Behavioral Interventions Beyond ABA
Applied Behavior Analysis (ABA) therapy aims to teach, maintain, or reduce behavior based on a system of reinforcements, and is widely considered the gold standard for supporting children with autism. However, no single solution will be a perfect fit for every child, and you may find that ABA isn’t right for yours. So, what are the alternatives to ABA? How can you find a provider and obtain funding? To learn more, we spoke with Dr. Douglas Vanderbilt, director of Developmental-Behavioral Pediatrics at Children’s Hospital Los Angeles and professor of clinical pediatrics at Keck School of Medicine and Occupational Science/Therapy at the University of Southern California, and Dr. Susan L. Hyman, a Professor of Pediatrics and Division Chief of Developmental and Behavioral Pediatrics at the Golisano Children’s Hospital of the University of Rochester.
Considering non-ABA therapies
While ABA therapy is considered the gold standard of behavior therapy, some adults with autism describe having negative experiences during sessions when they were younger. In addition, some parents question whether ABA is appropriate for children with other diagnoses.
According to Dr. Vanderbilt, ABA is engineered to promote data collection, which has led to large amounts of research in support of this intervention. However, “the key is, ABA doesn’t work for everybody. It doesn’t work for every family.” Other techniques may suit your child’s needs and individual goals.
Dr. Hyman explains, “There is an incredible amount of variation in the needs and presentation of autism at various ages; there’s no singular treatment.” However, she points out that the practice of ABA has grown enormously and is very different than when it was first developed. (Learn more about types of ABA therapy here.)
What to think about when choosing a specific intervention or provider
Dr. Hyman suggests focusing first on the goals of your child’s therapy, how to include the child’s family and natural environment, and how your child can learn both functional and spontaneous skills. She explains that this is so they “learn how to apply these skills across [their] day.”
When your child is evaluated either in early intervention or by their school district, the results can help you narrow down your options based on the areas where your child needs the most support. As Dr. Hyman explains, it’s essential for parents, schools, and other providers to match “an individual child and their profile (what their needs are) with what’s available” when making a decision.
When choosing a provider, Dr. Hyman wants to remind parents that even research-based therapies might not be implemented by some practitioners in the same way they were intended by the researchers, so they might not show the same results.
In addition, some interventions, like Floortime, offer classes and consultations that allow parents to implement them at home. Dr. Hyman suggests working with a provider to learn the system and help ensure that the therapy is practiced the way it was intended.
Developmental Relationship–Focused Interventions
Naturalistic Developmental Behavioral Interventions
Other types of behavioral interventions
How can I fund non-ABA therapies?
Obtaining funding for ABA alternatives can be tricky and will change based on which option you choose for your child. According to California’s Department of Mental Health Care (DMHC), “California’s mental health parity law has the same coverage requirements for children. California law also requires all plans to cover behavioral health treatment for autism or pervasive development disorder, which is frequently identified during childhood.”
It’s important to note that many private insurers won’t cover ABA or alternatives if the child doesn’t have an autism or pervasive developmental disorder diagnosis. Medi-Cal and Regional Center will, but they require evidence-based treatments. And because ABA has a large evidence base, insurers are more likely to fund it than its alternatives.
You may still be able to obtain funding for another intervention through:
Review your plan or contact your insurance provider’s customer service department to learn which services are covered under your policy.
Contact the treatment provider to find out if they accept your insurance.
According to California’s Department of Health Care Services (DHS), “Medi-Cal covers all medically necessary behavioral health treatment (BHT) for eligible beneficiaries under 21 years of age.” However, Medi-Cal requires evidence-based treatments, so you’ll need to check to see if the type of therapy you would like to pursue would be funded.
For BHT services to be funded, they must be recommended by a physician or psychologist as medically necessary.
By January 1, 2023, most Medi-Cal clients will receive their medically necessary behavioral therapies via their managed care plans (or with managed care as secondary coverage if the family also has private insurance). See the DHS directory for your MCP’s contact information.
To learn more about the changes to Medi-Cal going into 2022 and 2023, read about them here and listen to Undivided's Public Benefits Specialist, Lisa Concoff Kronbeck, break it down on our Instagram page.
Your local Regional Center will provide BHT services if your child remains in fee-for-service Medi-Cal. (Find your Regional Center here.)
Regional Center requires evidence-based treatments, so you’ll need to check with your service coordinator to see if the type of therapy you would like to pursue would be funded.
It is also important to note that Regional Center is the payer of last resort, so you must go through insurance first.
When Regional Center clients enroll in Self-Determination, they are given a yearly budget to use for services.
Once a behavioral health treatment plan is chosen, it can be added to the spending plan. It’s important to note that the chosen therapy must meet a goal listed in their Individualized Program Plan (IPP).
The chosen provider will also need to sign up with the client’s Financial Management Service (FMS). Learn more about Self-Determination here.
Your child’s school or district
- If you and the Individualized Education Program (IEP) team determine your child needs a particular therapy for them to receive a free, appropriate public education (FAPE), the district can cover the cost of service (note that this doesn’t mean you’ll necessarily get the service from a private provider, as the details will be worked out with the IEP team).
Out of pocket
- Contact the treatment provider to learn more about the specific payment options they offer. If you qualify, you may be able to set up a payment plan or pay on a sliding scale.
Check out Undivided’s Guide to Funding Resources for more information.
Have you tried using a different behavioral therapy with your child? What therapy did you choose, and how is it going? Let us know in the comments!