Every time one of my kids got a new evaluation, a doctor recommended ABA therapy. Every single time!
For years I took it as a prescription, not a preference. Now, after two neurodivergent kids and a pile of therapy hours, I understand why it happens so often and how to ask for more than a single lane.
One reason is the playbook. Major pediatric guidelines say early intensive behavioral interventions, including ABA, can help some young autistic children with language and daily living skills (AAP Clinical Report: Hyman, Levy, Myers). Doctors are trained to lean on guidelines.
There is also the system we have in place for healthcare. ABA is billable, staffed, and built to hand doctors neat reports with goals and data. Insurance panels know it. Referral forms are ready. In many areas, OT and speech therapy have long waits, and developmental or relationship-based options are harder to find. When a clinician has 15 minutes and a worried family, ABA becomes the quick, “do something now” answer.
But ABA therapy is not the only path. Depending on your child’s profile, you might consider speech therapy, occupational therapy for sensory regulation, AAC evaluations, social-emotional work, parent coaching models, DIR Floortime, naturalistic developmental approaches, mental health supports, and strong school-based services through an IEP. Some families mix and match. We did.
What I ask doctors now
- What specific goals are we targeting, and which therapy best fits each goal?
- Can we try a developmental or parent-mediated approach first or alongside ABA?
- How will we measure progress beyond compliance, like regulation, communication, and autonomy?
- Who will coordinate across ABA, OT, speech, and school so we are not working at cross-purposes?
- What are the exit criteria, and how often will we reassess?
If you choose ABA, look for programs that honor assent, collaborate with OT and speech, respect stimming, avoid punishment, and individualize hours. Data is helpful, but your child’s well-being is the real outcome.
Doctors recommend ABA therapy because the healthcare system points them there. You are allowed to ask for a menu, not a mandate. Your child’s needs, strengths, and joy should drive the plan, not a default referral because that’s what the insurance covers.
You need to do what’s right for your child. Not what’s right for an insurance company.
