Therapies and support: what families actually use
A short, honest guide to the main options, including where the autistic adult community and the clinical research disagree — because you'll meet that disagreement quickly and deserve to see it laid out.
The first ninety days after a diagnosis
Week one: breathe, and tell almost no one yet
You don't owe anyone an announcement. Read a little from autistic adults as well as clinicians. Nothing medical is urgent this week.
Week one: make two phone calls
Early intervention if your child is under three, or your school district's special education office if they're three or older. Follow up in writing the same day.
Weeks two to four: money and lists
Apply for your state's Medicaid waiver waiting list. Check whether your child qualifies for SSI. Ask your insurer for their written autism coverage policy, including whether your state's insurance mandate applies to your plan.
Month two: build the team
Speech therapy and occupational therapy are the most commonly useful starting points. Add others based on what your child actually struggles with, not a standard package.
Month two: treat the things that are treatable
Sleep, constipation, pain, anxiety. Fixing these often changes daily life more than any therapy.
Month three: find your people
A local parent group, your state's Parent Training and Information Center, and at least one autistic adult's perspective. Isolation makes everything harder and worse-informed.
The main options
Speech and language therapy
Not just pronunciation. A good speech-language pathologist works on communication in the broadest sense: requesting, refusing, conversation, comprehension — and AAC where speech isn't reliable. Widely covered by insurance, IEPs and early intervention. Look for someone who treats all communication as valid, not one who treats speech as the only goal.
Occupational therapy
Daily functioning: dressing, eating, handwriting, motor planning and sensory regulation. OTs are often the source of the most immediately usable advice for home. Evidence for specific "sensory integration" protocols is mixed; evidence for practical adaptation and skill-building is better.
Applied behaviour analysis (ABA)
The most common and most funded autism service in the US, and the most contested. It applies behavioural principles to teach skills and reduce behaviours, usually for many hours a week.
The case for: the largest evidence base of any autism intervention, insurance-mandated in all 50 states, and for some children — particularly those with self-injury or serious safety behaviours — families report substantial gains.
The case against: many autistic adults describe ABA, especially older and more intensive forms, as teaching compliance and masking at the cost of long-term mental health, and some research points to that association. Critics also note much of the evidence base uses weak study designs and measures adult-rated behaviour rather than the child's wellbeing.
If you use it: ask what the goals are and whether they benefit the child or the adults around them; refuse goals aimed at eliminating harmless stimming or forcing eye contact; insist on play-based, child-led methods and no aversives; look for naturalistic developmental behavioural approaches such as ESDM, PRT or JASPER rather than hours of table-top drills; and stop if your child becomes distressed, withdrawn or regresses.
Developmental and relationship-based approaches
DIR/Floortime, the Early Start Denver Model and similar approaches follow the child's lead and build communication through play and connection. Generally warmly received by the autistic community. The research base is smaller than ABA's but growing, and the two increasingly overlap in practice.
AAC and assistive technology
Picture exchange, sign, and speech-generating devices or apps. Should be offered early to any child whose speech isn't meeting their needs, including part-time speakers. Insurance and schools can be made to fund devices; a speech evaluation documenting the need is the lever. Multilingual families should ask for a device configured in the languages used at home — this is possible and it matters.
Mental health support
Adapted CBT has decent evidence for anxiety in autistic children who use speech. Find a therapist experienced with autism — standard talk therapy often misfires. Autistic children also need someone to talk to who isn't working on a goal sheet.
School services: IEP and 504
An IEP provides specialised instruction and related services under IDEA; a 504 plan provides accommodations under civil rights law for students who don't need specialised instruction. Request evaluations in writing. You can bring an advocate, record meetings in many states, disagree in writing, and request an independent evaluation at district expense if you disagree with theirs. You have the right to an interpreter and translated documents at every meeting.
Respite and family support
Short-term care so caregivers can rest. Often available through state waivers, DD agencies, or the ARCH National Respite Locator. Chronically underused by the families who need it most.
Bilingual and multilingual families
You will still occasionally be told to "pick one language" or to speak only English at home. The research does not support that advice. Autistic children raised bilingually do not show worse language outcomes than autistic children raised with one language, and dropping the home language costs a child their connection to family, culture and grandparents — a real loss with no demonstrated benefit.
- Speak to your child in the language you are most fluent and most natural in
- Ask for evaluation in your child's strongest language, with a qualified interpreter if needed
- Ask for AAC and picture systems in the home language, or in both
- An evaluation done only in English can badly underestimate a child's abilities — say so if that happens
Questions worth asking any provider
- What exactly are you trying to change, and who benefits when it changes?
- How do you respond when my child says no — with words, or with behaviour?
- What's your view of stimming?
- How do you involve autistic adults in how you work?
- What would make you recommend we stop or change the plan?
- How will I know in three months whether this is working?