For decades, the prevailing belief in Applied Behavior Analysis (ABA) therapy has been that “more is better.” However, recent research challenges this assumption, revealing that higher intensity doesn’t always lead to better outcomes. In fact, many children with autism thrive with lower-intensity ABA therapy, receiving fewer hours per week.
Why Does This Matter?
High-intensity ABA therapy is both costly and time-consuming. Programs exceeding 20 hours per week can cost $80,000 to $150,000 annually per child. Beyond the financial burden, such intensive schedules—comparable to a full-time job—can limit a child’s ability to engage in other important activities like school, sports, and hobbies. Children, like everyone else, benefit from downtime to relax and connect with family.
The Evidence Against “More Is Better”
A pivotal meta-analysis by Sandbank et al., published this summer in JAMA Pediatrics, found no significant correlation between ABA therapy intensity and improved outcomes. The researchers cautioned healthcare providers against routinely recommending therapy programs exceeding 20 hours per week.
These findings align with a 2021 randomized controlled trial (RCT) by Sally Rogers et al., which directly compared 15-hour and 25-hour weekly ABA schedules. Both groups demonstrated equivalent progress, suggesting that increased therapy hours do not necessarily yield better clinical outcomes.
Tailoring Dosage to Individual Needs
It’s important to note that these studies focus on average outcomes. Some children might benefit from higher-intensity ABA—especially those with co-occurring intellectual disabilities—but further research is needed to confirm this.
In our practice, the clinical team emphasizes tailoring therapy recommendations to each child. Factors such as age, baseline skills, co-occurring conditions, and barriers to treatment all influence the ideal dosage. In 2022, a study that we conducted on patient outcomes was published in the World Journal of Pediatrics. Our findings showed that children receiving client-specific ABA therapy made significant progress, regardless of the intensity.
Finding the Right Balance
So, how much ABA therapy is the “right” amount for a child? The decision should be made collaboratively with a qualified behavior analyst who understands your child’s unique needs. Be cautious of providers who prescribe high-intensity ABA as a one-size-fits-all solution. Many children benefit greatly from less than 20 hours/week of high-quality ABA therapy.
Our Commitment to Responsible Care
At Kyo, we are committed to making every moment count for the kids and families we serve. While ABA offers the structure and repetition that many children with autism benefit from, they also need time to be kids. This balance is vital. Every child deserves effective, responsible therapy, and we’re dedicated to being the provider who delivers just that.
