CASP Responds to New York Times Articles

Last Saturday, The New York Times published “Short Naps, Long Hours: How Autism Clinics Squeeze Medicaid Dollars Out of Preschoolers,” an article on applied behavior analysis (ABA) services for children with autism. It highlighted evidence of abuse by individual providers, as well as raised questions about organizations prioritizing profits over care. The article also presented a misleading picture of the evidence base supporting ABA’s efficacy.

There is no duty more sacred than caring for someone’s child. When a parent comes to an ABA center, they’re trusting providers with their child’s physical and mental wellbeing. Every behavior analyst, behavior technician, front desk worker, janitor, and CEO must protect that child and facilitate high-quality, evidence-based care. When an employee abuses a child, it’s an unforgivable breach of their sacred duty. These individuals must be prosecuted to the fullest extent of the law. And provider organizations must be held accountable. Their systems must be investigated and reformed to mitigate any future abuse.

Yet systems reform can’t undo an abused child’s trauma. It’s incumbent upon provider organizations to create safeguards that prevent it from happening in the first place. Moreover, states must issue clear guidance to organizations on how to prevent, document, and immediately report abuse. Transparency is critical to protecting children.

The Times article also raises questions about autism service provider organizations prioritizing profits over children’s development and wellbeing. As autism has been increasingly identified and diagnosed, all 50 states have adopted medical coverage for interventions like ABA. With that’s come a proliferation of autism service providers. Many are high quality. Others, unfortunately, are not. CASP’s message has always been clear: we don’t care if you’re a nonprofit, a small business, or backed by private equity. We care about the quality of your services, whether you provide kids a safe environment, and whether you’re acting ethically.

CASP is a 501(c)6 non-profit trade association. Like any trade association, we use basic criteria to admit members. To join CASP, organizations must attest that they provide evidence-based services for people with autism. However, CASP is unique from other trade associations in that our mission is to cultivate, disseminate, and advocate for best practices in autism services. We weren’t founded to reflexively, unconditionally support every member’s interests.

Our ABA practice guidelines are the generally accepted standards of care for providers billing health insurance. They were developed with autistic people’s outcomes in mind, not to drive profits for provider organizations. That’s why the guidelines stress the importance of individualization in dosage and treatment plans as well as providers’ ethical responsibilities.

Every day, thousands of children with autism receive high-quality care from trusted professionals nationwide. Any provider placing profits above that privilege and responsibility is failing children, hurting our industry, and undermining confidence in the science of behavior analysis.

Case in point: the Times article draws sweeping, misguided conclusions about ABA’s efficacy for kids with autism. For instance, it claims that a 2018 review concluded that ABA is ineffective. But that’s not what the review found. Rather, it found that children receiving Early Intensive Behavioral Intervention (EIBI)—intensive ABA services provided in early childhood—made meaningful gains in adaptive behavior, IQ, communication and language skills, social skills, and daily living skills.

Moreover, a 2026 meta-analysis found meaningful improvements in adaptive behavior, intellectual functioning, and reductions in autism severity when compared to control or treatment-as-usual groups.

Last year, the National Academies of Sciences, Engineering, and Medicine (NASEM) published its independent analysis of the Autism Care Demonstration (ACD) TRICARE benefit. The committee concluded that “there is a substantial body of literature, supported by multiple meta-analyses, indicating strong evidence of efficacy and effectiveness of applied behavior analysis (ABA) as an appropriate intervention to support autistic individuals…”

In the coming days, we’ll have more to say about the issues raised in the Times article. Our industry is at a crossroads. We have to acknowledge and address the prevalence of bad actors, hold ourselves accountable, and work with states to improve oversight. At the same time, we need to clarify misunderstandings about the science of ABA. Let’s take this important moment to rededicate ourselves to our sacred duty to care for children with autism and improve families’ lives.