Applied Behaviour Analysis Vs Occupational Therapy

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Introduction

It is often that parents and caregivers of children with special needs wonder about the difference between Occupational Therapy (OT) and Applied Behaviour Analysis (ABA).

If you’re trying to decide between ABA vs. Occupational Therapy for your loved one, this article will help break down the key differences between the two, and guide you on when each therapy may be appropriate. Whether your loved one was recently diagnosed or you’re seeking support to address specific developmental needs, understanding the roles of OT and ABA is crucial to making informed decisions for your loved one’s care.

Additionally, it is important to consider that the collaboration between an OT and an ABA therapist can be highly beneficial; since, they can create a comprehensive plan that incorporates behavioural strategies with skill-building activities to enhance your loved one’s independence across different settings.

What is the primary focus of Occupational Therapy?

Occupational Therapists work with individuals throughout their entire lifespan, from new-borns to the elderly, with a focus on enabling them to perform daily activities, often referred to as “occupations.” For children, play is considered their primary occupation and is recognized as a crucial aspect of development in occupational therapy (Royal College of Occupational Therapists, 2024).

As an OT clinician I am aware that play is a central focus when working with children with disabilities and their families. Paediatric occupational therapists utilize play to help children develop and strengthen a wide range of skills, including self-care (activities of daily living), fine motor abilities, sensory processing, social interaction, and emotional regulation.

Through careful task analysis, occupational therapists identify specific challenges a person may encounter and implement targeted interventions to address these challenges in ways that are both meaningful and engaging.

Areas that Occupational Therapist Addresses

Activities of Daily LivingActivities of daily living encompass tasks such as personal grooming, bathing, toileting, and brushing teeth.
Fine Motor SkillsOccupational Therapists assist their clients in building strength, coordination, and control through purposeful activities and exercises. Fine motor skills involve the small muscles in the hands. Therapists use interest-based activities to help improve these skills. This enhancement is essential for tasks such as writing, dressing, and cutting.
Sensory SkillsOccupational Therapists can identify sensory challenges and develop a sensory diet tailored to the person’s needs. Sensory diets help people stay regulated, enabling them to participate more effectively in meaningful activities.
Social SkillsThrough play, children can develop essential social skills such as sharing, taking turns, and cooperation.

What Is The Primary Focus of ABA?

ABA uses a science based behaviour analysis approach in which behaviours can be studied, and understood. By understanding behaviour, an ABA
therapist can create an intervention to teach skills, increase behaviours that can facilitate learning and independence, while decreasing behaviours that can be dangerous or hinder learning. ABA therapists design individualized programs that target specific areas of skill development by utilizing a tailored approach that is unique to the person’s needs.

Behaviour modification is the primary component of ABA therapy. Additionally, ABA therapists break down complex tasks into smaller, more manageable steps using techniques like shaping and chaining, enabling people to build on their existing abilities and gradually acquire new ones.

Areas That ABA Therapist Addresses

Challenging BehaviourUKBA(certs) can analyse the function of a behaviour and then develop a program to reduce that behaviour. Examples of behaviours that may challenge include eloping and aggression.
Social Skills DevelopmentABA therapists use various techniques to enhance
appropriate social skills, including Social Stories, modelling, as well as positive reinforcement for prosocial behaviours.
CommunicationABA therapists enhance their clients’ communication skills by using positive reinforcement, teaching body language, and helping clients understand facial
expressions.
Daily living SkillsABA therapists teach daily living skills by breaking tasks into smaller, manageable steps and gradually working towards completing the larger task.

What Are Some Key Differences And Similarities Between OT And ABA?

To gain a better understanding of ABA and OT approaches, it’s essential to examine the key similarities and differences between the two professions.

Comparing Philosophies Between OT And ABA

As an OT, I understand that the initial evaluation is critical for creating achievable goals. A key part of a thorough evaluation is connecting with the family to learn about their concerns and expectations from therapy. It’s essential that families are informed about the goals being targeted so that both the therapist and the family can work together, staying aligned to increase the likelihood of successfully reaching those goals.

OT philosophy focuses on a holistic client-centred approach by creating tailored interventions based on the client’s needs. Occupational Therapists assess the client’s physical, cognitive, emotional, and social functioning using various standardized tests. These identify strengths, challenges, and areas needing improvement. Based on an evaluation, they create personalized intervention plans that may include guiding clients through exercises or functional activities, teaching adaptive techniques, and introducing assistive devices. OTs continuously evaluate the effectiveness of their interventions, making adjustments as needed to support the client’s progress.

In contrast, ABA therapists focus primarily on behaviours of interest. They use a Functional Behaviour Assessment (FBA) to determine the purpose of a targeted behaviour by analysing its frequency, duration, intensity, and environmental factors. This assessment helps identify the reason behind the behaviour, for example, attention, task avoidance, access to tangibles, or sensory stimulation. With this information, ABA therapists develop behaviour intervention strategies tailored to improve the child’s overall behaviour and functioning.

Increasing Engagement Through Motivation

Both Occupational Therapists (OTs) and Applied Behaviour Analysis (ABA) therapists share the common goal of increasing a client’s independence. OTs often achieve this by emphasizing the client’s internal motivation through therapeutic play interventions, making the activities meaningful and engaging. On the other hand, ABA therapists focus on reinforcement techniques to encourage desirable behaviours. Reinforcement can be in the form of social recognition, such as praise, or tangible rewards.

I can personally attest that when someone engages in an activity that excites and motivates them, it no longer feels like work—it becomes something they look forward to. Many of my clients enjoy OT sessions because of my therapeutic use of self to transform work into play. Together, we achieve goals in a fun, engaging way that keeps them motivated and involved.

Target Population

Occupational Therapy (OT) is more versatile as it serves a wide range of individuals across various settings. OT practitioners work with people throughout their lifespan in diverse environments, including schools, inpatient rehabilitation, acute care, outpatient clinics, and skilled nursing facilities, among others. While ABA techniques can benefit other populations, their primary focus is on working with individuals with Autism.

As a practicing OT, I have had the privilege of working with clients across a range of diagnoses, including Autism, ADHD, Anxiety Disorders, Traumatic Brain Injuries (TBI), and trauma-related injuries, among others.

Practice Setting

Most ABA therapists work with individuals with Autism in settings such as the home, school, and community. In contrast, Occupational Therapists (OTs) practice in a wide variety of settings, including inpatient rehabilitation, acute care, telehealth, psychiatric facilities, skilled nursing facilities, and outpatient centres. I myself have worked in a variety of settings including acute care, inpatient care, school-based, outpatient paediatrics and telehealth.

Educational Requirements

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There are three levels of ABA therapy professionals. An RBT (Registered Behaviour Technician) is a paraprofessional with certification who delivers treatment under the supervision of a BCBA. A BCaBA (Board Certified Assistant Behaviour Analyst) holds an undergraduate-level certification in behaviour analysis and also works under the guidance of a BCBA. Finally, a BCBA (Board Certified Behaviour Analyst) has a master’s or doctoral degree in behaviour analysis. BCBAs supervise both RBTs and BCaBAs, and they are qualified to provide direct treatment to clients. The UK equivalent of a BCBA is the UKBA(cert).

To become an Occupational Therapist in the UK, you must have a degree in occupational therapy, and be registered with the Health and Care Professions Council.

Benefits of Collaboration

As an Occupational Therapist with over 8 years of experience, I’ve had the pleasure of working alongside ABA therapists. My background as a behaviour technician has given me a deeper appreciation for the value of collaboration with ABA professionals. Understanding their scope of practice enhanced my appreciation for
the benefits of interdisciplinary teamwork.

I recall a particularly challenging case involving a client who exhibited self-injurious behaviour. As an OT, I provided insights into environmental modifications, while the BCBA contributed by sharing behavioural strategies, which led to better outcomes for our client.

Collaboration between disciplines is associated with improved client outcomes. Occupational Therapists bring expertise in areas such as human body mechanics, motor functions, motor planning, and environmental accommodations, while ABA therapists specialize in understanding and addressing challenging behaviours.

There is also overlap between the two fields, as both OT and ABA practitioners are knowledgeable in reinforcement, shaping, and chaining techniques. By collaborating, an OT can enhance their use of behavioural strategies, while an ABA therapist can benefit from the OT’s expertise in motor skills and daily living tasks, especially when working with clients facing these challenges.

If a BCBA identifies that a behaviour serves an automatic function, working together with the OT can help identify alternative sensory activities that meet the same sensory needs as the challenging behaviour, leading to better outcomes for the client.

Outcome Goals

While both ABA and OT therapists share the goal of helping their clients become independent and successful in their environments, they often take different approaches when working with a particular client. Here’s an example: A client has difficulty staying seated during a writing task and frequently walks away. After providing the parents with a Sensory Profile Questionnaire, the OT identifies the client as a sensory seeker, particularly seeking movement. The OT might incorporate vestibular and proprioceptive activities, such as jumping on a
trampoline, doing wheelbarrow walks, or using a therapy ball before engaging in the writing task.

In contrast, a BCBA might approach the situation differently. They would likely conduct a Functional Behaviour Assessment (FBA) to understand why the client is eloping during the task. With the FBA results, the ABA therapist can create a targeted plan to address the behaviour. They will be able to identify the triggers that can cause a child to elope and help children learn coping strategies.

As an Occupational Therapist, I view my client holistically, considering all aspects of their well-being. Open communication with parents is essential. The initial evaluation is crucial for establishing a baseline and setting achievable goals. Maintaining ongoing communication with the family increases the likelihood of the client meeting those goals, as parents can reinforce what the client is working on in therapy. For example, if using a vestibular ball is effective during table top activities and the client is able to focus more, it’s important for parents to know so they can apply the same strategies at home, school or during other therapies.

Does my child need ABA or OT interventions?

It’s essential to recognize that every child is unique, with their own strengths and challenges. Both ABA and OT therapists frequently work with children with Autism. Parents who are unsure of which therapy to pursue should consult both a BCBA and an OT for formal evaluations. A skilled clinician from either discipline can assess whether therapy intervention would benefit the child.

From my experience, many of the children on my caseload who have behavioural challenges also receive ABA therapy. Once their behaviour is managed, they become more successful in other areas of therapy, including OT.

Case Study ABA vs. OT

I once worked with a client who exhibited aggressive behaviour when presented with non-preferred tasks. Although the BCBA and I approached the issue from different angles, our combined interventions successfully reduced the aggression from severe to mild.

The BCBA determined that the behaviour was maintained by escape and focused on reinforcing when the client engaged in functional tasks by offering tangible rewards and social praise. As the OT, I knew that this client enjoyed going down the slide, so I incorporated vestibular activities like sliding and swinging into our sessions.

By making the activities reinforcing, the client exhibited less aggressive behaviour, allowing me to gradually introduce non-preferred tasks, such as fine motor activities. With his behaviour under control, I was then able to focus on improving his fine motor skills, which were crucial for tasks like writing and dressing.

Conclusion

In summary, Occupational Therapists assist clients who face challenges with social interaction, sensory processing, and participation in daily activities, while ABA therapists concentrate on modifying targeted behaviours, enhancing communication skills, and generalizing skills across different settings.

Since every child’s needs are unique, a combination of therapies may be most effective for achieving optimal results (Gasiewski, et al., 2021). As an experienced Occupational Therapist, I have seen positive outcomes from collaborating with other disciplines, allowing me to provide more holistic and individualized treatment for each client on my caseload.

About the Author

Mrs. Santisteban is a paediatric Occupational Therapist with over 8 years of experience, having worked in a variety of settings such as acute care, inpatient rehabilitation, school-based therapy, outpatient paediatrics, and telehealth. During her undergraduate studies, she also trained as a behaviour technician. This combination of experience as both an OT and a behaviour technician provides her with a unique perspective, allowing her to appreciate the value of interdisciplinary collaboration in achieving better outcomes for her clients.

If you would like to connect with the author here is her Linkedin.

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References

Gasiewski, K., Weiss, M. J., Leaf, J. B., & Labowitz, J. (2021). Collaboration between behavior analysts and occupational therapists in autism service provision: Bridging the gap. Behavior Analysis in Practice, 14(4), 1209–1222. https://doi.org/10.1007/s40617-021-00619-y

Royal College of Occupational Therapists . (2024). What Is Occupational Therapy? RCOT. https://www.rcot.co.uk/about-occupational-therapy/what-is-occupational-therapy.