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Here at Valued Voices, a large percentage of our speech-language therapy clients also receive Applied Behavior Analysis (ABA) services. In this blog post, I’ll break down my thoughts, as a licensed speech-language pathologist (SLP), about ABA services for children with communication disorders.
ABA & SLP: Articulation & Apraxia
BCBAs do not receive education or training in the areas of articulation, phonology, or Childhood Apraxia of Speech (CAS). When children need support in speech sound production, frontal or lateral lisps, phonological processes, motor speech disorders, or intelligibility, this support must come from an SLP. An SLP can complete an evaluation to examine a child’s phonemic inventory, look for any relevant error patterns, and determine if there are oral motor or structural components that may be impacting speech sound production. Then, the SLP can formulate a treatment plan to improve intelligibility.
ABA & SLP: Gestalt Language Processing (GLP)
As our field currently understands language development, we categorize individual language learning styles into either analytic language learning (ALL) or gestalt language processing (GLP). Analytic language learners first learn sounds, then words, then combine words to form longer utterances. Gestalt language processors first learn larger chunks or “units” of language that are later broken down into individual words and recombined on the path to spontaneous language. If a child uses echolalia (direct imitation), often repeats phrases from shows or books, uses language that appears “off-topic” or non-literal, uses rich intonation or a “sing-song” voice, reverses pronouns (e.g. says “you’re ok!” instead of “I’m ok!”), or has a diagnosis of autism, they may be a GLP and should be evaluated by an SLP. The typical ABA methods of modeling language will not be effective for a GLP and can even hinder the child’s nuanced language development process. It is incredibly important for ABA providers who work with GLP clients to collaborate with a GLP-informed SLP to ensure that both ABA needs and Gestalt language development needs are being met across settings.
ABA & SLP: Unsafe Behaviors
Most pediatric SLPs have completed some form of behavioral support training and are highly capable of de-escalating a child who is experiencing big emotions or displaying unsafe behaviors. However, for families who are seeking support for ongoing unsafe behaviors such as self-injurious behaviors or eloping, ABA may be recommended. A BCBA will be able to collect data that analyzes the antecedent, behavior, and consequences that occur around a target behavior. With this data they will propose a plan to either decrease/eliminate unsafe behaviors or increase safe behaviors to replace the undesired behavior. When children demonstrate behaviors that impede their activities of daily living or compromise safety, it is also important to consult with an occupational therapist to explore sensory needs that may be contributing to these behaviors. For example, children who demonstrate destructive behaviors or rough play may be demonstrating signs of proprioceptive or vestibular needs rather than behavioral difficulties. A multidisciplinary approach can ensure that a child is receiving support in all areas of need.
ABA & SLP: Stuttering
Disfluencies, also known as stuttering, can be a typical part of communication development. This is especially true when children are experiencing a “language boom”. Disfluencies can present as whole word or phrase repetitions, sound repetitions, “blocks”, mid-speech inhalations, and more. An SLP can determine whether disfluencies are typical or atypical. Children who stutter can certainly be candidates for ABA therapy for other reasons, but ABA therapy cannot be used to treat disfluencies. Only a licensed SLP can evaluate stuttering-like behaviors and make appropriate recommendations for next steps.
ABA & SLP: Augmentative & Alternative Communication (AAC)
Augmentative and Alternative Communication (AAC) has no prerequisite skill requirements and the use of AAC creates a more accessible world for everyone! It is common for teachers, service providers, ABA therapists, and parents to utilize “low-tech” AAC options such as sign language, “baby signs” or core boards daily. However, when a treatment team or caregiver is considering “high-tech” AAC for a child who may benefit from the use of multimodal communication, the evaluation, trialing phase, device selection, and programming should be completed by a SLP. It is also the responsibility of the SLP to educate the child’s family and service providers, including the ABA team, on how to support language development and operational competence.
ABA & SLP: Receptive, Expressive, & Mixed Language Disorders
Language development is a highly complex process influenced by genetic, individual, and socioeconomic factors. Only an SLP can evaluate, diagnose, and treat a language disorder. The verbal communication goals for ABA therapy tend to view language through the lens of compliance rather than communication. For early communicators, SLPs will typically focus on supporting the emergence of functional communication skills through intrinsically motivating naturalistic, child-led, or play-based learning opportunities. ABA therapy most often implements more structured, repetitive, drill-based trials to teach and reinforce target verbal or non-verbal responses. When considering service opportunities for a child with a language disorder, it is important to distinguish a learned verbal response associated with a stimulus item vs. spontaneous autonomous communication.
ABA & SLP: Social Communication / Pragmatic Language
The term social communication, also known as pragmatic language, refers to the many ways we use verbal and nonverbal language to interact with others. We use social communication skills in the context of our own unique cultures to appropriately greet and say goodbye, select and change topics, modify how we speak to match the person we are speaking to, follow conversational rules, repair communication breakdowns, and so much more. While any adult can model social skills, only a licensed SLP can evaluate, diagnose, and treat a social (pragmatic) communication disorder. Children with social communication disorders may benefit from both individual and group therapy supports to first learn and then practice implementing target social skills. Some children with pragmatic language disorders also receive ABA therapy. In this case, SLPs and BCBAs can work together to ensure that target pragmatic skills are taught and reinforced across settings.
TAYLOR LASKY
Taylor, a speech-language pathologist with a Master of Science from Chapman University, is dedicated to empowering her clients and their families in a welcoming, family-focused environment. Passionate about early intervention, she uses play to enhance communication and social development, creating dynamic and personalized therapy sessions. Believing in a tailored approach, Taylor leverages each client’s strengths and interests to ensure meaningful progress while making therapy both fun and functional.
