For decades, applied behavior analysis (ABA) has been the dominant approach in autism therapy, largely due to insurance mandates and significant private equity investment. The result? ABA is often the first—and sometimes the only—option covered by insurance, leaving families with few alternatives. However, the autism therapy landscape is shifting as more providers explore and integrate alternative autism therapies alongside traditional ABA models.
One major factor fueling this shift is the increasing availability of funding for alternative autism therapies. While most providers still incorporate ABA, many are now offering a more comprehensive, multidisciplinary approach. These models include speech therapy, occupational therapy, and physical therapy alongside ABA, aiming to balance interventions rather than relying solely on one method. This approach recognizes the diverse needs of children with autism and allows for individualized treatment plans that extend beyond ABA’s traditional framework.
A Shift Toward Integrated Care Models
As demand for autism therapy services continues to grow, many providers are seeking ways to expand their offerings beyond ABA. The goal is to create a model where ABA is just one tool among many, rather than the central or sole approach to treatment.
Mike Cairnes, CEO of JoyBridge Kids, believes that integrating multiple therapies within a single clinic offers the best outcomes for children. JoyBridge Kids, which started in Tennessee and has expanded to Georgia and North Carolina, embraces an ABA-centered but multidisciplinary model. While ABA remains at its core, the company emphasizes a collaborative approach that includes SPOT (speech, physical, and occupational therapy) services. This integrated approach allows for a more personalized treatment plan that considers each child’s unique strengths and challenges.
However, a total departure from ABA remains unlikely. Experts note that ABA’s role in therapy is evolving rather than disappearing. Some clinics de-emphasize ABA without eliminating it, placing it alongside other treatment methods to create a more balanced and flexible framework. As Cairnes puts it, a successful autism therapy center should provide “all those services combined that work in collaboration”—a model that is difficult to implement but, once achieved, can significantly accelerate development in children.
The shift toward integrated care is also being driven by changes in how therapy is reimbursed. Insurance companies are increasingly looking for cost-effective solutions that deliver meaningful results. This has encouraged some providers to seek out alternative autism therapies that may require fewer hours than ABA-centric models, making therapy more accessible to more families.
Non-ABA Models: A Growing Alternative
Despite ABA’s continued prevalence, some organizations are charting a different course. Positive Development, a McLean, Virginia-based provider, offers an alternative model centered on developmental relationship-based intervention (DRBI). This approach prioritizes the parent-child relationship and integrates occupational, speech, and mental health therapy without relying on ABA.
According to Positive Development’s executive medical director, Dr. Josh Feder, this model better supports neurodivergent children by emphasizing their strengths and tailoring interventions to individual needs. Rather than attempting to modify behaviors to fit neurotypical norms, DRBI focuses on engaging children in meaningful relationships that promote growth and learning.
The company also sees strategic and economic advantages in moving away from ABA. Since DRBI requires fewer therapy hours per child compared to traditional ABA models, it is more scalable and financially sustainable. CEO Mike Suiters notes that the company has been able to secure broad insurance coverage for its services, making this alternative model more widely accessible than other alternative autism therapies, which are often not reimbursed at sustainable rates.
Suiters argues that lower-intensity models like DRBI can ultimately save insurers money while delivering better outcomes. ABA is currently a significant expense for behavioral health payers, and its rapid growth has led insurers to consider cost-effective alternatives. By requiring fewer therapy hours and maintaining strong outcome metrics, Positive Development has positioned itself as a viable alternative that insurers are willing to support.
In June 2023, Positive Development secured an investment from Healthworx, the investment arm of Blue Cross Blue Shield health plan CareFirst Inc. This investment signals growing interest in alternative autism therapies from both insurers and investors who see potential in alternative approaches to autism therapy.
The Future of Autism Therapy
As the industry evolves, many experts agree that the most effective autism therapy models will prioritize personalized, multidisciplinary care. Treehouse Pediatric Therapy in Chicago, for example, began as a physical and occupational therapy practice but later added ABA and pediatric mental health services. Owner Adnan Bhanpuri argues that autism therapy should move away from rigid, high-hour ABA models and toward more flexible, child-centered approaches.
“The idea is that we’re a place where mom and dad can come, and they’re truly getting all the services for their child as needed from one coordinated care team,” Bhanpuri explains. His company integrates various therapies to ensure children receive well-rounded support without being overwhelmed by excessive treatment hours.
Bhanpuri believes that while ABA will continue to be a component of autism therapy, its role will diminish over time. Families are increasingly looking for alternative autism therapies that allow children to participate in other meaningful activities rather than spending most of their time in therapy. This shift could lead to more models where ABA is included as part of a broader suite of services, rather than serving as the foundation of care.
Anya Perea, CEO of Jade Health, emphasizes the importance of avoiding polarization in the discussion about autism therapy. She argues that ABA, like any other intervention, should be one option among many rather than an all-or-nothing choice.
“What I don’t recommend and am passionate about is not villainizing or polarizing one treatment over another,” Perea said. She compares autism therapy models to treating patients with depression—some may benefit from traditional talk therapy, while others may find success with alternative treatments like psychedelic-assisted therapy. The key is to recognize that different individuals require different approaches, rather than assuming one method is inherently superior to another.
As more providers and investors recognize the benefits of alternative autism therapies, the future of autism therapy will likely continue evolving toward a more inclusive, flexible system. Rather than being locked into a single approach, families will have access to a range of options tailored to their child’s unique needs. Whether through hybrid models that integrate ABA with other therapies or fully non-ABA programs like Positive Development, the industry is undergoing a transformation that prioritizes individualized, comprehensive care over one-size-fits-all solutions.
