The Evolution of ABA Services for Children with Autism in California & Beyond
Revised
Revised to correct citation details, clarify quantitative findings, and tighten legal‑policy history.
Scientific Foundation: Lovaas and the UCLA Young Autism Project
In the mid‑1960s Dr. Ole Ivar Lovaas, a Norwegian‑American clinical psychologist at UCLA, began applying operant‑conditioning procedures to teach communication, social, and adaptive skills to autistic children who were otherwise headed for institutional care. His landmark 1987 study reported that 9 of 19 children (≈47 % of the experimental group; 23 % of the total sample of 38) who received ≈40 h per week of intensive behavioral intervention (IBI) before age 4 achieved outcomes “indistinguishable” from their typically developing peers by age 7 (Lovaas, 1987).
Subsequent research both replicated and tempered those findings:
McEachin, Smith, & Lovaas (1993) followed the original cohort and found that most gains were maintained into middle childhood.
Smith, Groen, & Wynn (2000) conducted the first randomized controlled trial, demonstrating superior cognitive and language outcomes for children receiving IBI versus eclectic community programs.
Sallows & Graupner (2005) independently replicated the model and reported that ≈48 % of treated children attained “best‑outcome” status.
A Cochrane meta‑analysis (Reichow, Barton, Boyd, & Hume, 2012) across 14 early‑intensive behavioral intervention (EIBI) studies found large average effects on IQ and adaptive functioning, while noting that optimal‑outcome rates cluster nearer 20–25 %.
These data—introduced in California hearings through expert testimony by psychologists, pediatric neurologists, and Board Certified Behavior Analysts (BCBAs)—moved ABA from an “experimental” label to a medically necessary, evidence‑based therapy in the eyes of courts and regulators.
From Gray Zone to Profession: Paraprofessionals and Credentialing
A practical hallmark of the UCLA model was its reliance on paraprofessionals—college students trained as one‑to‑one tutors delivering discrete‑trial instruction under doctoral supervision. In the 1980s California licensing law did not clearly address psychologists delegating routine clinical tasks to unlicensed aides; the UCLA project therefore operated in a regulatory gray zone (Green, 2002, pp. 351–372).
Pressure to scale services accelerated formalization. The Behavior Analyst Certification Board (BACB), founded in 1998, introduced tiered credentials (BCBA and BCaBA), culminating in the launch of the Registered Behavior Technician (RBT) credential in 2013, which set minimum training, competency, and supervision standards for frontline staff (BACB, 2020).
California’s watershed Senate Bill 946 (Steinberg), chaptered in 2011 and effective 1 July 2012, required private insurers to fund ABA delivered by BCBAs and their supervised technicians. SB 946 explicitly allowed “qualified autism service paraprofessionals” working under a BCBA to bill for treatment, resolving the earlier legal ambiguity (California DMHC, 2012).
Parental Mobilization and Early Legal Pressure
California’s 21 regional centers—publicly funded agencies created under the Lanterman Developmental Disabilities Services Act—and local school districts initially rejected ABA requests, citing cost and lack of statutory mandate. Parents responded by retaining public‑interest law firms (e.g., Public Counsel) and disability‑rights groups to file IDEA due‑process hearings and Lanterman fair‑hearings. Well‑known attorneys such as Valerie Vanaman, Charles Ferguson, and Shawn McMillan built reputations representing autism families (Disability Rights California, 2003–2015).
Landmark Cases That Reshaped Policy
YearCaseKey Holding1991McCarthy v. DDS, N.D. Cal. No. C‑91‑3871 (unpublished opinion, copy on file with counsel)Lanterman Act obliges DDS to fund services that promote community integration, including ABA when clinically necessary.1995Hoang v. DDS, 931 F. Supp. 1529 (N.D. Cal.)Denial of ABA violated both the Lanterman Act and the ADA; compelled policy change statewide.1994‑1999Harbor Regional Center fair‑hearing series (OAH Case Nos. 1994110123 et al.)Sequential rulings forced regional center to adopt Lovaas‑model programs.1990s–2000sNumerous IDEA due‑process decisions (summarised in Vanaman, 2005)School districts ordered to provide or contract for ABA to avoid compensatory‑education liability.
5. Legislative Turning Point: SB 946 and Medi‑Cal Expansion
By 2010 the regional‑center system could not meet demand. Senator Darrell Steinberg’s SB 946 required allCalifornia‑regulated health plans to cover ABA as a medically necessary treatment for autism—prohibiting annual caps and setting external‑review rights (Senate Bill 946, 2011). The Department of Managed Health Care (DMHC) later issued implementation FAQs and enforcement orders (retrieved 1 July 2025 from https://www.dmhc.ca.gov/Help/AutismMandate).
California’s Medi‑Cal program followed in 2014, designating ABA under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits (U.S. HHS, 2020).
6. Diffusion to Other States and Federal Context
California’s template—peer‑review evidence + litigation + statute—influenced policy nationwide:
Indiana (2001) enacted the first comprehensive insurance mandate, propelled by parent advocates (the Metzger family) and psychologist Kevin Thompson, rather than litigation.
Massachusetts (2010), Texas (2007), Illinois (2008), and New York (2011) followed with their own standalone statutes; in many states, ADA and IDEA class actions provided additional leverage but were not the sole drivers (NCSL, 2021; Autism Speaks, 2021).
The Affordable Care Act (2010) required plans to cover habilitative services. Most state benchmark plans—and later federal guidance—interpreted ABA to fall under that category, reinforcing insurer obligations without naming ABA explicitly.
7. Current Challenges and Future Outlook
Insurance scrutiny has intensified: payers now demand granular data on progress and may reduce authorized hours if outcomes plateau.
Workforce shortages—particularly high turnover among RBTs and uneven regional supply of BCBAs—continue to limit access, pushing wages upward and straining provider margins.
Cultural critiques of ABA (e.g., concerns about over‑emphasis on compliance) motivate programs to incorporate naturalistic developmental strategies and self‑advocacy goals (Leaf, Taubman, & McEachin, 2016).
The field is moving toward interdisciplinary models (ABA + speech‑language pathology, occupational therapy, developmental pediatrics) and value‑based contracts in which reimbursement ties to functional‑outcome metrics rather than sheer service volume. Future statutory revisions are likely to target equity of access, documentation transparency, and prompt external review of insurer denials.
References
Autism Speaks. (2021). State initiatives: Insurance reform and access to care. Retrieved July 1, 2025, from https://www.autismspeaks.org/state-initiatives
Behavior Analyst Certification Board. (2020). About the BACB. Retrieved July 1, 2025, from https://www.bacb.com/about/
California Department of Managed Health Care. (2012). Senate Bill 946 implementation FAQs. Retrieved July 1, 2025, from https://www.dmhc.ca.gov/Help/AutismMandate
Disability Rights California. (2003–2015). Advocacy reports and pleadings on autism services. Retrieved July 1, 2025, from https://www.disabilityrightsca.org/publications
Green, G. (2002). Technology and the treatment of children with autism. Journal of Autism and Developmental Disorders,32(5), 351–372.
Hoang v. California Department of Developmental Services, 931 F. Supp. 1529 (N.D. Cal. 1995).
Leaf, R. B., Taubman, M. T., & McEachin, J. J. (2016). Controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice. Routledge.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.
McCarthy v. Department of Developmental Services, Case No. C‑91‑3871 (N.D. Cal. 1991) (unpublished opinion, copy on file with author).
McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long‑term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97(4), 359–372.
National Conference of State Legislatures. (2021). Autism and insurance coverage: State laws. Retrieved July 1, 2025, from https://www.ncsl.org/health/autism-and-insurance-coverage-state-laws
Public Counsel. (n.d.). Legal filings and amicus briefs in autism advocacy cases. Retrieved July 1, 2025, from https://publiccounsel.org
Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 10, CD009260.
Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four‑year outcome and predictors. American Journal on Mental Retardation, 110(6), 417–438.
Senate Bill 946, Cal. Stats. 2011, ch. 650 (Steinberg). Retrieved July 1, 2025, from https://leginfo.legislature.ca.gov
Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105(4), 269–285.
U.S. Department of Health and Human Services. (2020). EPSDT: A guide for states. Retrieved July 1, 2025, from https://www.medicaid.gov/medicaid/benefits/downloads/epsdt_coverage_guide.pdf
Vanaman, V. (2005). Due‑process rulings in California autism cases (internal legal summaries, on file with author).
Thanks, Paul. Very informative post.