I used to assume more hours meant more help. What I missed was who was in the room with my kids most of the time. In our case, it was entry level technicians with very short training, not licensed clinicians. That gap mattered in ways I did not see until our home fell apart.
We were told “more hours.” No one asked whether the person running those hours had the skills our kids needed.
Short fact: The common entry credential for ABA technicians, the RBT, requires a 40 hour course, a competency check, and an exam, then ongoing supervision by a BCBA (BACB).
Here is why training depth matters. Neurodivergent kids are whole people, not sets of behaviors. Sensory needs, communication differences, feeding challenges, and anxiety all show up in real life. A short course does not teach the depth of AAC, feeding safety, trauma informed care, or co regulation. So tough moments get labeled as “noncompliance,” and the plan becomes more drills instead of more support.
If your child has trouble staying focused in therapy, a technician might reach for a token board when what helps is movement, a quieter room, or chewy tools. If your child scripts or uses a device, a technician may prompt “use your words” instead of modeling language on the device. If eating is stressful, pressure to “take a bite” can make meals scary. We lived all of this.
We landed in that setup because our doctor recommended it fast and insurance approved it even faster. ABA was easy to staff with techs. OT and speech were “limited,” “waitlist,” or “not medically necessary.” That bias steered us toward volume, not fit. Our kids looked fine at a table, then crashed in the car. The binder said progress. Our life said cost.
What helped us pivot
- Ask who will work with your child most hours. Are they licensed? How often will the supervisor be in the room, not just on a call.
- Protect consistency. Cap the team at two people. Request notice for any swap. You can decline.
- Start small. Run a short trial and track sleep, appetite, recovery time after sessions, and willingness to go.
- Request OT, Speech, and feeding evaluations in writing. Ask for goals tied to daily life, like dressing, mealtimes, and functional communication.
- Choose caregiver coaching over more tech hours. Tools that work in your kitchen beat checkboxes at a clinic.
When we shifted to OT and Speech, we saw calmer mornings and communication that felt real. A sensory informed OT adjusted routines so our kids’ bodies could settle. A speech therapist built AAC and play based language at home. Fewer hours, steadier faces, better fit.
It can feel overwhelming to push back. You are not alone. If insurance is loud about one path, remember that coverage is not care. Choose providers who respect regulation and communication, not just compliance. Your child’s nervous system will give you better data than any billing code.
