It is a fair question, and a common one. Parents who are about to start ABA, or who have just started, often worry that therapy could make their child more anxious, more withdrawn or more "shut down," or teach them to hide who they are. Some have read accounts from autistic adults who say ABA hurt them. This page takes those fears one at a time, explains what is and is not known, and gives you specific warning signs and the questions to ask.
Can ABA make autism itself worse?
Autism is a lifelong difference in how a person communicates, relates to others and experiences the world. ABA does not change whether a child is autistic, and it should not try to. What can change, for better or worse, is how your child feels, behaves and copes. So the useful question is narrower: can a program leave a child more distressed, less able to communicate, or less like themselves? The honest answer is yes, a poorly designed or poorly run program can. A well-run program should be watching for exactly those signs.
Researchers have not measured this well. A 2021 review of 150 reports on early interventions for young autistic children found that only 11 mentioned adverse events. A 2023 review in the BMJ (Project AIM) concluded that adverse events were "poorly monitored, but possibly common," and that the benefits of interventions "cannot be weighed against the potential for adverse effects" because of that gap. That is not proof of harm. It means that you, the parent, are an important part of the safety system.
Why do some behaviors get worse after ABA starts?
There are a few different things a parent might see, and they mean different things.
A short-term spike that the plan expected
When a behavior such as screaming no longer gets the result it used to (for example, getting out of a task), it often gets louder or more frequent for a short time before it fades. Behavior analysts call this an extinction burst. A good plan predicts it, keeps everyone safe, and teaches a replacement skill at the same time, such as asking for a break. Your BCBA should warn you in advance, tell you how long it is likely to last, and show you the data.
Distress caused by the program
If your child cries at the door, fights to avoid sessions, sleeps badly, or seems frightened of staff, the program itself may be too demanding, too fast or a poor match. This is not something to wait out. Ask for a meeting.
Loss of skills
If your child loses words or skills they used to have, tell your child's doctor promptly. Loss of skills can have many causes, including medical ones, and it should be checked by a physician rather than explained away by a therapy team.
Can ABA teach my child to mask?
"Masking" or "camouflaging" means hiding autistic traits to fit in, such as forcing eye contact, suppressing stimming or copying scripts. A 2021 systematic review found that higher self-reported camouflaging is associated with worse mental health outcomes in autistic people. That review was not about ABA, but it explains why autistic adults raise this concern: programs that reward "looking typical" can push children toward masking.
The fix is in the goals. Ask why each goal matters for your child. Good goals help a child communicate, stay safe, do things they want to do, and have more control over their day. Goals that only make a child look less autistic, like stopping harmless hand-flapping, deserve a hard look. Our article on whether ABA is harmful covers the wider criticism.
What about burnout and too many hours?
Autistic adults describe "autistic burnout" as deep exhaustion after long periods of strain. There is no research that sets a safe number of therapy hours for every child. What you can do is watch your child's energy across the whole week. Insurer policies describe a wide range of hours: Aetna's guide, for example, describes focused programs at 1 to 20 hours a week and comprehensive programs for young children at 10 to 25. More is not automatically better. If your child is exhausted, ask whether hours, session length or timing can change.
Warning signs, and what a good provider does
| What you notice | Why it matters | What a good provider does |
|---|---|---|
| Your child cries, hides or fights to avoid sessions week after week | Sessions may be aversive, not just challenging | Pauses demands, rebuilds rapport through play, reviews goals and pace with you |
| Staff push through when your child says no or pulls away | Ignoring assent can teach a child that their "no" does not count | Treats signs of withdrawal as information and changes the activity |
| Physical restraint or holding a child in place to finish a task | Restrictive methods carry risk and should be rare | Uses the least intrusive strategies; under the BACB code, restrictive methods only after less intrusive ones have failed or when risk of harm is higher |
| Goals target harmless stimming or eye contact | Can push toward masking | Explains each goal's purpose and drops goals you do not agree with |
| New sleep problems, fear or loss of skills | Could be stress or a medical issue | Encourages a doctor visit, adjusts the plan, documents what changed |
| You are not allowed to watch sessions or see data | Removes your ability to check | Welcomes observation and shows graphs at every review |
| Behavior spikes with no warning or plan | Could be an expected burst or a sign of a poor plan | Told you in advance, has a safety plan, reviews data within days |
How can I keep track at home?
A simple log helps you and the BCBA tell an expected bump from a real problem. Once a day, jot down three things: how your child seemed before and after the session (calm, tired, upset), any new or bigger behavior, and anything that changed at home, such as illness, poor sleep or a new sibling. Bring the log to your next parent training session. Patterns over two or three weeks tell you far more than one hard day, and they give the team concrete facts to work with.
What should I ask before and during ABA?
- "How do you know when my child does not want to take part, and what do you do then?" (The BACB ethics code asks behavior analysts to obtain assent "when applicable.")
- "Will you ever use restraint? Under what conditions?"
- "What should I expect in the first month, and could anything get harder before it gets easier?"
- "How often will we look at data together, and what happens if it shows no progress?" (The code requires behavior analysts to take "appropriate corrective action" if outcomes are not being realized.)
- "Can I watch a session, at home or at the center?"
- "Who do I call the same day if I am worried?"
For more on how willingness to participate is built into care, read assent-based ABA and our guide to compassion-focused ABA.
How Hope Center handles distress
Our approach is trauma-informed, assent-based and play-based, with tasks presented in a fun, non-forceful way. When a child is upset, staff use therapeutic calming. We use the least intrusive and safest strategies, such as brief response interruption and redirection, and we remove hazards. We do not use restraint. If a child cannot be kept safe, staff call 911 and report to the behavior analyst, who returns the call within 24 hours.
Parents are trained weekly and can text or call the RBT, the BCBA or the front desk. Every plan is reviewed by our clinical director before it goes to insurance. If you are worried about how your child is reacting to therapy, here or anywhere, contact us or call 561-337-8865 for a free consultation.