"Comprehensive ABA refers to treatment provided directly to the patient to improve or maintain behaviors in many skill areas across multiple domains (e.g., cognitive, communicative, social, behavioral, adaptive). Treatment often emphasizes establishing new skills but may also focus on reducing challenging behaviors, such as elopement, and stereotypy, among others. Access to comprehensive ABA should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions. Treatment targets are generally drawn from the following domains: • adaptive and self-care • attending and social referencing • cognitive functioning • community participation • coping and tolerance • emotional development • family relationships • language and communication • play and leisure • pre-academic skills • reduction of challenging behavior • safety skills• self-advocacy, independence, and autonomy • self-management • social relationships • vocational skills One example of comprehensive treatment is intensive ABA treatment for young children with ASD. In this example, the primary goal of treatment is to close or narrow the gap in development compared with peers. Intervention must be implemented as early as possible to improve the developmental trajectory of children diagnosed with autism. Effective early intervention focuses on establishing foundational skills, such as environmental awareness, imitation, functional communication, self-management, daily living skills, and the building blocks for social interaction. These foundational skills reduce the pervasive impact of ASD and minimize the likelihood of additional disability in the form of intellectual impairment. In addition to building skills, early development is the optimal period to reduce and mitigate challenging behaviors. The proportion of treatment time spent on any given domain is subject to the individual needs of the patient and family. For example, when establishing foundational “learning to learn” skills (e.g., imitation, observational learning, discrimination), treatment time devoted to other skills may be reduced to allow a greater focus on the skills that will transform learning and progress in subsequent areas (i.e., pivotal skills). In addition, slow rates of progress may signal the need to increase the amount of treatment to establish critical skills. As noted above, comprehensive treatment should not be limited by age, as this type of program can be appropriate for adolescent and adult patient populations. For example, persons who engage in harmful and risky behaviors and/or have substantial deficits in skills that jeopardize their health, safety, and independence may require such programs. Comprehensive treatment may be 1:1 initially, with gradual transitions to small-group formats as appropriate. Treatment may be provided in structured sessions or using naturalistic methods depending on the individual needs of the patient. As the patient progresses and meets criteria to receive treatment in other places, services may be provided in multiple settings.
"Focused ABA refers to treatment, provided directly to the patient, to improve or maintain behaviors in a limited number of domains or skill areas. Access to focused intervention should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions. Focused ABA treatment is appropriate for patients who: (a) need to acquire a limited number of skills fundamental to health, safety, inclusion, and independence. Such behaviors may include but are not limited to safety skills, following instructions, social skills, self-care, communication, feeding, toileting, cooperating with medical and dental routines, and participating in independent leisure activities. or (b) demonstrate challenging high-risk behaviors that must be prioritized due to health and safety concerns. In many cases, addressing these behaviors in a timely fashion is critical as they can also interfere with treating other medical needs. Examples of challenging behaviors that may be the focus of intervention include but are not limited to self-injury, property destruction, aggression toward others, inappropriate sexual behavior, threats, pica, elopement, stereotypic motor or vocal behavior, challenges with routines related to safety or adaptive functioning, disruptive behavior, and dysfunctional social behavior. Focused ABA treatment may be delivered solely to increase adaptive behaviors (e.g., oral care, independent toileting). However, when the focus of treatment is the reduction of challenging behavior (e.g., pica, property destruction), establishing alternative adaptive behavior should be included in the treatment plan. The absence of adaptive behavior such as functional communication or leisure skills often sets the stage for the emergence of serious behavior disorders and leaves patients with limited opportunities to access meaningful reinforcers. When the main purpose of treatment is the reduction of challenging behavior, the behavior analyst identifies situations in which the behavior occurs to determine its purpose or function for that patient. Understanding the function may necessitate a specific type of assessment, known as a functional analysis, that involves systematically varying environmental events to measure the effects on the behavior of interest. When the function of the challenging behavior has been identified, the behavior analyst designs a treatment plan that alters the environment to reduce the motivation for the challenging behavior and/or establish an alternative adaptive behavior. Some patients display significant challenging behaviors that require treatment in specialized settings (e.g., intensive outpatient, day treatment, residential, or inpatient programs). Such treatment typically requires high staff-to-patient ratios (e.g., 2–3 staff members for each patient) and close on-site direction by the behavior analyst. These programs often utilize specialized equipment and treatment environments, such as observation rooms and room adaptations, which aid in maintaining the safety of both patients and staff. When the primary purpose of focused treatment is to increase socially appropriate behavior, services are often delivered in dyads or small groups. In this setting, patients with similar or varying disorders, and/or typically developing peers, are often included. The treatment team supports the practice of behavioral targets in the treatment session but also programs for the generalization of skills outside those sessions. Some patients may require 1:1 treatment sessions either prior to or concurrently with group sessions for the group format to be an appropriate treatment modality."
