Kids Don't Suddenly Lose Their Diagnosis At 8

Dear ABA Community,

There have been tremendous changes in ABA over the last three decades. The incidence rate of autism has skyrocketed from 1 in over 10,000 to 1 in 36. Insurance is now the primary payor. Private equity owns the majority of large ABA practices. The landscape looks very different than it did when many of us started. Some of these changes have been beneficial. Others — not so much.

As someone who started as a therapist in 1990, I’ve witnessed this evolution firsthand and regularly speak with others who have been in the field just as long. There’s a consistent theme in those conversations: two shifts have taken a turn for the worse and are having a real impact on both our industry and the quality of care being delivered.

The most frustrating for me is that the vast majority of larger ABA providers now discharge learners at 8 years old. This shift coincided with PE entering the space and the move toward clinic-based models over home-based services.

The impact is far-reaching.

First and most obvious — there are children who need services and aren’t receiving them. I have personally seen children “graduate” at 8, regress, and return needing 20+ hours per week. That could potentially have been avoided with a clinically driven fade to 10 hours, then less, then discharge when appropriate — not because of an arbitrary age cutoff.

The second-level impact is workforce related. We now have a large number of RBTs whose entire experience is with 2–7 year olds. Many have never received CPI or other safety training. They are not prepared to serve older children, teens, or younger learners with more significant behaviors. While it may be convenient to focus on the youngest population and higher authorized dosages, it does a disservice to the patients and families we serve.

Personally, I would fully support insurance companies mandating that providers serve a broader age range.

The second issue is related: training.

The preparation of RBTs has shifted from intensive, multi-week training that included lecture, modeling, role play, shadowing, competency checks, and ongoing mentorship — to a 40-hour video series.

I’ve said this many times, so forgive me if I sound like a broken record. Great clinicians are not created by watching 40 hours of videos.

Those modules can absolutely be part of a training plan. But they cannot be the training plan.

Too often I hear RBTs say, “I don’t feel like I know what I’m doing.” How can we expect someone to commit to a career in this growing field — a field that desperately needs talent — if they feel incompetent? And if they feel underprepared, what does that mean for Johnny, Joey, and Jane’s progress?

Children are unlikely to reach their full potential if services are capped at 8 years old and delivered by staff who have not been adequately trained or mentored. Yes, the ABA landscape is dynamic. We deal with rate compression, staffing shortages, MCO contract instability, and challenges that are largely outside our control.

But we do control two things:

How we train our teams.
And who we choose to serve.

If we want this field to remain credible, clinically strong, and sustainable, we have to raise our own standards — not lower them to accommodate convenience or short-term margins.

Kids don’t outgrow autism at 8. And clinicians don’t become competent through shortcuts.

We can do better. And we should.

Let’s start holding ourselves — and each other — accountable to building programs that are clinically driven, age-inclusive, and grounded in meaningful training. The families we serve deserve nothing less.

Warm Regards,

Kim Finger Ph.D.
CEO ABA Building Blocks