Today my son had an appointment to get evaluated for ASD and was expecting to leave school early. He didn’t really care about the doctor appointment; he cared about leaving school early. He knew for a while and was expecting it to happen.

My husband and I scrambled to try to contact the doctor’s office performing the evaluation, the insurance company and the doctor that requested my son get evaluated to try and make it happen so he could keep the appointment. In the medical world here in the USA, even if we had the STAT request for the documentation and the insurance could retrieve it, it still could take at least 24-48 hours for processing to take effect.

A few hours before the appointment, we found out that insurance had denied prior authorization for the evaluation due to not having the supporting medical documents to “qualify” him for evaluation. I knew our insurance did not require us to have an official referral, but I did not know this evaluation needed a prior authorization.

We ended up having to re-schedule the appointment and we all were disappointed. I was able to settle myself down and continue my session at work, while my husband kept his day off work (he took the day off to take our son to this appointment). Being neurodivergent, my son had a difficult time processing the broken expectation he had for his day; he exploded with tears. My husband took him out to lunch to calm down and process the change and brought him back to school afterwards. Re-entry to school was also challenging when it was out of his normal routine. My husband offered a small toy reinforcement if my son went back to school and had a good afternoon.

In ABA, we could call this type of statement a ‘first- then’ statement. For example, “First you go back to school and have a good afternoon, then I will pick you up and we can buy a small toy at the store”. At work, we will say to clients, “first work, then break”. This idea helps with motivation to perform the less preferred tasks and link them to a higher preferred or more enjoyable task afterwards. It is how I grew up doing homework assignments. First homework, then I have free time. As an adult, first home chores and help my son to bed, then I can have my own down time.