EDUCATION
How Many Hours of ABA Does a Preschool-Aged Child Need?
One of the first questions families may have when considering ABA is, “How many hours does my child need?” A doctor may recommend a certain amount of treatment. An ABA provider may make a recommendation after completing an assessment. Insurance may also have its own requirements for the number of hours it will approve.
The short answer is that there is not one number that is right for every preschool-aged child. The amount of ABA a child needs should be based on what the child’s assessment shows and what they need to make meaningful progress.
How Are ABA Hours Determined?
A doctor or diagnosing provider may recommend ABA and sometimes suggest a certain number of hours. That recommendation can be helpful, but an ABA assessment gives the BCBA a closer at the child’s current skills and behavioral needs. This information is used to develop treatment goals and help determine an appropriate level of treatment.
The Council of Autism Service Providers (CASP) emphasizes that treatment intensity should be individualized. The number and complexity of a child’s goals can help determine the scope and intensity of treatment. A BCBA may look at communication, social interaction, play, adaptive skills, and independence. Behaviors that interfere with learning, safety, or participation in everyday activities can also influence how much support may be needed.
What Do Autism Support Levels Mean?
The DSM-5-TR describes three levels of support associated with autism:
Level 1: Requiring support
Level 2: Requiring substantial support
Level 3: Requiring very substantial support
These levels describe the amount of support a person may need. However, they do not translate directly into a specific number of ABA hours. Two children with the same autism support level can have very different skills, behaviors, and treatment goals. This is why the ABA assessment is an important part of deciding what level of treatment may be appropriate.
What Are Focused and Comprehensive ABA?
Families may also hear ABA described as focused or comprehensive. These terms describe the scope and typical intensity of treatment.
Focused ABA generally addresses a smaller number of specific skills or behavioral concerns. CASP guidelines describe focused treatment as typically involving about 10 to 25 hours of direct ABA per week.
Comprehensive ABA addresses needs across several areas of development. Goals may involve communication, social skills, adaptive functioning, independence, learning, and challenging behavior. Comprehensive treatment typically involves about 30 to 40 hours of direct ABA per week.
These ranges can help families understand the difference between treatment models, but they are not automatic prescriptions. Current guidance emphasizes individualizing treatment intensity based on the child’s goals and needs. Hours can also change over time as the child develops new skills and responds to treatment.
Can Insurance Affect the Number of ABA Hours?
Yes. The number of hours a BCBA recommends and the number of hours an insurance plan authorizes may not always be the same.
Insurance requirements vary. Some plans may consider factors such as autism support level, whether treatment is focused or comprehensive, the child’s skill deficits, behaviors being treated, and the clinical reason for the number of hours requested.
Families may also hear the term medical necessity during this process. Medical necessity refers to whether the requested treatment is clinically supported under the insurance plan’s criteria. For example, Aetna’s ABA Medical Necessity Guide looks at a child’s level of functional impairment, clearly identified target behaviors, measurable progress, and whether the level of impairment supports the number of ABA hours being requested. This is one example of why an insurance company may look at more than the autism diagnosis alone when deciding how many hours to authorize.
For families using MO HealthNet (Missouri Medicaid), the state has specific requirements for ABA services. Covered ABA services must be medically necessary and pre-authorized, and medical necessity for initial ABA intervention is determined using an ABA assessment for intervention planning. MO HealthNet also considers whether a child has behavioral excesses or deficits that significantly interfere with activities at home or in the community. Private insurance plans may use different criteria, so families should check with their individual plan to understand how ABA hours are reviewed and approved.
For parents, the important distinction is that the BCBA develops a clinical recommendation based on the assessment results. The insurance company or funding source then determines what it will authorize under its own coverage requirements.
Questions Parents Can Ask
· What did my child’s ABA assessment show?
· How did you determine the recommended number of hours?
· What skills or behaviors are influencing the recommendation?
· Is my child’s treatment considered focused or comprehensive?
· Will my child’s hours change as they make progress?
· Are flexible scheduling options available?
What This Looks Like at Great Strides
Assessment results drive our recommendation for treatment hours. Our BCBAs review information from the child’s diagnosis and other service providers while also completing an assessment to identify the child’s current skills and behavioral needs. We use several assessment tools, including but not limited to the Early Start Denver Model (ESDM) Curriculum Checklist, VB-MAPP, SRS-2, and the Vineland Adaptive Behavior Scale. This information helps guide treatment intensity, goals, and placement within our programs.
The ESDM Curriculum Checklist looks at skills across multiple areas of development and helps guide individualized teaching goals. Our classrooms provide a developmental continuum for early learners through pre-K, with placement based on each child’s current skills and assessment outcomes. As children build new skills, they can progress through the program at their own pace.
Our BCBAs also consider behaviors that may interfere with learning, safety, independence, or participation in daily activities when developing and reviewing treatment. As treatment continues, direct observation, supervision, data, and session documentation help the clinical team monitor progress and determine whether programming or treatment recommendations should be adjusted. Because every child and family have different needs, scheduling is individualized as well. Recommended treatment hours are based on the child’s assessment results and clinical needs while also taking the family’s availability and schedule into consideration. This allows each child’s schedule to reflect the level of support that is appropriate for them and manageable for their family.
So, How Many Hours Does My Child Need?
There is no single number of ABA hours that is right for every preschool-aged child. Focused and comprehensive treatment ranges can provide a helpful starting point, but the recommendation should come back to one important question: What does this individual child need to make meaningful progress?
A thorough ABA assessment helps answer that question. Parents should feel comfortable asking why a certain number of hours is being recommended, what their child will be working toward during that time, and how the recommendation may change as their child progresses.
Sources & Further Reading
American Psychiatric Association (APA). DSM-5-TR Clinician-Rated Severity of Autism Spectrum and Social Communication Disorders.
Council of Autism Service Providers (CASP). (2024). Applied Behavior Analysis Practice Guidelines for the Treatment of Autism Spectrum Disorder: Guidance for Healthcare Funders, Regulatory Bodies, Service Providers, and Consumers, Version 3.0.
Aetna. Applied Behavior Analysis Medical Necessity Guide.
Missouri Code of State Regulations. 13 CSR 70-98.030: Applied Behavior Analysis Services.
Rogers, S. J., & Dawson, G. Early Start Denver Model Curriculum Checklist for Infants and Young Autistic Children, Second Edition. Guilford Press
