ABA vs Speech Therapy First for Autism: What to Know

Understanding ABA and Speech Therapy for Autism

When a child is diagnosed with autism spectrum disorder (ASD), families quickly encounter two of the most common recommended therapies: Applied Behavior Analysis (ABA) and speech therapy. Both are evidence-based and can be life-changing, but they target different areas. ABA is a comprehensive approach that uses principles of learning and behavior to increase useful behaviors and reduce those that interfere with learning. Speech therapy focuses specifically on communication - including spoken language, nonverbal cues, and social use of language. The question of which should come first is natural, and the answer depends on your child's individual strengths and challenges.

🔗 Related reading: Autism IEPs & School Services in California Guide · Find ABA Near Me

What ABA Therapy Addresses

ABA therapy is delivered by a Board Certified Behavior Analyst (BCBA) who designs individualized programs to teach skills across many domains: communication, social interaction, self-care, play, and academics. It also works to reduce challenging behaviors like aggression or self-stimulation. ABA is often intensive (20-40 hours per week) and data-driven, with progress measured continuously. For many children with autism, ABA builds the foundational learning-to-learn skills - such as attending to a speaker, imitating actions, and following simple instructions - that make other therapies more effective.

What Speech Therapy Addresses

Speech-language pathologists (SLPs) focus on all aspects of communication. This includes articulation (how sounds are made), expressive language (using words and sentences), receptive language (understanding what others say), and pragmatic language (using communication socially, like taking turns in conversation). For nonverbal or minimally verbal children, speech therapy may introduce augmentative and alternative communication (AAC) systems like picture cards or speech-generating devices. Speech therapy sessions are typically less intensive than ABA, often 1-3 hours per week, but can be highly targeted.

🔗 Related reading: Ohio Parent's ABA Therapy Start Checklist · Local ABA Therapy

Key Differences Between ABA and Speech Therapy

• Scope: ABA addresses a wide range of behaviors and skills; speech therapy is narrowly focused on communication.
• Intensity: ABA often requires many hours per week; speech therapy is usually less frequent.
• Provider credentials: ABA is led by a BCBA; speech therapy is provided by a licensed SLP.
• Methodology: ABA uses reinforcement and data tracking; speech therapy uses play-based and structured language activities.
• Goal overlap: Both can target communication, but ABA may teach the motivation to communicate while speech therapy teaches the specific forms.

Should ABA or Speech Therapy Come First?

There is no universal rule, but many experts and families find that starting with ABA first can be beneficial. Here's why: ABA can help a child develop the ability to sit, attend, imitate, and follow directions - all skills that make speech therapy more productive. For instance, if a child cannot yet imitate sounds or maintain eye contact, a speech therapist may struggle to make progress. ABA can also reduce interfering behaviors like tantrums or self-stimulation that might disrupt speech sessions. However, if a child has severe communication delays that cause frustration, starting speech therapy immediately - sometimes alongside ABA - can reduce problem behaviors by giving the child a way to express needs. The ideal approach is a comprehensive evaluation by a BCBA and an SLP who can collaborate. A free matching service like Get ABA Therapy can connect you with vetted BCBA-led providers who routinely coordinate with SLPs.

When ABA First Makes Sense

• The child has significant challenging behaviors that interfere with learning.
• The child lacks foundational learning skills (e.g., imitation, attending).
• The child is very young (toddler or preschool age) and needs broad skill building.
• Insurance requires prior authorization for speech therapy, or ABA is more readily available.

When Speech Therapy First Might Be Better

• The child has mild behavior challenges but is significantly delayed in communication.
• The child is older and has missed early language milestones.
• The child is already using some functional communication but needs articulation or pragmatic language support.
• The family has limited access to ABA hours but can get speech therapy quickly.

Can ABA and Speech Therapy Be Done at the Same Time?

Absolutely - and often this is the most effective approach. Many children receive both therapies concurrently, with the BCBA and SLP communicating regularly to align goals. For example, the ABA team might work on requesting items using a picture exchange system, while the speech therapist focuses on vocalizing the word for that item. Coordination is key: the BCBA can reinforce speech therapy targets throughout the day, and the SLP can incorporate behavioral strategies to keep the child engaged. If you're using a free matching service like Get ABA Therapy, ask potential providers how they collaborate with other therapists. Some clinics offer both ABA and speech therapy under one roof, which simplifies coordination.

Costs and Insurance Coverage

Both ABA and speech therapy are considered medically necessary for autism and are typically covered by health insurance, including Medicaid. However, coverage details vary widely by state and plan. ABA is often covered under a specific autism benefit, while speech therapy may fall under habilitative services. Many plans require prior authorization and have limits on the number of sessions per year. Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit generally covers both therapies for children. If you're unsure about your coverage, a free matching service can help you find providers who accept your insurance and can verify benefits. Always check with your insurance company before starting therapy.

Practical Tips for Parents

• Start with a comprehensive evaluation from a developmental pediatrician, BCBA, and SLP to identify your child's priority needs.
• Consider your child's age: Early intervention (birth to age 3) often includes both therapies through your state's Early Intervention program.
• Ask providers about their experience with children who have autism and how they collaborate with other therapists.
• Be patient - progress may be slow, but consistent therapy over months and years yields the best outcomes.
• Monitor your child's response: If one therapy seems to cause extreme distress, discuss adjustments with the provider.
• Use a free matching service to find vetted, BCBA-led providers who can guide you on sequencing therapies.

Common Mistakes to Avoid

• Assuming one therapy is 'better' than the other - they serve different purposes and often work best together.
• Delaying therapy while waiting for the 'perfect' order - starting either therapy is better than waiting.
• Not communicating between therapists - lack of coordination can lead to conflicting goals.
• Ignoring your child's unique profile - what worked for a friend's child may not work for yours.
• Overlooking the importance of parent training - both ABA and speech therapy should include coaching for parents to generalize skills at home.

How Get ABA Therapy Can Help

Get ABA Therapy is a free service that connects families with vetted, BCBA-led ABA providers in your area. We understand that choosing between ABA and speech therapy - or deciding the order - can be overwhelming. Our matching experts can discuss your child's needs, help you understand what to look for in a provider, and even check insurance coverage. We do not provide therapy ourselves, but we make the search for quality care easier. Whether you decide to start with ABA, speech therapy, or both, we can help you find a provider who will work collaboratively with other professionals to give your child the best start.