As a parent of two neurodivergent children, I have walked this path for many years. We spent a long time involved with ABA therapy. Our doctor recommended it quickly, and our insurance approved it without delay. It felt like the clear path forward. Later, I learned why that referral process often feels so smooth.
ABA fits easily into the healthcare billing system. Each hour translates directly into billable units. Large blocks of therapy time are simple for insurance companies to authorize. Most of those hours are delivered by staff with lower training costs, while a supervisor tracks data and updates goals. This creates neat charts that look good to payers. The business model thrives by filling calendars, not necessarily by asking what truly helps your child thrive at home.
“Why is the solution always more hours instead of changing the plan?”
This was our reality. We were offered 30 hours of therapy within days of our initial referral. Staff members rotated frequently. Our children managed to hold it together during clinic hours, but they came home overstimulated and quiet. Our evenings became tense and challenging. When I voiced my worries, the common response was to increase therapy time. No one asked how our children were sleeping, eating, or recovering after their sessions.
At the same time, we faced waitlists and hit coverage limits for Occupational Therapy, Speech Therapy, and feeding support. These sessions are often shorter, harder to scale for providers, and reimbursed differently by insurance. **It became clear that the system was guiding us towards what was easiest to fund, not what our children truly needed to flourish.**
When we shifted our primary focus to OT and ST, everything began to change for us. Our occupational therapist adjusted clinic lights, lowered background noise, and added movement before any task. Our speech-language pathologist joined our children in their play, always keeping their AAC device available. We started seeing real communication emerge naturally in our own kitchen.
Using AAC does not prevent speech; in fact, it can support language growth when implemented well (ASHA).
If your child is finding therapy challenging, the answer is not always simply more hours. Often, a different approach is what is needed. For example, if your child has trouble staying focused during a session, ask the therapist to dim the lights, lower their voice, or incorporate movement and deep pressure first. If dropping your child off at the clinic sparks tears, try shortening sessions and ensuring they consistently work with the same one or two people. If mealtimes at home collapse after therapy, seek out responsive feeding support. This means no more “one more bite” battles.
Practical Steps to Prioritize Your Child’s Needs Over Business Models:
- Ask your doctor, “If all support services were equally covered, what would you recommend?” Write down their answer.
- Request comprehensive Occupational Therapy, Speech Therapy, and feeding evaluations in writing alongside any ABA referral.
- Establish a weekly therapy cap that allows for protective space: ensuring dinner, sleep, and at least one clinic-free day.
- Closely observe your child during the 24 hours following therapy sessions. Note changes in sleep patterns, eating habits, mood, and their willingness to return for future sessions.
- Ask your child’s providers, “What do you adjust or offer before placing any demands on my child?” A good answer will include discussions about light, sound, movement, pacing, and planned breaks.
- Contact your insurance provider about appeals processes, out-of-network options, and superbills for licensed therapies like OT and ST.
It can feel overwhelming to advocate and push back against the system. Please know that you are not alone in this. **Insurance approval is a financial decision made by a company, not a family decision based on your child’s unique needs.** Choose care that genuinely respects your child’s nervous system and their growing voice. Choose support that meets your family where life truly happens — in your home, around your dinner table, and during everyday play. This is where meaningful, lasting progress is made.
