Young children with autism spectrum disorder (ASD) can benefit from different types of early intervention. Two treatment approaches commonly recommended for ASD are Applied Behavior Analysis (ABA) and Speech Therapy. While ABA primarily focuses on increasing adaptive behaviors and teaching life skills, it can also encompass communication. On the other hand, Speech therapy directly helps children to develop better language and communication skills.
This article will explore these different approaches to help you decide which will benefit your child most.
What is ABA Therapy for Autism?
ABA is a type of therapeutic intervention frequently used to treat children with Autism or other developmental disorders. ABA seeks to understand how behavior works, how behavior is affected by the environment, and how learning takes place. During therapy, our understanding of behavior and its interaction with the environment is applied to socially significant situations to teach new skills and to maintain learned skills.
Behavior analysts view all human actions as behavior-based, including language and language acquisition. B.F. Skinner, who is one of the pioneers of modern behaviorism, uses the term “verbal behavior” to refer to language actions. Skinner broke language down into four primary verbal operants:
- Mand – a stated demand or request such as “I want milk” that will result in immediate reinforcement (milk is received).
- Tact – an observation, label, or description of the environment. For example, when looking at a tree the child says “tree”.
- Intraverbal – Responses to prompts offered by other people. For example, Dad says, “I’m going to the car”, and the child responds with “I want to go for a drive.”
- Echoic – Repetition of the verbal behavior of others. For example, Dad says, “Truck” and the child says “Truck” immediately after.
Given that language development is regarded as a form of behavior, the tools and techniques that ABA therapists use to teach other skills can be applied to language development. Language impacts our behavior and behavior impacts language; therefore, most ABA therapists will inevitably address language-related issues during their careers.
What is Speech Therapy for Autism?
Speech therapy addresses issues with language and communication. It is designed to help children with Autism improve their verbal, nonverbal, and social communication skills. The ultimate goal of speech therapy is to help children with Autism communicate meaningfully.
During the early years of Autism, the 1940s to 1950s, language deficits were viewed as a core feature of ASD. At the time there were limited therapeutic options available, and treatment focused mainly on behavioral management.
However, in the 1960s and 1970s, speech therapy began to incorporate behavioral techniques to shape and reinforce communication skills in children with ASD. Then in the 1980s to 1990s there was the emergence of communication-focused therapies. This involved approaches that specifically targeted communication and language deficits in children with Autism.
In addition, Augmentative and Alternative Communication (ACC) systems were utilized more commonly, which enabled non-verbal children to communicate with others. Subsequently, speech therapy for Autism continued to evolve and develop into what it is today, which is a highly individualized, evidence-based intervention.
ABA Therapy vs Speech Therapy Techniques
Both ABA therapy and speech therapy can be used to address speech and language difficulties in children with Autism. They have a shared end goal of enabling children to be autonomous and successful communicators in their everyday interactions. The difference between them is that ABA will use strictly behavioral methods to enhance specific behavioral responses, while speech therapy frequently incorporates an eclectic approach.
Behavior therapists always begin intervention with a Functional Behavior Assessment (FBA), which can be modified to identify language-specific deficits. There are specialized language assessment tools that have been developed to assist in the process. Two examples are:
- VB_MAPP: The Verbal Behavior Milestones Assessment and Placement Program, which is based on B.F. Skinner’s theory of verbal behavior.
- ABLLS-R: The Assessment of Basic Language and Learning Skills, Revised, which divides skills into repertoire areas and enables them to be reassessed to track progress in each area.
Following the FBA, a behavior therapist will begin conducting verbal behavior therapy (VB) to teach communication using a combination of the principles of ABA and B.F. Skinner’s theory of language. This approach breaks language into four primary verbal operants: 1) Mand (i.e., to request), 2) Tact (i.e., describes an object or environment), 3) Intraverbal (i.e., a response to another person’s verbal language), and 4) Echoic (i.e., to repeat another’s verbal language).
Verbal Behavior begins with teaching children to make simple requests through pointing, signing, picture exchange, or verbal language. This allows the child to learn that their communication is meaningful because their request is reinforced by obtaining the desired item. Verbal Behavior uses a variety of strategies and techniques to teach language development:
- Discrete Trial Training – which involves breaking complex tasks down into manageable components. Through the use of repetition and positive reinforcement, children learn to associate verbal responses with desired outcomes.
- Functional Communication Training – which teaches children with Autism alternatives to verbal responses such as using signs, pictures, or AAC devices. This type of training enables nonverbal children to express themselves effectively.
- Incidental Teaching – which uses natural opportunities to teach communication. This method is primarily taught to parents and caregivers. Scenarios are created that motivate children to communicate. For example, providing a child with a salty snack and no drink can motivate them to request water or juice.
- Joint Attention Activities – This helps to encourage social engagement by teaching a child to focus on an object or activity with someone else.
Similar to ABA, speech therapy begins with an evaluation to assess the child’s communication strengths and challenges, followed by the development of an individualized treatment plan. In addition, speech therapy uses some of the same techniques as Verbal Behavior, such as functional communication training, incidental teaching, and joint attention activities.
Other techniques used by speech therapists to teach children with Autism language skills are:
- Augmentative and Alternative Communication Devices (AAC): This is helpful when a child is unable to speak. It allows children to voice their needs and wants by using sign language, pictures, or voice output AAC devices where a child communicates by pushing buttons or hitting switches.
- Articulation Therapy: This therapy teaches sounds and syllables through play, video modeling, and audio recordings.
- Oral Motor Therapy: This exercises the mouth and could use massages and the instructions of different textures. This technique is used when children have speech problems related to physical attributes.
How Long Does Each Last?
Every child with Autism is unique, and many factors must be taken into consideration when determining how long therapy should last. For most children, the more often they can attend either ABA therapy or speech therapy, the better the outcome will be. Most children receiving ABA therapy for language development receive three to four hours per week while speech therapy is provided for approximately one to two hours per week.
However, the best indicator for success in either therapy is how often parents or caregivers use the strategies taught during therapy in everyday life. Essentially, the number of hours per week of ABA or speech therapy is less important than the amount of time a parent or caregiver spends practicing the new skills in all environments.
If parents or caregivers consistently attend and participate in speech therapy and practice homework outside of therapy, the average duration of therapy is typically four to five months. For those receiving ABA therapy, the total duration is on average one to three years.
This is also based on consistent attendance at therapy sessions and parents or caregivers implementing the recommended strategies in the home and other environments outside of the therapeutic setting.
ABA vs Speech Therapy Effectiveness
More than 20 years of research from journals associated with behavior analysis have documented positive language development outcomes for children with Autism who received verbal behavior therapy. Albert, et al. (2012) showed that ABA can increase a child’s ability to make various requests. In 2015, Allan, et al found that ABA increased a child’s ability to make associations during intraverbal responses. Barbara and Kubina (2005) demonstrated the effectiveness of ABA techniques in teaching a child to tact (label items in the environment). Bourret, Vollmer, and Rapp (2004) found that vocal mand training procedures effectively increased children’s vocal requests for preferred items. In 2009, Egan and Barnes-Holmes discovered that teaching mand operants first enabled the quicker acquisition of tact operants. Lastly, Greenberg, et al. (2014) discovered that using a picture exchange system can increase vocal language in children with Autism.
Several studies have also been conducted to demonstrate the effectiveness of speech therapy on individuals with Autism. Batool and Ijaz (2015) demonstrated that children who received speech therapy experienced improved results on the Childhood Autism Rating Scale (CARS). The authors concluded that the difference was attributed to enhancing the child’s verbal and nonverbal communication. Schlosser and Wendt (2008) conducted a systematic review of studies on AAC devices and concluded that AAC devices did not impede speech production in children with Autism.
While limited studies are comparing the effectiveness of ABA therapy and speech therapy on language development in children with Autism, several studies have shown that implementing behavior modification techniques in speech therapy sessions can increase the overall success of speech therapy. For example, Lane and Brown (2023) demonstrated that using ABA techniques such as reinforcement and shaping, can increase the rate of language acquisition.
Who Benefits the Most From Both Therapies?
The choice between ABA therapy and speech therapy depends on the unique needs of each individual child. Both ABA therapy and speech therapy work best when used as early intervention, which means children as young as two years old can begin receiving either therapy option.
ABA is effective in teaching communication to children more profoundly affected by Autism. In addition, if there are significant behavioral challenges that are affecting learning, then ABA therapy would be the better option.
Speech therapy is recommended particularly with more mildly affected individuals or if your child suffers from oral motor difficulties, articulation difficulties, or comprehension challenges. Speech therapy is also more widely available and may be more likely than ABA therapy to be covered by insurance policies.
Do ABA Therapy and Speech Therapy Work in Tandem?
Many children diagnosed with Autism receive both ABA therapy and speech therapy in tandem. As shown above there is some overlap in the strategies and tools used to teach language development within ABA and speech therapy which can result in conflicting or incompatible goals. Kelli Marshall, a speech-language pathologist, states that it is vital to collaborate with Board Certified Behavior Analysts (BCBAs) to ensure that goals are aligned, and boundaries are respected. Each profession must operate within its scope of expertise.
Outcomes for children with Autism are better if ABA therapy and speech therapy collaborate. ABA techniques (such as reinforcement and shaping) can be integrated into speech therapy sessions to improve results, and speech therapists can offer advice on selecting an appropriate communication mode for children.
However, if your child has significant behavior challenges that impact learning, inability to focus for extended periods, or extreme task avoidance or defiance then it is more beneficial to begin with ABA therapy and then transition into speech therapy or add speech therapy to the treatment being received.
In conclusion, both ABA therapy and speech therapy are evidence-based interventions that can increase language acquisition in children with Autism. These treatment approaches are more effective when used as early intervention. ABA therapists and speech therapists should collaborate and create joint goals for clients to optimize results. When deciding which option to choose, consider your child’s unique needs. If there are concerns with behavior impacting learning, ABA will be required to address these. However, if your child’s main concern is articulation or comprehension, speech therapy is recommended.
Albert, K. M., Carbone, V. J., Murray, D. D., Hagerty, M., & Sweeney-Kerwin, E. J. (2012). Increasing the mand repertoire of children with autism through use of an interrupted chain procedure. Behavior Analysis in Practice, 5, 65–76. https://doi.org/10.1007/BF03391825
Allan, A. C., Vladescu, J. C., Kisamore, A. N., Reeve, S. A., & Sidener, T. M. (2015). Evaluating the emergence of reverse intraverbals in children with autism. Analysis of Verbal Behavior, 31, 59–75. https://doi.org/10.1007/s40616-014-0025-8
Barbera, M. L., & Kubina, R. J. (2005). Using transfer procedures to teach tacts to a child with autism. Analysis of Verbal Behavior, 21, 155–161. https://doi.org/10.1007/BF03393017
Batool, I., & Ijaz, A. (2015). Effectiveness of speech and language therapy for autism spectrum disorder. Journal of Pakistan Psychiatric Society, 12 (1).
Bourret, J., Vollmer, T. R., & Rapp, J. T. (2004). Evaluation of a vocal mand assessment and vocal mand training procedures. Journal of Applied Behavior Analysis, 37, 129–144. https://doi.org/10.1901/jaba.2004.37-129
Egan, C. E., & Barnes-Holmes, D. (2009). Emergence of tacts following mand training in young children with autism. Journal of Applied Behavior Analysis, 42, 691–696. https://doi.org/10.1901/jaba.2009.42-691
Greenberg, A. L., Tomaino, M. E., & Charlop, M. H. (2014a). Adapting the picture exchange communication system to elicit vocalizations in children with autism. Journal of Developmental and Physical Disabilities, 26, 35–51. https://doi.org/10.1007/s10882-013-9344-2
Lane, J. D., & Brown, J. A. (2023). Child Communication Research and Practice: Collaborative Roles for Behavior Analysts and Speech-Language Pathologists. Policy Insights From the Behavioral and Brain Sciences. https://doi.org/10.1177/23727322221144652
Marshall, K. (September 21, 2022). Collaborating with Applied Behavior Analysts: Everything you need to know. Speechpathology.com Retrieved at: https://speechpathology.com/articles/collaborating-with-applied-behavior-analysts-20531
Schlosser, R., & Wendt, O., (2008). The effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review. American Journal of Speech-Language Pathology, 17 (3), 212-230.