ABA Therapy in Multilingual Households

Michael Mohan

August 7, 2025

Navigate language differences with ease in ABA Therapy in Multilingual Households—support that speaks every family's language.

When families raising children with autism spectrum disorder (ASD) speak multiple languages at home, they often face a challenging question: Should they maintain their multilingual environment or focus on just one language to support their child’s development? This dilemma becomes even more complex when considering Applied Behavior Analysis (ABA) therapy, the most widely used evidence-based treatment for autism.

Understanding the Multilingual Reality in Autism

Up to 25% of children on the autism spectrum grow up in bilingual environments, reflecting the increasing linguistic diversity in our global society. Over half of the world’s population is bilingual (people who utilize two languages daily) if not multilingual, speaking 3 or more languages. Some statistics say 43% of the global population is bilingual, 40% is monolingual speaking only one language, and 17% are multilingual speaking several languages.

This multilingual reality is particularly pronounced in countries like the United States, where in 2016, 22% of the US children spoke a language other than English at home, most commonly Spanish. As one of the fastest growing communities within the United States (US), it is expected that by 2045, the Latino population will grow up to 24.6%. As a population, it is projected that Latinos will make up 28% of the total US population by 2060.

The ABA Therapy Landscape: Current Statistics

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association. “Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. The demand for ABA services continues to grow exponentially:

ABA is the most-utilized therapy for individuals with autism, currently used to treat 64% of individuals with ASD, according to the National Survey of Children’s Health.
There are more than 33,633 ABA therapists currently employed in the U.S.
The demand for certified ABA therapists has skyrocketed, showing a 5,852% increase from 2010 to 2021.

ABA Therapy Effectiveness Statistics

Research consistently demonstrates the effectiveness of ABA therapy:

Lovaas found that 90% of children make large gains through ABA therapy. He also found that 47% of the children studied in his research were “indistinguishable from their peers” after receiving intensive ABA therapy.
Approximately 45% of therapies considered successful in the long-term utilize ABA techniques. Notably, children who receive ABA therapy before age four exhibit significant improvements in social skills and communication, with around 50% making advancements in these areas.
Research has shown that children who receive at least 20 hours per week of ABA therapy make greater progress than those who receive less than 10 hours per week.

Debunking the Multilingual Myth in Autism

For decades, professionals often advised families to restrict language exposure to just one language, fearing that multilingualism would hinder language development in children with autism. However, mounting scientific evidence challenges this outdated perspective.

Research Findings on Multilingualism and Autism

In summary, the available evidence does not support the hypothesis that multilingualism poses unique barriers to the language and communication development of children on the autism spectrum. Multiple studies have reached similar conclusions:

Hambly and Fombonne (2012) compared language outcomes in 4.5 year old children with ASD who were exposed to bilingual versus monolingual home environments. They found no statistically significant difference in standardized tests of receptive and expressive language between children with ASD raised in multilingual homes versus children raised in monolingual homes.
Findings suggested bilingualism does not have a negative impact on language development for children with ASD, but the majority of parents reported that practitioners predominantly advised against providing a bilingual environment.
There seems to be consensus regarding the assertion that bilingualism does not entail any additional difficulty for language development in children with ASD from the age of 3.

Potential Benefits of Bilingualism

Research has even identified potential advantages of multilingualism for children with autism:

There are indications of positive effects of bilingualism, for example, in verbal fluency
Research to date indicates that at worst bilingual exposure in children with ASD has no effect on language development and at best offers advantages on adaptive functioning, social communication, and receptive language
Bilingualism does not make learning each language harder. The brain doesn’t get confused and can separate two languages early in development. Growing up with more than one language doesn’t hinder cognitive skills. Being raised with several languages helps a child connect with their family and community.

The Cultural Context: Latino Families and ABA Therapy

Latino families represent a significant portion of multilingual families seeking ABA services. Research has examined their unique experiences and cultural considerations:

Seven participants (36%) indicated that they had received ABA services for more than 3 years, and 11 participants (62%) indicated receiving services for less than 3 years. When examining barriers to ABA services, the most common reported initial barriers to begin ABA services were an extended waitlist time, issues around insurance/funding, and the COVID-19 pandemic.

Cultural Values in ABA Service Delivery

Understanding cultural values is essential for effective ABA service delivery. Key values identified in Latino families include:

Familismo – Close family bonds and collective decision-making
Confianza (trust) and personalismo (friendliness)
When we asked parents what they valued around ABA services, they reported: treatment planning, individualized planning, data progress, and involvement.

Best Practices for ABA Therapy in Multilingual Households

Cultural Competency in ABA Practice

As applied behavior analysis (ABA) is widely prescribed as an intervention for autistic children, ABA practitioners must have a thorough understanding of the impact of language and culture on the individuals and families they serve.

Key Recommendations for Practitioners

Embrace Multilingual Environments
- As a parent, speak the language you are most comfortable with. This is best for both parents and children.
- Some studies showed that there were no significant group differences in language levels between children raised in bilingual vs. monolingual homes; moreover, bilingually exposed children with autism do not experience additional delays in language development.
Cultural Adaptation of Services
- Prior to obtaining consent for assessment and services, a care provider should deliver all documents, forms, and other communication in the client and family’s primary language. This may require the use of qualified translators, sign language interpreters, Braille materials, or other accommodations for individuals with hearing, vision, or other impairments.
- Many groups, including Latino families, are requesting more linguistically adapted and culturally sensitive ABA practices and greater access to information about their children’s diagnosis provided in their native language.
Family-Centered Approach
- To acknowledge the value placed on family cohesion and the role of extended family networks in many cultures, grandparents may be encouraged to participate in parent training sessions.
- Engaging extended family members in the therapeutic process is crucial, especially in cultures that prioritize community involvement. This collaboration fosters a supportive environment that is conducive to the client’s development.

Overcoming Barriers

Several barriers exist in providing culturally competent ABA services:

Language Barriers
- The presumed scarcity of ABA practitioners and supervisors whose language skills or cultural backgrounds match clients’ families may be inferred from the data from related fields. Currently, a shortage of bilingual and multicultural practitioners may result in a system where most therapies are delivered in English, regardless of the appropriateness of doing so.
Cultural Misunderstanding
- The diagnostic process for bilingual children can bring additional challenges, with observational components of commonly used assessments being misinterpreted as autism-specific differences rather than differences in cultural norms. The absence of eye-contact and pointing behaviours, for example, are generally interpreted as autistic traits, yet in some non-western cultures, for a child to exhibit these behaviours with adults is inappropriate.

Practical Implementation Strategies

For Families

Maintain Home Language
- If important people in a child’s life speak more than one language, exposure to only one language isolates a child.
- When parents stop speaking their native language with their child, it can result in the child not being able to understand or speak with extended family members or participate in cultural activities.
Seek Culturally Competent Providers
- Therapists and BCBAs who are multicultural and/or multilingual are likely to be valuable for families from various backgrounds that are receiving ABA services in the US. For example, an immigrant family whose native language is not English may feel more comfortable working with therapists and/or BCBAs who share similar cultural background or language as them.

For ABA Providers

Workforce Diversification
- In order to increase the availability of multilingual ABA clinicians, ABA agencies should proactively reach out to potential therapists who are multilingual at recruiting events.
- Efforts to diversify the ABA workforce are crucial in achieving better treatment outcomes for clients from various backgrounds. A workforce that reflects the diverse cultural makeup of the community helps to foster trust and improves rapport between therapists and clients.
Cultural Training and Education
- Understanding different cultural values and beliefs: BCBAs® must understand the different cultural values and beliefs that their clients may hold. This includes understanding things like the importance of family, the role of religion, and the views on education and disability.
- Cultural humility involves recognizing one’s limitations and committing to ongoing learning and growth in cultural competence. A humble approach allows ABA therapists to engage with clients in a spirit of mutual respect and collaboration.

The Economic Impact and Future Directions

The cost of ABA therapy remains a significant consideration for families:

While some insurance plans cover ABA therapy, many families still struggle to afford the cost. The average cost of ABA therapy ranges from $120 to $200 per hour, with some families paying upwards of $50,000 per year for treatment.
Supporting an individual with autism can incur significant annual expenses, estimated at approximately $60,000 throughout childhood. In fact, the overall financial burden associated with autism care reached $268 billion in 2015 and is projected to climb to $461 billion by 2025.

Global Prevalence and Need

The global autism prevalence continues to rise:

An estimated 61.8 million (95% uncertainty interval 52.1–72.7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788.3 (663.8–927.2) per 100 000 people, equivalent to 1064.7 (898.5–1245.7) autistic males per 100 000 males and 508.1 (424.6–604.3) autistic females per 100 000 females.
It is important to note that the global prevalence of autism has shown an increasing trend over time. Estimates have risen from 0.6% in 2003 to 1.25% in 2021. The rising numbers reflect improvements in diagnostic categories, research quality, methodology, increased awareness, and acceptance of autism.

Research Gaps and Future Directions

One particularly pressing question remains: should ABA therapy be conducted in only one language or two, particularly in the early stages of intervention, for children from multilingual families? Several research priorities have been identified:

Longitudinal Studies: Although current research seems to indicate benefits for bilingualism in children diagnosed with autism, more research is needed to better understand the course and pace of language development for parents wishing to maintain a bilingual environment.
Cross-Cultural Research: Autism research is heavily skewed towards western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives.
Training and Supervision: In addition, we discuss potential future directions for the field, in terms of increasing the number of international students in graduate programs, enhancing diversity curricula within graduate programs and continuing education, and efforts by professional organizations to address diversity.

Conclusion

The evidence is clear: multilingualism does not hinder language development or ABA therapy outcomes for children with autism. Instead, maintaining a multilingual environment can offer significant benefits, including stronger family connections, cultural identity preservation, and potential cognitive advantages.

Now, more than ever, is the time for greater attention to the issue of multilingual diversity within ABA treatment for ASD. Greater attention, research, resources, and development efforts directed to this issue will not only help bring great equity and justice to multicultural families, but also build a richer, more varied, and vibrant future for the great science of ABA that we know and love.

For families navigating ABA therapy in multilingual households, the message is encouraging: you can embrace your linguistic heritage while providing your child with evidence-based treatment. The key lies in finding culturally competent providers who understand and respect your family’s unique cultural and linguistic needs.

As the field continues to evolve, the integration of cultural competence and multilingual awareness in ABA practice will become increasingly crucial. By embracing diversity and implementing culturally responsive approaches, we can ensure that all children with autism, regardless of their linguistic background, receive the highest quality care possible.

References

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