Hard choices: ABA, medicine, and telling them
The hard choices, both sides
Loving, faithful people land on opposite sides of these.
Intensive behavioural therapy (ABA)
The parents' case. It is the most available therapy in the US, the one insurers cover, often the only funded option in a county. For a child who bites through skin or runs into traffic, a programme that reduces that is not a philosophy question. Cochrane's 2018 review found children in early intensive behavioural intervention did better than comparison groups on adaptive behaviour, IQ and language after about two years.
The autistic adults' case. Many autistic adults describe these programmes as training in compliance: suppressing the stimming that calms them, accepting touch they hate, learning that no is not accepted. ASAN holds that autistic people "deserve access to high-quality, evidence-based, ethical services that work towards our goals, as defined by autistic people ourselves." The evidence is thinner than the marketing. Cochrane found "no evidence at post-treatment that EIBI improves autism symptom severity", called its findings "weak evidence", and drew them from five studies of 219 children, only one randomised.
The questions that tell a respectful programme from a harmful one. Ask them on the tour, and watch the faces.
- Show me a goal you set last year. Whose goal was it? Goals should be things the person would want: asking for help, making a friend, staying safe. Not quiet hands.
- What happens when a child says no, or walks away? A no should be respected. Anyone who calls it "escape behaviour" to be extinguished has told you what you needed to know.
- Do you use any punishment, response cost, or planned ignoring? There is no acceptable amount of punishment. Ask twice.
- How much of a session is play, and how much is drills at a table? Play-based beats compliance drills, and 40 hours a week of anything is a lot for a small child.
- Can I watch a whole session, unannounced, any time? A yes without hesitation is the best single sign you will get.
Declining a programme is a legitimate choice. So is taking one and setting your own limits on hours and goals. Both are done in love.
Medication
No medicine treats autism itself. Two are FDA-approved for irritability with autism in children and teens (aggression, self-injury, tantrums): medicine, plainly. Others treat what comes with it: seizures, ADHD, anxiety, depression, severe sleep problems. We give no doses. Some families find that treating anxiety hands their child back their week; others find side effects that cost more than the symptom did. Ask: What is this treating, how will we know in six weeks whether it worked, and what would make us stop?
Telling the child their diagnosis
Some parents wait, out of a real fear of handing a child a label to carry. The case for telling early: they already know they are different, and without a word for it they usually decide the difference is a fault in them.
The National Autistic Society advises starting with difference itself, making clear it is not bad or scary, introducing it slowly across many conversations, and explaining that they do not have an illness. Told early and plainly, it is a fact about themselves, like being tall. Told at 15, after years of quiet appointments, it lands as a secret that was kept.
Verified September 2026 against Cochrane, the Autistic Self Advocacy Network and the National Autistic Society. Sources on the sources page. Background for a caregiver, not medical, legal or financial advice.