When a child is diagnosed with autism, two recommendations usually arrive together: speech therapy and ABA therapy. They come with different providers, different paperwork, very different weekly hour counts, and sometimes different waitlists. Most parents end up asking the same things. Which one does my child need? Is one a substitute for the other? Can we do both without taking over our whole week?
Here is how the two differ, where they overlap, what the research actually shows, and how to decide what fits your child.
One note up front: Bloom is a speech therapy practice, and we do not provide ABA. That is why this guide leans on outside sources for both sides of the comparison and links to them so you can read them yourself.
The Short Answer
Speech therapy is provided by a speech-language pathologist (SLP) and focuses on communication: understanding language, using words or other ways to communicate, social communication, and speech clarity.
ABA therapy (applied behavior analysis) is overseen by a behavior analyst and uses the science of behavior, mainly positive reinforcement, to teach new skills and reduce behaviors that get in the way of daily life.
The CDC's overview of autism treatment puts the two in different categories. It groups speech and language therapy with developmental approaches and ABA with behavioral approaches, and it notes that "developmental approaches are often combined with behavioral approaches." For many families the real question is not which one to pick. It is how the two will fit together.
What Speech Therapy Does for Autistic Children
ASHA's clinical guidance on autism states that speech-language pathologists "play a central role in the screening, assessment, diagnosis, and treatment of persons with autism spectrum disorder." In practice, an SLP working with an autistic child may target:
- Social communication: joint attention, taking turns, starting and keeping up a conversation
- Expressive language: requesting, protesting, commenting, and combining words into sentences
- Receptive language: understanding questions, directions, and figurative language
- Speech clarity: speech sound errors or motor speech difficulties such as childhood apraxia of speech
- AAC (augmentative and alternative communication): picture systems or speech-generating devices for children who are nonspeaking or minimally speaking
Sessions are usually play-based and built around the child's interests, and good therapy spends real time coaching parents so new skills show up at home. Our guide to speech therapy for autism covers each of these areas in more depth.
What ABA Therapy Is
The Behavior Analyst Certification Board (BACB) describes behavior analysis as "the science of behavior." It explains that ABA techniques "generally involve teaching individuals more effective ways of behaving through positive reinforcement and working to change the social consequences of existing behavior."
ABA programs usually involve two levels of staff:
- Board Certified Behavior Analyst (BCBA): a graduate-level certification. BCBAs assess the child, write the treatment plan, and supervise other staff.
- Registered Behavior Technician (RBT): a paraprofessional certification. RBTs often deliver the day-to-day sessions and, according to the BACB, practice "under the direction and close supervision" of a supervisor who is responsible for their work.
ABA goals can include communication, play, self-care, daily routines, and reducing behaviors that cause harm. Methods range from structured teaching, such as discrete trial training with repeated, step-by-step instruction, to approaches embedded in natural settings.
ABA is also known for its intensity. Early intensive behavioral intervention (EIBI), the most studied form of ABA for young children, is described in a 2018 Cochrane review as "delivered for multiple years at an intensity of 20 to 40 hours per week."
How the Two Differ
- Who provides it. Speech therapy comes from a licensed SLP, usually with the CCC-SLP from ASHA. ABA is designed by a BCBA and often delivered by RBTs.
- The core question. An SLP asks how does this child understand and share meaning? A behavior analyst asks what happens before and after this behavior, and how can we teach a more effective one?
- Scope. Speech therapy stays centered on communication, plus feeding and swallowing. ABA can address almost any skill or behavior, including communication.
- Intensity. Speech therapy is usually scheduled as shorter sessions, often weekly, with home practice in between. Comprehensive ABA programs can run many hours a week.
- Setting. Both can take place in a clinic, at home, or at school, and speech therapy can also be delivered by telehealth.
Where They Overlap
Communication is the shared ground, and it is where families most often run into trouble.
Many ABA programs teach communication skills such as requesting, and some of the same tools show up on both sides. The National Clearinghouse on Autism Evidence and Practice reviewed studies published from 1990 to 2017 and identified 28 evidence-based practices for autistic children and youth. The list includes practices associated with behavioral work, such as discrete trial training and reinforcement, alongside practices central to speech-language work, such as AAC and naturalistic intervention. Neither field owns every tool.
The problem comes when two teams pull in different directions. One team introduces a speech-generating device while the other requires spoken words before a child gets what they asked for. Or one therapist honors a gesture as communication while another ignores it. A child caught between the two learns that communication works in one room and not the next.
The fix is coordination, and ASHA supports it directly: its autism guidance notes that "SLPs might collaborate with Board Certified Behavioral Analysts to maximize resources and promote optimal outcomes."
What the Research Shows
Methods based on ABA have been researched for more than 50 years, as a 2022 paper in the Journal of Autism and Developmental Disorders points out. When systematic reviewers grade the strongest of that research, though, the picture is more measured.
The 2018 Cochrane review of early intensive behavioral intervention found five studies with 219 children, only one of which was a randomized controlled trial. It reported gains in adaptive behavior, IQ, and expressive and receptive language compared with usual services. It rated the evidence as low or very low quality, and it concluded that there is "weak evidence that EIBI may be an effective behavioral treatment for some children with ASD."
That does not mean ABA does not work. It means the strongest studies are small, and results vary from child to child. Autism intervention research in general, speech-language approaches included, relies heavily on small studies, which is why reviews like the National Clearinghouse report pool many of them. The honest takeaway is that no single approach has earned the right to be the default for every autistic child. The plan should come from an evaluation of your child.
The Concerns Parents Hear About ABA
If you have spent time in online autism communities, you have probably seen strong criticism of ABA. You deserve a fair summary rather than a sales pitch from either side.
The 2022 paper mentioned above, by Leaf and colleagues (Journal of Autism and Developmental Disorders 52(6):2838-2853), set out to examine these concerns. Its authors included behavior analysts, parents, and autistic individuals. It described the criticism raised by autism rights and neurodiversity advocates as including "discontent with historical events and possible harm from the procedures and goals targeted." The paper itself comes largely from within the ABA field and recommends ways to move the practice forward.
ASHA's position on speech therapy speaks to the same issue. Its guidance says the goal of intervention is "to promote positive outcomes—not to force people with ASD to mask their autistic traits or to lose their identity."
Whichever services you choose, the same questions sort good providers from poor ones:
- What specific goals will you target, and who helped choose them?
- Will you try to reduce behaviors that are harmless, like stimming or hand flapping? Why?
- How do you respond when my child is upset or refuses?
- How will my child's current way of communicating, whether words, signs, gestures, or a device, be respected?
- How involved will I be, and how will we measure progress?
Speech Therapy, ABA, or Both?
Start with what is actually getting in the way of your child's daily life.
Lean toward a speech-language evaluation first if the main concern is communication. That includes few or no words, speech that is hard to understand, trouble following directions, difficulty with back-and-forth interaction, or a child who is frustrated because they cannot get their message across. Our guide to the signs your child may need speech therapy can help you sort this out.
Lean toward a behavior analyst consultation first if the main concern is behavior that affects safety or daily functioning. Examples include self-injury, aggression, running away, or serious difficulty with routines like toileting and sleep.
Consider both if your child has significant needs in both areas, which is common. If you do both, protect your child's week. A three-year-old also needs unstructured play, rest, and family time. Ask each provider how their recommended hours were chosen.
Making Both Work Together
If your child sees an SLP and an ABA team, a few habits make a big difference:
- Share reports. Give each provider the other's evaluation and treatment plan.
- Sign releases. A signed consent lets the therapists talk directly instead of relaying messages through you.
- Use one communication system. Whatever your child uses to communicate should go with them to every session and be used the same way.
- Align goals. If speech therapy is working on two-word requests, the ABA team should know that and build on it.
- Keep asking what is working. Plans should change as your child grows.
The two services are usually billed by different providers, and coverage varies by plan, so verify benefits for each one. Our insurance coverage guide walks through the questions to ask your plan.
Where Bloom Fits In
Bloom provides speech-language therapy, not ABA. Every child works directly with Laura Friedman, MS, CCC-SLP, QOM, a certified speech-language pathologist with more than 15 years of experience whose specialties include autism spectrum disorders, motor speech disorders, and language impairments. Sessions are available in person in Dallas and through online speech therapy nationwide.
If your child already has a behavior analyst, bring their current goals to the evaluation so communication targets can line up with what the rest of the team is doing. You can see the full range of speech therapy services, including speech therapy for children. And if you are also sorting out a sensory or motor referral, our comparison of speech therapy vs. occupational therapy covers that boundary.
Frequently Asked Questions
What is the difference between speech therapy and ABA therapy?
Speech therapy is provided by a speech-language pathologist and focuses on communication: understanding and using language, social communication, speech clarity, and alternative ways to communicate such as AAC. ABA is overseen by a Board Certified Behavior Analyst and uses the science of behavior, mainly positive reinforcement, to teach new skills and change behaviors that get in the way of daily life.
Is ABA therapy the same as speech therapy for autism?
No. They are separate professions with separate credentials. ABA programs frequently include communication goals, but that does not make them speech therapy. A speech-language pathologist holds a master's degree, a state license, and usually the CCC-SLP from ASHA, while ABA programs are designed and supervised by a BCBA.
Does my autistic child need speech therapy or ABA?
It depends on what is getting in the way. If the main concern is communication, start with a speech-language evaluation. If the main concern is behavior that affects safety or daily routines, a consultation with a behavior analyst may come first. Many children benefit from both.
Can a child do speech therapy and ABA at the same time?
Yes, and many autistic children do. It works best when both teams share reports, talk directly, and use the same communication system with the child.
Why is ABA therapy controversial?
Some autistic adults and neurodiversity advocates have criticized ABA's history and programs that targeted harmless autistic traits or pushed compliance. Supporters point to decades of research on ABA-based methods. Whatever you choose, ask any provider what goals they will target, who chose them, and how they respond when your child is distressed.
How many hours a week is ABA compared to speech therapy?
It varies widely. Early intensive behavioral intervention is described in the research as 20 to 40 hours per week over multiple years, while speech therapy is typically shorter sessions paired with parent coaching. Your child's plan should come from an evaluation, not a default number.
Not Sure Where to Start?
You do not need to have the whole plan figured out before you call. Schedule a free consultation with Laura Friedman to talk through your child's communication, in person in Dallas or online from anywhere in the country. If what you describe points to a need outside speech-language pathology, you will hear that too.