Navigating autism and ABA

[Anonymous]

I’m looking for a therapist for my son who is high functioning, doing well in school academically and socially but needs sone assistance with organizational skills snd managing some autism-related behaviors. Every clinic seems to push 15+ hours of ABA which we don’t have the need nor bandwidth for. They all ask for insurance upfront—it’s usually the first or second question and it’s starting to feel kinda gross. Is this the only option?

[Anonymous]

What are his behaviors?

[Anonymous]

There are independent BCBAs who are usually enrolled with one or two insurance companies or accept self-pay. Most don't bill more than 30 hours per week total for all clients and therefore accept clients who only need a few hours per week. The BACB website will let you search by zipcode for providers.
You could also look at one of the virtual ABA companies if you're more interested in places that offer parent coaching or work more with older kids who are fairly independent for a couple hours per week.

[Anonymous]

Anonymous wrote:What are his behaviors?

Some stimming at home and out of the house (humming, lining up stuff mostly), hyper focus on stuff that may not be of interest to others but there are kids and adults who he engages with well about, and disorganization at school (forgetting homework but when he's on task his grades are great). He's doing well socially overall, has hobbies, and good sense of humor.

[Anonymous]

Are you wanting to pay with insurance or can you afford self-pay?

[Anonymous]

Anonymous wrote:Are you wanting to pay with insurance or can you afford self-pay?

I’m fine paying for it with insurance. What’s raising little red flags for me is that these ABA providers all ask about insurance within literally five seconds of picking up the phone. And without even reading an evaluation describing my child, they’re “requiring” at least 15 hours per week. Are they milking the insurers even if it’s not necessary?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Are you wanting to pay with insurance or can you afford self-pay?

I’m fine paying for it with insurance. What’s raising little red flags for me is that these ABA providers all ask about insurance within literally five seconds of picking up the phone. And without even reading an evaluation describing my child, they’re “requiring” at least 15 hours per week. Are they milking the insurers even if it’s not necessary?

No they aren’t milking the insurance, it’s more like the other way around. Unfortunately the insurance system broke the field of ABA almost immediately from the perspective of affordable service delivery. It stinks too because the parents that fought so hard to get it really cared and were doing the right thing but almost immediately insurance became nothing but a hassle for the provider. I’ll never forget writing an insurance report many years ago that took 25 hours, I could’ve done a different - and better- type of report that might have taken 5 hours but their requirements were so exact that it took 5 times longer.

So the reason the provider asks immediately about insurance is because the provider may not accept your insurance, different insurance companies have different requirements for diagnostics and BCBA/RBT hours, intake, assessments, etc. I would not write these providers off for asking about insurance, I’d just give them grace and try to understand that insurance often dictates how they work. I’d actually worry if this wasn’t a first question they asked you because it determines their next steps.

Regarding hours I’ve not seen any insurance except TRICARE cover BCBA only for 5 hours per week. You can fairly easily get this for that age if you’re private pay. You also might be able to pay up front and submit reimbursement to your insurance, you used to be able to do that with some insurance companies. (I’m not sure how it works now I haven’t accepted insurance in years because it got to the point where insurance company regulations were going against my standards for best practice so I dropped them completely.)

From a clinical perspective 5 hours per week for that age is probably doable, it’s what you’d call a consultative role where more focus is on parent training and maybe a few key skills/behaviors. But you do need a higher level of skill/experience to pull it off imo. Check the website as suggested above for BCBA’s or find a company that’s BCBA only and ask about a weekly consult via private pay. The BACB website provides you with initial date of certification, look for people that have been certified awhile, they’re more likely to take a case like this, I would think. I also think once you tell them you are private pay they will probably be able to work more with your individual needs.

*opinions are my own, don’t represent the BACB

[Anonymous]

Why are you considering ABA for a child who you describe as “high functioning”? ABA isn’t for executive functioning skills. It can teach him to stop stimming but please tell me you’re not going to use ABA to make your autistic child stop stimming.

[Anonymous]

Anonymous wrote:Why are you considering ABA for a child who you describe as “high functioning”? ABA isn’t for executive functioning skills. It can teach him to stop stimming but please tell me you’re not going to use ABA to make your autistic child stop stimming.

Tell me you don’t understand ABA without telling me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What are his behaviors?

Some stimming at home and out of the house (humming, lining up stuff mostly), hyper focus on stuff that may not be of interest to others but there are kids and adults who he engages with well about, and disorganization at school (forgetting homework but when he's on task his grades are great). He's doing well socially overall, has hobbies, and good sense of humor.

So the only thing on this list that the child needs help with this the disorganization.

[Anonymous]

Are you sure ABA is what your ds needs? It sounds like maybe a counselor or an executive coach might have some good stratigies for him. How about a social skills group?

I am good with ABA, but it's not for all kids-my own dc is considered high functioning and it's not really a good fit for them. We did try at one time, actually the place we tried only recommended 12 hours a week. 3 weeks in, covid came and that ended that and we never restarted.

Of course they are going to ask about insurance. They have to make sure that they accept yours.

[Anonymous]

I think with a kid like this, it's important to understand the criticisms of ABA that are often made by older kids and adults with Autism who have endured it.

I think there is a place for ABA, if it's done very carefully, in certain situations where a lack of skill is causing a child significant distress, and impacting quality of life. But there is a high risk of ABA becoming or being experienced as abusive, and using it to treat stimming or hyper focus is not an appropriate use. Anyone who accepted a client for ABA with those goals would be unethical.

Having said that, the vast vast majority of ABA clients can not afford it without insurance, so starting with the question of whether this program takes your insurance makes sense. If you say "No, I plan to private pay, we have so much money that I'm happy to pay thousands of dollars a months, and am not interested in what it costs or saving some of that cost." I am sure they will continue with you.

[Anonymous]

Your child does not need ABA. Look into speech therapy, OT, exec function coaching. Wide variety of services that can help your child’s identified areas of most needs, not what the therapist finds easiest to deliver.

[Anonymous]

Anonymous wrote:Your child does not need ABA. Look into speech therapy, OT, exec function coaching. Wide variety of services that can help your child’s identified areas of most needs, not what the therapist finds easiest to deliver.

None of those things will address it, and certainly not in 5 hours.

[Anonymous]

Anonymous wrote:I think with a kid like this, it's important to understand the criticisms of ABA that are often made by older kids and adults with Autism who have endured it.

I think there is a place for ABA, if it's done very carefully, in certain situations where a lack of skill is causing a child significant distress, and impacting quality of life. But there is a high risk of ABA becoming or being experienced as abusive, and using it to treat stimming or hyper focus is not an appropriate use. Anyone who accepted a client for ABA with those goals would be unethical.

Having said that, the vast vast majority of ABA clients can not afford it without insurance, so starting with the question of whether this program takes your insurance makes sense. If you say "No, I plan to private pay, we have so much money that I'm happy to pay thousands of dollars a months, and am not interested in what it costs or saving some of that cost." I am sure they will continue with you.

We did ABA with our DC starting at 10/11. It was the best decision we ever made. We’ve addressed stimming (and many other things) because it was preventing him from making friends. It was not abusive AT ALL, I’m quite shocked that you would even suggest that.

OP, we did private pay-started at 15 hours a week and cut back slowly- several years later we’re now at 5-10 hours a month. It was so worth it, please don’t listen to people like this with an agenda or axe to grind.