ABA Meets Speech Therapy… It was Love at First SD

“I don’t believe in ABA”

“ABA makes them like robots”

“ABA doesn’t work. I’ve done it before, I know!”

“Why would I do ABA when I’m here to do speech therapy?”

Over the past seven years I have been on a professional journey.  It began with ABA (Applied Behavior Analysis) and then speech therapy.  While on this journey a wonderful thing happened, a beautiful relationship, the marriage of “Speech” and “ABA.” All I have to say is “Congratulations!” to the speech therapists that DO use behavior therapy throughout their session with children with ASD (Autism Spectrum Disorder). 

 OK, so let’s get started…  Let me fill you in on how this rather “secret” relationship works and why.  My hope is that it will open up your eyes to a better way to provide speech therapy to children with ASD...

Meet little “Tommy.”  Tommy is a five year old little boy with ASD.  Tommy has difficulty with transitions, fleeting eye contact and some of his goals involve expanding his utterances, manding (i.e., requesting under the control of his own motivation) and answering basic social questions (e.g. “What’s your name?”).  He is in an 8:1:4 (8 children, 1 teacher and 4 teacher assistants) classroom with other children who have the same/similar diagnosis.  The classroom follows an ABA model. The students (Tommy being one of them) use and benefit from visual schedules, physical prompts, clear concise directives, errorless learning, first-then boards, token boards, sensory enriched activities and discrete trial teaching amongst other manipulatives and curricula materials that make them as successful as possible.  Tommy’s day is regimented for the most part, and he benefits from knowing in advance (via a visual schedule) what activity is coming next.  This helps him with transitions and decreases problem behaviors. 

Tommy is frequently asked “What are you working for?” in order to ensure that his reinforcer is effective enough to engage him in the task at hand.  All of these components, along with behavior therapy training, make for a successful student with Autism!  I mention “with Autism” because unlike other students who receive speech and language therapy, Tommy learns in a very different manner due to his diagnosis. 

We all know that no two children with the same diagnosis are alike.  They are functioning on different levels and what one child might be able to do with ease, another one struggles with. With that in mind, why wouldn’t we as the professionals want to make our learner’s ability to communicate and understand language less stressful?  I ask this question because throughout my career I have met many a therapist who have had plenty to say about ABA without ever actually diving into it and giving it a try. 

OK, let’s get back to speech therapy… Right now it’s 10:30am, “Let’s go check your schedule Tommy…it’s time for speech!”  Tommy is prompted to get his speech notebook and his token board.  He is asked by his speech therapist, “What are you working for?” Tommy chooses “iPad” and walks out of the classroom with his speech therapist by his side.  His hand is not held, nor is the teacher screaming at him to stop running or making noises.  All because from day ONE, Tommy’s speech teacher set the ground rules.  When Tommy started running she immediately prompted him to “try that again, walk quietly.”  So after a few speech sessions, Tommy quickly learned that if he walks quietly to speech he will earn a token… that much closer to playing on the iPad.  Tommy is then told to sit down.  Speech therapy begins…”What’s your name…Tommy” says his speech therapist and Tommy looks away and begins to engage in non-contextual vocalizations (one of his self stimulatory behaviors).  The speech therapist gains his eye contact and again delivers the S^D (discriminative stimulus- a stimulus employed to evoke a response) again followed by an errorless learning technique where the therapist immediately provides Tommy with the answer to his question.  This time, he replies “Tommy” and earns a token for answering correctly.  The session goes on and the more trials that are interspersed throughout play and goals are facilitated, the more independent Tommy’s responses become.  The therapist thus fades the prompt across a few sessions. Tommy is then able to answer “What’s your name?” without the use of a prompt.”  Is he answering like a robot (read in robot language! LOL…“Hello- My name is Tommy.”  No! Want to know why? It’s simply because WE as therapists aren’t robots, we are teaching Tommy how to respond appropriately to a specific question when asked by anyone anywhere.  By systematically breaking down targets/goals that Tommy is working toward, the speech therapist has allowed him to acquire the target skills and maintain his previously acquired skills.

Throughout the session, Tommy DOES engage in stereotypy or self stimulatory behaviors (repetitive body movements or repetitive movement of objects that stimulate one’s own senses) however, he is reminded of what he is working for and if needed a physical/gestural or visual prompt is provided in order to allow him to attend to the task at hand.  Through the use of behavior therapy (i.e., discrete trials, errorless learning, natural environment teaching and reinforcement) the speech therapist was able to target “speech” goals thanks to the principles of ABA.  Her speech session was productive and Tommy earned what he was working for.  It’s a win-win situation!

If you were wondering why there were random quotes at the top of my post, it’s because those were just a handful of the “ignorant” things that many well educated speech therapists have told me in the past!  It broke my heart to watch some of their learners struggle through a 30 minute speech session only to be more frustrated because the tools that were available for the therapist to utilize were simply ignored!  Don’t be close minded to a therapeutic approach just because your professional title is “Speech Language Pathologist.”  Rather, utilize every bit of information that other professionals in the same/similar field have to offer you, if you give it a try and understand its principles, you might just learn something yourself! By the way… ABA IS evidence based practice, which means that over many years it has proven to be the only effective way in treating/teaching children with ASD.  Just some food for thought!

Kimberly Shea, MA, SLP

Private Practice, Massapequa, NY