What types of autism therapy provider should I choose?
Autism providers may differ in ways that can be hard for parents to fully assess before initiating therapy, especially if they don’t know the right questions to ask. We’ve put together a list that characterizes the different types of providers. It is not comprehensive but instead highlights some major differences between providers:
|Range of what you’ll find
|Why it matters
|Types of services
|Single specialty only (ABA, speech, or OT), multiple specialties, or integrated providers and care teams
|Single-specialty providers leave most care coordination for the parent
Integrated providers enable more convenience and likely better coordination for the family
|Models of ABA used
|DTT (discrete trial training), NDBIs (naturalistic developmental behavior interventions), or a hybrid
|Both models are evidence-based but look different in practice (NDBIs are more naturalistic and play-based)
|Location of services
|Clinic-based, home-based, or a hybrid||Both in-clinic and at-home models are evidence-based; some families may prefer one over the other
|Age range served
|Children not yet in school, school-aged children, or children of all ages||Some providers may specialize in certain ages, while others accept all ages
|Ownership||Clinician-owned or investor-owned||Varies by the provider, but ownership decision-making has the potential to influence your care experience
What questions should I ask to providers?
Selecting a provider or a group of providers for your child with autism is a deeply personal choice. This important decision usually involves asking for recommendations from other families and your child’s pediatrician or other healthcare providers. Since the process can be overwhelming, we’ve created a set of guiding questions you may want to consider when picking a provider:
- What types of services will my child need, and who offers them?
The services that are medically indicated will vary for each child with autism. If your child will likely need multiple services (e.g., speech therapy, occupational therapy, ABA therapy), parents often prefer settings where the care is integrated and providers coordinate with one another instead of the parent having to be the sole “quarterback” for the child’s care. And if your child is already receiving some services but may benefit from others, ask your provider about how they’ll coordinate care with other providers.
- If ABA is recommended for my child, what type of ABA do I want for them?
As we mentioned in Section 3, ABA is an umbrella of therapies that are applied in various programs. If you prefer an ABA therapy that is more play-based and naturalistic, look for providers who have certification and/or advanced training in naturalistic developmental behavior interventions (NDBIs) such as the Early Start Denver Model (ESDM) or Pivotal Response Therapy (PRT). To identify if a provider offers mostly discrete trial training (DTT), you could ask how much time their patients spend in structured settings, such as working at a table with a therapist.
- Do I want my child to receive services in our home or a clinic-based setting?
This is usually one of the clearest differences between provider types. Providers who offer hybrid models still tend to lean toward either the home setting or a clinic setting.
- What is the training and retention process for their staff?
How much staff turnover do they see? Many frontline staff members receive their training directly from the provider. Ask the provider what training policies and procedures they’ve implemented before working with your child. Also, a center that frequently cycles through frontline providers may have a harder time maintaining quality, consistent care for the child.
- Is the provider using evidence-based services?
A set of evidence-based, research-backed services has been shown to be effective and helpful for children with autism. One red flag to watch for is a provider who offers therapies that don’t have consistent scientific evidence.
- What are the treatment goals?
Goals may vary based on the provider. Ask them to describe the goals of therapy for your child to ensure they meet your priorities. Therapy goals should be individualized, based on a standardized assessment tool to track progress, and match your goals as a parent.
- What support will I get as a parent?
Ask which parent training or parent support programs the provider offers. Do they have a parent training program in place? What topics are covered? What principles is the program based on?
- What is their track record of success and outcomes?
Ask other families or professionals about their experience using a provider, and ask the provider for any data they can share on the proficiency they’ve demonstrated with children with autism.
- What is the clinic leadership like?
Who are they? What do they value?
- Is my insurance accepted?
Autism care can become costly for families if services are not paid for by health insurance. Which insurance networks are the provider in, and is your insurance accepted? Are any payment plan options available?
How do I find a provider focused on naturalistic/play-based autism therapy?
Naturalistic developmental behavior interventions (NDBIs) are a form of ABA therapy that prioritize play-based, developmentally appropriate, and naturalistic care. If this type of therapy is important to you, look for certified or trained providers in an NDBI. These providers have received advanced training and/or certification in a discipline, such as the Early Start Denver Model (ESDM) or Pivotal Response Treatment (PRT).