Peer-reviewed article
Autism care: reimagining the spectrum.
Merahn S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a policy and conceptual paper about autism care frameworks in the United States. It argues for moving away from applied behavior analysis as the default intervention and proposes a new prevention-oriented model of autism services organized by universal, selective, and indicated intervention levels. The paper advocates for neurodiversity-affirming, strengths-based approaches that consider the whole child and their environment.
Key points
- Current US autism care is dominated by ABA as the insured 'gold standard' intervention
- Recent advances in genomics and neuroscience show autism as a heterogeneous neurotype rather than a unitary disorder
- Contemporary approaches emphasize neurodiversity, strengths-based perspectives, and environmental context
- Many autistic children have complex care needs requiring coordinated interdisciplinary services
- The paper proposes a prevention-oriented 'spectrum of care' model aligned with public health taxonomy
Limitations
This is a conceptual framework paper without empirical data on outcomes or effectiveness of proposed models. It does not evaluate or test any specific intervention with children.
Abstract
Autism care policy is at a critical inflection point. Applied behavior analysis (ABA), long established as the "gold standard" through state insurance mandates in the US, has functioned as the default reimbursable intervention for autistic children. However, advances in genomics, neuroscience, developmental psychology, and scholarship on autistic lived experience have expanded understanding of autism as a heterogeneous neurotype characterized by meaningful differences in neural organization rather than a unitary disorder. Contemporary models emphasize neurodiversity, strengths-based perspectives, and the interaction between developmental processes and environmental contexts in shaping functional outcomes. Many autistic children also meet criteria for complex care needs, requiring coordinated, interdisciplinary services across health, educational, and community systems. This manuscript proposes reframing the "autism spectrum" from a hierarchy of symptom severity to a prevention-oriented "spectrum of care." Adapting a public health taxonomy, interventions are organized into universal, selective, and indicated levels, targeting the prevention of avoidable disability, distress, and participation barriers. This model aligns autism services with whole-child, neurodiversity-affirming, and developmentally informed care, emphasizing relational health, autonomy, and life-course participation.