Specialized therapies are used to minimize the symptoms and maximize the abilities of persons with developmental, emotional, and cognitive issues. Occupational Therapy (OT) and Applied Behavior Analysis (ABA) are commonly used therapies that are specifically designed to not only reduce symptoms of various developmental disorders but also teach new skills that will increase a person’s ability to partake in independent daily living. This article will explore the similarities and differences between these two therapy options and help you determine which option is better suited for your child’s specific needs.
What is Occupational Therapy for ASD?
Occupational Therapy (OT) selects techniques from various other therapies and medical interventions to create a holistic treatment approach to a multitude of developmental and emotional disorders. OT helps individuals with fine motor difficulties, gross motor difficulties, sensory difficulties, and social and communication difficulties. For people with Autism, OT programs typically focus on social skills, learning styles, sensory processing challenges, and self-care to better enable children to adapt to various sensory inputs and social situations and be able to partake in a wider range of activities.
What is ABA Therapy?
Applied Behavior Analysis (ABA) is based on the theory of behaviorism which describes how we learn. According to behaviorism, all behavior is learned through antecedents (what happens before a behavior) and consequences (what happens after a behavior, such as rewards and punishment). ABA is primarily used to help ASD people enhance socially important skills. ABA programs will focus on social, communication, academic, and daily living skills. The goal of ABA is to teach any skill that will enhance daily living while working to reduce behaviors that impact daily living.
Who is Each Therapy For?
Children with Autism are assigned levels based on the degree of support required. Three levels help doctors, parents, therapists, and caregivers to understand the child’s ability to communicate and navigate the challenges of daily living. The level of each child is determined by looking at the degree of impairment of social functioning and the presence of restrictive or repetitive behaviors.
Level 1 Autism is the least severe and intervention is mostly needed to address social difficulties and sensory processing challenges. For example, a child may have difficulty starting a conversation, asking a friend to play, adapting to changes in routine, touching particular textures, or buttoning a shirt.
One of the best treatment options for younger children with Level 1 Autism is Occupational Therapy (OT) because of its focus on emotional growth, social communication, and social interaction. OT will ultimately improve a child’s fine motor and gross motor skills for routine tasks such as buttoning a shirt, help them to become more socially interactive with peers, and teach them to process various sensory experiences through play and practice.
Level 2 Autism is characterized by more noticeable social deficits. For example, children with Level 2 Autism may have difficulty communicating, have limited language skills, inflexible behaviors, distress when changes occur, and feel threatened or overwhelmed by various sensory inputs (e.g., strong smells, loud sounds, bright lights). Applied Behavior Analysis (ABA) is more commonly used with Level 2 Autism because it will improve a child’s language and communication skills, teach them to adapt to changes in routine, and increase behavior flexibility.
However, it is common for children with Level 2 Autism to receive both ABA and OT. While ABA will improve a child’s socially important skills, OT will improve their ability to adapt to sensory inputs and further enhance their ability to communicate and interact with new environments.
Level 3 Autism is the most severe form. People at this level have debilitating impairments to their verbal and nonverbal communication and limited abilities to analyze and interact with their environment. While OT is versatile and can serve a wide range of individuals across their lifespan, intensive ABA programs are best suited to treat Level 3 Autism.
However, these types of ABA programs are most effective when intervention begins before the age of 3 years. ABA intervention will focus on assistive communication devices and adapting the child’s environment to best meet their needs. ABA is more widely used with Level 3 Autism because it can be done in any environment, these professionals know how to consistently implement reinforcement and punishment techniques to guide clients and parents can be trained to utilize these techniques.
Occupational Therapy VS ABA Methodologies
Occupational therapy (OT) uses a client-centered approach which involves a systematic process to access, plan, implement, and evaluate interventions that help clients achieve their goals and enhance their overall quality of life.
The first step in OT involves assessing the client’s physical, cognitive, emotional, and social functioning. Various tools and standardized tests are used to determine the client’s strengths and areas of difficulty. Based on the assessment results, an individualized intervention plan is created that directly addresses the client’s unique needs and challenges. The occupational therapist will then work directly with the client to provide hands-on therapy, teaching adaptive techniques, providing assistive devices, and guiding the client through exercises and activities that will increase their ability to operate independently.
Throughout the process of implementation, the occupational therapist will continually evaluate the plan’s effectiveness and make changes as necessary. In addition, the occupational therapist may recommend modifications to the home or school to create a more supportive environment. When the client has achieved their goals or has reached a predetermined level of independence, the occupational therapist will plan for discharge which can entail resources for self-management or maintenance programs. Throughout the entire process, the client remains at the center and the occupational therapist strives to ensure the client experiences meaningful change.
Applied Behavior Analysis (ABA) also uses a client-centered approach and begins with an assessment of the client’s strengths and challenges.
However, the ABA assessment focuses more specifically on the behavior of interest by gathering information such as its frequency, duration, intensity, and any environmental factors that may be contributing to it.
These assessments are referred to as Functional Behavior Assessments (FBAs) and are used to determine the function or purpose of the targeted behavior. Based on the assessment results, specific and measurable goals are set. For example, a goal might be set to increase the number of words a child with Autism can speak or reduce the number of times a student gets out of their seat during a teaching session. Before any behaviors are introduced, baseline data is collected to establish the current frequency or intensity of the behavior. This data will help to determine the effectiveness of the intervention.
Following this phase, the behavior analyst or a trained therapist will implement the plan consistently and systematically while collecting data. This data is regularly analyzed to determine treatment effectiveness. The plan is adjusted if minimal change in frequency or duration is noted. A key goal of ABA is to promote the generalization of behavior change in all settings (e.g., home or school) and with different people.
Strategies are designed to help clients transfer their skills to various real-life situations. Maintenance plans are also established to ensure the success of skill acquisition. ABA is effective in improving communication skills in children with Autism and addressing behavioral challenges in multiple settings.
Both OT and ABA are highly individualized forms of treatment for Autism that begin with assessment and goal setting and move to plan intervention and monitoring. OT and ABA ensure that skills and techniques learned are transferable to multiple environments and that the environment will support these newly learned skills. However, ABA focuses specifically on meaningful behavior change (e.g., increased a child’s ability to wait their turn on the playground) whereas OT addresses skills needed to function in everyday life (e.g., getting dressed).
OT vs. ABA Effectiveness
Research studies have shown that OT interventions can be effective in improving various aspects of functioning and quality of life for children with Autism. Some key findings are outlined below:
- Roley, S.S., et al. (2015) found that OT interventions that focus on sensory integration and regulation help children with Autism to manage sensory sensitivities by reducing sensory overload and improving self-regulation skills.
- Pan, C.Y. (2010) found that OT interventions can enhance motor coordination and skills in children with Autism which has a positive effect on their daily functioning.
- Case-Smith & Arbesman (2008) found that OT interventions using visual supports or social stories can lead to meaningful increases in communication and socialization in children with Autism.
- Hsieh, K, et al. (2018) found that OT activities of daily living such as dressing, toileting, and feeding can improve the independence and self-care of children with Autism, which can lead to greater autonomy.
ABA is widely recognized as one of the most effective evidence-based treatments for children with Autism. Some key findings are outlined below:
- Smith, T., et al. (2000) found that ABA interventions are effective in reducing challenging behaviors such as aggression and self-injury, while simultaneously promoting the acquisition of new skills to replace the challenging behaviors.
- Dawson, G., et al. (2010) found that early intervention and intensive ABA programs can lead to significant improvements in cognitive, language, and adaptive skills in young children with Autism.
- Reichow et al. did a systemic review in 2012 that found that ABA interventions can lead to improvements in language development and social interaction for children with Autism.
- Perry et al. (2008) showed that involving parents in ABA interventions can lead to better outcomes and generalization of skills to the home environment.
It is important to note that OT and ABA interventions for children with Autism can vary based on individual needs and goals. Therefore, the programs should be tailored to each child’s strengths and difficulties.
It is important to consider ethical principles when seeking services for children with Autism. Before agreeing to receive ABA or OT first ensure that you fully understand the nature of the services being provided. The therapist should explain the goals, methods, and potential risks and benefits of the therapy. Parents should continually be allowed to ask questions or seek clarification to make informed decisions about their child’s treatment.
Parents of children with Autism should always expect the ABA therapist or OT to maintain the confidentiality of their child’s personal information and treatment records. This includes sharing information with other healthcare providers only after receiving consent from parents or guardians.
It is good practice to check the credentials and ask for references to ensure the ABA therapist or OT is licensed or certified to work with children on the Autism spectrum. The ABA therapist or OT should develop programs that are tailored to your child’s unique needs, preferences, and abilities. Parents should be highly involved in the treatment planning process for both ABA and OT.
ABA therapists and OTs should act in the best interest of your child with the aim being to improve their overall well-being. ABA therapists and OTs must use evidence-based practices and have a reasonable expectation of benefits. Both ABA and OTs should monitor and communicate the effectiveness of treatment. If they are unable to meet goals or targets, they should refer the child to other services and/or discharge them from their care.
Care for a child with Autism should take a collaborative approach. Confirm that all healthcare providers working with your child communicate regularly. This will help to hold service providers accountable and keep everyone informed of treatment plans to avoid conflicting approaches. Open and honest communication is key to addressing any ethical concerns or issues that may arise during treatment.
In addition to the above ethical considerations, the Autistic community raises concerns about behavioral interventions for children with Autism. The controversy surrounding ABA therapy primarily centers around its intensity, the approaches used, and the potential impact it has on individuals. ABA therapy can be intensive, requiring many hours per week which can be stressful for children and families.
It can also be seen as potentially suppressing autistic traits and behaviors instead of respecting neurodiversity. ABA can be seen as making individuals with Autism conform to societal norms and expectations. There is an emphasis on compliance over understanding and respecting the individual’s needs, preferences, and communication styles. This approach has led to concerns about the potential of emotional harm and masking in autistic individuals.
It is important to note that the ABA field has evolved and many contemporary ABA therapists use child-centered, individualized approaches that consider the needs and preferences of the families.
Ethical ABA therapists seek to strike a balance between promoting positive behavior and respecting the autonomy and dignity of the individual. While ABA remains a widely used approach, it is essential to engage in informed discussions, stay informed about the latest research, and consider alternative interventions when making decisions about treatment plans.
Collaboration Between Occupational Therapy and ABA Therapy
ABA and OT can work in tandem to provide children with Autism with a well-rounded and effective treatment approach. ABA’s focus on behavior analysis and skill development can be seamlessly integrated with OT’s expertise in sensory processing, motor skills, and daily life activities.
Through collaboration, these two disciplines can jointly assess the individual’s unique strengths and challenges, set shared treatment goals, and develop interventions that address behavioral, sensory, and functional needs.
This holistic approach ensures that individuals receive comprehensive support, with ABA targeting behavior modification and communication skills while OT addresses sensory integration, fine and gross motor skills, and activities of daily living. By working in tandem, ABA and OT can enhance the overall effectiveness of the treatment plans in place and facilitate their success in various settings.
ABA and OT identify areas of difficulty for children with Autism, aiming to enhance their capabilities. Both interventions share a common emphasis on deconstructing tasks and striving towards the goal of nurturing skill sets and improving the behavior of children with Autism.
The difference lies in their approaches. OT focuses on cultivating life skills through playful activities and is better suited for children with Level 1 Autism, while ABA employs an evaluative model to pinpoint positive and negative behaviors and is best suited for Level 2 or 3 Autism. When choosing between the two treatment options be mindful of the ethical considerations and the ultimate goal for your child.