FATHOM NORTHBefore ABA therapy starts, someone has to figure out where your child is right now. That's the assessment: usually a few hours with a BCBA, spread across one or more visits, that turns into your child's treatment plan. Here's what actually happens — and what those acronyms mean.
What the visit looks like
Less clinical than you're imagining. A good assessment mostly looks like a BCBA playing with your child, on the floor, with a clipboard nearby. They'll present toys and small tasks, watch what your child does with them, and take notes constantly. They'll also interview you — at length. Expect questions about communication, eating, sleeping, play, fears, meltdowns, and what your child loves. The parent interview is not small talk; you are one of the primary data sources.
Your child does not need to perform. Refusing, wandering off, and melting down are all information, not failure. BCBAs expect all of it.
VB-MAPP, in plain English
The VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program) is a structured checklist of language and social milestones, organized in three developmental levels that roughly track ages 0–18 months, 18–30 months, and 30–48 months. It looks at skills like:
- Asking for things (called "manding" — from "demand")
- Naming things (called "tacting" — labeling what they see)
- Responding to others' language (following directions, answering)
- Imitation, play, and social skills
The result is usually shown as a grid that fills in from the bottom. It shows a profile — maybe strong at asking for things but limited at back-and-forth conversation — and that shape, not a single score, drives which goals come first. The VB-MAPP also includes a barriers assessment: a look at what's getting in the way of learning, like heavy prompt-dependence or difficulty with change.
ABLLS-R, in plain English
The ABLLS-R (Assessment of Basic Language and Learning Skills, Revised) covers similar ground with a wider net — 500+ items across 25 skill areas, including academics, self-help (dressing, toileting), and motor skills. Think of it as a very detailed inventory of what your child can do independently, can do with help, and isn't doing yet.
Which one your clinic uses matters less than that they use a real tool and can explain the results to you in ordinary words. Some clinics use others (the PEAK, the Vineland for adaptive skills, the AFLS for older kids' life skills) — all legitimate. The red flag is a clinic that can't name its tools at all.
What to bring
- Recent evaluation reports (diagnostic, school, Birth to 3, speech/OT)
- Your own one-page list: top 3 concerns, top 3 hopes
- A few of your child's favorite things — familiar items help the BCBA find what motivates them
- Snacks, and realistic expectations about nap-time scheduling
What happens after
The BCBA writes a treatment plan: proposed goals, proposed weekly hours, and how progress will be measured. In most insurance-funded ABA, this plan goes to your insurer for authorization before therapy starts, which adds waiting time — ask your clinic and your plan what timeline to expect, so the quiet weeks don't catch you off guard.
Five questions to ask when you get the results
- "Can you walk me through the profile in plain words — strengths first?"
- "Which of these goals matter most to daily life at home?" (Your priorities belong in the plan. Say them.)
- "Why this number of hours? What would make it go up or down?"
- "How often will you re-assess?" (Many programs re-assess as part of insurance reauthorization — ask what your plan requires.)
- "What can we start doing at home while authorization is pending?"
One last thing, because assessment day can sting: the point of the grid is not to catalogue everything your child can't do. It's to find the exact edge of what they can do — because that edge is where teaching starts, and where it works.
That's the end of this one.
The assessment tells you how a clinic will get to know your child; the ten questions tell you how to get to know the clinic before you commit.