OT and Applied Behavior Analysis Therapists: Collaborative Care

May 2nd, 2019 in  Allied Health
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OTs and ABA therapists share a lot of the same goals and even use similar techniques to treat patients. Working together can mean making huge strides!
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What is Applied Behavioral Analysis?

If you are working in a pediatric setting with children with autism, it’s likely that your clients also receive ABA therapy, or applied behavioral analysis. It has become the most recommended treatment for autism spectrum disorders (ASD) and has immense amounts of evidenced-based research to support it. ABA is based on the science of learning and behavior, aiming to execute meaningful changes in client behavior and is often a sought-after approach for health insurance companies, caregivers, and teachers as change is clearly tracked.

The behaviors being targeted are carefully and meticulously documented to observe the effectiveness or ineffectiveness of interventions used to produce the desired change. In other words, it’s really easy to see change through quick snapshots of graphs or charts.

ABA can be misconstrued as a process of teaching clients rigid, rote skills in a drill sergeant-like fashion, all while sitting at a desk at the child’s home or school. Although behavior therapists often use discrete trial training to initially teach a skill, the best behavior therapists know the importance of generalizing skills across environments and within natural settings. Because of this, behavior therapists work with their clients in a variety of settings to encourage the desired change across all environments.

“Having an OT and ABA therapist work well together is a beautiful thing for a client.”

For example, if a therapist is working on teaching a child to “wait,” without engaging in any negative behaviors, the therapist and child may work on discrete trial training with a child in the home first. While there, they may work on a task like waiting for up to 30 seconds for a preferred toy, multiple times in a row. Once waiting with positive coping skills is mastered in that setting, the therapist may work on the exact same skill (i.e. waiting) somewhere in the community, such as a park or store. After working with a single toy, the therapist can expand to working with the child on successfully waiting for their turn at a swing or slide. This way the therapist can ensure mastery of the skill throughout the child’s natural environments.

So, what discipline utilizes ABA? The answer is typically behavior therapists, meaning registered behavior technicians (RBTs) or board certified applied behavior analysts (BCBAs). Just as a COTA works under the supervision of an OTR, an RBT works under the supervision of a BCBA. There are far too many acronyms to throw around, so see below for the short and sweet breakdown of different behavior therapist roles along with their schooling requirements, credentials, etc.

BCBA, BCaBA, RBT, Oh MY!

BCBA (Board Certified Behavior Analyst)

  • Schooling
    • Graduate degree required
    • 1500 hours practicum supervision experience under a BCBA
    • Board Certified
  • Responsibilities
    • Evaluating clients
    • Creating behavior plans
    • Interpreting data collected on interventions
    • Measuring effectiveness of intervention strategies
    • Determine best-practice for data collection with respect to specific behavior being targeted
    • Supervise BCaBAs and RBTs

BCaBA (Board Certified Assistant Behavior Analyst)

  • Schooling
    • Undergraduate degree required
    • 1000 hours practicum experience supervised under a BCBA
    • Board certified
  • Responsibilities
    • Assist BCBA in data collection
    • Assist in administration of assessments under supervision of BCBA
    • Assist in interpretation of effectiveness of intervention strategies
    • Assist in creating individual behavior plans
    • Implement intervention strategies
    • Supervise RBTs
  • BCaBA may NOT practice independently; must be supervised by BCBA

RBT (Registered Behavior Technician)

  • Schooling
    • High school diploma or equivalent
    • 18 years or older
    • 40-hour training for certification
    • Competency assessment
  • Responsibilities
    • Direct treatment and implementation of services and behavior plans
    • Data collection

Advanced Behavioral Analysis and Occupational Therapy

It’s important to note that in OT school, you learn ABA principles and use them often, even if you don’t realize! Think about things like chaining, grading tasks, using different reinforcement strategies, and modifying environments. From my perspective as an OT, we are using the same principles and strategies, but we call them different things.

  • ABA and OT both:
    • Know the importance of individualized therapy and tend to utilize a holistic approach to analyzing a client
    • Value approaching intervention strategies using bottom-up approaches
    • Value teaching skills across environments to ensure generalization and promote natural teaching moments
    • Utilize task analysis to break down tasks, understand where the client’s break-down is, and how to grade a task up or down

Sensory Processing and Behavior

ABA therapists understand the importance of the client’s ability to process, understand, and respond to sensory feedback from the environment; however, OTs tend to have more extensive training and expertise in sensory processing and integration, resulting in the ability to correlate sense and behavior. ABA therapy can sometimes view a child’s behavior as black or white, occurring or not, while OT can sometimes place too much weight on the sensory integration component, thinking all behavior is due to sensory processing dysfunction.

The reality is, sensory processing plays a part in everyone’s behavior and behavior plays a part in everyone’s sensory experience. Here is an example of how a behavior may have started due to avoidance of sensory stimuli and became a learned behavior:

Initially, a child may engage in a negative behavior such as fleeing (elopement) because a particular sound in a noisy hallway is overstimulating. However, over time, and after repeating the same responses to walking in a noisy hallway, the elopement may become a learned behavior. The child may continue to engage in the behavior because they gain the attention of nearby adults.

Typically the relationship of the function to the behavior is not so clear cut. That is why it is so important to collaborate with behavior experts!

ABA and OT Collaboration

Let’s pretend we have a 4-year-old child with a diagnosis of moderate autism spectrum disorder. This child’s parents report she has difficulty sustaining attention and that she presents with impulsivity, along with speech and fine motor delays. The short-term goal for this scenario is to get the child to complete a four piece, interlocking puzzle independently.

I’m going to give a few examples of techniques an OT may use to treat this child and examples of techniques that an ABA therapist may use in treating this child with the same short-term goal of completing the interlocking puzzle. We will keep these intervention strategies strictly in OT principles for the OT and ABA principles for the behavior therapist.

OT

  • Sensory integration strategies to
    • Encourage motor planning and motor control
    • Provide preparatory sensory integration and sensorimotor activities (i.e. heavy work, vestibular feedback activities on dynamic and/or suspended equipment)
  • Build upper extremity stability
  • Hand strengthening exercises
  • Oculomotor control activities
  • Environmental modifications
    • Provide visual supports
    • Explore dynamic seating or increased postural support seating options to support body awareness for attention
    • Modify child’s environment

ABA

  • Errorless learning techniques (i.e. hand over hand prompting)
  • Discrete trial training (i.e. rote, rigid repetitive teaching)
  • Token economy
  • Positive reinforcement strategies
  • Visual supports

As you can see, many of these methods can overlap from OT to ABA and vice versa. An ABA therapist could easily incorporate some SI strategies into their treatment session with the guidance of an OT, and an OT can easily pull in some positive reinforcement strategies or implement a behavior intervention plan with some guidance from an ABA therapist!

Having an OT and ABA therapist work well together is a beautiful thing for a client. ABA therapists are masters of understanding behavior and creating positive change in a person’s behavior. OTs play a vital role in setting the client up to be ready for that change through sensory integration. We also have expertise in understanding the motor functioning required for ADLs and the academic skills that may be a cause of some negative behaviors.

Collaboration doesn't have to start or end with ABAs! Check out our tips for making the most of working with a PT partner!

I like to think that OTs are working from the ground up and strengthening the child’s foundational neurological processes. We are there to assist the child so that they are comfortable and ready to cope with and respond to change. It is vital for us as OTs to advocate for our clients’ sensory processing needs and provide information regarding how a child may be interpreting the world around them.

This will help their behavior therapists understand what the child may be experiencing and why some of their behaviors may be presenting as they are. With that said, sensory processing is not always the function of all behavior all of the time. Behavior is complex, and there are many components to every individual's behaviors, and the best way to improve the function of your clients and understand those differences is to collaborate with your colleagues! Cheers to collaboration!


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