This blog post is inspired by an all too familiar discussion in online groups, parent support groups, and conversations within homes worldwide.  The discussions that lead to decisions typically involve one of these phrases

“I think I’m going to let go of speech and increase ABA.  ABA can target social skills.”

“I think I need him in a social group because ABA is not improving the social skills.”

“I need him to have more hours in ABA to target social skills and language.  All speech works with is articulation and phonology.”
I must admit that I cringe when I read or overhear such discussions.  I cringe because I want the general popoulation to understand what a speech-language pathologist really does.  I cringe because I want the general populatino to understand that Language is Listening, Speaking, Reading, Writing, and Pragmatic (social).  I cringe because I want the general population to understand what ABA Therapists traditionally know and do not know.  So instead of writing this information to the listserve, I am blogging in an effort to reach and teach.

1. Speech-Language Pathologists have training in evaluating, diagnosing, and treating speech and language disorders.  Language encompasses the ability to speak from a speech sound-coordination perspective (articulation) as well as language of communication (sentences, vocabulary, social communication, nonverbal communication).

2. Not all professionals are the same.  It is true that all SLPs do not work with or desire to work with certain disorders.  Our profession is wide spread in terms of specialties.  General population or consumers must do their due diligennce in finding an SLP who has a speciality in autism in terms of Applied Behavior Analysis and social communication.  These two approaches can work very well within and complement the ABA program.  By just working with an SLP who only specializes in oral motor, articulation, etc. the disservice is that a narrow approach to treat a whole disorder does not move progressively nor does it empower.  It’s like trying to see the world through a keyhole….now you get the picture 🙂

3. ABA Therapist’s have a great method of collecting data, analyzing data, and it is a true evidenced based approach to treatment.  Still, they should not be working alone.  Autism is a language based disorder.  The foundation of the lead therapist or a key therapist on your child’s team shoudl be an SLP who gets it. One who knows the progression of language, understands behavior as a function of communication, can use behavior principles to shape language albeit social, vocabulary, receptive, or expressive.  The ABA Therapist needs guidance and consulation on what to shape, when to shape, and what those expectations should be.  The program should not be separate but together.

4. Cost wise.  Speech by the hour is more expensive in comparison to the hour of ABA.  But it will all add up eventually.  Cost effectiveness should be based on the program, the results, and the progress.  Yes you can get two hours of ABA for the cost of one hour of speech therapy.  But, the move to adding more should be based upon programming.  When decisions are based upon programming, it moves the decision making to be based on the vision, the data, and the goal toward making the client more independent.

Often times when I overhear or read about the decision to add more of something, take away something else; I always inwardly ask

1. Did the parent make clear their expectations for treatment?

2. As consumers of the general population, does this family understand the components and contributions of each member of the team?

3. Did the questions to therapists’ move beyond the basic requirements of credentials, into higher or more meaningful conversations about treatment paradigm, philosophy, data from single case studies of treatment?

So to the parent who simply stated “I’m getting rid of my SLP to add more ABA to work on social skills…any thoughts?”  My thoughts are simply Did you choose the right team from the beginning?

Having Crucial and Critical Conversations are essential in a treatment program.  After working with many families for over 10 years, I know that not addressing the elephant in the room will just consume the treatment space.  Being an SLP who loves ABA (BCBA cometh soon) and sees the value of ABA, I know that great programming will give parents answers to the unanswered questions and simultaneously Empower and Make our Clients Better.

After all…our clients should benefit from having known us.  It is our job to make them better.  When parents don’t see better happening…they should move on with better questions for the next team.