The Real Difference Between ABA Therapy and Speech Therapy for Autism

When your child is diagnosed with autism, you are suddenly thrown into a world of therapies: ABA, speech, occupational therapy, physical therapy, feeding therapy. The alphabet soup is overwhelming, and everyone seems to recommend something different.

Many parents ask us: does my child need ABA or speech therapy? What is the difference? Will one cover what the other does?

These are smart questions, and the answers matter because therapy is expensive and time consuming. You want to invest in what will actually help your child.

What Speech Therapy Actually Does

Speech therapy, formally called speech language pathology, focuses on communication. Despite the name, it is not just about speaking. Speech language pathologists work on:

• Expressive language. Helping your child communicate their wants, needs, thoughts, and feelings. This could be through spoken words, sign language, picture exchange systems, or communication devices.
• Receptive language. Making sure your child understands what others say to them. Following directions, answering questions, understanding concepts.
• Articulation. The physical production of speech sounds. If your child says "wabbit" instead of "rabbit," that is an articulation issue. SLPs work on tongue placement, mouth movements, and sound production.
• Pragmatic language. The social use of language. Taking turns in conversation, staying on topic, understanding tone and body language.
• Feeding and swallowing. Many SLPs also address oral motor skills related to eating, especially if sensory issues or physical challenges affect feeding.

In a typical speech therapy session for an autistic child, you might see the SLP sitting at a table working on labeling pictures, practicing sentence structures, or using a communication device. Sessions usually last 30 to 60 minutes, often once or twice a week.

What ABA Therapy Actually Does

ABA therapy takes a broader approach. While communication is often a target, ABA addresses the whole range of skills an autistic child needs to function independently.

ABA therapists work on:

• Communication. Yes, just like speech therapy. But ABA focuses more on the function of communication rather than the form. An ABA therapist might not care if your child says "cookie" or signs it or points to a picture, as long as they are effectively communicating they want a cookie.
• Social skills. Playing with peers, making eye contact, responding to name, understanding emotions, making friends.
• Daily living skills. Getting dressed, brushing teeth, toileting, eating independently, following routines.
• Behavior reduction. Decreasing harmful behaviors like tantrums, aggression, self injury. ABA identifies why these behaviors happen and teaches replacement skills.
• Academic readiness. Sitting in a chair, following instructions, transitioning between activities, completing work.
• Play skills. How to play with toys functionally and imaginatively, how to engage with others during play.

ABA therapy is typically more intensive than speech therapy. Many kids receive 10 to 40 hours per week, often in the home. Sessions are longer and therapists work on multiple goals within each session.

Where They Overlap

Here is where it gets confusing. Both ABA and speech therapy can work on communication. So if both are addressing language, are you paying for the same thing twice?

Not quite. Here is the difference in approach:

Speech therapy tends to focus on the mechanics and structure of language. An SLP might work on expanding your child's sentence length from two words to three words. They might drill specific sounds until your child can produce them correctly.

ABA therapy focuses on the function and spontaneity of language. An ABA therapist teaches your child to request things they actually want in the moment, to protest things they do not like, to comment on their environment.

Think of it this way: an SLP teaches your child how to build grammatically correct sentences. An ABA therapist teaches your child when and why to use those sentences.

Both are valuable. They complement each other beautifully when the providers collaborate.

When Your Child Needs Speech Therapy

Your child will benefit most from speech therapy if:

They have significant articulation issues. If your child is talking but no one can understand them because their speech sounds are unclear, an SLP is essential. ABA therapists generally do not have specialized training in oral motor skills.

They need work on specific language structures. If your child needs to understand complex grammar, sentence formation, or language concepts like pronouns and verb tenses.

They have feeding or swallowing challenges. If your child is a picky eater due to oral motor difficulties, an SLP with feeding specialty can help.

They use or are learning an AAC device. Alternative and augmentative communication systems are often programmed and managed by SLPs.

When Your Child Needs ABA Therapy

Your child will benefit most from ABA therapy if:

They have significant behavioral challenges. If your child has frequent tantrums, aggression, self injury, or elopement, ABA is the gold standard treatment.

They are not yet communicating at all. If your child is completely nonverbal and is not attempting to communicate through any modality, ABA can establish the foundation.

They need intensive intervention. If your child has significant delays across multiple areas, the comprehensive nature of ABA addresses everything at once.

They lack play skills or social skills. ABA goes deeper into peer interaction, imaginative play, and real world social situations.

They are transitioning to school and need readiness skills. Following directions, sitting during circle time, transitioning between activities.

When Your Child Needs Both

Many kids with autism benefit from both ABA and speech therapy running concurrently. In fact, this is probably the most common scenario.

Your child receives 15 hours per week of ABA therapy at home. The ABA therapist works on requesting preferred items, following simple instructions, tolerating transitions, and reducing tantrum behaviors.

Twice a week, your child sees an SLP for 45 minute sessions. The SLP works on articulation so your child's words are clearer, expands sentence length, and practices conversation skills.

The ABA therapist and SLP communicate monthly. The SLP shares which words and sentence structures your child is learning. The ABA therapist makes sure to use those targets during natural play and daily routines.

Your child makes faster progress because the two therapies reinforce each other.

How to Coordinate Services

If your child is receiving both ABA and speech therapy, coordination is critical.

Insist that providers communicate. Ask your BCBA and SLP to schedule a meeting or phone call to share goals and strategies.

Share reports. When your SLP writes a progress report, give a copy to your ABA team and vice versa.

Use consistent language at home. If your SLP is teaching your child to request using the phrase "I want," use that same language during ABA sessions and at home.

Avoid conflicting goals. Sometimes providers unintentionally work on opposite things. Get everyone on the same page about expectations.

Does Insurance Cover Both

This depends on your insurance plan. Most Colorado insurance plans are required to cover ABA therapy for autism under state and federal mandates. Speech therapy is also typically covered, though sometimes with session limits.

If your child qualifies for both, insurance will generally pay for both as long as they are deemed medically necessary.

Medicaid covers both ABA and speech therapy for eligible children with autism, often with fewer limitations than private insurance.

If insurance is denying one or both, appeal. Many families in Colorado successfully appeal initial denials.

Making the Decision

Start with these steps:

Get a comprehensive evaluation. Before starting any therapy, have your child evaluated by professionals who can assess all areas of development.

Listen to professional recommendations. The evaluators will recommend specific therapies based on your child's profile.

Consider your child's primary needs. If your biggest challenge is behavior, prioritize ABA. If it is purely speech clarity with minimal other delays, maybe speech therapy alone is sufficient. If it is communication combined with behavior and social delays, you likely need both.

Start with what is available. Sometimes the decision is made for you based on provider availability and insurance approval.

Reassess regularly. Your child's needs will change over time. Stay flexible.

ABA therapy and speech therapy are not interchangeable. They are different approaches with different goals, though they overlap in communication. Many kids with autism need both. When coordinated well, they create a powerful intervention that addresses your child's needs from multiple angles.

The therapies you choose now lay the foundation for your child's future. Choose based on your child's individual profile, trust the professionals guiding you, and insist on coordination between providers.