Virginia Spielmann, PhD, OTR/L

If you are a parent of an autistic child, you have probably heard these words early and often: We recommend ABA therapy.

It can feel confusing and even disheartening. You do your research, talk to other parents, and start learning about sensory processing and occupational therapy. You begin to wonder: if my child’s challenges are sensory and motor based, why wasn’t that the first recommendation?

You are not alone in asking this question. The answer lies less in what works best for children and more in how systems were built.

ABA Became the System Before We Fully Understood Autism

Applied Behavior Analysis (ABA) has existed for decades, long before autism was understood through developmental, sensory, or relational science. It was one of the first “treatments” to describe autism in ways insurance companies and educational systems could fund: measurable behaviors, tracked progress, and visible outcomes.

It fit perfectly into the bureaucratic structures that value data points and charts. Once ABA was written into policy and billing codes, it became the system itself.

Alicia Broderick, in her book The Autism Industrial Complex (2022), describes how financial and institutional incentives dictate the therapies families are most often told to pursue. It is rarely about ill intent. Instead, recommendations follow a system designed to fund what is easy to quantify, not what best supports human development, regulation, and sensory health.

Insurance Rewards What Can Be Counted

Insurance companies value measurable change: hours billed, goals checked off, and behaviors reduced. ABA fits that model neatly because it produces clear numbers.

But sensory regulation, participation, and emotional safety, the central aims of occupational therapy, are not so easily scored. These outcomes are qualitative, relational, and deeply human. They unfold in the rhythms of play, comfort, and curiosity and we are only recently learning how to measure these.

As a result, most insurance policies define “autism treatment” as behavioral health service, almost always meaning ABA. Sensory integration therapy often falls under “rehabilitation,” which may not be covered fully or at all. The difference is systemic, not scientific.

Science Has Evolved Beyond Behavior

When ABA took root, autism was seen primarily as a set of behaviors. Over the past two decades, our understanding has expanded dramatically.

Research now shows that sensory and motor differences are not side issues; they are central to the autistic experience.

• Donnellan, Leary, and Hill (2013) described repetitive movements and “non‑compliance” as adaptive motor and sensory coping strategies.
• Torres and Donnellan (2015) demonstrated that subtle variations in movement and sensory feedback shape how autistic individuals experience and respond to their surroundings.
• Robertson and Baron‑Cohen (2017) confirmed that sensory processing differences are a defining characteristic of autism.

When we understand these findings, “behaviors” look very different. Many outward behaviors are the visible language of inner sensory and motor experiences, of bodies doing their best to stay safe and connected in an unpredictable world. Addressing those internal systems helps children regulate, relate, and learn from a place of safety rather than control.

Occupational Therapy Nurtures the Whole Child

Occupational therapists are trained across anatomy, neurology, mental health, and sensory integration. We see the child as a sensory, motor, emotional, and social being whose systems are constantly developing in relationship with others and the environment.

When a child avoids eye contact or resists a task, we do not ask How can we make them do it? We ask What is their body telling them right now? How does this space feel to them? And what can we adjust so the experience feels manageable, meaningful, and even joyful?

This is not about compliance. It is about connection.

It is about nurturing what Dr. Jean Ayres called the self‑organized child, a child whose brain and body communicate smoothly enough that they can engage, play, think, and relate spontaneously.

The goal is not to fix or normalize a child but to help them become a classroom citizen: someone who can choose to participate because they understand what is happening, feel safe to do so, and have the sensory and motor foundation to manage the environment. We aim for children to have agency, self‑determination, and a genuine sense of belonging.

Systems Change Slowly

Healthcare and education systems are slow to evolve. It takes years for new science to reshape funding policies and professional norms. That is why many parents still hear “ABA” more than anything else — not because it is the most aligned with current understanding, but because it is what the system has long supported.

Thankfully, this is changing. More professionals and families are beginning to value approaches that honor body‑based learning, sensory diversity, and relational connection. Each year, more evidence points to the importance of sensory integration and motor development as foundations for emotional regulation, participation, and lifelong well‑being.

For Parents Seeking Clarity

If you are navigating recommendations for your child, know that you deserve answers that make sense for your child as a whole person. Ask questions. Explore how sensory, motor, and emotional systems shape your child’s daily life. Notice what helps them feel calm, curious, and connected.

Occupational therapy aims for growth through joy, safety, and participation, not compliance. The best therapy helps your child want to go to school because they can manage the environment, understand it, and find delight in being with others on their own terms.

Remember: what is most widely recommended is not always what is most genuinely supportive. What matters is helping each child thrive as the capable, connected, self‑organized person they are becoming.

References

• Broderick, A. (2022). Autism Industrial Complex: How Branding, Marketing, and Capital Investment Turned Autism into Big Business. New York: Routledge.
• Donnellan, A. M., Leary, M. R., & Hill, D. A. (2013). Rethinking Autism: Implications of Sensory and Movement Differences for Understanding and Support. Frontiers in Integrative Neuroscience.
• Torres, E. B., & Donnellan, A. M. (2015). Motor differences in autism: Novel methods for characterization and intervention. Frontiers in Integrative Neuroscience.
• Schaaf, R. C., & Lane, S. J. (2015). Toward a Best‑Practice Protocol for Sensory Integration in Children with Autism Spectrum Disorder. American Journal of Occupational Therapy.
• Robertson, C. E., & Baron‑Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671–684.