Autism spectrum disorder is no longer a rare diagnosis. Where prevalence once stood at 1 in 150, it now sits at 1 in 31 — meaning statistically every classroom in America has at least one autistic student. The systems designed to serve those families have not kept pace. In a recent Behavioral Health Tech webinar, four experts across provider, payer, and clinical perspectives gathered to discuss where autism care has succeeded, where it's failing, and what a better future could look like.

The conversation featured Robin McIntosh, Co-founder and CEO of Avela Health; Mike Suiters, CEO and Co-founder of Positive Development; Rachel Goldberg, VP of Strategic Partnerships & Product Innovation at NovaOne; and Dr. Frank Webster, CMO at Health Care Services Corporation.

A System Built for a Different Era

The core tension in autism care today, as Robin McIntosh framed it, is straightforward: the current model pays by the hour. Families seeking help for their child are handed a prescription of 10, 20, or even 40 hours of Applied Behavior Analysis (ABA) per week, regardless of whether that intensity is feasible, appropriate, or even desired. The system rewards volume, not outcomes.

"Any system designed for that old volume would snap under pressure," Robin said, referring to infrastructure built when prevalence was far lower. "That's what we're seeing now."

Mike Suiters added that while access to ABA services has improved, driven partly by significant private investment, demand still outpaces the supply of high-quality providers. There's also an ironic consequence of early advocacy wins: efforts led largely by Autism Speaks in the early 2000s secured insurance coverage mandates in all 50 states. But because those mandates were written narrowly around a single intervention, they effectively enshrined ABA as the default. Eighty percent of all randomized controlled trials in autism research have been published since 2010, well after most mandates were drafted. The result, as Dr. Webster observed: coverage that consistently directs families toward the most expensive option, even when lower-intensity alternatives might fit better.

Three Families of Intervention, Only One Typically Covered

Mike outlined the three main categories of evidence-based autism interventions:

• Applied Behavior Analysis (ABA): The most well-known and most heavily covered. Programs range from comprehensive (25–40 hours/week) to focused (15–25 hours/week), with the strongest evidence base for children under age 6.
• Developmental Relationship-Based Interventions: Approaches that emphasize building social and relational capacities. Typically lower intensity, often parent-mediated, and more naturalistic in delivery.
• Naturalistic Developmental Behavioral Interventions (NDBIs): A hybrid blending ABA and developmental approaches, ranging from higher-intensity programs like the Early Start Denver Model to parent-mediated options like Project Impact.

Despite solid research support across all three, most insurance funnels families toward ABA. Low-intensity options under 15 hours per week are scarce in covered networks. For adolescents and adults, the gap is even larger. The ABA research base was built around young children, and applying it to college students or 40-year-olds makes little clinical sense. Of the estimated 7 million Americans with an ASD diagnosis, 5 million are adults, yet autism-informed psychotherapy and adult support services remain hard to find and rarely covered.

Autism Is Heritable. The Family Is the Patient.

One often-overlooked point Robin raised: autism is highly heritable. If a family has an autistic child, there's roughly an 80% likelihood that at least one parent, grandparent, sibling, or close relative also carries the condition (diagnosed or not).

An approach centered entirely on the child misses most of the picture. "If you don't have an all-ages solution, you don't have a solution," Robin said. "It's not about the kid. It's about fixing the environment so that everybody can thrive."

Avela Health is built around this whole-family model. Rather than prescribing a fixed number of hours, Avela starts by understanding each family's values and context, offering naturalistic developmental approaches for young children, modified psychotherapy and adapted CBT for adolescents and adults, occupational therapy, caregiver coaching, and navigation support throughout. The program is virtual, available nights and weekends, with a 24/7 call line.

Autism Is Not Monolithic

Several panelists pushed back on the narrative that autism is a disorder requiring urgent, intensive correction.

"Autism is a neurotype," Robin said. "It's a brain type. Sometimes it's difficult to be autistic in this world because the world wasn't built for an autistic mind. But that doesn't mean autism is something to be solved."

Dr. Webster shared his own experience learning in his mid-30s that he'd been diagnosed with dyslexia as a child. He'd built a career in psychiatric emergency services partly because his brain thrives in fast-moving, high-complexity environments. "Not everybody needs treatment," he said. "There is a whole lot of strength in people who have autistic spectrum presentations."

The panelists were careful to hold both truths: that neurodivergence can be a genuine source of strength, and that for individuals with profound autism or significant support needs, intensive intervention may be absolutely necessary. The system should be diverse enough to serve the full range.

What Payers Are Up Against

Rachel described the position health plans occupy as genuinely difficult. Autism care costs for many plans are growing more than 50% year over year, representing hundreds of millions of dollars annually, with no clear signal that higher spend produces proportionally better outcomes.

Dr. Webster drew a useful parallel to eating disorder care. Fifteen years ago it was scarce and uniformly high-intensity. Investment poured in, programs multiplied, and the system eventually overcorrected with too many residential beds chasing a population better served by lower-intensity options. Models like Equip and Within emerged to fill the gap. He sees the same arc unfolding in autism care.

Advice for Families

The panelists converged on several practical themes for families navigating the system:

• Know your options. ABA is one intervention, not the only one. Developmental approaches, NDBIs, OT, and autism-informed psychotherapy all have research support.
• Start with what fits your life. A technically excellent program that's impossible to sustain helps no one.
• Don't confuse hours with efficacy. Volume of therapy isn't the same as quality or appropriateness, especially for older kids, teens, and adults.
• Look for whole-family involvement. Providers who don't engage parents and caregivers are missing a critical component of effective care.
• Don't assume your insurer is the obstacle. Health plans often have care navigation services specifically designed to help members find appropriate care.

Advice for Payers

• Contract for value, not volume. Paying by the hour incentivizes keeping families in care longer, not helping them improve faster.
• Cover alternative evidence-based interventions. Expanding beyond ABA gives families better-matched options, often at lower cost.
• Make alternatives easy to find. The best low-intensity option is useless if families can't find it in-network.
• Measure what matters across the whole family, including caregiver mental health, family wellbeing, and functional quality of life, not just child-level clinical metrics.

Where Policy Goes from Here

The conversation closed on a note of grounded optimism. "Start and end with the science," Robin said, cautioning against cherry-picked or outdated research driving coverage decisions. Dr. Webster stressed the importance of genuine stakeholder engagement: "You've got to engage the entire community, not just sections of it."

The system is under pressure, and that pressure will keep growing. But the solutions are becoming clearer, the evidence is stronger, and more people across the provider, payer, and family ecosystem are finally asking the same questions.