Why Autism Care Needs Mental Health and Behavioral Health Under One Roof

Autism is being recognized sooner, and in more children, than at any point before. Doctors know what to look for, and parents are speaking up earlier when something feels different. The CDC’s most recent surveillance report found that about 1 in 31 children aged 8 were identified as having autism in 2022, and at the network’s California site the figure was closer to 1 in 19.[1] That is real progress. For many families, though, the diagnosis is only the first door. The ones that come after it can be much harder to find. 

Picture a family who is doing everything they were told to do. Their son is seven and goes to ABA three days a week, and he is making genuine gains. He asks for things with words now instead of grabbing them. He can sit through most of dinner. But over the last few months, something new has crept in. He lies awake at night. He panics before school and asks the same worried questions again and again. His mother has not slept properly since spring, and some mornings she cries in the car after drop-off, where nobody can see her.

The ABA team notices the anxiety and suggests the family look for a therapist. So the family starts over: new intake forms, new insurance calls, a waitlist, and a clinician who has never met their son and may not feel confident working with children with autism. The behavior plan lives in one office. The worry lives in another. The parents become the only bridge between the two.

Dr. Mitze Burnett has watched versions of this story unfold throughout her career, and it is a large part of why Burnett Therapeutic Services (BTS) is built the way it is. She is both a licensed Marriage and Family Therapist and a Board-Certified Behavior Analyst at the doctoral level, a pairing that is still fairly rare. This article looks at why children with autism so often need both behavioral and mental health support, what happens to families when those services are split apart, and why Dr. Burnett believes they belong under one roof.

Autism Rarely Arrives Alone

What many parents are not told early enough is how often autism comes with company. A 2023 review that pooled 340 studies and close to 590,000 people with autism found that additional diagnoses are common across every age group.[2] Among the most frequent were:

• ADHD, affecting about 37 percent

• Anxiety disorders, affecting about 35 percent overall and roughly 42 percent of children and teens

• Sleep problems, affecting about 43 percent

• Depressive disorders, affecting about 18 percent

For Dr. Burnett, those numbers change the questions that parents and clinicians should be asking. What skills does this child need to learn? That still matters. But so does this: what is the child feeling, and what is happening in the family around them? A behavior that looks like defiance may actually be fear. A meltdown at every transition might be partly sensory, partly learned and partly an anxiety that nobody has named yet. When a child cannot easily put their inner world into words, the adults around them need to learn how to read both the behavior and the emotion underneath it.

Parents Are Carrying More Than Anyone Sees

The second reason Dr. Burnett argues for integrated care has less to do with the child and more to do with the people raising them. BTS explored the emotional side of a new diagnosis in an earlier post, Through the Parents’ Eyes: Welcoming a Child’s Autism Diagnosis, and the research has only made the case stronger since.

A review published in 2025 combined 40 studies involving 13,853 caregivers of children with autism around the world. It estimated that 45 percent were experiencing symptoms of depression, and in studies from the Americas the rate was 38 percent.[3] In Dr. Burnett’s view, these findings simply put numbers to what clinicians see every week: parents who are organized, devoted and running on empty.

That strain does not stay with the parent. Researchers at La Trobe University in Australia followed young children with autism and their parents over time and found that higher parenting stress when the children were around three and a half was linked to more outbursts and aggressive behavior a year later.[4] The study was small, and the authors are careful about what it can and cannot prove. Still, they concluded that support aimed at parents, and at parenting stress in particular, could improve later outcomes for parents and children alike.

ABA has always asked a lot of families, and for good reason. New skills take hold fastest when they are practiced at home, at the park and in the grocery store, which is why BTS builds parent training with parent goals into each of its families programs, including clinic-based ABA programs. Dr. Burnett is quick to point out, though, that parent training lands very differently on a parent who is depleted. A mother can learn the ideal reinforcement strategy, but if she is depressed, exhausted or quietly grieving the future she once imagined, she may have very little left to use it with. Looking after the parent belongs inside the treatment plan, not somewhere off to the side.

What Goes Wrong When Care Is Split

In most communities, ABA and mental health services grew up in separate worlds, with different funding streams, different training paths and different vocabularies. Families end up as the messengers.

Research shows how hard that gap can be to cross. When a team in New York City phoned outpatient clinics to see whether they offered mental health treatment to young people with autism, comorbid with depression or suicidal thoughts, only 47.1 percent of clinics in the mental health system and 25 percent of clinics in the developmental disability system did.[5] The authors suggested that simply finding a provider across so many separate systems may be the first and most difficult barrier a family meets.

Dr. Burnett sees the cost of that split in small, ordinary ways. A therapist sets a goal around facing worries while the behavior plan, without meaning to, lets the child avoid every situation that triggers them. A parent hears one strategy on Monday and a conflicting one on Thursday. Progress notes sit in two files that never meet. Nobody is doing anything wrong, exactly. They are just not in the same room.

What “Under One Roof” Really Means

Integrated care does not mean blending ABA and therapy into one vague service. Each discipline brings something the other lacks. Behavior analysis is precise about what happens before and after a behavior and how to build new skills one step at a time. Mental health care pays close attention to emotions, relationships, trauma and the family system. The strength comes from letting each one inform the other.

The evidence for treating anxiety in children with autism has also grown. A 2023 analysis that pooled five randomized controlled trials, with 280 anxious children with autism aged 7 to 16, found that cognitive behavioral therapy outperformed control conditions in five of the six areas of anxiety measured, with medium to large effects.[6] That is genuinely encouraging, and it shows why it helps when the people treating anxiety understand autism and the people teaching skills understand anxiety.

At BTS, a family can move from a psychological evaluation to behavioral services in the clinic, at home or in the community, and to individual, couples or family therapy through mental health services, all without leaving the agency. That means fewer handoffs and fewer moments where parents must retell the hardest parts of their story to a stranger. An evaluation that picks up anxiety alongside autism can lead to a recommendation the same organization is ready to act on. A BCBA who notices a parent struggling can connect them with a colleague rather than handing over a phone number.

For clinicians reading this, Dr. Burnett’s point is not that BCBAs should become therapists or that therapists should start writing behavior plans. Scope of practice matters, and each license exists for a reason. Her point is that collaboration should be built into the structure of care instead of being left to chance and good intentions.

A Whole Child and a Whole Family

Dr. Burnett often returns to a simple idea. A child with autism is more than a list of target behaviors, and a parent is more than an extra pair of hands for the treatment plan. Both are people, with inner lives that shape every session, every goal and every step forward.

For families who are just starting out, the message is a gentle one. If your child is in ABA and you are noticing worry, sadness, sleep trouble or emotional overload, those concerns deserve attention too. So does your own wellbeing. Asking for support with how you are feeling is not a distraction from your child’s care. Very often, it is one of the most useful things you can do for it.

The values that guide BTS shape this approach: the team leads with mission, persists with purpose, celebrates progress and respects individuality, because no two children, and no two families, are alike. Bringing behavioral and mental health care under one roof is how those values become practical. It keeps the child’s story in one place, and it treats a mother’s sleepless nights and a child’s racing heart as parts of the same picture, because most of the time they are.

If you are unsure where to begin, or you would like to talk about ABA, therapy or an evaluation, contact BTS here or call the intake team at (707) 299-8250 (opt 1 for ABA; opt 2 for Mental Health Services, and they will take it from there. For further resources, visit the BTS Autism Resources for Parents guide.

References

[1] Shaw, K. A., Williams, S., Patrick, M. E., et al. (2025). Prevalence and early identification of autism spectrum disorder among children aged 4 and 8 years: Autism and Developmental Disabilities Monitoring Network, 16 sites, United States, 2022. MMWR Surveillance Summaries, 74(2), 1-22. https://doi.org/10.15585/mmwr.ss7402a1

[2] Micai, M., Fatta, L. M., Gila, L., Caruso, A., Salvitti, T., Fulceri, F., Ciaramella, A., D’Amico, R., Del Giovane, C., Bertelli, M., Romano, G., Schünemann, H. J., & Scattoni, M. L. (2023). Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 155, 105436. https://doi.org/10.1016/j.neubiorev.2023.105436

[3] Lam, X. R., Cheng, L. J., Leo, C. S. Y., Toh, Z. A., & He, H. G. (2025). Global prevalence of depression in caregivers of children with autism: A systematic review and meta-analysis. Journal of Pediatric Nursing, 80, e74-e85. https://doi.org/10.1016/j.pedn.2024.11.020

[4] O’Connor, E., Grant, M., Green, C. C., Treyvaud, K., & Hudry, K. (2025). Prospective association of parenting stress with later child behavior problems in early childhood autism. Journal of Autism and Developmental Disorders, 55(6), 2021-2026. https://doi.org/10.1007/s10803-023-06177-2

[5] Cervantes, P. E., Conlon, G. R., Seag, D. E. M., Feder, M., Lang, Q., Meril, S., Baroni, A., Li, A., Hoagwood, K. E., & Horwitz, S. M. (2023). Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. Autism, 27(3), 704-713. https://doi.org/10.1177/13623613221112202

[6] Cervin, M., et al. (2023). Effects of cognitive-behavioral therapy on core aspects of anxiety in anxious youth with autism. Research in Autism Spectrum Disorders, 107, 102221. https://doi.org/10.1016/j.rasd.2023.102221