Getting the Most out of Therapy: 

So often children who are diagnosed with a disability are provided a plethora of services which can be overwhelming to parents. This is especially true for younger children with recent diagnosis due to the proven efficiency of early intervention. Parents who are just learning about the needs their children have are given several referrals for services they have never heard of. This is such an emotional process for any parent of a child at any age and they are rarely given one person to make sense of it all. This series it meant to help explain the services your child may be receiving as they relate to ABA, how these services can be used to support an ABA program, and how to facilitate this collaboration between providers who can also be unfamiliar with each other’s specialties.

Part 2: Occupational Therapy and Applied Behavior Analysis

Many children with autism face developmental challenges in a variety of areas that impact their ability to perform daily activities. This includes areas such as leisure, self-care routines, using eating/writing utensils, sensory sensitivities, navigating a backpack, and more. Occupational therapy applies to people of any age across a variety need. 

Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes.

Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science. 

(American Occupational Therapy Association, 2021)

Like ABA and Speech/Language therapies, OT is most efficient when implemented consistently. The word therapy implies a course of treatment dependent on the progress of the person receiving it. This places occupational therapy on the same playing field as behavior therapists, who also measure success on client progress. Similar to speech/language therapy, OT services are usually provided on a weekly basis, ranging from 30 to 90-minute and tend to have a very specific focus. With ABA programs addressing such an array of goals, they often overlap with goals provided by OTs. 

Does ABA overlap with occupational therapy services? YES (again)! This clinician has most commonly seen two areas of ABA programs that are impacted positively by collaboration with an Occupational Therapist. The most popular area of discussion regarding OT is sensory issues. Addressing sensory needs is no doubt an essential component for those that need it. In ABA everything is related to observable behavior, which does not lend itself to easily programming sensory needs into every activity. An occupational therapist has tools that assist with the same goals as an ABA program, such as increasing how long a child can sit at a table. Items such as specialized seat cushions, weighted vests, fidget toys, or even prescribed ‘diets’ can be simple additions that do not impede the individual. In fact, that is the whole focus of OT, to provide accommodations to the environment so that it is more conducive to the child’s needs. 

Can these therapies support each other considering how different the focus is? Absolutely! One of this clinician’s favorite examples of this is handwriting. Being able to write or produce written words is an extremely important skill that is a concern of any parent. Most ABA programs incorporate a writing or tracing goal. When consulting with an OT, who can target fine motor development, you learn about supports that can help make writing easier for your child. Besides special pencil grips or textured paper, an OT can determine that there is a lack of muscle development impacting the three-point grasp used with a writing utensil.  An OT might suggest using a very small broken crayon when writing, because the smaller the item being written with the more precise the grasp. By letting a child use this tiny crayon during every writing goal in a daily ABA program, they develop more muscle memory and precision using the correct hand position for writing. An OT can assist the BCBA in all things fine motor including goals such as eating with a fork or brushing teeth. The areas that these therapies can support each other is very broad. 

Creating a common goal and establishing collaboration between therapists is a really great way to get the most out of your child’s individual program. Imagine a focus on the letter ‘a’ where the SLP is working on the letter sound, the OT is working on writing it, and the behavior technician is using those interventions to practice it in a systematic data-driven way on a daily basis. This type of program cohesion sets the stage to give your child the best supports from every angle for skill acquisition. Too often these therapies are isolated from each other, when they can actually work with each other. If an OT is working a program for using a toothbrush that integrates sensory desensitization for brushing one’s teeth and the BCBA programs a task analysis for brushing teeth that focuses on positive reinforcement, they can come together rather easily. By combining the positive reinforcement of sequenced steps with an approach that minimizes sensory aversion while providing materials that are conducive to the individuals fine motor needs is utilizing the strengths of each specialist to create a routine catered to your child’s success.  

Getting this type of collaboration between therapists is not easy. It can often be hindered by insurance, which won’t allow concurrent therapies, or lack of knowledge by the individual practitioners who do not understand the benefits of other approaches. As a parent the best tool you have is already programmed, focusing on your child and what they need. By paying attention to the goals of your child’s various therapies and learning why each specialist approaches those goals in the way that they do, you can become the bridge that connects the best supports from each area. This type programmatic cohesion will give each child the individual supports they need to reach their highest potential. 

Author:

Sheila Panno, MEd, BCBA, LBA

BCBA Clinician

Works Cited:

American Occupational Therapy Association, I. (2021). What is Occupational Therapy? Retrieved from American Occupational Therapy Association: https://www.aota.org/Conference-Events/OTMonth/what-is-OT.aspx