Occupational Therapy vs. Applied Behavior Analysis: Building the Full Picture
If your child was recently diagnosed with autism, your calendar probably looks like a jigsaw puzzle of specialist appointments. Two terms you will hear more than any others are Occupational Therapy (OT) and Applied Behavior Analysis (ABA).
At first glance, they can seem like they’re doing the same thing. Both therapists might be on the floor playing with your child, and both are working on "skills." However, they are looking at your child through two very different lenses.
At Tellos, we believe you shouldn't have to choose one over the other. Instead, you need to understand how these two disciplines combine to provide the most effective therapy for increasing functional skills in autism. While one builds the behavior, the other builds the physical and sensory capacity.
Here is the straightforward, tactical breakdown of the differences between OT and ABA, and how they team up to support your child’s independence.
The Fundamental Difference: "Why" vs. "How"
To simplify it for a busy parent:
ABA focuses on the Why of Behavior: ABA is rooted in the science of learning. It looks at what a child does and what happens in the environment to make that behavior happen again. It uses data to teach new social, communication, and learning skills by breaking them into small, manageable steps.
OT focuses on the How of Function: OT is rooted in biology and neurology. It looks at how a child’s body and brain process the world. It focuses on the physical, sensory, and motor skills needed to perform "the job of living"—things like getting dressed, writing, or staying calm when a room is too loud.
What Does ABA Target?
ABA is often the "architect" of learning. It builds the foundation of how a child interacts with others and follows routines. It assumes that if we can identify the motivation, we can teach the skill through reinforcement.
Communication: Learning to ask for a snack using words, signs, or a device instead of screaming.
Social Skills: Learning the "rules" of play—taking turns, responding to a name, or following instructions from a teacher.
Behavior Reduction: Using a Functional Behavior Assessment (FBA) to figure out what a child is trying to say through their actions and replacing meltdowns with better tools.
Academics: Breaking down "pre-learning" skills like matching, sorting, and sitting at a desk so the child is ready for a school environment.
What Does OT Target?
OT is the "specialist" for the physical and sensory experience. If ABA teaches a child to get dressed, OT teaches them the finger strength to pull the zipper and the sensory tolerance to handle the feel of the fabric against their skin.
Sensory Integration: Helping a child who is over-sensitive to lights or sounds (hypersensitive) or someone who needs extra movement to feel "grounded" (hyposensitive).
Fine Motor Skills: Improving hand and finger strength for handwriting, using a fork, or manipulating buttons.
Gross Motor Skills: Working on balance, coordination, and "proprioception"—knowing where your body is in space without looking.
Self-Regulation: Providing "heavy work" (like pushing a cart) or sensory breaks to help a child stay in a "calm-alert" state rather than being "revved up" or "shut down."
The Synergy: A Real-World Example
Let’s look at a common goal that causes stress in many households: Eating a Meal.
The ABA Role: The ABA therapist focuses on the routine. They work on the child staying in their seat, using a "First/Then" board (First three bites, then iPad), and rewarding the child for trying a new food. They handle the motivation.
The OT Role: The OT notices the child has "oral motor" issues—it’s actually hard for them to chew certain textures. They also notice the child is overwhelmed by the smell of the food or the sound of the clinking silverware. The OT provides specific tools, like a weighted lap pad or a special spoon, to make the physical act of eating possible.
Without ABA, the child might have the physical ability to eat but no motivation to stay at the table. Without OT, the child might want to stay at the table but find the sensory experience of the food physically painful or nauseating.
Why Collaboration is Your Secret Weapon
In the past, these two fields sometimes existed in silos. Today, we know that the most successful programs are collaborative. As a parent, you shouldn't feel like you are a "middleman" relaying messages between two different worlds.
When your ABA team and your OT team talk to each other, your child wins.
The OT can give the ABA therapist a "sensory diet" to use during sessions to keep the child focused.
The ABA therapist can use reinforcement techniques to help the child get through a difficult fine-motor task (like cutting with scissors) that the OT is teaching.
This synergy prevents your child from being overwhelmed. If the OT knows the child is working on a very difficult communication goal in ABA, they might make their OT session a bit more "low-demand" and sensory-focused that day to prevent a meltdown.
The Parent’s Perspective: Managing the Balance
It is completely normal to feel overwhelmed by the number of hours your child spends in therapy. Here are three tactical ways to keep the "jigsaw" from falling apart:
Shared Goals: Once every quarter, ask your OT and BCBA (from the ABA team) to jump on a 15-minute call. Make sure their goals aren't contradicting each other.
The "Skill vs. Will" Test: If your child isn't doing a task, ask yourself: Are they refusing? (ABA focus) or Are they struggling physically? (OT focus).
Home Integration: Don't try to be a therapist 24/7. Ask each provider for one simple thing you can do during your normal routine (like bath time or car rides) so that therapy doesn't feel like an extra chore.
Your Tactical Takeaway: The "Specialist" Gut Check
Not sure which one you need to prioritize right now? Use this quick check:
Is the environment the problem? If your child is constantly "on edge" because of sounds, smells, or the "feel" of their clothes, an OT evaluation is your first priority.
Is the interaction the problem? If your child is struggling to follow directions, communicate their needs, or play with peers, ABA will provide the most direct support.
The Bottom Line: ABA and OT aren't competitors; they are teammates. ABA provides the structure, the habit, and the communication tools, while OT provides the sensory and physical comfort. When both are in sync, your child doesn't just "behave"—they thrive in their own skin.
