Applied behavior analysis (ABA), long the go-to behavior modification option for autistic children, is used worldwide to mitigate other social and behavioral issues, as well—e.g., smoking, personality disorders, and obsessive-compulsive disorder. The method has even been used in relationship counseling. Despite the absence of side effects and the fact that a great deal of clinical and anecdotal evidence supports the model’s success, ABA is not without its risks.

The cost.

The fact that ABA is expensive and time consuming may make it seem undesirable to, or place it out of reach for, prospective clients. The time commitment involved—sometimes as much as 40 hours per week–can also seem daunting. Parents with children undergoing behavioral analysis may find the process stressful, especially given the need to keep up home and school participation.

On the other hand, thirty-one states have adopted ABA coverage as one of their benefits under the Affordable Healthcare Act, and it’s one of the few autism therapies covered by most state Medicaid programs.

One size doesn’t fit all.

The effectiveness of applied behavior analysis depends largely on the individual. Although ABA can be tailored to some extent, putting it into actual practice is the only way to determine if it will work for a specific client.

Autism, for example, is so complex, behavioral analysis doesn’t work for every child. There’s also the fact that while ABA for autistic children tends to focus on learning necessary skills, autistic adults have developed their own learning preferences, so the process must be adjusted accordingly.

Others may not reinforce, or may resist, behavioral changes.

If skills a patient learns in the therapeutic setting aren’t reinforced in other environments, they simply won’t take hold. Outside encouragement—e.g., from parents and teachers—is critical. It’s also important to note that changes in one individual can cause dramatic shifts in family and/or social dynamics, which may result in a breakdown of those systems. These issues should be dealt with at length before therapy begins.

The patient may become frustrated or upset during therapy.

Even positive change can cause stress.

Adults undergoing applied behavioral analysis may feel uncomfortable and resist sharing sensitive information or unpleasant emotions. Children may act out when they feel frustrated in their attempts to learn new tasks.

As behavior analysis begins, children can resist giving up undesirable behavior that was reinforced in the past. This can result in an “extinction burst,” or temporary escalation of the old behavior. If the parents and therapist maintain a consistent approach and agree on problem-solving strategies, these episodes can be limited or avoided.

Finally, it’s important to remember unexpected high-stimulus environments can’t be avoided completely. Behavorial analysis must teach individuals skills they can use to accept and/or cope with these environments, and with change in general, or risk losing ground.

Addressing behavior alone can mask something else.

Behavioral analysis focused only on changing challenging behaviors can be risky. It’s critical to pinpoint the stimulus for that behavior. Otherwise, the behavior may change, while other serious problems remain. In an interview in Psychology Today expert Adam Holstein makes this point about a child who acted out at school. Interventions designed to pinpoint the reasons for his behavior uncovered child abuse at home.

Related Resource: Top 10 Best Applied Behavior Analysis Online Programs 2015

While the above-listed risks do exist, the Surgeon General of the United States has recognized applied behavior analysis as the most effective way to meet the learning needs of people with autism and related developmental disabilities. ABA has been endorsed by both the National Institutes of Health and The Association for Science in Autism Treatment.