What is ABA?
Behavior Analysis is the science of behavior. ABA (Applied Behavior Analysis) is the name of a process of systematically assessing and evaluating behavior, and applying interventions that are based on the principles of learning theory, in order to alter and improve socially significant behaviors. .

BBehavior Analysis is a data-driven science, therefore it relies heavily on objective information, direct observation and measurement, and the systematic arrangement of events, in order to obtain desirable behavior. These evidence-based procedures are utilized with children with developmental disorders to enable them to acquire and maintain functional skills such as communication and social skill development. ABA focuses on breaking down complex skills into prerequisite and component steps, and teaching in a systematic and individualized manner, whether the targeted behavior is simple (such as increasing frequency of eye contact) or complex (maintaining social interactions).
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Why is ABA important for my child with a development disorder?
ABA focuses on the process of behavior change with respect to development of adaptive social behavior and reduction of maladaptive behavior. Specific “socially significant behaviors" include academics, communication, social skills and adaptive living skills. For example, ABA methods can be used to:

• Teach new skills (for instance, the socially significant behaviors listed above)
• Generalize or transfer behavior from one situation to another (for example, from communicating with caregivers in the home to interacting with classmates at school);
• Modify conditions under which interfering behaviors occur (for instance, changing the learning environment so as to foster attention paid to the instructor);
• Reduce inappropriate behaviors (for example, self injury or stereotypy).

How Can I Learn More About ABA?
Please refer to the CARD website (www.centerforautism.com) to learn more about ABA. CARD also provides training on a variety of ABA related topics which can be requested through the website as well.
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What is the CARD program?
The CARD Program recommends that 1:1 behavioral therapy be administered initially in the home setting, and then generalized to other settings such as school. The techniques used in teaching are based on Applied Behavior Analytic practices and include Discrete Trial Teaching (DTT), Natural Environment Training (NET), Errorless Teaching and Fluency-Based Intervention.

The content of instruction covers a wide range of skill areas such as speech and language skills, gross and fine motor skills, academic skills, self-care, and most importantly, socialization, cognition, and executive functioning skills.

The CARD early-intervention plan typically consists of intensive treatment in which basic skills are taught in the first years, and advanced social and abstract cognitive skills are taught in the later years. CARD treatment is typically allocated in the following manner, with variation depending on each child's particular symptoms and rapidity of learning.

The following features characterize the treatment received by all CARD clients:

• Treatment is individualized and comprehensive; all skill domains are addressed (language, social, adaptive and academic);
• The principles of behavior analysis are used to build functional skills and reduce challenging behaviors;
• Individuals with experience in autism treatment and advanced training in ABA supervise treatment;
• The learning objectives are age appropriate;
• One-to-one therapy is initially administered in the home, then generalized to other settings such as school or a group format;
• Treatment is intensive: 20-40 hours of therapy per week;
• Children receive at least 2 years of service; and
• Children start treatment between 20-59 months old.

For more information on the CARD program, read the text from Dr. Granpeesheh’s conference presentation.
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How does one get started with a CARD program for their child?
If you would like to start a CARD program, you can either complete the enrollment package request form found on the CARD website www.centerforautism.com or contact the CARD office nearest you.
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Do you provide therapists for families? How many therapists should work with my child?
Yes, we do provide therapists. The number will vary depending on the number of hours of service your child receives each week. Each of our therapists typically provides 6-10 hours of therapy per week to each child. Therefore, a child with a 40-hour/week program will have a team of 4-5 therapists.
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Can a parent be trained to implement this treatment?
The involvement of the parent(s) and family is essential to an effective program. The procedures must be generalized beyond the environment and conditions in which the skills are originally taught, so parents and other close family members automatically become a part of the child’s treatment team. Time spent with the child’s family can ensure faster acquisition, generalization, and maintenance of the targeted behaviors, but only if parents are adequately trained to use the behavioral principles and regular treatment hours are maintained by the rest of the team. For this reason, we ask that at least one parent attend the team meetings to provide input, to be aware of the short and long term goals for their child, and to be adequately trained by the supervisor. In addition, as part of the treatment for your child, CARD strongly recommends Parent Training services so that you can learn about ABA techniques. These can be very helpful in managing any challenging behaviors your child might have.
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How do you handle difficult behaviors?
We implement a number of techniques to address specific behavioral issues. Ethically, Behavior Analysts must first identify the function of a behavior before developing an intervention to address it. Procedures to reduce a difficult behavior should always be accompanied by a simultaneous procedure to increase a desired behavior that will serve the same function as the undesired behavior. We rely heavily on positive reinforcement to teach these alternative and functionally equivalent behaviors.

Because each child has a different set of behaviors, if your child is exhibiting challenging behaviors we recommend a functional behavior assessment so that a behavior intervention plan can be designed specifically for your child.
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How is progress evaluated?
Data collection is the basis for procedural decisions. Different methods of evaluation lend themselves to different behaviors. At CARD, we use several to measure a child’s progress. These include:

• Standardized annual, pre-, and post-assessments (language, cognitive, adaptive skills)
• CARD’s Skills Index (a detailed inventory of all skills in development, to help assess your child’s specific strengths and deficit areas)
• Functional Behavior Assessment (annually and as needed) to determine both the function and rates of challenging behaviors
• Continuous data (session data to assess new skills acquired and rates of challenging behaviors)
• Reports from parents
• School, home, and clinic observations (conducted weekly)

How much does a CARD program cost?
Rates for services vary depending on your location. Please contact the office closest to you to determine the cost of a CARD program for your child.
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Do you only work with children who have an autism diagnosis?
No, at CARD we work with all children on the autism spectrum. This includes children with autism, Asperger’s Syndrome and PDD (pervasive developmental disorder, not otherwise specified).
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Is ABA appropriate for older children?
Yes. Treatment has been demonstrated to be most effective when initiated early in life, however there are many research articles that document the positive effects of ABA-based interventions for individuals of all ages.
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How are you different from other providers?
CARD works hard to provide comprehensive treatment services to children with autism. While CARD excels in its basic ABA program, it also offers numerous specialty programs that add to our success:

• CARD stays focused on the treatment of each child as an individual, and insists that each program remain flexible, and tailored to the child.
• The parents of CARD patients are an integral part of the treatment team. They are trained in the program and are required to participate in the maintenance and generalization of mastered skills. Parents must be fully committed to their child's treatment in order to access CARD services.
• All CARD programs are based on the outcome of ongoing research protocols that allow us to update our curricula and maintain age appropriate goals.
• In order to promote optimal generalization of acquired skills, CARD therapy services are provided in the homes and schools of the patients.
• Regular program monitoring and supervision is considered an essential component of each patient's program. The patient, parents, and entire therapy team meet 2-4 times per month to discuss progress, advance the program where needed, conduct parent training, and provide skill reinforcement to CARD therapy staff.
• CARD's commitment to each child is made evident by regular supervision, frequent parent contact, collaboration with teachers and district representatives, and regular meetings with adjunct therapy providers including occupational therapists, speech pathologists, dieticians, and physicians.
• CARD aggressively troubleshoots for those patients not progressing in the program. Each child’s program is constantly monitored and adjusted in order to ensure the best possible rate of learning.
• Standardized assessments conducted by independent assessors demonstrate that a great many of CARD's patients who receive intensive intervention and begin services at or before the age of 42 months are without identifiable symptoms and are fully mainstreamed into typical educational settings when services are terminated.
• CARD utilizes a comprehensive alternative communication program to ensure that non-vocal children have effective means of communication. This program incorporates the Picture Exchange Communication System and an advanced reading/literacy program developed at CARD.
• CARD Supervisors are certified by Scientific Learning Corporation to provide and monitor the Fast ForWord program that is designed to improve the speech of children with autism and developmental disorders.
• CARD has created programs to address advanced cognitive deficits, including a variety of Executive Functioning exercises derived from the most current autism literature.
• For Instances when parents want CARD to continue, the CARD II program addresses all of the needs of children from age 9-21. CARD has also developed specific programs to assist children receiving biomedical interventions. These include Pill Swallowing, Feeding and Desensitization. CARD has devised programs that teach ways to tolerate spending time in a hyperbaric chamber, or to receive IV (intravenous) treatments.
• CARD has created programs that incorporate the latest research pertaining to development of these skills to address advanced cognitive and socialization deficits for older children.

How do you derive your curricula and how do you decide what to teach?
CARD is known for the complexity and comprehensiveness of its curricula, which have been developed since 1990. CARD’s curriculum consists of thousands of programs that have been designed to teach the individual skills needed by the children with whom we work. Our Skills Index is a detailed list of skills seen in normally developing children from birth to age 21. Each skill area corresponds to several programs for teaching within CARD’s eight curriculum areas:

• Language
• Adaptive Skills
• Motor Skills
• Academic Skills
• Social Skills
• Cognitive Skills
• Executive Functioning Skills
• Play Skills

Are there families that I can talk privately to, or support groups?
Some of our current families are happy to speak with our new parents. With your written approval we can give your telephone number to one or more, who will contact you to arrange a meeting. Often, you’ll be able to observe their child’s program, and discuss the program with the parents at length.

Also, each month Thoughtful House hosts a meeting on a Monday night to offer more information on treatment and research going on at Thoughtful House and with CARD. This is an excellent opportunity to learn more about all of the treatment options available at Thoughtful House.
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How do I find out about possible sources of funding for this program?
We recommend contacting a knowledgeable advocate or attorney to discuss issues related to funding your child’s program. We will be happy to provide you with referrals. Typically, an advocate will accompany you to your IEP, and will provide input that may help to secure funding from your school district.
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How many hours should my child have?
Because this program is unique in that it is individualized to the particular needs of a child, each child’s recommended hours of treatment will vary. In all cases, the program must be intensive in nature and include 1:1 instruction in order to be effective. Research shows that a minimum of 25 hours/week is necessary to gain the full benefits of ABA for children starting intervention before age five. For older children, the hours recommended will vary according to their specific needs.
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How should my child’s day be structured?
We find that for a child beginning the program, the morning hours are ideal for therapy. For children receiving 30 hours per week or more, we recommend a morning session from 9-12 followed by a lunch and play break, and 2 sessions in the afternoon. Weekends should be spent with family, working on community outings and the generalization of concepts taught during the week.
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Does C.A.R.D. have any data to support its success?
CARD actively conducts research to evaluate the efficacy of our programs.

Some of our current protocols:

• Outcome level analysis of CARD early intervention program
• Analyses of the effects of decreases in treatment hours
• Evaluation of biomedical treatments for autism
• Assessment of acquisition and maintenance of complex language and social skills for children with autism
• Effective ways to teach safety skills to children with autism
• Ongoing functional analysis of challenging behaviors

What is my role in my child’s program?
Good communication among the parents, therapists, and supervisor is important to the success of the child’s program. Your supervisor will depend on your input at clinic meetings. In addition, we request that parents read the log notes daily, and continually work to generalize concepts and skills their child has learned during the 1:1 therapeutic time. It is also imperative that parents consistently apply any procedures that have been set up at the team meetings (also called "clinics"). Above all, consistency is the number one factor determining the success of the program.
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