Abby Barnes, M.S., CCC-SLP
Autistic children often need different types of therapies and support to help them grow and develop new skills. Speech therapy is one of these supports. Another therapy some families choose is applied behavioral analysis (ABA). While ABA generally focuses on a child’s behavioral responses, communication responses can be included, as well.
When children in ABA seem to show progress with speech, language, or communication, parents may wonder, “Is speech therapy really necessary? My child is doing so well in ABA; I see them saying and doing new things.”
It makes sense to have these questions. The new things your child is doing can’t be discounted, and you should feel proud of their growth! But just because a child is showing progress in communicative responses doesn’t mean speech therapy isn’t needed. Speech therapists approach communication development very differently than ABA therapists. According to the American Speech-Language-Hearing Association, children who have a delay in communication development should be under the care of a licensed speech-language pathologist, even if they already receive ABA therapy.
Let’s take a closer look at the differences between ABA and speech therapy, as well as how speech therapy helps autistic children communicate.
What is ABA therapy?
ABA stands for applied behavior analysis. ABA therapy is intended to help autistic kids with behaviors that could be seen as challenging. These may be safety-related behavioral problems such as outbursts, running away, or not following directions.
ABA therapy can also help children learn daily living skills such as self-care and hygiene. In addition, ABA can address communication skills for kids who need this help.
What are ABA therapy sessions like?
Typically, kids receive ABA therapy for 10 to 40 hours per week. ABA sessions are usually quite structured. The sessions are behavior based, using external stimuli and lots of repetition until the child shows the targeted behavior or decreases the “negative” behavior. For example, the child may be rewarded with a toy each time they follow a direction or say a specific word.
In recent years, ABA therapy has come under scrutiny for several reasons:
The quality of evidence supporting it
Some providers’ use of older techniques based on negative reinforcement
A focus on compliance rather than the child’s individual autonomy
A one-size-fits-all approach
The strongest model of ABA therapy is one that includes families, is highly individualized, and uses a collaborative approach to ensure all the child’s needs are met by appropriate professionals and interventions.
What are speech therapy sessions like for children with autism?
Speech therapy for autistic children is provided by a speech-language pathologist, also known as a speech therapist. It begins with an evaluation of the child’s communication strengths and differences. From there, the speech therapist creates a treatment plan of short-term and long-term goals for the child.
An example of a short-term goal may be for the child to begin using single words to express their wants and needs. A long-term goal might be to eventually begin using short sentences to communicate their wants and needs. Speech therapists are trained in techniques for building up earlier skills to help their clients reach more complex goals.
During sessions, the speech therapist takes data on how the child performs toward their goals. This helps them keep track of progress, understand which type of support works best for that child, and know when to adjust goals when needed.
Speech therapy for autism is child-led
Speech therapy sessions are typically child-led and play-based. Caregivers attending alongside their child may think they’re simply watching their child play with toys or other items. However, play has an essential role in communication.
Play promotes interaction between two people–genuine, fun interaction. When an autistic child is comfortable and ready, they can begin to engage in the play tasks. This sets the stage for natural communication, and the speech therapist is right there to support and reinforce that communication.
Something to keep in mind is that this therapy approach is internally motivating to the child. They participate because they want to. Communication tasks are not based on external factors such as negative or positive reinforcement, as they often are in ABA therapy. For example, if a child doesn’t ask for a toy using words, the speech therapist will not take that toy away from them.
This therapy approach is internally motivating to the child. They participate because they want to.
Let’s look at another example. Let’s say the speech therapist introduces a puzzle to the child, but the child loses interest in it. Instead, they go over to a basketball and try to reach it. The speech therapist then shifts the activity to help the child communicate what they feel or want–even if it’s different from what the therapist first intended.
The child may be feeling frustrated that they can’t reach the basketball. Or they may be excited and want to tell the speech therapist about it. The therapist can monitor what the child may be feeling and give them words to use, perhaps by encouraging them to say “help” or “ball.” If the child isn’t using words, the therapist may encourage them to use gestures, such as pointing or making simple signs.
In speech therapy, the goal is to give the child the tools to respond to their own wants and needs, engage with others, and communicate more clearly. Communication happens internally. We decide what we want to communicate, then express it to someone else. In ABA therapy, the approach to communication is teaching the child to respond. Of course, we want kids to be able to respond, but we also want them to be able to truly express their own thoughts and feelings.
What is the difference between ABA and speech therapy?
There are several differences between ABA therapy and speech therapy. ABA is highly structured, repetitive, and focused strictly on the behavior a child is showing. Speech therapy is focused on the whole picture of communication: what the child is doing well and what they need support with. Speech therapy sessions are child-led and encourage natural interaction between the child and therapist.
Expressable’s clinical care model, for instance, provides intervention in a person's natural environment, at home–where the skills they’re learning are intended to carry over and be used every day. ABA can be provided in home-based services, but it is often delivered at a clinic, making it harder to transfer new skills to the home.
Speech therapists should be involved in the assessment and intervention of all people with communication disorders.
While both ABA and speech therapy address communication concerns, the approaches are very different. The American Speech-Language-Hearing Association states that speech therapists should be involved in the assessment and treatment of all people with communication disorders. An autistic child might work on communication skills with a board-certified behavioral analyst (BCBA) in ABA therapy. However, a BCBA does not hold the same level of education and expertise in communication development and intervention as a speech therapist does. Speech therapists have extensive training in typical and nontypical language development, from infants through to older adults.
The importance of neurodiversity-affirming care
If you’re the caregiver of an autistic child, it’s important to find a speech therapist who is neurodiversity-affirming. Neurodiversity refers to the idea that everyone’s brains work differently, and these differences are natural. The term neurodiversity-affirming refers to people (such as parents, caregivers, teachers, and therapists) who view these brain differences as natural. They provide care to neurodivergent people by accepting their differences, focusing on their strengths, and working to support them while building new skills.
A neurodivergent person’s communication skills may look different than we expect, and that’s okay!
Keep in mind, being neurodiversity-affirming doesn’t mean we deny that neurodivergent people may have challenges. Rather, we provide support and accommodations in areas that are meaningful to the person and their families, instead of trying to “fix” them.
Expressable speech therapists are committed to providing neurodiversity-affirming care. A neurodivergent person’s communication skills may look different than we expect, and that’s okay! We support them in developing communication skills that feel authentic to them, so they can grow and connect with others.
Contact Expressable to learn how speech therapy can benefit your child
Speech-language pathologists have a master’s degree in communication sciences and are required to maintain their state and national licenses throughout continued education. They are experts in communication and can help families with autistic children solve what may seem like challenging situations.
You can schedule a free consultation call to learn more about how we support autistic kids and their families. We’re here to answer your questions and help you decide on the right next steps.
An important note: We believe that when speaking about any community as a whole, the best approach is to prioritize that community’s voices, needs, and preferences. Within the larger autism community, the current language preference is identity-first (e.g., "autistic adults"), which is why we use that language in our content. Expressable is committed to listening to and learning from the populations we serve. If and when their preferences change, we’ll adjust our approach accordingly.
