ABA Therapy or Occupational Therapy First? A Parent's Guide

Understanding the Two Therapies

When your child is diagnosed with autism spectrum disorder (ASD), you may hear about two common therapies: Applied Behavior Analysis (ABA) therapy and Occupational Therapy (OT). Both can be incredibly helpful, but they target different areas. ABA therapy is a scientifically validated approach that focuses on increasing positive behaviors (like communication and social skills) and reducing behaviors that interfere with learning. It uses principles of reinforcement and data-driven strategies. Occupational therapy, on the other hand, helps children develop the skills needed for daily living-things like dressing, eating, writing, and playing. OT often addresses sensory processing issues, such as being over- or under-sensitive to sounds, textures, or lights.

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Key Differences Between ABA and OT

Goals and Focus

ABA therapy typically targets behavioral, communication, and social goals. For example, an ABA therapist might work on teaching a child to request a snack using words or a picture card, or to take turns during a game. OT focuses on functional skills: improving fine motor control for holding a pencil, learning to tolerate different food textures, or calming down when overwhelmed by sensory input.

Methods and Settings

ABA is often delivered in a one-on-one setting, at home, in a clinic, or at school, using structured teaching and natural environment training. OT can be done in a clinic with specialized equipment (like swings and weighted blankets) or in the child's natural environment. Both therapies are play-based and child-centered, but their approaches differ.

Who Provides the Therapy

ABA is led by a Board Certified Behavior Analyst (BCBA) and implemented by Registered Behavior Technicians (RBTs). OT is provided by a licensed Occupational Therapist (OTR/L) or an Occupational Therapy Assistant (COTA) under supervision. Both require specific training and credentials.

Factors to Consider When Choosing the Order

Your Child's Primary Challenges

If your child has significant behavioral challenges-like aggression, self-injury, or severe difficulty following instructions-starting with ABA can help establish safety and readiness to learn. Once these foundational behaviors are in place, OT can be more effective. Conversely, if your child is overwhelmed by sensory input (e.g., cannot tolerate being touched, avoids certain textures), OT may need to come first to help regulate their nervous system so they can participate in ABA.

Age and Developmental Stage

For very young children (under 3), early intervention often combines both therapies. In many states, early intervention programs include both ABA and OT. For older children, the decision may hinge on school readiness: if a child needs to sit at a desk and write, OT might take priority; if social skills are the main barrier, ABA may be more urgent.

Availability of Providers

In some areas, there may be a waitlist for ABA or OT. Our free matching service at Get ABA Therapy can help you find vetted, BCBA-led ABA providers in your area, and we can also guide you on finding OT providers. Sometimes, starting with whichever therapy is available sooner can be beneficial, as long as both teams communicate.

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Can They Be Done Simultaneously?

Absolutely. Many children benefit from receiving both therapies at the same time. The key is coordination. Ideally, the ABA team and OT team should share goals and strategies. For example, if OT is working on sensory regulation, the ABA team can reinforce those calming techniques during challenging moments. If ABA is teaching a child to request a break, OT can incorporate that into sensory activities. When done well, the therapies reinforce each other.

Practical Tips for Parents

• Talk to your pediatrician or developmental specialist. They can help prioritize based on your child's evaluation.
• Ask providers for their opinion. A good BCBA or OT will be honest about what order might work best.
• Start with the therapy that addresses the most urgent need. If safety is a concern (e.g., elopement or aggression), ABA first is often recommended.
• Consider a trial period. Try one therapy for a few weeks and see how your child responds. You can always add the other later.
• Ensure insurance coverage. Both ABA and OT are often covered by insurance, including Medicaid. Check your plan's benefits and any prior authorization requirements.
• Use a free matching service. We can help you find BCBA-led ABA providers who accept your insurance, saving you time and stress.

Common Mistakes to Avoid

• Waiting too long. Early intervention is key. Don't delay starting any therapy while you decide the perfect order.
• Not communicating between providers. If your child sees both an ABA therapist and an OT, make sure they talk to each other (with your permission).
• Assuming one therapy is 'better' than the other. They serve different purposes and are both valuable.
• Ignoring your child's cues. If your child is extremely distressed in one therapy, it may be worth adjusting the order or approach.

How Insurance and Costs Play a Role

ABA therapy is widely covered by insurance due to its evidence base and mandates in many states. OT is also commonly covered, but may have session limits. Both may require a doctor's prescription and a diagnosis of ASD. Our free service can help you find ABA providers in your area who accept your specific insurance plan, including Medicaid. We do not bill for our matching service-we simply connect you with vetted providers.

Final Thoughts: There Is No Wrong Answer

Ultimately, the decision of whether to start ABA therapy or occupational therapy first depends on your child's unique needs. Some children thrive with ABA first; others need OT to lay the groundwork. Many families find that doing both concurrently, with good communication, yields the best outcomes. Trust your instincts, consult with professionals, and take advantage of free resources like our matching service to find qualified, BCBA-led providers. Your child's progress is a journey, and every step forward counts.