If your child has recently been diagnosed with autism spectrum disorder (ASD), or you suspect it, one of the first things your pediatrician or testing psychologist may suggest are outside services; therapies that will help your child and broaden their perspective. Some of the more common recommendations include occupational therapy (OT), speech therapy (ST), and physical therapy (PT). Applied behavior analysis (ABA) may also be suggested. While all of these treatments are separate, they can coexist and complement each other, particularly when a child receives a diagnosis at a young age with subsequent early intervention therapies.
Read on to learn more about how ABA can integrate with and complement your child’s other therapeutic services.
What Are Common Types of Therapy for ASD?
Quite often, a child may struggle developmentally as a part of their autism diagnosis or for separate reasons (e.g., speech apraxia is more common in those with an autism diagnosis than those without one). Different treatments and therapies target certain developmental areas. The most common therapies that are delivered alongside ABA or as a part of a child’s treatment plan are OT, PT, and ST.
Speech therapy isn’t just so your child can learn to talk—speech therapy can be utilized for language and speech disorders as well as dysphagia (trouble swallowing). If your child struggles to communicate, even if they are pre-verbal, speech therapy can help. A speech and language pathologist (SLP) can support your child’s development of early language skills, fluency, language comprehension, articulation, and more.
A main goal in speech therapy is to help your child communicate better so that they are understood and can use their skills with others. Early intervention programs for children with autism may employ the Picture Exchange Communication System (PECS), augmentative and alternative communication (AAC) devices, or American Sign Language (ASL) to help promote communication. It’s important to understand that the more communication channels your child has, the more they will thrive. In other words, learning ASL or PECS doesn’t create a barrier to verbal communication later on; in fact, children who learn these other systems have a higher chance of speech than children who do not receive help through speech therapy.
Sometimes speech therapy is also combined with feeding therapy, for children that have dysphagia or food aversions.
Sessions are often short, in 30- to 45-minute blocks, and can include play-based activities centered around communication, reading, using a device to communicate, articulation work (such as with a popsicle stick), and other methods to help promote communication.
Children with an autism diagnosis are more likely than their neurotypical peers to have another developmental delay, such as missing milestones or struggles with gross and fine motor skills. If your child was diagnosed with autism, your pediatrician may suggest an occupational therapy assessment to see if your child needs extra services.
OT is often quite fun for kids and can include a kids’ gym to play in, ball pits, slides, zip lines, trampolines, balance beams, writing and cutting tasks, and more. If your child is working on gross motor skills, they may practice catching a ball with their therapist or walking on a balance beam. If your child is working on fine motor skills, they may practice tracing their name, making letters, or cutting with scissors.
Like speech therapy, OT usually occurs in 30- to 45-minute increments. You may often find that OT and speech are offered at the same clinic or at the same time within a clinic (a dual appointment where both the OT and speech therapist work with your child).
A physical therapist is an expert in movement. You may associate PT more with offering help after an injury, but PT can help children with ASD as well. While OT focuses on fine and gross motor skills, PT offers more intensive help with gross motor skills and basic motor skills. Depending on your child’s diagnosis and other factors, they may experience physical limitations that can affect their daily living. Having regular physical therapy sessions can improve your child’s overall coordination, hand-eye coordination, and help them participate in games, activities, and sports that require movement.
Like OT and speech, PT sessions are often 30 to 45 minutes in length. You may find physical therapists who specialize in autism spectrum disorders in clinics alongside occupational and speech therapists as well.
What Does ABA Seek to Accomplish?
If a neurotypical child has behavioral concerns, they may be taken to a therapist, psychologist, or psychiatrist. If a child with autism has behavioral concerns, the gold standard in treatment is applied behavior analysis. Some children with autism may have comorbid delays or disorders (e.g., oppositional defiant disorder (ODD)); in which case, psychiatry may come into play, but in most cases, ABA clinicians are brought in to address concerns with behavior. A Psychologist, Neurologist of Psychiatrist will often refer clients for ABA treatment.
The American Psychological Association (APA) calls ABA an evidence-based practice. In other words, ABA treatments have undergone a thorough research and review process, supporting that ABA can be a very successful treatment for those with autism. ABA is based on the science of behavior and learning. Using ABA therapy, trained professionals can gain a better understanding of how learning occurs, how the environment affects behavior, and how behavior “works” overall.
Before therapy can begin, a person must be evaluated and assessed. This looks not only at modifying unwanted behaviors but also at your child’s abilities and strengths. Comprehensively, this can create a treatment plan to help your child thrive and reach their goals.
After your child is assessed, your child’s board-certified behavioral analyst (BCBA) will draw up a treatment plan and behavior support plan (BSP). Just like every person with autism is different, every individualized ABA treatment plan is different as well, to meet every person where they are. The plan will be simply based on your child’s strengths and areas they need to work on, such as transitioning from one activity to another, or accepting “no” when being denied access to a preferred activity.
ABA is often play-based, but it is intensive and it is recommended that children receive 10 to 40 hours of ABA therapy per week, which often looks like two to eight hours of ABA therapy per day. ABA is also appropriate for adolescents and even adults.
One of the hallmarks of ABA is the ABCs, which stands for antecedent-behavior-consequence. When it comes to understanding behavior, this means:
- Antecedent: what provokes a certain behavior.
- Behavior: the behavior provoked by the antecedent.
- Consequence: the response to the behavior.
In ABA therapy, the “C” (consequence) is emphasized by positive reinforcement. For example, if screen time has expired, a parent asks for an iPad back, and the child hands over the iPad, they are positively reinforced through praise or another reward. If giving back the iPad is a regular struggle, your ABA team can work toward the goal of giving the iPad back seamlessly.
ABA sessions can occur anywhere, whether they are in-clinic, in-home, in schools, or out in the community. Clinic sessions may be focused on social skills groups and interactions with other peers and adults, while home-based ABA may tackle head-on behavioral issues your child may be experiencing at home, while ABA in schools will do the same with issues your child may be experiencing at school. Not every school has a BCBA or RBT on staff, and having an ABA clinician come in for sessions can be extremely helpful for the child, teacher, and peers.
ABA can also take place in the community. If your child has difficulties with social events, or even everyday tasks, such as going to the grocery store, your ABA clinician can support you and your child during these times, helping with techniques that will reinforce expected behaviors. Community ABA, as you’ll read below, may also be combined with your other services, whether it’s in the interest of time, the best needs of the child, or a mixture of both. Speech, occupational, and physical therapists can work together with your ABA clinicians to formulate a more comprehensive treatment plan that can also carry over to home and school.
How Do I Integrate ABA with Other Services?
Because the recommendation for ABA hours can be high, you may be wondering how you’re possibly going to fit in all of these services while still dealing with your child receiving an autism diagnosis.
If your child is age 3 or under at the time of diagnosis, they likely qualify for early intervention services. These services can look different in each state, but frequently, your child is given a team that helps them progress in the earlier years. Your team will include a speech therapist, occupational therapist, behaviorist (typically a BCBA), and physical therapist if needed.
Once your child reaches 3, their services are typically taken over by the public education system. Services delivered in school, such as speech therapy and OT, can help but often aren’t enough to help your child progress. This is when you seek outside clinicians.
Just as a speech therapist, OT, and PT may be at the same clinic, ABA services may be provided as well. However, ABA providers are often separate. One important thing to do is to sign releases for all of your child’s providers (and their school), so that clinicians can freely talk to one another about your child’s treatment plans and goals. This open communication allows clinicians to be on the same page—what your child is working on in one therapy can overlap with another as further reinforcement.
It may also be possible to combine services, depending on your appointment. ABA sessions can happen anywhere, including out in the community. You can have your BCBA or registered behavior technician (RBT) come to a speech, OT, or PT appointment, particularly if your child is experiencing behavioral difficulties during therapies.
You can also combine sessions if the dedication to time is more than you can bear. With your child being in school, it may be next to impossible to find some free time on a weeknight. Combining therapies doesn’t take away from each individual therapy; instead, the team working with your child can put their heads together to ensure your child thrives, meets their milestones, and reaches their goals.
Therapies for ASD & Insurance
Before you combine therapies from different locations, check with your insurance company. Provided that your child has a medical diagnosis of autism, and not just an educational one, ABA services are typically covered. However, it is up to the insurance company if you are allowed to combine therapies or not. Some insurance companies allow it, and some do not. If you have all of your therapies in one clinic (OT, speech, PT, ABA), then the coding process should allow you to combine them. If you are booking several practitioners together at the same time, check with insurance first.
To learn more about applied behavior analysis services, or to schedule a consultation or an assessment, reach out to Acclaim Autism today to speak with a professional.
ABA and Speech Therapy: Comparing Two Therapeutic Concepts. (n.d.). Regis College Online. Retrieved July 16, 2023, from https://online.regiscollege.edu/blog/aba-and-speech-therapy/
Autism spectrum disorder. (n.d.). American Psychological Association. Retrieved July 16, 2023, from https://www.apa.org/topics/autism-spectrum-disorder
Autism Vs Speech Apraxia: What is the Link? (2022, January 31). Stamurai. Retrieved July 16, 2023, from https://stamurai.com/blog/autism-vs-speech-apraxia/
Early Intervention for Autism | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2021, April 19). National Institute of Child Health and Human Development. Retrieved July 16, 2023, from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/early-intervention
Ellis, C. (2022, July 14). How ABA Therapy Works with Other Therapies for Autism. Acorn Health.
Frolli, A., Ciotola, S., Esposito, C., Fraschetti, S., Ricci, M. C., & Cerciello, F. (2022, September 26). AAC and Autism: Manual Signs and Pecs, a Comparison. Behavioral Sciences, 12(10), 359. 10.3390/bs12100359
Speech Therapy: What It Is & How It Works. (2023, May 3). Cleveland Clinic. Retrieved July 16, 2023, from https://my.clevelandclinic.org/health/treatments/22366-speech-therapy
What are the Differences in OT, PT, Speech and ABA in Early Intervention? (2023, May 11). Manhattan Psychology Group. Retrieved July 16, 2023, from https://manhattanpsychologygroup.com/what-are-the-differences-in-ot-pt-speech-and-aba-in-early-intervention/