Understanding the stages of speech development, the impact of autism on speech development and providing appropriate support and interventions can empower autistic children to reach their full communication potential, enriching their lives and those of their families.

First Word Milestones and What They Mean to Some Families

First word milestones represent a breakthrough in overcoming communication and autism-related challenges, and signify that a child is finding their voice. They’re a testament to the hard work, dedication, and the incredible journey of growth that families and their autistic children have embarked upon.

This journey is unique and can present challenges along the way. Each milestone, especially the first words, holds deep meaning and significance for families. It represents progress and communication breakthroughs while strengthening the bond between parents and their child.

Understanding the stages of speech development, the impact of autism on speech development and providing appropriate support and interventions can empower autistic children to reach their full communication potential, enriching their lives and those of their families.

Let’s understand the different speech development stages in autistic children, why some children miss milestones, how autism affects speech and language, and what first word milestones mean to families with a autistic children.

Speech and Language Therapy for Autism

Speech and language development in autistic children can vary widely. While some may follow a similar progression to neurotypical children, others may experience delays or differences in reaching speech milestones. 

Understanding the different stages of speech development can provide insight into the developmental journey of autistic children and the relationship between autism and communication. Here are the typical developmental stages in speech and language development.

1. Preverbal communication

This stage involves the use of nonverbal communication, such as eye contact, gestures, and vocalizations, to express needs and engage with others.

2. Babbling

Children begin producing repetitive syllables and sounds, laying the foundation for later speech.

3. Single words

In this stage, children use individual words to communicate their needs, desires, and thoughts.

4. Phrase and sentence formation

As language skills evolve, children start combining words into phrases and sentences to convey more complex ideas.

Understanding why autistic children may miss first word milestones

Speech development in children can be understood in terms of the development of various capacities, including expressive language (the ability to express oneself through words or gestures) and receptive language (the ability to understand and comprehend spoken language).

It involves the acquisition of vocabulary, grammar, sentence structure, and the development of speech sounds and articulation.

Despite these generalities, speech and language development remains unique for every child. Additionally, the process through which autistic children in general reach first word milestones will often differ from their neurotypical peers. So just how does autism affect communication?

Here are some factors that can contribute to autistic children missing these early language milestones.

Communication challenges

Autistic children often face difficulties in expressing themselves verbally and understanding spoken language. They may struggle with the back-and-forth nature of conversation, have limited vocabulary, or find it challenging to use words to convey their needs and emotions. These communication challenges can impede their progress in reaching the first word milestone.

Sensory sensitivities

Many autistic children experience sensory sensitivities, where they may be hypersensitive or hyposensitive to certain sensory stimuli. In terms of speech and language development, these sensitivities can affect their ability to process and imitate sounds. Sensory sensitivities to noise, for example, may make it harder for an autistic child to focus on and understand spoken words, leading to delays in acquiring their first words.

Motor skills and oral-motor coordination

Developing speech involves intricate coordination of the oral muscles to produce specific sounds. Some autistic children may experience challenges with fine motor skills, including those required for precise tongue, lip, and jaw movements. Difficulties in oral-motor coordination can also impact their ability to articulate sounds, resulting in delays or difficulties in developing their first words.

Delayed social communication skills

Autistic children often experience delays in social communication skills, such as joint attention and understanding social cues. These delays can affect their language development, including the acquisition of first words. Communication is not just about words; it also involves engaging with others, taking turns, and understanding the social context of conversations. Without these foundational skills, autistic children may experience delays in reaching their first word milestones.

Individual differences and unique developmental trajectories

It’s essential to recognize that each autistic child is unique and has their own strengths, challenges, and developmental trajectory. While some may miss the typical timeline for first word milestones, they may excel in other areas of development. It’s crucial to focus on individual progress and provide support tailored to each child’s specific needs rather than comparing them to neurotypical or allistic benchmarks.

Autistic characteristics to look out for

There’s a direct relationship between autism and language, and understanding this as a marker to assess your child’s development can be very useful. If you suspect, or are uncertain, that your child may be autistic, these are some characteristics of autism to look out for. 

Delayed speech

Some autistic children may experience a delay in producing their first words or demonstrate trouble with their overall speech development.

Echolalia

Repetitive or echoed speech, where children repeat words or phrases without understanding their meaning, is common among some autistic individuals.

Difficulty with pragmatics 

Pragmatic language skills, such as taking turns in conversation, understanding social cues and using appropriate gestures, may be challenging for some autistic individuals.

Verbal apraxia

Some autistic children may struggle with planning and coordinating the precise movements required for speech, leading to difficulties in articulation.

What first word milestones mean to families

For families with an autistic child, the articulation of first words is a remarkable and heartwarming milestone. It signifies progress in communication skills, an important step towards self-expression and a deeper connection with their child. These first words can bring immense joy, hope and pride to families who have tirelessly supported their child’s speech and language development.

Early intervention with Lighthouse Autism Center

Early intervention plays a vital role in supporting autistic children in their speech and language development. Speech therapy, applied behavior analysis (ABA) and other evidence-based interventions can address communication challenges, promote language acquisition and enhance social communication skills. 

Lighthouse Autism Center (LAC) has a plethora of autism resources to complement their innovative Lighthouse Fusion ABA Therapy to help you with early detection and intervention.

Early detection of ASD and early application of ABA therapy can positively impact your autistic child’s quality of life. Parents are encouraged to act quickly to get the full benefit of ABA and give their children the best opportunity to develop their social, behavioral, and communication skills.

The Benefits of Early Intervention and Full-Time ABA Therapy

Any therapist you talk to about autism and autistic children will tell you that the earlier you detect Autism Spectrum Disorder (ASD) in your child, the more effective any intervention will be. This is especially true of Applied Behavior Analysis (ABA) therapy in autism. 

Research has shown that early ABA intervention in autism at a young age is associated with better outcomes in life skills development and helps reduce challenging behaviors that can make it difficult for children with autism to interact with others and learn in traditional ways.

Find out why it is important to detect ASD early and the benefits of early intervention for autism with ABA therapy.

How do I know my child is autistic?

Signs of ASD can start showing up in babies as young as six months old. And by the time they’re 12–18 months old, those signs can become even more noticeable. 

In fact, the American Academy of Pediatrics recommends that all 18–24-month-old children be screened for ASD and other developmental disorders. If you do see anything that worries you, don’t hesitate to talk to your child’s doctor about it. 

Common signs cut across three different categories – social, communication, and behavior. These signs may manifest in the following ways:

Social

• Avoiding eye contact
• Not responding to smiles or other facial expressions
• Making facial expressions that don’t suit the context
• Struggling to understand other people’s facial expressions
• Ignoring objects when they’re pointed out
• Not pointing out objects to others
• Having difficulty showing empathy
• Less likely to share things with others
• Not responding when their name is called
• Not using toys or other objects during play as expected

Communication

• Not saying single words by 15 months or two-word phrases by 24 months
• Repeating words without understanding their meaning
• Showing little interest in communicating with others
• Losing language or social skills between 15 months and 2 years old.
• Unable to express feelings or thoughts independently
• Not babbling, or echoing sounds as an infant

Behavior

• Engages in repetitive behaviors (stimming), such as rocking, spinning, twirling fingers, or flapping hands, to self-regulate
• Walks on toes for extended periods
• Prefers routine and struggles with changes or transitions to new activities
• Can become fixated on a specific object or interest
• Repeats certain activities or actions over and over
• Has heightened or diminished sensitivity to smell, sound, light, texture, or touch

By catching any potential issues early, you can give your child the best possible chance for early intervention and successful treatment.

What is ABA?

ABA is a type of therapy that helps individuals with ASD learn new skills and shape their behavior by using positive reinforcement and other teaching strategies in a way that’s fun and engaging for the person receiving therapy.

ABA therapy has been shown to be really effective for people with ASD of all ages. Benefits include improvements and help with all kinds of skills, like communication, social interaction, and self-care.

Does early intervention work for autism?

The short answer is yes. Early intervention in children with autism means starting a treatment or therapy during the pre-preschool years – basically from birth to around age 3 – and there are many reasons why. 

At that age, the brain is super flexible and able to learn a lot more easily than it will be later on. That’s why starting treatment early is so important – it gives your child the best possible chance to make big strides in their development.

Here are some key reasons why early detection of autism and early intervention with ABA therapy is so important.

Neuroplasticity

The biggest advantage of early intervention when it comes to Autism Spectrum Disorder has to do with something called neuroplasticity. This simply means that the brain can change and adapt based on what it’s experiencing.

When kids with ASD receive early intervention, there’s a better chance that their brain development will be positively influenced, creating and shaping new neural pathways early on. This can sometimes even prevent challenging behaviors from becoming habits, which can be a big help for both the child and their family.

Learning and school-readiness

Another benefit of early intervention is that it can help children with ASD to be better prepared for starting school. ABA can help children with autism develop the skills they need to learn effectively in a group or classroom setting, like paying attention to the teacher, following directions, and working cooperatively with peers.

Communication skills

ABA is particularly effective in developing communication skills in autistic children. This can include teaching them how to use language to communicate their needs, wants, and thoughts. Depending on the needs of the child and family, different communication styles can be taught, and ABA teams should collaborate with other providers to best determine what direction to go in. 

Social skills

ABA can also help children with ASD develop social skills, such as how to make friends, take turns, and engage in conversation. The sooner they learn these, the easier their lives will be in social settings. 

Behavior

Early intervention with ABA can also help reduce challenging behaviors in autistic children. In many instances, it teaches them how to manage their emotions, follow rules, and engage in other appropriate behaviors, including how to ask for space or a break if needed. 

Parenting

Parenting a child with autism is challenging, which makes it important to really understand your child’s unique traits and behaviors. This is especially true when they’re upset or distressed and may not communicate in the same way as other kids.

ABA teaches new techniques that can help you interact with your child in a more effective way and offer innovative solutions that can make a big difference for both you and your child. ABA therapy is not just about working with your child, it’s about incorporating the family into services and making sure the skills your child learns in therapy can be transferred to the home setting. 

Matching their peers

A really important study done by Dr. Ivar Lovaas showed that almost half of the children who received early intensive ABA Therapy were able to catch up to the average range of their peers in intellectual and educational function. 

Independent living skills

It is really important for autistic children to do things independently, just like other children, and early intervention helps your child learn important life skills right from the beginning.

When you start working on these skills early on, your child is much more likely to become confident and independent as they grow. This can be a big help in dealing with all kinds of challenges that come up in daily life. Think of things from washing their own hands, to toilet training, dressing independently, to packing their own lunch. 

Intervene early with the Lighthouse Autism Center

Lighthouse fusion ABA therapy is an innovative approach used by the Lighthouse Autism Center to fuse the best practices of ABA and speech therapy into a one-of-a-kind clinical model that delivers better outcomes for children with autism. LAC combines this with various autism resources to help you and your child live a better life.

As with any travel plans, preparation is key. It is especially challenging when traveling with an autistic child. From finding autism-friendly destinations to transport options and even insurance, ensuring you prepare well will reduce risks and make the trip a happy experience for everyone.

Preparing for a Trip With Autistic Children 

Planning any family trip or vacation is always fun but also incredibly stressful. This becomes even more challenging when you need to prepare for a trip with an autistic child. Apart from the normal checklists any trip requires, parents who combine the challenges of autism and traveling have to consider many other factors.  

From managing your and your child’s autism-related travel anxiety to ensuring their safety and comfort in new environments, here are a few tips on how to reduce risks and increase the fun on your next trip. 

Planning the trip

The planning phase of the trip is crucial to travel for a person with autism. It requires extra attention and preparation to ensure that the child’s needs are met at every stage of the trip so that everyone can enjoy the vacation. 

Research your destination

Before you book anything, research your destination to ensure that it is suitable for your child. Highly stimulating experiences like amusement parks, playgrounds, and performance venues can be overwhelming for children, especially those living with sensory overload.  

Consider destinations like Sesame Place, the world’s first theme park to be designated as a certified autism center. They have trained staff who are knowledgeable about autism and how to provide support to individuals with sensory sensitivities as well as sensory guides to help families plan their visit and navigate the park. There are also quiet rooms where visitors can take a break from the noise and crowds and have some downtime.  

Here is a comprehensive list of questions you can forward to any prospective destination to assess their readiness to host you and your child: 

• Can you tell me how long the wait times are? 
• Where can we find our room or seat? 
• How long does the program, event, or attraction typically last? 
• What sets your location apart from others like it? 
• Do you offer sensory guides for your guests? 
• What type of training do your employees undergo, if any? 
• Are there any times when staff members won’t be available to assist me? 
• Do you have any employees who specialize in autism? 
• How many people are usually around? 
• Is the street typically busy? 
• What kind of view can we expect from our room or seat? 
• How noisy is it usually? 
• Is it generally quiet during the night? 
• Is it hot and humid outdoors? 
• What material are the seats/linen made of? Cloth, leather, or plastic? 
• Is it possible to receive a menu beforehand? 
• Am I allowed to bring my own food? 
• What kind of food substitutions are allowed? 
• How far away is our room from the pool and kitchen? 
• Do you use scented detergent or cleaners in the rooms? 
• Where is the garbage and waste collected, and how often is it done? 
• Is there a designated area where I can take my child if they become overwhelmed? 
• How easy is it to get to that space? 
• What safety procedures do you have in place in case of a medical emergency? 

Special travel insurance

Autism travel insurance is a type of travel insurance that’s specially designed to provide extra coverage and protection for people with autism when they’re traveling. Beyond normal travel coverage, special autism travel insurance can also cover additional expenses that may arise due to autism-related incidents.

For example, if someone who is autistic experiences a behavioral or sensory meltdown during their trip, the insurance can help cover any costs associated with that incident, like the cost of a hotel room or a medical professional’s assistance. 

Autism travel card

An autism travel card is a special card or document that autistic children should carry when they travel. It helps to let transportation officials and other service providers, like hotel staff, know that your child is autistic and might need some extra help or accommodations during their trip. 

The card usually has basic information like their name, age, and picture, along with details about their sensory needs, communication preferences, and any other support they might need. Combine the card with a list of your child’s specific issues so that if they get lost or wander off, adults who find them are able to respond accordingly.  

Different organizations or agencies might have their own version of the card, but they all serve the same purpose. 

Preparing your child

This is perhaps the most important aspect of the trip. Both you and your child may be entering an unfamiliar environment which can spark anxiety and serious behavioral reactions.  

Ensuring that your child is well prepared and ready to tackle these new challenges and changes to routine and environment will go a long way to making their and your trip enjoyable. 

Create a schedule and social story 

Detailed schedules should include the travel process, holiday activities, meals, and breaks. This will help your child feel more comfortable and reduce anxiety. 

It’s a great idea to illustrate the schedule in a picture and/or word social story. This will help them understand what to expect and feel more comfortable with the unfamiliar experience. 

Include pictures or descriptions of all aspects of the trip, especially when you combine autism and air travel. Make sure to illustrate security processes, the terminal, the airplane, hotel/accommodation, activities etc. You can also add sensory experiences that your child may encounter during the trip, such as ear-popping during takeoff and landing. 

These concepts require reinforcement. A useful technique is to get your child to explain the schedule back to you repeatedly. You can also mark the departure date on a calendar at least three weeks before and get them to mark each day off. 

Additional training

If you find your homespun efforts are falling a little short, then consider travel training for autism, a program that helps autistic children learn how to travel in a more structured way. It teaches them many of the skills and knowledge they need to be able to navigate the trip, while also helping prepare you as a parent. 

Travel training programs can vary depending on the specific program, but they usually include a mix of classroom instruction and hands-on training. These could include exposure therapy where the child can be acclimated to certain sensory stimuli like sand, snow, escalators, or even the feel of wearing a bathing suit. 

On the way

Release pent-up energy 

Travel often requires long periods of sitting still and being quiet, which can be challenging for children who have a lot of energy. To help your child relieve any pent-up energy before departure, encourage them to engage in high motor activity. 

Activities that involve gross motor movements, such as running or jumping on a trampoline, for approximately 20 minutes, can be especially helpful. This type of activity can help your child release energy and reduce feelings of restlessness, making it easier for them to remain calm and comfortable during the journey. Many airports now have child play spaces that would be ideal for a pre-flight activity session. 

Bring items of comfort along

Comforting items from home, such as a favorite blanket or toy, help your child feel more at ease in unfamiliar surroundings. You should also consider not washing certain items to keep the smell of home constantly present as a comfort in times of distress.  

Sensory supplies 

A good idea is to keep a bag of supplies in the car based on what you know about your child’s needs and their sensory sensitivities. Consider giving your child a small backpack with items they can access on their own as well. 

Include sensory blockers like headphones to help with noise hypersensitivity. Other helpful items for sensory relief can include portable fans, hand sanitizer, and moisture-wicking towels. 

While you’re there

Once you arrive at your destination, it is important to reinforce much of the preparation that was done with your child and ensure that the venue/accommodation can deliver on what was presented. You also need to be prepared for any eventuality you may not have considered.  

Establish a routine

On arrival, it is important to remind your child of all the preparation that was done and then establish a routine for the rest of the vacation. Use all the tools you would at home to make them immediately comfortable in the new space, and put up the schedule you prepared as a visual reference.  

Plan for sensory breaks 

Your child may need breaks from sensory stimulation, so plan for quiet or calming activities during the trip. This can include activities like reading, drawing, or playing with sensory toys. Assuming you booked at a certified autism center, the resort, hotel, or park may offer specially-designed facilities for this.  

Inform all service providers

Let hotel staff and tour guides know about your child’s needs in advance so they can be prepared to provide any necessary accommodations. It is, however, important to remind them when you arrive and during the stay, as staff can rotate, or your instructions may not make it all the way down to the cleaners, waiters, and other service staff.  

Have a backup plan

With all the planning and preparation in the world, there will always be situations that you cannot anticipate. In these cases, you need an emergency backup plan to mitigate any unforeseen stimuli, changes, or triggers that could overwhelm your child. 

This could include returning to your hotel room for a break or finding a quiet, less stimulating activity. To avoid unnecessary anxiety and distress, be prepared to stop any activity immediately to limit the impact on both you and your child.  

Lighthouse Autism Center, a partner on your autism journey

Planning for any changes in your child’s life is a challenge. Let Lighthouse Autism Center help you navigate these spaces through their innovative programs and products like their Lighthouse Fusion ABA Therapy and the numerous autism resources they house on their website. 

Autism Spectrum Disorder (ASD) diagnoses seem to be on the rise. Why is this? We investigate what current data reveals about autism rates, the disparities that exist, and why the statistics don’t necessarily tell the whole story. 

If There’s No Autism Epidemic, Why Are the Autism Statistics Climbing? 

Having just emerged from the throes of the COVID pandemic, it’s fair to say that we have become acutely aware of the many medical conditions that afflict us as a society. More recently, though, we are witness to another perceived crisis, the autism epidemic.  

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects a person’s communication, social interaction, and behavior. It’s called a “spectrum” disorder because it affects people in different ways and to varying degrees.  

Some people with ASD may have difficulty with social cues or communicating their wants and needs, while others may struggle with repetitive behaviors or intense interests in specific topics. ASD is typically diagnosed in childhood and can affect a person throughout their life. 

According to multiple reports from the CDC and other medical journals, autism spectrum disorder statistics show sharp increases in the last few years. Yet experts say there is no need to be alarmed and that there is no epidemic. Let’s look at the data and investigate why the numbers continue to rise, and why experts remain calm. 

What the data says

According to several studies reported by the Center for Disease Control (CDC) as well as medical journals like Pediatrics and Autism Research, autism facts and statistics show a marked rise in the number of ASD diagnoses in children between the ages of 4 and 8, both in the USA and the rest of the world. 

Autism in the USA

A study published in the journal Pediatrics found that the rate of autism among children in the New York and New Jersey metropolitan areas tripled between 2000 and 2016.  

In the CDC’s 2021 follow-up report on autism in the USA, statistics showed similar increases to what was observed in New York and New Jersey. In 2016, one in 54 children had been diagnosed with autism by age 8, compared to 1 in 150 in 2000. 

Another study announced by the CDC in 2023 showed that the number had jumped significantly to 1 in every 36 children. This was up from 1 in 44 in 2021. 

Autism across the world 

A recent study published in the journal Autism Research revealed that the global prevalence of ASD has increased to around 100 in 10,000 (or 1 in 100) children. This is a significant rise from the 2012 global prevalence report, which estimated that 62 in 10,000 children had ASD. 

What are the reasons for the rise in numbers? 

So what do these statistics on autism really mean? And why don’t the experts seem to be worried? The answer, it appears, is layered. There are a number of factors that contributed to autism seeing an increase in statistics, but most of them point to better reporting rather than an increase in the actual number of cases. 

Better diagnoses

According to the team who conducted the New York and New Jersey study, the increase in autism spectrum disorder diagnosis is mainly due to the advancements in diagnostic capabilities and a greater understanding and awareness of the disorder. This is especially prevalent in diagnoses of ASD in children without intellectual disabilities.  

The study showed the percentage of 8-year-olds diagnosed with autism in New York and New Jersey without intellectual disabilities had increased more rapidly than those with intellectual disabilities. From 2000 to 2016, the percentage of those without intellectual disabilities increased five times, while the percentage of those with intellectual disabilities increased only twice. 

This is primarily attributed to advancements in diagnostic techniques rather than an increase in cases. 

The increase in autism prevalence in other parts of the world is also attributed to improvements in public awareness and healthcare systems that respond to autism. 

Now, children are diagnosed at an earlier stage, and regions such as Africa and the Middle East, which were previously underrepresented, have made progress in measuring autism prevalence. 

Racial and gender disparities

The New York and New Jersey study also showed that although the gap has decreased, there are still racial disparities in autism diagnoses. In the past, Black and Hispanic children were diagnosed with autism less frequently than white children.  

The recent analysis revealed that Black children without intellectual disabilities were 30% less likely to be diagnosed with autism than white children. 

According to a neurodiversity scholar at the College of William & Mary, too many marginalized individuals who belong to racial or gender minority groups may not receive an autism diagnosis due to less effective screening tools.  

As diagnostic tools and expertise continue to improve, more individuals from these groups may receive a diagnosis, leading to an increase in autism diagnoses overall. 

Autism in women and girls

Studies have shown that autism is often underdiagnosed in girls and women, as well as in people with less visible symptoms. The latest CDC report shows a 4-to-1 ratio of male-to-female diagnoses, but some scholars are not completely convinced that this accurately reflects the reality on the ground. 

In other research, some academics found that there are often more autistic female students than male students in college groups. And as one social worker has shown, many women are diagnosed with autism later in life, often after they’ve become mothers or grandmothers. This suggests that there are still many girls and women who are going undiagnosed today. 

As these diagnoses increase, so will the overall number of cases. 

Genetics

According to one analysis, around 83% of the risk of developing autism comes from inherited genetic factors. The study pointed out that autism is likely influenced by 2,000 to 3,000 genes, but only about 100 of them are consistently linked to the disorder. 

It was also shown that older parents are more likely to have autistic children, and recent trends show that more people are waiting longer to have children. This is flagged as another possible contributor to the increase in ASD prevalence. 

Lighthouse Autism Center makes life better

Given the increased awareness of ASD prevalence in the USA, it is important to seek out support systems and resources to help families with autistic children. The vast repository of autism resources and LAC’s innovative and groundbreaking Lighthouse Fusion ABA Therapy provide autistic children with the ideal path to holistic well-being. 

Applied Behavior Analysis (ABA) therapy is a necessary medical expense to help our autistic children thrive. But do our health insurance providers cover ABA therapy? Let’s find out how to check your coverage, how your coverage works, why you might not be covered, and how to get the best out of it.

How Do I Know if My Insurance Covers Aba Therapy?

Autism spectrum disorder (ASD) is a well-known and understood condition, yet we often don’t know whether our health insurance providers cover the treatments our autistic children need to thrive in the world. This is especially true of insurance coverage for ABA therapy. 

Applied Behavior Analysis (ABA) therapy is a treatment that helps people with autism spectrum disorder and other developmental disabilities improve their behavior and communication skills using behavioral principles. 

ABA typically involves working with a licensed ABA therapist, who designs and implements a personalized treatment plan for your child. The frequency and duration of therapy sessions may vary depending on their specific needs. Obviously, these treatments and sessions cost money. 

So does your insurance actually cover ABA therapy? To avoid any nasty surprises when we submit claims against our health insurance policy for ABA therapy, it is important to know the answer to this question beforehand. You’ll need to know your coverage works, why you might not be covered, and how to get the best out of your coverage. 

How does ABA coverage work?

Health insurance coverage for autism, and more specifically, ABA therapy insurance, is dependent on a few things. Firstly, you need to understand the type of health insurance plan you have.

In the past, there were very few formal regulations governing ABA therapy for autism and insurance coverage. More recently, however, state and federal governments introduced laws to ensure more uniform coverage across plans and divided the plans into two specific types: self-funded plans and fully insured plans.

Self-funded

These plans are regulated by federal laws rather than state laws. Under this plan, your employer decides what is covered and what isn’t. These plans are not mandated to cover ABA therapy, but as a result of federal mental health parity law requirements, ABA coverage on self-funded plans is increasing.

Fully insured

These are the most common plans offered by employers and must comply with state laws regarding coverage of ABA benefits. Under this type of plan, the insurance company decides what is covered and what is not covered, subject to state regulations. All 50 states mandate that these plans cover ABA. 

The following list will give you an idea of how fully insured plan regulations differ from state to state.

Arkansas

ABA therapy is covered if provided by a supervised, Board Certified Behavior Analyst.

California

A plan covering physical treatments must also cover mental health services. ABA is considered a covered treatment.

Delaware

ABA therapy and necessary items or equipment needed for treatment are covered.

Florida

ABA therapy is covered under state-regulated plans. If you were diagnosed with a developmental disability at age eight or younger, you are eligible for coverage. If you’re over 18, you will still receive coverage as long as you’re still in high school. Coverage for autism in Florida is capped at $36,000 per annum, with a lifetime limit of $200,000.

Georgia

ABA is not explicitly covered in Georgia.

Indiana

In Indiana, ABA is not explicitly covered, but treatment for autism and related disorders can’t be subject to limits or deductibles.

Massachusetts

ABA therapy is covered under MassHealth Standard, CommonHealth, and Family Assistance. There are age limits, but private, fully funded options are available too.

Montana

ABA is not explicitly mentioned, but treatment for autism spectrum disorder can be capped at $50,000 per year for children under eight.

New Hampshire

Coverage for autism is covered under state-regulated plans. Coverage is capped at $36,000 per year for individuals aged 0 to 12 and $27,000 per year for those aged 12 to 21.

It is crucial, however, to check your plan properly. While all 50 states include ABA therapy and autism treatments in their base requirement, some may not enforce full coverage as part of the state regulation. 

How to find out if you’re covered

The first step is to establish which type of plan you’re on. Call your employer’s health insurance representative (usually the HR department) to find out exactly which plan you are on. Once you know if you’re on a self-funded or fully insured plan, you need to find out if you have ABA insurance coverage.

When talking to your health insurance representative about insurance for ABA therapy, you need to ask the following questions: 

1. Does my current plan cover the screening, diagnosis, and treatment of autism spectrum disorder?
2. Does the plan cover ABA therapy?
3. Can I obtain a copy of the Summary Plan Description (SPD) to review coverage details and specific exclusions in writing? It’s crucial to document coverage in writing for future reference.

Choosing a new or different plan

If your current plan does not offer sufficient cover, consider changing your plan. Most employers offer multiple plans, while some even offer both self-funded and fully insured options.

If you have the option of a fully insured plan, you should inquire about the state that regulates the plan, which is typically the state where the company is headquartered rather than your place of residence. 

You should also ask whether it is a small group or large group plan. You can then check whether the state that regulates the fully insured plan mandates coverage in the type of plan offered by your company.

Child-only insurance

Young children with autism often require up to 40 hours of ABA therapy per week, making a child-only insurance plan a wise financial decision. This will allow your child to receive the recommended amount of therapy necessary to reach their full potential.

You can go through the Healthcare Marketplace to obtain a child-only insurance plan. The ABA benefit is included in the “Essential Health Benefits” package, which is mandatory for all Marketplace plans in Texas and Colorado.

It’s important to note that Healthcare Marketplace plans can only be purchased during designated Open Enrollment periods.

How to get the most out of your coverage

Once you have selected a plan that suits your needs and budget, you should spend time interrogating the details of ABA therapy for autism and the insurance coverage per benefit. Knowing how your plan works will empower you to extract as much value as possible without incurring additional costs. Here are some benefits and rules you should keep in mind when using your insurance. 

Deductibles

The deductible is the amount you need to pay before your insurance starts contributing. You’ll have to pay this every year.

Copayment or coinsurance

You’ll either have a copay or a coinsurance. A copay is a fixed amount you pay per visit, including for ABA therapy. Coinsurance is a percentage of the total charges you’re responsible for paying after you’ve paid the deductible.

Out-of-pocket maximum

This is the highest amount you’ll have to pay in a year. Once you reach it, you won’t have to pay any other out-of-pocket expenses for ABA therapy for the remainder of the year. Like your deductible, the out-of-pocket maximum resets each year.

Documentation requirements

Experts recommend that a good insurance plan requires ongoing documentation of your child’s progress. Your child’s Registered Behavior Technician (RBT) will need to submit documentation to show that the treatment is effective. A Board Certified Behavior Analyst (BCBA) will review the progress reports. Although you are not responsible for creating these reports, they are a crucial component of ABA therapy.

In-network practitioners

Use therapists and Board Certified Behavior Analysts (BCBAs) who are in-network with your insurance provider.

Pre-authorizations

Make sure to submit all necessary paperwork before beginning ABA therapy sessions to be certain the costs have been authorized. Failing to do so could leave you responsible for paying the entire bill. A formal diagnosis of autism spectrum disorder and a comprehensive behavior assessment are generally required for ABA therapy.

Lighthouse Autism Center covers your autism treatment needs

Lighthouse Autism Center meets the requirements of most health insurance plans. Through diligent use of your insurance, you can take full advantage of our Lighthouse Fusion ABA Therapy and the many other autism resources available from the Lighthouse Autism Center.