Playing Nicely in the Sandbox: ABA Collaboration for Speech, OT, and others
It can be a fine line when working with different providers. OT and ABA may be working on skills related to daily living. Speech and ABA may be working on increasing communication and social skills. It can be difficult to understand who is responsible for what.
This often leads to finger pointing between the providers and then frustration for you since no one will work on it. When some insurance companies see “autism” on the chart, they assume ABA is the best way to work on it even if another provider may actually have better training in that specific area. To prevent confusion for your child, it is important for the providers to work on things in a similar way but having one discipline responsible for the goal is important so there is one provider that is leading the goal. If you are getting different answers from different providers, bring up the idea of a team meeting to ensure everyone is on the same page.
While not a hard rule, over time working in schools and with other providers, these are typically the lines I keep in mind. Ultimately, ABA, Speech, OT, school, etc should all be working with you and answering your questions as well as open to collaborating with each other in the best interest of your child.
Speech and ABA
While both are working on communication, there may be some differences in how or why it is targeted.
If there are specific prompting strategies used in speech, ensure your ABA team knows about them so they can also use them in session
This will give your child more access to the specific strategies across people and locations which will help with learning
The focus of communication in ABA is to meet the child’s wants and needs, especially as a means to reduce behaviors that can cause harm to themselves or others and for social skills
We do not focus on things like lisps, articulation issues, ensuring proper mouth or tongue movement for sound production, etc. If needed, the SLP will identify specific goals related to these areas for your child
I have made the expectation to work on articulation for matters of health or safety like the child saying their name more clearly if they mumble
If we are using actions in ABA, it is likely to give your child more actions to use to ask for (interactions with others, play skills, activities, etc.), rather than teaching more vocabulary.
If we are working on pronouns or prepositions in ABA, it is likely because there are behaviors coming from the child mixing up the pronouns - like saying “you want (item)” instead of “I want (item)” or “I want the ball in the box” instead of “I want the ball on the box”
The ABA team should defer to the Speech team on the modality to use - this could be vocal communication, signs, AAC, or another way.
The ABA team may be able to implement signs or PECS but there are limitations to both of these approaches. If your child is not easily picking up language and communication, you should also be receiving speech therapy - do not assume the BCBA can do this for your child.
OT and ABA
While both are working on daily living skills, there may be some differences in how or why it is targeted.
The OT needs to ensure the child has the fine motor or gross motor skills to be able to do age-appropriate actions. This may include motor planning.
If the child is not able to do the age-appropriate actions, the OT should give you an idea of how the skills will be targeted to gain independence with age-appropriate actions or for devices that can be used to help the child be more independent
If your child is not potty trained, they should identify with you which fine and gross motor skills are prerequisites to work on first to work on the goal in the future
They can give ideas for potty seats, adaptive clothing or home items, etc. to support independence.
If they say “ABA will work on it” and your child does not have the prerequisite fine or gross motor skills, it’s time to ask more questions. BCBAs do not have training on how to support fine or gross motor skills, or types of adaptive equipment to meet needs.
ABA may work on increasing independence with daily living routines, following instructions related to routines, supporting multi-step instructions, etc. which is more related to the behavioral aspect of these skills rather than the motor skills related to these skills.
It is important to note that the child may be engaging in behaviors to escape the daily living task to avoid sensory triggers, due to tired muscles or lack of strength, etc. in addition to other potential triggers. Each situation should be reviewed by the OT and BCBA together, if possible.
Sensory needs
BCBAs are not trained in sensory strategies. We are able to identify if something is an automatic behavior that may benefit from sensory strategies but not what specific sensory input they may be seeking
The OT should be able to identify the type of input the child is seeking and provide some alternatives that meet the same needed
The OT and BCBA can work with the parents to determine a safer replacement that meets the same sensory need and the BCBA can work on using that as a replacement
ABA will not typically be responsible for things like holding a pencil correctly, using scissors correctly, or other school related fine-motor tasks. If it comes up during preferred activities, then we can offer reminders but we are not trained in how to do these appropriately like an OT would be.
School and ABA
In-home ABA will typically not work on anything academic
This includes math, reading, writing, homework, etc.
Exception may be made if there are behaviors related to transitioning to doing homework where transitions to neutral or non-preferred activities could be targeted rather than getting the correct answers on a homework assignment
Insurance will typically not cover these goals for a home-based ABA service
If your child needs support with those areas only, likely a tutor or small group instruction may be better.
If ABA is pushing into a preschool or other classroom, the BT will support the child to follow the routine.
The teacher and school staff will set the routine and instructions and the BT will support the child to follow those instructions.
It is important for the behavior plan the ABA team uses to also be used to the best of the schools’ ability when they are not there. This can be accomplished in an IEP or team meeting.
The BCBA can incorporate parts of the classroom into the ABA sessions
Things like using the same visual schedule, the same transitional warnings/statements, using the AAC device from school, using the same playground rules, or other protocols from the school can help give more practice to the child
Depending on the funding source for ABA, your BCBA may or may not be able to attend IEPs, school observations, or collaboration with the school team members. Many insurance agencies do not recognize the importance of this collaboration so work with your BCBA to see what is possible.
Doctors and ABA
Doctors should not be providing a prescription for 40 hours per week or any specific number of hours
They can make the recommendation for you to go to an ABA provider based or even “prescribe” ABA based on need. The BCBA will be able to provide a more accurate recommendation for your child specifically after the initial intake process.
If the BCBAs recommendation is different from the Doctors, discuss this with the BCBA and Doctor. If possible, a meeting between the two may help. If you are still in disagreement, then find another ABA provider. The ABA agency will likely not change their recommendation but it is important to listen to the recommendation and why that recommendation was given.
BCBAs can provide data from programs or behavior tracking to the doctor when looking at the effects of new medications or medication changes
Any new behavior that even has the potential to be medical should be checked out by the doctor first
This includes regression with using the toilet/potty training, different breathing patterns, any crying that looks like it is in response to pain or there is no pattern in the cause, among other things. If a BCBA makes this suggestion to you, please listen to them even if it seems silly. It is to ensure your child's safety.
There has been an idea in the field for years that BCBAs are difficult to work with - and yes, some are - but opening up the lines of collaboration and understanding how each provider can support is a great way for a parent to advocate for effective services.