Center-based vs. Home-based Treatment for Autism

“Would you prefer to have therapy at home or in our center?” This is often one of the early questions presented to families starting ABA therapy with a new provider. This question may leave parents a little stumped. What are center services? What do home services mean? Therapy that takes place in a center usually requires parents to transparent their child to the center location for therapy. There are often other children also receiving therapy at a center at one time, using small rooms or office dividers to create individual workspaces for the clients. Parents are often not allowed into the therapy space due to protect the privacy of all of the clients. In home-based therapy involves the therapist coming to your home to do therapy. An adult must remain in the home while therapy takes place, and you may be asked to allow the therapist and client to use a room or space in the house in which they can work undisturbed for the duration of the therapy session. Each location offers unique benefits and drawbacks. Many times the location of the therapy depends on the funding party or even the availability of services in the local counties. If the choice of center or home is available for your family, discuss this with your child’s BCBA to decide what setting makes the most sense for your child and your family.

Studies suggest that children made great developmental progress in motor and language skills in programs at dedicated centers. Centers offer the opportunity to interact with other children on a regular basis which may make it easier to work on social and play skills. Many centers include short sessions of group learning or “circle time” similar to what might be found in a typical preschool or kindergarten classroom. This makes it easy to practice school readiness skills. There are usually larger spaces that are dedicated play spaces or sensory spaces, with access to lots of toys and larger play equipment that are impractical for most homes. This makes it very easy to try out new activities and develop new interests for your child. There are, of course, drawbacks to this setting. Transportation is required to get to and from the center; that might not be feasible for your family due to schedules, distance, or access to vehicles. It is more difficult for parents and other family members to feel included in the therapeutic process because they aren’t able to see and hear what is happening during sessions. Some children are just not ready to be introduced to new environments or the newness of the environment is so distracting that they cannot learn. Another consideration is that even in “normal”, non-Covid times, illness spreads quickly through the center, much like at schools. Even with the most thorough, attentive cleaning by staff, young children are not good at understanding the need for semi-sterile environments.

Alternatively, children made progress in self-help and social skills home-based programs. Activities of daily living such as dressing, toileting, bathing, and taking care of one’s living environment, most naturally occur at home. When a new skill is learned in the environment in which that skill is most likely to be needed, there is a higher chance that the skill will be maintained over time. Additionally, practicing these skills in the privacy of their own home helps maintain our clients’ dignity and ownership of their own bodies. The biggest advantage of home-based therapy is that the therapy is imparted in the relaxed surroundings of the individuals where they feel the safest & secure. This also facilitates the active participation of the parents, family members, and caregivers. Important life skills, like personal hygiene, eating, and bathing, are much easier to teach & reinforce in a home setting where these life skills are carried out on a daily basis. Home-based therapy can also be challenging for families there may be a space or room that is unavailable to the family during sessions. Siblings can feel left out of what they perceive as fun when one child in the family is getting so much one on one attention. Home-therapy requires that an adult remain in the home during therapy which can be limiting for family schedules and parent’ work schedules. It may be difficult to work on social and play skills if there are no near-age peers available. This means that social and play skills are being practiced with adults, and it may be difficult to transfer those skills to peers in the future. It may also be difficult for the client to generalize new skills that are intended for use in settings outside the home or across multiple settings. This means that if your child learns to raise his or her hand before responding (a school skill), they may not understand for a while that they need to raise their hand before responding at school. The child might think that hand-raising is only required at home, with their therapist.

Center-based therapies are very effective because of structure & control thanks to the location they are provided in. The therapists at centers are able to create and implement a structured routine in such a setting. They can control the environment, handle challenges and curate mock situations to teach skills such as paying attention, taking turns, and following instructions. Skills can be reinforced with the right conditioning and the routine of tasks performed daily.

In a home setting, the child may benefit more from a one – on – one session with the therapist. The Therapist has no distraction and is able to devote quality time to the child paving the way for progress. This may not be the case in a center setting with many kids, distractions all of which may not be conducive for a child and their learning. In a home, the child is learning alone whereas, in a center, the child can learn & emulate from others as well as paving the way for social skill opportunities with similar kids. With home based therapy, there is more involvement of family, and training can be imparted to them to take it forward, whereas this may not be the case in a center setting as parents may not be so involved.

At the end of the day, it is a personal choice of a family determined by a number of factors. In brief, child should get the best therapy possible, to their specific needs, to help them develop and grow into their best selves.