ABA vs Occupational Therapy for Autism: What Parents Really Need to Know

1. The Real Question You're Asking

When parents ask me "ABA or OT?", what they're really asking is: "Which therapy will help my child be happier, more independent, and less overwhelmed by the world?"

They're asking because their child is struggling. Maybe they're non-speaking and frustrated because they can't communicate their needs. Maybe they're melting down every time you try to leave the house because the world is too loud, too bright, too much. Maybe they're seven years old and still can't button their shirt or use the bathroom independently.

The question isn't really "which one is better." The question is "what does my child need right now, and which approach addresses those specific needs?"

What This Article Won't Do

I'm not going to tell you one therapy is superior to the other. I'm not going to claim that every autistic child needs the same intervention. And I'm definitely not going to pretend these decisions are simple.

What I will do is help you understand what each therapy actually does, how they're different, and how to think through which approach — or combination of approaches — might support your child's growth and wellbeing.

2. What ABA Actually Is (Beyond the Basics)

Applied Behavior Analysis is the most researched intervention for autism, but it's also widely misunderstood — sometimes because providers explain it poorly, sometimes because the field has changed dramatically over the decades.

The Core Philosophy

ABA is based on learning theory: how behaviors are learned, maintained, and changed through interactions with the environment. The fundamental premise is that all behavior serves a function — it gets us something we want or helps us avoid something we don't want.

In ABA therapy, a Board Certified Behavior Analyst (BCBA) identifies what behaviors are getting in the way of your child's learning and independence, figures out why those behaviors are happening, and designs interventions to teach alternative, more effective behaviors.

What ABA Typically Targets

• Communication skills: Teaching requesting, labeling, answering questions, conversation skills — particularly for children with limited or no verbal language
• Social skills: Turn-taking, joint attention, responding to name, understanding social cues, peer interaction
• Daily living skills: Getting dressed, toileting, eating independently, brushing teeth, following routines
• Behavior reduction: Decreasing behaviors that are harmful or significantly interfere with learning — like aggression, self-injury, elopement (wandering)
• Academic skills: Pre-reading skills, counting, following instructions, classroom participation

How It Actually Works

Modern ABA should be play-based and naturalistic, not just table-top drills. A therapist might work on requesting by playing with your child's favorite toys — waiting for them to indicate they want the toy (however they can communicate that), immediately giving them the toy as reinforcement, and gradually building more complex communication.

The "data-driven" aspect means therapists track everything: how many times did Marcus request a toy? How many times did he melt down today versus last week? Is this approach working, or do we need to try something different?

The Time Commitment Reality

This is important to understand upfront: comprehensive ABA typically involves 20-40 hours per week. That's more than a full-time job for your child. Focused ABA (targeting specific skills) might be 10-20 hours weekly.

This is a massive commitment. It affects your entire family's schedule. Be honest with yourself about whether this is sustainable for your life right now.

3. What Occupational Therapy Actually Is

Occupational therapy is less specific to autism — it's used for many conditions including cerebral palsy, developmental delays, ADHD, and physical disabilities. But for autistic children, OT addresses some of the most challenging aspects of daily life.

The Core Philosophy

OT focuses on the "occupations" of childhood — the activities that fill a child's day and are essential for development. This includes play, self-care, school participation, and social interaction. The goal is to remove barriers that prevent a child from participating in these activities independently.

For autistic children, OT primarily addresses sensory processing differences — the way their brains receive, organize, and respond to sensory information from their environment and their own body.

What OT Typically Targets

• Sensory processing: Helping children tolerate (or seek out) sensory experiences — textures, sounds, lights, movement, body awareness
• Fine motor skills: Handwriting, using utensils, buttoning shirts, tying shoes, manipulating small objects
• Gross motor skills: Balance, coordination, body awareness in space, strength for daily activities
• Self-regulation: Teaching the body how to shift between alertness levels — calming down when overstimulated, waking up when under-stimulated
• Daily living skills: Getting dressed, grooming, eating (especially for picky eaters), organizing belongings
• Executive functioning: Planning, organization, time management, transitioning between activities

How It Actually Works

OT sessions often look like structured play. Your child might swing, crash into mats, play in sand or water, manipulate playdough, complete obstacle courses, or practice getting dressed using adaptive equipment.

The occupational therapist is carefully designing these activities to provide specific sensory input that helps organize your child's nervous system. When a child is crashing into crash pads, they're getting proprioceptive input (deep pressure to joints and muscles) that many autistic children find calming and organizing.

The Sensory Integration Approach

This is OT's signature contribution to autism intervention. Up to 70% of autistic children struggle with sensory processing. They might:

• Cover their ears at sounds others barely notice
• Refuse to wear certain clothing because it "hurts"
• Seek deep pressure constantly — crashing, squeezing, jumping
• Avoid getting messy at all costs — or seek messy play obsessively
• Have no awareness of where their body is in space, bumping into things constantly

OT helps children's nervous systems process this sensory information more efficiently, reducing overwhelm and meltdowns.

The Time Commitment Reality

OT typically involves 30-60 minute sessions, usually 1-3 times per week. This is significantly less intensive than ABA. Many families find OT more sustainable long-term because of the lighter schedule.

4. The Key Differences That Actually Matter

Let's cut through the jargon and look at what really distinguishes these approaches:

The Philosophical Difference

Here's something deeper that matters: ABA fundamentally asks "How can we change the child's behavior to be more adaptive?" OT asks "How can we help the child's body and nervous system work better so daily activities become possible?"

Neither question is wrong. They're just different entry points. Sometimes you need both.

5. The Sensory Processing Piece Nobody Explains Well

This deserves its own section because sensory processing differences are at the root of so many autism challenges, and they're often invisible to people who don't experience them.

What Sensory Processing Actually Means

Your child's brain is constantly receiving information from eight different sensory systems (not just the five we learned in school). For autistic children, this information often comes in too loud, too soft, too jumbled, or completely disconnected.

The eight sensory systems are:

• Visual: What we see — lights, colors, movement, patterns
• Auditory: What we hear — volume, pitch, overlapping sounds
• Tactile: Touch, texture, temperature, pressure on skin
• Gustatory: Taste — flavors, food textures
• Olfactory: Smell — strong or subtle odors
• Vestibular: Balance, movement through space, head position
• Proprioceptive: Body awareness — where your body is, how much force you're using, position of joints
• Interoceptive: Internal body signals — hunger, thirst, need for bathroom, emotions, pain

When these systems aren't processing information efficiently, everything becomes harder. A child might not be "being defiant" during circle time — they might be in physical pain from the fluorescent lights and overwhelmed by 20 voices talking at once.

Why This Matters for Therapy Choice

If your child's primary challenges stem from sensory processing differences, occupational therapy is specifically designed to address this. Sensory integration therapy (a specialized approach within OT) helps organize the nervous system so your child can tolerate and respond to sensory input more effectively.

ABA can teach coping strategies and alternative behaviors when sensory overload happens, but it doesn't directly address the underlying sensory processing challenges. That's OT's wheelhouse.

Signs Your Child Might Need OT for Sensory Issues

• Extreme reactions to sounds, lights, textures that others don't notice
• Constantly seeking or avoiding movement (spinning, climbing, refusing playground)
• Very picky eating related to textures, not just taste
• Difficulty with clothing — tags, seams, certain fabrics cause distress
• Frequently bumping into things, unaware of where their body is
• Difficulty transitioning between activities or environments
• Meltdowns that seem to come from "nowhere" (often sensory overload)
• Difficulty sitting still (may need movement input to focus)
• Doesn't seem to notice pain, temperature, or hunger

Research shows that sensory integration therapy produces significant improvements in sensory processing, social skills, adaptive behavior, and motor skills. For many autistic children, addressing sensory challenges is the foundation that makes other learning possible.

6. Which Therapy for Which Challenges?

Let's get practical. Based on what your child is struggling with right now, here's how to think about which approach might help:

Consider ABA If Your Child:

• Is non-speaking or has very limited language and needs systematic communication teaching
• Engages in dangerous behaviors like aggression, self-injury, or elopement that require intensive intervention
• Has significant skill deficits in multiple areas that need structured, step-by-step teaching
• Needs intensive support building foundational skills like attending, imitating, following instructions
• Would benefit from systematic social skills training with clear instruction and practice
• Requires behavior support that follows functional assessment and data-driven intervention

Consider OT If Your Child:

• Has sensory sensitivities or seeking behaviors that interfere with daily activities
• Struggles with fine motor tasks like handwriting, using utensils, buttoning, zipping
• Has difficulty with body awareness — clumsy, bumps into things, doesn't understand where their body is in space
• Can't regulate their alertness level — either constantly revved up or frequently lethargic
• Has extreme picky eating related to textures and sensory experiences
• Struggles with transitions and environmental changes
• Has difficulty with self-care skills despite having the cognitive ability — the physical/sensory aspects are the barrier

Consider Both If Your Child:

• Has significant needs in both areas — communication/behavior AND sensory/motor
• Needs skill building (ABA) but can't focus or engage until sensory needs are met (OT)
• Would benefit from the intensive hours of ABA but also has underlying sensory processing challenges
• Is showing limited progress in one therapy alone

7. When ABA and OT Work Together (And Why That's Often Ideal)

Here's something that might surprise you: research shows that ABA and occupational therapy are not only compatible — they can work synergistically to produce better outcomes than either approach alone.

How They Complement Each Other

Think of OT as preparing the foundation and ABA as building the house. OT helps your child's nervous system organize itself so they can be available for learning. ABA then teaches specific skills in a systematic way once your child is regulated enough to engage.

Specific examples of synergy:

• Communication: OT addresses oral motor skills and sensory issues affecting eating/speaking. ABA teaches the communication system (verbal language, pictures, AAC device) systematically
• Mealtime: OT works on tolerating different food textures and using utensils. ABA teaches the behavioral routine of sitting at table, taking bites, and expanding food variety
• Getting dressed: OT builds motor planning and addresses clothing sensitivities. ABA teaches the step-by-step sequence and builds independence
• School participation: OT creates sensory strategies for sitting at desk and handling classroom stimuli. ABA teaches task completion, following directions, and social skills

What Coordinated Care Looks Like

When therapies are truly coordinated, the OT and BCBA:

• Share assessment information and jointly identify priorities
• Communicate regularly about the child's progress and challenges
• Design complementary interventions that support each other's goals
• Sometimes observe each other's sessions to understand the full picture
• Work together on goals that span both disciplines (like self-care skills)

In practice, this coordination doesn't always happen automatically. You may need to facilitate it — sharing progress notes between providers, scheduling joint meetings, or explicitly asking them to coordinate.

The Research Support

Studies on combined approaches show:

• Children receiving both ABA and OT showed more improvement than those receiving either therapy alone
• Sensory integration therapy improved children's ability to participate in and benefit from ABA
• Interprofessional coaching between ABA and OT clinicians improved both therapists' effectiveness
• Combined approaches led to better outcomes in communication, social skills, and adaptive behavior

The evidence is clear: for many children, an integrated approach works best.

8. Making the Decision That's Right for Your Family

Understanding the differences is one thing. Actually making a decision is another. Here's how to think this through:

Start With Your Child's Most Pressing Needs

Don't try to address everything at once. What is making life hardest for your child right now?

• If they're non-speaking and desperate to communicate, communication is your priority
• If they're in sensory distress multiple times daily, sensory regulation is your priority
• If dangerous behaviors are happening, safety is your priority
• If they can't participate in basic daily activities, functional skills are your priority

Let the most urgent need guide your initial therapy choice. You can always add or switch later.

Consider Your Family's Capacity

Be honest about what your family can actually sustain:

• Can you accommodate 20-40 hours of weekly therapy in your home or schedule?
• Do you have transportation to get to clinic appointments 2-3 times weekly?
• How do therapy schedules affect siblings, work, and family time?
• What's your stress capacity for managing multiple providers and schedules?

An "ideal" therapy plan that causes family breakdown isn't actually ideal. Better to start with what's sustainable.

Try, Assess, Adjust

You don't have to get it perfect from the start. Choose an approach, give it a genuine trial (usually 3-6 months), and honestly assess whether it's helping. Ask yourself:

• Is my child making meaningful progress toward goals that matter for their life?
• Does my child seem more comfortable, happier, more capable?
• Are challenging behaviors decreasing?
• Is my child more able to participate in family and community activities?
• Is this approach respecting my child's dignity and individual experience?

If the answer to these questions is no, don't be afraid to make changes — different provider, different approach, different intensity.

Questions to Ask Providers

When evaluating therapists, ask:

• "What does progress look like in your therapy, and how will we measure it?"
• "How do you involve parents in the therapy process?"
• "Do you collaborate with other providers working with my child?"
• "What happens if an approach isn't working — how do you adjust?"
• "How do you ensure my child's comfort and emotional wellbeing during sessions?"
• "Can you show me examples of how you'd work on [specific challenge your child faces]?"

Good therapists welcome these questions. If someone becomes defensive or dismissive, that's information.

Trust Your Instincts

I can't emphasize this enough: you know your child better than any professional. If something feels wrong — even if the therapist has credentials and uses evidence-based practices — trust that feeling. Your child's wellbeing matters more than any protocol.

9. How Achieving Stars Therapy Fits Into Your Options

Let me be transparent about how Achieving Stars Therapy positions itself in this landscape, and when it might be a good fit for your family.

What Achieving Stars Offers

Achieving Stars specializes in in-home ABA therapy with full Medicaid coverage throughout Colorado and New Hampshire. Their model specifically addresses several barriers families commonly face:

• Wait times: Most families start services within 2-4 weeks rather than waiting 3-6 months
• Insurance complexity: Their intake team handles 100% of Medicaid paperwork and authorization
• In-home model: Eliminates transportation barriers and allows learning in the natural environment
• BCBA involvement: Every client gets personalized assessment and ongoing BCBA supervision
• Evidence-based approach: Combines Natural Environment Teaching with structured methods, heavy data collection

When Achieving Stars Makes Sense

Consider Achieving Stars if:

• Your child needs intensive ABA intervention (they specialize in this specifically)
• You have Medicaid coverage and want someone to handle the authorization complexity
• In-home services work better for your family than clinic-based therapy
• You need to start services quickly rather than waiting months
• You want a provider that serves all of Colorado/New Hampshire (useful if you might relocate)

What Achieving Stars Doesn't Provide

To be clear about what they don't do:

• They don't provide occupational therapy (they're ABA-specific)
• They don't offer center-based therapy with sensory gyms
• They focus on ABA intervention, not other therapy modalities

This means if your child's primary needs are sensory-related, you'd still need to arrange OT separately. Many families use Achieving Stars for ABA and work with occupational therapists through their school or private practice.

The Combined Approach Option

Here's a common scenario: A family chooses Achieving Stars for in-home ABA therapy because their child needs intensive communication and behavior support. They also arrange 1-2 hours weekly of occupational therapy through:

• School-based OT services (through the child's IEP)
• Private OT clinic for sensory integration therapy
• Outpatient OT at children's hospital or therapy center

This combination gives them the intensive ABA their child needs plus the sensory support that makes the ABA more effective. The key is making sure both providers know about each other and ideally coordinate their approaches.

Questions to Ask Achieving Stars Specifically

If you're considering them, ask:

• "My child also has significant sensory processing challenges. How does your ABA approach address this?"
• "Do you coordinate with occupational therapists? What does that look like?"
• "Can you accommodate a sensory diet or sensory breaks during ABA sessions?"
• "What's your approach to working with children who have high sensory needs?"
• "How flexible is the therapy if we decide to add OT services?"

A quality ABA provider should be able to incorporate sensory strategies and work collaboratively with OTs, even if they don't provide OT services directly.

Final Thoughts: There's No Single Right Answer

If you've read this whole article hoping I'd just tell you "do ABA" or "do OT," I'm sorry to disappoint. But the truth is more nuanced and more hopeful than a simple answer would be.

The truth is: your child is unique, their challenges are unique, and the right therapeutic approach for them might look different from what works for someone else's child.

What I Want You to Remember

Both ABA and OT can help autistic children develop skills and independence. Neither is inherently superior. They address different challenges through different methodologies. Many children benefit from both, either simultaneously or at different developmental stages.

Your child's sensory experience matters enormously. If sensory processing is at the root of their struggles, OT should be part of the picture. You can't just behaviorally train a child out of genuine sensory distress.

Progress matters more than protocol. If a therapy isn't producing meaningful improvements in your child's life after a reasonable trial period, it's okay to change course. Don't stay committed to something that isn't working just because "this is the evidence-based treatment."

You can say no. To goals that don't matter to your family. To therapy intensities that break your family. To approaches that distress your child. You're the parent, and you get to make these calls.

You can say yes to trying something. You don't need to have everything figured out before you start. Pick one thing, try it, learn from it, adjust. Progress isn't linear, and neither is the process of finding what works.

The Questions That Matter Most

As you're making these decisions, keep coming back to these questions:

• What is making life hardest for my child right now?
• Which therapy approach directly addresses that challenge?
• Is my child showing signs of genuine progress and increased wellbeing?
• Are we respecting who my child is while supporting who they're becoming?
• Is this sustainable for our family?

Let these questions guide you more than any expert opinion or therapy marketing.

You're Not Alone in This

Thousands of parents have stood exactly where you're standing right now — overwhelmed by options, scared of making the wrong choice, desperate to help their child thrive. Most of them figured it out through trial and error, course corrections, and trusting their knowledge of their own child.

You'll figure it out too. Not perfectly. Not all at once. But you'll find what works for your child, adjust when it stops working, and keep advocating for what they need.

Your child is lucky to have you — someone who cares enough to research, question, and make thoughtful choices about their support. That matters more than choosing the "perfect" therapy.