A consequential debate over the future of autism care is spreading across state capitals, and it's moving fast.
In just the past several months, Colorado enacted sweeping new regulation of applied behavior analysis providers, and Indiana adopted new Medicaid accreditation requirements for ABA agencies. Massachusetts, where policymakers moved first, is already influencing broader conversations about how quality should be defined and measured. These actions reflect a growing recognition that states are no longer asking whether autism services should be held to higher standards, they're deciding what those standards should be.
The goal behind these moves, greater quality and accountability, is laudable and timely. But taken together, they raise a broader national question: As states establish standards for autism services, will quality be defined through individual treatment disciplines, or will we develop standards that reflect the full range of professionals serving autistic individuals and families?
The answer will matter for every state weighing this decision next.
America has built a vast network of professionals dedicated to serving autistic individuals and their families. Psychologists, behavior analysts, speech-language pathologists, occupational therapists, physicians, educators, counselors and many others do extraordinary work every day.
What we have not built is a strong, unified professional field capable of speaking across disciplines about quality, accountability and outcomes.
Families don't experience autism through professional silos — they experience it only through their child.
Yet they are often left to navigate a fragmented system in which different professions operate under different standards, different incentives and different definitions of success. Now, as policymakers understandably demand greater accountability, there is a risk that we respond to fragmentation by institutionalizing it.
If states define quality too narrowly around a single profession or model of care, they could hardwire today's divisions into tomorrow's autism system.
Autism is not one-size-fits-all. Neither is autism care.
An autistic child struggling to communicate may need a very different combination of services than an adult trying to succeed in the workplace. A family in a rural community faces different challenges than one living near a major academic medical center.
Quality must begin with the individual.
That means decisions about care and services should be informed by evidence, meaningful outcomes and individual needs, not allegiance to a particular discipline or intervention model.
It also means the autism professional community must take greater responsibility for defining excellence across the field.
We need clearer, evidence-informed expectations for professional competence. We need better ways to measure outcomes across disciplines. And we need stronger collaboration among professionals, researchers, educators, autistic individuals and families.
Accountability must be part of that conversation.
Recent cases involving fraud and abuse in autism services deserve serious attention and aggressive enforcement. Bad actors exploit families, taxpayers and the credibility of thousands of ethical professionals.
But fighting fraud should not mean restricting legitimate care, squeezing out independent or community-based providers, or forcing every professional into a single model.
Nor should we continue relying on systems that measure success primarily by the number of billable hours delivered.
The better question is whether services are producing meaningful outcomes for autistic individuals and their families.
The decisions states make now could shape autism care for years to come.
Policymakers should absolutely demand higher standards. Families deserve confidence that the professionals serving them are qualified, ethical and accountable.
But we must get the definition of quality right.
The autism field needs standards that reflect the breadth of the profession, recognize evidence-informed approaches across disciplines and focus relentlessly on meaningful outcomes.
The people doing this work should have a voice in shaping those standards. Autistic individuals and families must be part of the conversation. And policymakers should resist solutions that reinforce the very divisions we need to break down.
More states will confront these questions. We can keep regulating one discipline at a time or we can use this moment to build a more unified, accountable and outcomes-focused autism profession.
The choice is ours to make. States, providers, researchers and families all have a role in building it and the time to start is now.
Robin McLeod, PhD, LP, is CEO of the National Society of Autism Professionals.
