Developmental Pediatrician vs ABA: Which Should Come First?
In short: A developmental pediatrician typically provides a formal autism diagnosis, while ABA therapy is a treatment approach. Most families see the developmental pediatrician first for an evaluation, then use that diagnosis to access ABA and other therapies. Get ABA Therapy is a free service that can help you find a vetted BCBA-led provider after you have a diagnosis.
Key takeaways
- A developmental pediatrician diagnoses autism and rules out other conditions; ABA therapy is a treatment for autism.
- Most insurance plans, including Medicaid, require a formal diagnosis before covering ABA therapy.
- You can start early intervention services (like speech or occupational therapy) while waiting for a developmental pediatrician appointment.
- ABA therapy is most effective when started early, but it can help at any age.
What Is a Developmental Pediatrician?
A developmental pediatrician is a medical doctor with specialized training in child development and behavior. They evaluate children for conditions like autism spectrum disorder (ASD), ADHD, and developmental delays. Their role is diagnostic: they conduct comprehensive assessments, review medical history, observe behavior, and may use standardized tools like the ADOS-2 (Autism Diagnostic Observation Schedule). After the evaluation, they provide a formal diagnosis and recommendations for therapies, including ABA, speech therapy, and occupational therapy.
🔗 Related reading: BCBA vs RBT: Quality in ABA Therapy · Local ABA Therapy
What Is ABA Therapy?
ABA (Applied Behavior Analysis) therapy is a scientifically validated treatment for autism. It focuses on teaching new skills-like communication, social interaction, and daily living-and reducing challenging behaviors. ABA is delivered by a Board Certified Behavior Analyst (BCBA) who designs a personalized plan, and implemented by registered behavior technicians (RBTs). It is not a diagnostic service; it is a therapeutic intervention. Many families use ABA to help their child build independence and improve quality of life.
Which Comes First: Developmental Pediatrician or ABA?
In most cases, the developmental pediatrician comes first. Here is why: a formal diagnosis from a qualified professional is typically required before insurance will cover ABA therapy. Without a diagnosis, you cannot access ABA through insurance or most public programs. However, there are exceptions. Some early intervention programs (like those funded by Part C of IDEA) may provide services based on developmental delay without a specific autism diagnosis. Additionally, you can start other therapies-like speech or occupational therapy-while waiting for a developmental pediatrician appointment.
Why the Order Matters
Getting a diagnosis first ensures that ABA therapy is tailored to your child's specific needs. The developmental pediatrician's report often includes recommendations for the type and intensity of ABA. It also helps the BCBA design a more effective treatment plan. Skipping the diagnostic step can lead to delays in insurance approval and may result in therapy that is not fully aligned with your child's profile.
🔗 Related reading: ABA Therapy at Home for 2-Year-Olds: Key Benefits · Nearby ABA Therapy
What to Expect from a Developmental Pediatrician Evaluation
The evaluation process can take several hours and may be spread over multiple visits. Here is what typically happens:
- Initial consultation: The doctor reviews your child's medical history, developmental milestones, and any concerns you have.
- Direct observation: The doctor observes your child's behavior, play, and interactions.
- Standardized testing: Tools like the ADOS-2 or M-CHAT may be used.
- Parent interview: You will be asked about your child's behavior at home, school, and in social settings.
- Report and diagnosis: You receive a written report with the diagnosis and recommendations.
Wait times for developmental pediatricians can be long-often 6 to 12 months in many areas. While you wait, you can start early intervention services through your state's program (like Early Intervention in many states) or private therapies.
What to Expect from ABA Therapy
Once you have a diagnosis, you can begin looking for ABA providers. Here is the typical process:
- Initial assessment: A BCBA meets with you and your child to conduct a functional behavior assessment (FBA) and develop a treatment plan.
- Goal setting: Goals are created based on your child's needs-like improving communication, reducing tantrums, or learning self-care.
- Ongoing therapy: RBTs work with your child in home, clinic, or school settings, with regular supervision from the BCBA.
- Progress monitoring: Data is collected and reviewed to adjust the plan as needed.
ABA is often covered by insurance, including Medicaid. Many plans require a prior authorization, which your provider can help with. If you need help finding a vetted BCBA-led provider, Get ABA Therapy is a free service that can match you with options in your area.
Costs and Insurance Coverage
The cost of a developmental pediatrician evaluation varies widely. Without insurance, it can range from $1,500 to $5,000 or more. Many insurance plans cover the evaluation, but you may need a referral from your primary care doctor. Check with your plan about coverage and any out-of-pocket costs.
ABA therapy costs can be high-often $50 to $150 per hour-but most insurance plans, including Medicaid, cover it for autism. The Affordable Care Act requires many plans to cover autism treatments, but specifics vary. Always verify with your insurance company. Get ABA Therapy can help you find providers who accept your insurance.
Practical Tips for Families
- Start early: If you suspect autism, begin the diagnostic process as soon as possible. Early intervention leads to better outcomes.
- Get on waitlists: Call multiple developmental pediatricians to find the shortest wait time. Ask about cancellation lists.
- Use early intervention: While waiting, contact your state's early intervention program (for children under 3) or your school district (for children 3 and up).
- Document everything: Keep records of evaluations, insurance communications, and therapy notes.
- Ask about telehealth: Some developmental pediatricians offer remote evaluations, which can reduce wait times.
- Consider a psychologist: A licensed clinical psychologist with autism expertise can also provide a diagnosis, often with shorter wait times.
Common Mistakes to Avoid
- Waiting too long: Delaying evaluation can mean missing early intervention windows.
- Skipping the diagnosis: Starting ABA without a formal diagnosis can lead to insurance denials and less targeted therapy.
- Not checking insurance: Always verify coverage before scheduling appointments or starting therapy.
- Ignoring other therapies: ABA works best alongside speech, occupational, and other therapies.
- Going it alone: Use free resources like Get ABA Therapy to find vetted providers and navigate the process.
How Get ABA Therapy Can Help
Get ABA Therapy is a free matching service that connects families with vetted, BCBA-led ABA providers. We do not provide therapy ourselves, but we help you find options that fit your child's needs and your insurance. After you have a diagnosis, simply fill out our form, and we will match you with providers in your area. We also offer guidance on insurance and the intake process. Let us take the stress out of finding quality ABA care.