Treatments and Services

Therapies for Challenging Behaviors

To help children and teens with autism spectrum disorder change problem behaviors, we use evidence-based therapy called applied behavior analysis (ABA). We work with parents and other caregivers to assess how your child acts and the purpose of their behavior. For example, the behavior might get your child something they want, like attention. Or it might help your child avoid something they do not want, like a noisy classroom.

Then we make a treatment plan and teach skills to help reduce your child’s problem behavior. Appointments are at Seattle Children’s Autism Center.

We have 2 programs:

  • Our Biobehavioral Program is for kids and teens with intellectual and developmental disabilities, including autism, who have severe behavior problems. Our team will work with you to assess and understand your child’s problem behavior. We provide brief, focused treatment to reduce this specific behavior and teach behaviors that work better. We help children and teens ages 3 to 21.
  • RUBI is a training program for parents and other caregivers of children ages 3 to 10 with autism and mild-to-moderate behavior problems. We work 1-on-1 to teach you ways to reduce your child’s problem behaviors and improve daily living skills, such as self-care and helping around the house. Experts in the RUBI Autism Network have created and tested this step-by-step training. RUBI stands for Research Units in Behavioral Intervention.

Biobehavioral Program

  • The Biobehavioral Program assesses and treats children and teens with intellectual and developmental disabilities and very challenging behaviors, such as:

    • Self-injury, like biting their hand or banging their head
    • Aggression, like hitting, kicking or pushing
    • Destroying property, like breaking or throwing belongings
    • Eating items that are not food (pica)
    • Not following rules or directions (noncompliance)
    • Tantrums
  • Assessing your child

    The first step is to assess your child’s and family’s needs for services. Bring your child’s favorite toys to this intake visit. Depending on your child, the visit may be with a behavior analyst or with a team at the Biobehavioral Assessment Clinic. The team may include:

    • Behavioral psychologist
    • Psychiatrist, psychiatry fellow or psychiatric nurse practitioner
    • Speech and language pathologist

    At the end of the intake visit, the team or behavior analyst will give you detailed recommendations. Together, we will decide if your child and family may benefit from:

    • Intensive outpatient service, 2-hour visits each weekday for 2 weeks
    • Outpatient service, 1-hour visits twice a week for 12 weeks
    • Brief consult service, weekly 1-hour visits for 13 weeks

    Analyzing your child’s behavior

    We will coach you to collect data about your child’s behavior and, if needed, do a functional analysis. This means tracking how their behavior is affected by:

    • Changing factors in the environment around your child
    • Changing what happens right before and after the problem behavior

    Creating a treatment plan

    Using what we learn from the functional analysis, the team will create a treatment plan to reduce the behavior. Most often this includes:

    • Changing factors in the environment
    • Teaching your child behaviors to serve the same purpose without causing problems
    • Making sure the problem behavior no longer serves its old purpose
    • Coaching you to use ABA techniques, like positive reinforcement

    Fine-tuning the plan

    Your family is an important and active part of our team. We work with you to:

    • Test the plan in the clinic to be sure it works for your child
    • Track how well the plan is working at home
    • Adjust the plan if needed
    • Consult with your child’s school to make sure the plan fits that setting
  • Our team includes these experts:

    Psychologists

    Psychologists have a doctoral degree in psychology and extra training in how and why children behave the way they do. They diagnose and treat mental health issues that affect a child’s thoughts, emotions or behavior. Our psychologists are also doctoral-level, board-certified behavior analysts (BCBA-D).

    Psychiatrists and psychiatric fellows

    Psychiatrists and psychiatric fellows from the University of Washington are part of our team. Fellows are medical doctors who have finished adult psychiatry residency and are training in the specialty of child and adolescent psychiatry.

    Psychiatry nurse practitioners

    Psychiatry nurse practitioners are registered nurses with advanced training and education in psychiatry. They diagnose, treat and teach patients and families about mental health issues. They may do medicine evaluations and prescribe medicine.

    Speech and language pathologist

    A speech and language pathologist (SLP) checks how well your child can speak, understand, read, write and swallow. The SLP will set therapy goals to help your child communicate better.

    • James Mancini, MS, CCC-SLP

    Behavior analysts

    Behavior analysts are health professionals with advanced training in how people behave and how to change it. They may assess your child’s behavior, study how changes affect that behavior and make a treatment plan to improve it. Our behavior analysts are licensed by the state and are board certified.

RUBI Parent Training Program

  • This program is for parents and other caregivers who have a child:

    • Between 3 and 10 years old
    • Diagnosed with autism or related developmental disabilities
    • Who has problem behaviors that get in the way of daily life
    • Who can follow simple, 1-step instructions

    We help with behaviors like:

    • Hitting, kicking and biting
    • Tantrums and meltdowns
    • Screaming
    • Not doing what you ask (noncompliance)

    This program is NOT a good fit for children who:

    • Mainly need to address self-harming, severe aggression, eating nonfood items (pica) or running or wandering off (elopement)
    • Only need to increase language skills, play skills or social skills
    • Only have problem behaviors at school
  • RUBI is an outpatient service. You and a therapist will work 1-on-1 in weekly 1-hour sessions for up to 13 weeks. Your child only attends the first visit. It is best if the same adults attend each week. The program has the best results when caregivers make the time and effort to learn the skills and practice them at home.

    We explain why kids behave the way they do. Sessions also cover how to:

    • Prevent problem behaviors from happening
    • Promote positive behaviors in your child
    • Respond to problem behaviors more effectively
    • Teach your child new skills that can replace a problem behavior
    • Make positive behavior changes last over time and work across situations

    We will work with you to schedule a regular day and time for your visits. One month after you finish the program, you will have a follow-up visit.

  • The RUBI program at Seattle Children’s is run by Karen Bearss, PhD, a leading expert in treating challenging behaviors in children with autism. Dr. Bearss supervises a team of therapists who work with families. 

Scheduling an Appointment

  • If your child is already being seen at Seattle Children’s Autism Center, ask your child’s therapist to refer you.
  • If your child is not a current patient at Seattle Children’s, ask your child’s primary care provider or mental health provider to place a referral for the Biobehavioral Program or RUBI Parent Training.
  • When we get the referral, we will place you on our waiting list. When a space opens, we will contact you to set up your first visit.

Contact Us

Learn more about how to get services at the Autism Center.

Providers, see how to refer a patient.

Paying for Care

  • We bill you or your insurer for each session.
  • It’s always best to call your insurance plan to check your benefits. Find out if they cover the cost of the program and how much you need to pay if the full cost is not covered.
  • The procedure code billed for RUBI Parent Training sessions is 90846. This is “family therapy without patient.”
  • The Biobehavioral Program bills both ABA codes and psychiatric codes, depending on the type of therapy provided. Your provider can explain billing codes for your child’s therapy.
  • Read about insurance and mental health coverage at Seattle Children’s.
  • Learn more about paying for care at Seattle Children’s, including billing and financial assistance.