J. (2023). Dignity and respect: Why therapeutic assent matters. Behavior Analysis in Practice, 16(4), 913-920. https://doi.org/10.1007/s40617-023-00772-6

Hourican, T. A. (2025). The role of applied behavior analysis therapy in autism spectrum disorder. Lynchburg Journal of Medical Science, 1(2). https://doi.org/10.63932/3067-7106.1041

Leaf, J. B., Cihon, J. H., Ferguson, J. L., Milne, C. M., Leaf, R., & McEachin, J. (2021). Advances in our understanding of behavioral intervention: 1980 to 2020 for individuals diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 51(12), 4395-4410. https://doi.org/10.1007/s10803-020-04481-9

Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. (2022). Concerns about ABA-based intervention: An evaluation and recommendations. Journal of Autism and Developmental Disorders, 52(6), 2838-2853. https://doi.org/10.1007/s10803-021-05137-y

Martinez, S., & Mahoney, A. (2022). Culturally sensitive behavior intervention materials: A tutorial for practicing behavior analysts. Behavior Analysis in Practice, 15(2), 516-540. https://doi.org/10.1007/s40617-022-00703-x

Mathieu-Sher, R., Johnson, P., Straub, E., Lao, A., Alzahrani, D., McCallum, E., & Schmitt, A. (2024b). Teaching compassionate-based behaviors across communication partners to students of applied behavior analysis: A preliminary investigation of comparative effectiveness. Discover Education, 3(1), Article 101. https://doi.org/10.1007/s44217-024-00198-4

Mathur, S. K., Renz, E., & Tarbox, J. (2024). Affirming neurodiversity within applied behavior analysis. Behavior analysis in practice, 17(2), 471-485. https://doi.org/10.1007/s40617-024-00907-3

Morris, C., Oliveira, J. P., Perrin, J., Federico, C. A., & Martasian, P. J. (2024). Toward a further understanding of assent. Journal of Applied Behavior Analysis, 57(2), 304-318. https://doi.org/10.1002/jaba.1063

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Rohrer, J. L., Marshall, K. B., Suzio, C., & Weiss, M. J. (2021). Soft skills: The case for compassionate approaches or how behavior analysis keeps finding its heart. Behavior Analysis in Practice, 14(4), 1135-1143. https://doi.org/10.1007/s40617-021-00563-x

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2019). How much compliance is too much compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1641258

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2019). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654 666. https://doi.org/10.1007/s40617-018-00289-3

Wilkenfeld, D. A., & McCarthy, A. M. (2020). Ethical concerns with applied behavior analysis for autism spectrum “disorder.” Kennedy Institute of Ethics Journal, 30(1), 31-69. https://doi.org/10.1353/ken.2020.0000

Reference for this article

Alzahrani, D. & Mathieu, R. (2026). Clinical Corner: Is ABA the right choice for my child? How can I better understand ABA in today’s evolving field? Science in Autism Treatment, 23(5).

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