When our pediatrician said to start ABA immediately, we did. It was presented as the default, the safe pick, the thing insurance would cover without a fight. Years later, I wish we had paused to ask who benefits from that speed. For our two kids, ABA soaked up time, energy, and precious early years while the supports that actually helped, Occupational Therapy and Speech Therapy, were rationed to a trickle.
What I wish someone had explained
ABA was easy to authorize, with dozens of weekly hours greenlit. But the person with my kids most days was not a licensed clinician. Sessions were run by technicians, supervised by a BCBA who rarely saw our child in context. In contrast, OTs and SLPs are state licensed professionals, trained in sensory regulation, feeding, motor planning, language, and AAC. Yet we were told to accept far fewer OT and ST sessions because insurance prefers the ABA bundle.
Here is the part no one emphasized to us: who delivers the care matters, and the goals matter even more. Our kids were pushed to comply with adult led targets that ignored sensory needs and communication differences. Progress notes looked good on paper, but meltdown recovery, self advocacy, and functional communication lagged behind.
The insurance funnel we fell into
We learned the system is built to approve ABA quickly and at high volumes. OT and ST required letters, re evals, and constant appeals for adequate frequency. That bias shaped our path more than our children’s actual needs.
- Ask who will be with your child most of the time and what credentials they hold.
- Request goals that prioritize regulation, autonomy, and communication, not just compliance.
- Insist on integrating OT and ST from the start, with clear care coordination.
- Set a time bound review plan with measurable, family valued outcomes.
- If insurance says no to OT or ST frequency, ask for a written rationale and appeal.
If the only reason you are choosing a therapy is because insurance makes it easy, pause and reconsider.
ABA may be the right fit for some families. It was not for ours. The most meaningful gains came from licensed OT and ST that respected sensory needs and gave our kids real tools to communicate. If I could start over, I would build around those therapies first and fight the paperwork battle early, rather than letting the insurance funnel decide our children’s care plan.
