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In my experience, ABA is necessary for some families, although it might not always be for the best reasons. It is often used as respite for families instead of a partnership. Often, ABA technicians are not fully trained, as in many states, it is a certificate that will encompass 20-0 hours of training in total. Think about that...

This is not the technician's fault; it is the system.*

Insurance reimburses ABA at a higher rate and allows for increased time. As a caregiver, why would a person not choose ABA over other services? Often, ABA will come to the home or have a "drop off" program.

With that said, I have worked with families who see ABA as extremely valuable, and it works for them---consider cultural expectations! While completing this Padlet, I implore you to consider culture, family dynamics, time constraints in American culture, and how ABA impacts the client long-term.

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While in undergrad I was placed in a practicum (for a psychology course) providing ABA, in-home, for an autistic child. I was trained and worked under the direction of a BCBA. Following the practicum, the family privately hired me to continue to provide services for their child in the home, which grew into providing respite care as well. Then, I started OT school... I continued to work with the family while in grad school and my ABA interventions drastically shifted. I found myself incorporating sensory input into my sessions, adaptive strategies for fine motor skills, community outings and working on social skills- with the approval of the BCBA and enthusiasm of the family. This is where I saw a huge shift in trust, engagement, and functional skill acquisition. OT school provided a paradigm shift for me, looking holistically at the child and my approach to my interventions and time spent with him. Reflecting on this time in my budding career, there are also many things now that I would shift and do differently as a more experienced OT.

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I have no previous experience with ABA therapy, so it was interesting for me to read the differences in opinions across the shared articles. Welch and Polatojko (2016) emphasized how both ABA and OT have unique perspectives on approaching autism, but argued that each has specific skills that would benefit from a more collaborative and perspective-shifting approach. On the opposite side of the view, Shyedy et al. (2022) state that ABA therapy promotes dependency in children and is only shown to be effective in children with autism with specific characteristics. The authors discuss how no evidence shows that ABA therapy can be used to effectively support non-verbal children with autism.

I believe the last article shared helps to bring this all together a little more for me. The analysis completed by the authors to compare both OT and ABA interventions independently with children with autism helped to specify the way these approaches are focused. Schaaf et al. (2025) describe ABA as focusing more on observable behaviors and compliance, and OT focuses on regulation, sensory processing, and meaningful occupational engagement. It would be important for families and caregivers to understand the differences and similarities of both approaches so they can make more informed decisions for the preferred intervention plan.

References

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M.,  Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children. Autism Research, 0(1-15).

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126-134.

Welch, C. D., & Polatajko, H. J. (2016). The Issue Is—Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70, 7004360020. http://dx.doi.org/10.5014/ ajot.2016.018689

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In undergrad, I majored in psychology, so ABA is something that I am decently familiar with. With that being said, I was never a huge fan and always thought the approach was a bit aggressive/more negative. After reading these articles, I believe that I have had a bit of a perception shift, and that OT and ABA can be used together, but depending on the situation, they would be better off alone. The last article that we read helped solidify this belief. In this article, it states that Ayer's Sensory Integration approach showed a greater improvement in daily living skills, whereas ABA showed a greater improvement in reducing repetitive behaviors (Schaaf et al, 2025). This shows that each of these interventions can be beneficial and shows improvement, but each child will not always need each intervention style, and we see results when they are used together as well as when they are used separately. One question that I do have is what results would look like if ABA interventions were used on "neurotypical" children, and how that differs from these studie,s which primarily focus on children who have ASD.

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A comparative trial of occupational therapy using Ayres sensory integration and applied behavior analysis interventions for autistic children. Autism Research. https://doi.org/10.1002/aur.70099

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I personally feel that I have a decent understanding of ABA. In undergrad, I majored in psychology and took a course on behavior modification. At one of my practicums in undergrad I also had the chance to observe ABA a couple of times. I do see where there is some overlap between the two professions, including collaboration with other professionals, putting a focus on goals, and prioritizing the clients social and cultural contexts (Welch & Polatajko, 2016). I did enjoy reading how it was made clear that OTs to create a more holistic and client centered care compared to ABA, which was super exciting and releiving to hear (Welch & Palatajko, 2016).

A question I do still have and am trying to comprehend is, do OTs and ABAs work together, or does a kid typically work with one or the other? This question had arisen because in reading the article Schaaf et. al. (2025), it seems that both professions had similar goals for the client and were both beneficial; it was just in how the goal was met through the intervention style. Is this something that can be decided by the parents, or is a referral made to one or the other?

Lastly, one thing I did learn and I was happy to read is that OT is creating more research within the neurodiverse community more specifically, ASD. I was originally shocked to see that this is something that was silent for a while, but it is now becoming common (Welch & Palatajko, 2016).

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J., M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A comparative trial of occupational therapy using Ayres sensory integration and applied behavior analysis interventions for autistic children. Autism Research. https://doi.org/10.1002/aur.70099

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70, 7004360020. http://dx.doi.org/10.5014/ajot.2016.018689

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What stood out to you from the research articles?

When reading the articles, it was interesting to see that ABA can enhance OT practices, and vice versa. Some articles criticized ABA for its use of extinction behavioral techniques, which can be harmful to children (Shkedy et al., 2021). However, OT and ABA do share common characteristics for understanding and managing behaviors in children. I graduated with my undergraduate degree in psychology, so B.F. Skinner's positive and negative reinforcement, and ABA practices are familiar to me. I have always thought that ABA was something that can be used in practice with OT; however, its methods of managing behavior haven't been seen to show improvement in behaviors, specifically in autistic children. When reading about how these 2 practices can help each other by providing holistic viewpoints to ABA and bring more evidence-based strategies to OT, it can be effective for maintaining and ensuring carryover with managing behaviors both in and out of therapy (Wlesh & Polatajko, 2016).  I would like to know more about what kinds of negative reinforcement and extinction behaviors are most commonly used in ABA for autistic children, and how OT can bring a holistic perspective to help bring more antecedent and consequence behaviors into ABA sessions.

References

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70(4), 7004360020p1. https://doi.org/10.5014/ajot.2016.018689

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One aspect that stood out to me in the articles was that ABA therapists are not required to take courses on autism, brain function, or childhood development, as noted by Shkedy et al. (2021). This is surprising to me because they work a lot with children with autism, and if they do not understand what is considered typical development, how are they able to determine where a child who may have intellectual disabilities should be developmentally? From what I have seen so far in our coursework, we cover all of these things, and I wouldn't say that I am an expert in these areas, but I have an understanding of what is typical and what is atypical. I also find it interesting that ABA is not really talked about in OT literature, but OT is talked about in ABA literature (Welch & Polatajko, 2021).

Something that I learned is that ABA is similar to OT in that it has research backing and focuses on environmental factors as a key aspect (Welch & Polatajko, 2021). I also learned that ABA board certification aligns with the COPM-E (Welch & Polatajko, 2021).

In my own experience, I have seen both sides of the spectrum for ABA therapists, the ones who “punish” stimming behaviors and those who do not see the stimming behaviors as an issue. I think ABA can be beneficial if the focus is on the overall well-being of the child and not trying to make the child adapt to what are considered social norms.

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Rupple, and Zane. Advances in Neurodevelopment Disorders https://doi.org/10.1007/s41252-021-00201-1

Welch, C. D., & Polatajko, H. J. (2021). Applied behavior analysis, autism, and occupational therapy: A search for Understanding. The American Journal of Occupational Therapy. 70(4) https://doi.org/10.5014/ajot.2016.018689

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I have very little experience with ABA, and reading the articles was an interesting experience. After reviewing the articles, what stood out to me was that the study by Schaaf et al. found that using OT-ASI and ABA resulted in improvements in goals and daily living skills (2025). The article demonstrates that OT and ABA can be used in conjunction, but not every child will benefit from combining both intervention styles.

The commentary by Shkedy et al. presented a strong critique of ABA, particularly for nonverbal autistic populations (2021). The authors argued that ABA neglects the internal experiences of autistic individuals, such as anxiety, sensory overstimulation, and self-regulation needs. This perspective makes me consider the ethics involved in providing care, as we must ensure that we respect clients' autonomy and cause no harm.

Welch and Polatajko noted that while OT tends to emphasize sensory integration and developmental approaches, ABA has a strong evidence base for skill acquisition and functional outcomes (2016). Their review suggested that ABA and OT share overlapping priorities and could work well together if used effectively. The Welch and Polatojko article also discussed that ABA has a reputation among some OTs as being overly compliance-based and not client-centered (2016). By applying ABA principles within a holistic OT framework, therapists could maximize outcomes while maintaining the core values of occupational therapy.

References

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A comparative trial of occupational therapy using AYREs sensory integration and applied behavior analysis interventions for autistic children. Autism Research, 0–15. https://doi.org/10.1002/aur.70099

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5. https://doi.org/10.5014/ajot.2016.018689

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Something that stood out to me in the articles was the overarching theme that ABA and OT can be paired together well (Welch and Polatajko, 2016). Before, I saw ABA and OT as two separate entities versus a cohesive unit. In undergrad, I was a psychology major and my professors felt very passionate about ABA therapy. None of them promoted ABA therapy and were extremely against it. My perception of ABA is to stop all socially inappropriate behaviors (Shkedy et al., 2021) as a whole versus celebrating some of those behaviors, especially if they are not harmful to the individual or their peers. Also, I believe that positive reinforcement is a great thing, however ABA I noticed would overuse it sometimes. I shadowed a 19 year old who had ABA for his whole life and he would get an M&M every time he did something he was asked to do. To putting on his book bag, pants, shirts, anything, every time he got an M&M. The OT did not want to continue this but also knew it would be hard to change 19 years of this. After reading the articles, I can see where ABA and OT would be beneficial together. OT definitely has a more holistic, client centered approach (Schaff et al., 2025) and ABA focuses on behavior which could be useful when limiting undesirable or unsafe behaviors. It is also surprising to me that there is a lack of training for ABA therapists and that not all are completely certified. A question I have regarding this is how is this ethical or legal? Another question I have is what would a treatment session look like with an OT and an ABA therapist?

Resources:

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., ... & Molholm, S. (2025). A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children. Autism Research.

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126-134.

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: a search for understanding. The American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5.

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Shortly after I graduated from undergrad, I was hired as a behavior technician for a company providing ABA services. I was completely unfamiliar with what ABA was at the time, and was trained to the point of almost becoming registered in this role (you just have to pass an exam). I loved working with my clients, but felt burnt out from the lack of support from my BCBA, and always thought that these kids may benefit more from other services, such as OT. When reading through the articles, unfortunately, the one that resonated the most with my experience was by Shkedy et al. (2021). Seeing the research about non-verbal individuals particularly interested me, as this was the majority of my clients. Many of my interventions with my non-verbal kiddos focused on erradicating stimming behaviors and working on using an adaptive communication device (without the guidance or prescription from an SLP). However, in line with the remarks made by Shkedy et al. (2021) and the results identified by Schaaf et al. (2025), my clients who had functional communication skills, or who might be considered "high functioning", progressed really well with ABA interventions. These clients were better able to communicate their needs and collaborate toward treatment goals.

I would still hesitate about recommending these services if asked. I found Welch and Polatajko's (2016) article to be somewhat ironic. Throughout the article, they discuss how both OT and ABA have benefits, and also conclude that the two services should be used in synergy. However, I felt as though throughout the article, they unintentionally described how an OT could easily implement ABA techniques into their own discipline, but ABA could not do the same for OT techniques. After learning more about the science behind ABA, I feel like OT is a more holistic and ethical approach with more robust evidence for its interventions. Sensory experiences and perceptions are the cause of many behaviors, which I don't think would be appropriately addressed if a child is only receiving ABA services.

References

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A comparative trial of occupational therapy using Ayres sensory integration and applied behavior analysis interventions for autistic children. Autism Research. https://doi.org/10.1002/aur.70099

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. The American Journal of Occupational Therapy, 70(4), 7004360020p1–7004360020p5. https://doi.org/10.5014/ajot.2016.018689

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I have a solid understanding of ABA therapy. My best friend and roommate from undergraduate studies is an RBT who is about to earn her Master's degree in ABA. Throughout our undergraduate years, I watched her go through various internships and develop a passion for helping young children with autism. Currently, she works for an interdisciplinary clinic, where she collaborates with OTs, SLPs, and other RBTs under the supervision of BCBAs. She absolutely loves her job, and our conversations about our fields are always really interesting. We find common ground and share a similar approach to our work, which helps in understanding each other's professions. I enjoy hearing about her experiences and have lots of respect for her as a professional. She treats her clients with respect and strives to help them manage their behaviors and develop coping skills.

One of the key points reinforced for me by the articles is that OT and ABA share similar scopes and approaches when working with clients. I also liked the perspective from the article that addressed the common misconceptions surrounding ABA, particularly that it is not client-centered (Welch & Poletajko, 2016). After many discussions with my best friend, I realized that this is true. Whenever she designs her interventions, she consistently follow client-centered approaches that align with the principles of ABA.

I think that ABA often receives unfair criticism due to its not so great past. At its core, ABA is based on solid principles, and Welch and Poletajko (2016) have noted that it is significantly supported by evidence in the field. I think there is great value in ABA, especially when it's integrated within an interdisciplinary team. When behavior analysts work in an open-minded and supportive environment, they can effectively support the children they work with, making ABA a valuable addition to a child’s care team.

References:

Welch, C. D., & Polatajko, H. J. (2016). The issue is—applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70, Article 7004360020. https://doi.org/10.5014/ajot.2016.018689

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I personally have very little experience with ABA, but I have always heard how controversial this topic/practice is. After reading these articles, and my peers' posts, I can definitely understand how ABA might be beneficial for some clients, but inappropriate for others. Something that stood out to me from this week's readings was how passionate the Shkedy et al. (2021) article was, especially in discussing how ABA practice goes directly against the ethical code of ABA therapists when treating non-verbal ASD clients. There was emphasis on the fact that therapists should treat and "do no harm," so I was extremely shocked to learn that some ABA practitioners are eliciting pain due to their lack of understanding of autistic brain functions. A main takeaway for me from this particular article was that ABA therapists are highly undertrained and lack crucial knowledge in psychology to be treating the non-verbal autistic population. That being said, the other two articles highlighted for me that ABA techniques or strategies used by a licensed practitioner, like an OT who has an in-depth understanding of psychological premises, may in fact be beneficial for pediatric clients. For me personally, this assignment has only further emphasized how controversial ABA practice can be. I think I will only be able to form my own opinion once I am able to experience ABA first hand. I also hope that newer ABA therapists in this day and age are making it a point to further their knowledge base, especially in holistic and client-centered care.

Reference:

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is Abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

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I personally found these articles really interesting to read and dive deeper into ABA. I have heard lots of different views on ABA, and these articles did a good job giving an overview of ABA and how it can be tied to OT. I specifically enjoyed the article by Welch and Polatajko, when they were talking about how you can use ABA in OT while taking a holistic approach (2016). I personally think that ABA can be really helpful for children with ASD if used correctly.

I have seen this approach used in school and have worked with children who were also in ABA therapy. I have seen the benefits and believe this can be useful in practice. I think using ABA along with other parts of OT we could make a big difference in children's and families' lives.

Welch, C. D., & Polatajko, H. J. (2016). The Issue Is—Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70, 7004360020. http://dx.doi.org/10.5014/ ajot.2016.018689

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Overall, before engaging with this week’s content, I had an overwhelmingly negative perception of ABA therapy as a whole. I have a close family friend who had a very poor experience with her child’s BCBA. The BCBA was not in agreement with the SLP and OT and did not want the child to have access to a speech device, which was improving her participation in play, school, and independence with ADLs at home. This disagreement was ongoing and produced significant barriers for the child to access the speech device at school. In the end, the child’s mother was a strong advocate for her and stopped ABA therapy, as she felt that it was inhibiting her progress overall. My personal experiences working with BCBAs and RBTs while shadowing OT and engaging in fieldwork have not been negative, but the way that they approach behavioral situations isn’t always how I would with an OT lens, as it seems to be very cut and dry and focuses on extrinsic sources, whereas OT should approach the scenario holistically.

I think this perception is consistent with that of many professionals outside the world of ABA therapy, often considering the notion that ABA principles rely heavily on extrinsic motivating factors, and do not or cannot hold up long-term (Shkedy et al., 2021). ABA therapy seeks to eliminate unwanted behaviors, some of which are self-soothing or stimming behaviors (Shkedy et al., 2021). This suggests that ABA therapy principles are not as holistic or client-centered as OT principles.

However, ABA offers promising opportunities for seamless integration with occupational therapy, demonstrating benefits in enhancing occupational engagement across many domains (Welch & Polatajko, 2016). Research indicates that occupational therapy sensory integration principles can be incorporated into ABA practices to support improved engagement and skills with clients with ASD (Schaaf et al., 2025).  However, the integration of OT and ABA would require effective interprofessional collaboration and communication on the part of each professional. I think the first step in promoting this collaboration is to continue presenting evidence and open dialogue of ABA’s positive applications to foster a more positive perception overall.

I do think that there is a time and place for ABA therapy, and I see the value that it can have. I think that with continued striving for interprofessional collaboration, OT and ABA can effectively work together to improve overall occupational engagement for clients.

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., & Molholm, S. (2025). A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children. Autism Research.  https://doi.org/10.1002/aur.70099

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126-134. https://doi.org/10.1007/s41252-022-00276-4

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: a search for understanding. The American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5. https://doi-org.suproxy.idm.oclc.org/10.5014/ajot.2016.018689

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In undergrad at SU, I majored in Psychology and completed a Behavior Modification course that discussed ABA. After reading these articles, I have a better understanding of ABA and its relation to OT.

I learned that a difference between OT practice and ABA is that OT uses a holistic perspective with clients by analyzing their behaviors and occupational performance (Welch & Polatajko, 2016). I was able to gain a better understanding of ABA, which includes considering an individual's desires, feelings, and thoughts, besides just observing (Welch & Polatajko, 2016).

From the research articles I read, the information that I found interesting is about OT-ASI and ABA. I enjoyed reading about the two different interventions that were used to compare with autistic children. To learn that both these interventions improve daily living skills and individualized goals is a good thing to hear. Even with these two different interventions targeting different topics, with OT-ASI targeting sensory integration to improve participation in daily activities and ASF targeting participation in family activities by having changes in environmental variables (Schaaf et al., 2025). Overall, I believe reading these research articles has given me the opportunity to grow my understanding of ABA and learning about the differences and similarities related to OT.

References:

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children. Autism Research. https://doi.org/10.1002/aur.70099

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Welch, C. D., & Polatajko, H. J. (2016). Applied Behavior analysis, autism, and occupational therapy: A search for understanding. The American Journal of Occupational Therapy, 70(4), 7004360020p1. https://doi.org/10.5014/ajot.2016.018689

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Several key points stood out to me from the research articles. The first thing that stood out to me was how compatible occupational therapy (OT) and applied behavior analysis (ABA) are and how they can be used together to enhance clients' outcomes. According to Welch and Polatajko (2016), OT and ABA are both strength-based approaches to help build the client's skills. They both consider how the environment can impact the clients' behaviors and engagement in daily occupations.  OT and ABA also have similar guidelines, such as prioritizing client behaviors and skills that may threaten the health or safety of themselves or others, be a barrier to their inclusion in activities, limit participation, and are developmentally and functionally appropriate skills (Welch & Polatajko, 2016). However, ABA does not consider internal factors that can also impact their behaviors. According to Sandoval-Norton et al. (2021), ABA has an ethical issue with its scope of practice since it inherently ignores all internal constructs. ABA focuses solely on external factors to understand and modify client behaviors, making its approach less holistic and client-centered compared to OTs.

One thing I recently learned is that ABA therapists are not required to understand the internal processes and abilities of clients before developing a treatment plan for them. According to Sandoval-Norton et al. (2021), "ABA therapists are not required to take a single course on autism, brain function, or child development" (p. 127). When working with clients with disabilities such as autism, ABA therapists must understand their diagnosis and how both internal and external factors impact their behaviors to make the appropriate treatment to address those problem areas. Not having that understanding would lead ABA therapists to practice outside their scope and make unethical decisions that do not best meet their clients' needs (Sandoval-Norton et al., 2021). ABA lacks that holistic and client-centered approach in their practice, which is necessary to make those modifications so they will have effectiveness over the long term. Although there is a lack of research on the effects of long-term use of ABA, this treatment has been known to promote more pain than benefits to clients (Sandoval-Norton et al., 2021). Overall, ABA has limitations in its approach, but when used along with OT, it can potentially lead to positive outcomes in the client's participation in daily activities.

Reference:

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2021). Long-term ABA therapy is abusive: A response to gorycki, ruppel, and zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5. https://doi.org/10.5014/ajot.2016.018689

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I don't have any experience with ABA but I feel like what I have heard is generally negative or controversial. One thing that surprised me was the vast difference between two of these articles. Welch & Polatajko spoke of how ABA is commonly used in ASD interventions and how ABA and OT have some compatability in terms of attention to social and cultural context and an emphasis on collaborative, client-centered goal setting (Welch & Polatajko, 2016). Shkedy et. al. had quite the opposite approach. This article discussed the lack of efficacy ABA presents, ethical concerns, and a ack of understanding of ASD within ABA (Shkedy et. al., 2021).

I think that by working together, OT and ABA can compliment/ enhance interventions for individuals with ASD. Occupational therapists have a holistic perspective that can broaden the ABA approach by providing a deeper analysis of an individual's thoughts, feelings, and sensory differences. They can also help develop proactive strategies by examining the environment and setting the client up for success. In turn, ABA principles can enhance the effectiveness and evidence-based nature of OT interventions. Since ABA is effective in areas that OT also addresses, such as self-care and play, integrating ABA can enhance outcomes with their clients. An OT with insight into ABA principles can also prevent unintentionally reinforcing undesirable behaviors by knowing when to apply calming strategies.

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021).

Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126-134. https://doi.org/10.1007/s41252022-00276-4

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: a search for understanding. The American Journal of Occupational Therapy, 70(4), 7004360020p1-7004360020p5.

https://doiorg.suproxy.idm.occ.org/10.5014/ajot.2016.018689

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I do not have any experience with ABA, but it is discussed a lot, especially in the special education classroom setting. I have always been intrigued by it, as it seems that a lot of families that have children with autism speak highly of it. Something that stood out to me in the research articles was the idea that ABA is aggressive and unethical, especially with children who are nonverbal (Shkedy et al., 2021). This article, titled "Long-Term ABA Therapy is Abusive: A Response to Gorycki, Ruppel, and Zane," also discusses how ABA does not educate on the development of the brain, child, or even the autism diagnosis itself. This alarmed me because I feel that this is pertinent information to know and understand when treating individuals with ABA. This lead me to the question, "What can be done to formulate and develop a more comprehensive ABA educational program that would lead to a more ethical stance?"

Something new that I learned from reading these articles is the effectiveness of coupling ABA and occupational therapy with the Ayres sensory integration approach. This is something that I can see as widely effective because you are utilizing a client-centered approach with an effective behavioral approach. This study is also fairly new, which could help lead to further findings and advancements down the road (Schaaf et al., 2025).

Citations:

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

Schaaf RC, Ridgway EM, Jones EA, Dumont RL, Foxe J, Conly T, Sancimino C, Yi M, Mailloux Z, Hunt JM, Kirschner L, Leiby BE, Molholm S. A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children. Autism Res. 2025 Aug 15. doi: 10.1002/aur.70099. Epub ahead of print. PMID: 40815044.

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I personally don’t have any experience with ABA therapy. However, I am familiar with what ABA therapy is and its impact to solve behavioral problems healthily. As I was reading “Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane” by Shkedy et. al (2021), I was quite shocked but interested in the fact that ABA is critically viewed as “unethical” and highly flawed, especially when applied to individuals who are autistic. What also stood out to me was that Ivar Lovaas, who was the founder of ABA therapy, initially used behavior modification for gay conversion therapy and for changing behaviors that he believed were “sexually abnormal.” Learning this from the article made me realize how some of the early practices at that time were rooted in harmful and outdated views of human behavior.

It led me to question why there continues to be a lack of training in areas like autism, brain development, and internal constructs, considering how much these factors play a role in human behavior.

On the other hand, it is interesting to learn from another article, “Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding” by Welch & Polatajko (2016), that ABA is still widely supported and used for many settings. I also found it interesting that OT treatment approaches moreso focus on sensory integration and developmental practices and building strengths for children with autism, while ABA is seen as highly focused on behavior (Welch & Polatajko, 2016). Though I think that combining the two will definitely help to provide a stronger focus on areas of play skills, social participation, and developmental skills that may be prominent to both supporting and impacting a child’s life.

Resource

Welch, C. D., & Polatajko, H. J. (2016). Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding. American Journal of Occupational Therapy, 70(4), 7004360020p1. https://doi.org/10.5014/ajot.2016.018689

Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2021). Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126–134. https://doi.org/10.1007/s41252-021-00201-1

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As someone who was unaware of Applied Behavior Analysis (ABA), prior to OT school, most of what I have learned about this type of therapy has been negative. After completing the readings, my understanding remains true. Specifically, authors Shkedy G. and D. as well as Sandoval-Norton (2021), published a powerful piece regarding the cruel intentions behind ABA therapy. After reading this article, I conducted a basic Google search in which I asked "Is ABA ethical." The first article that comes up is from the National Institute of Health titled "Ethical Concerns with Applied Behavior Analysis..." This in and of itself spoke loudly to me. After reading this article, it answered my initial question. The other article that stuck out to me, comparatively, was the article regarding Ayres Sensory Integration (ASI) (Schaaf et al., 2025). Based on the discussion and findings, it appears as though ASI and ABA approaches made great strides in intervention for children with autism. According to the article and the limitations, it was difficult to compare the two considering the limitations and positive outcomes achieved by both (Schaaf et al., 2025). These findings stuck out to me because of classroom discussions our cohort has had about ABA. From these discussions, I always assumed that ABA was a generic, straightforward approach that was not client centered in nature. So, after reading this article and considering what little I knew of the topic, I asked Google if "ABA was a one size fits all approach." In turn, I learned from the Autism Speaks Foundation that it is not this type of approach. This begs the question, "If it has to be written verbatim that it is not a 'one size fits all approach,' then is it?"

As client-centered, holistic practitioners, it would be inappropriate for us to assume that standardized or universal interventions for autism are the best approach to treatment. That, for me, is where I am entirely lost on ABA therapy because it seems to be this type of approach that assumes each patient can be treated the same as the last instead of considering the patients for who they are as a person. In my opinion, this is where we are advanced as occupational therapists who incorporate many different approaches to intervention and conduct holistic healthcare from a client-centered view. My parting note is that whenever you look up anything about ABA, the Google AI loves to say that it is evidence-based. If that is true, why do many researchers call it unethical? Is the evidence ethical? Is this approach client-centered?

References:

Schaaf, R. C., Ridgway, E. M., Jones, E. A., Dumont, R. L., Foxe, J., Conly, T., Sancimino, C., Yi, M., Mailloux, Z., Hunt, J. M., Kirschner, L., Leiby, B. E., & Molholm, S. (2025). A comparative trial of occupational therapy using Ayres Sensory Integration and Applied Behavior Analysis interventions for autistic children. Autism Research. https://doi.org/10.1002/aur.70099

Shkedy, G., Shkedy, D., & Sandoval-Norton, A. H. (2021). Long-term ABA therapy is abusive: A response to Gorycki, Ruppel, and Zane. Advances in Neurodevelopmental Disorders, 5(2), 126-134. https://doi.org/10.1007/s41252-021-00201-1

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In my gap year preceding attending the OTD program, I applied to and got accepted into a Behavioral technician role. I was looking to do something in my gap year that would give me hands on experience working with kids in a treatment sense and a friend of mine worked as a technician as well and suggested that I apply. I attended my onboarding training and began the online training that i needed to complete within 60 days after seeing a patient. This means that with no training aside from 4 hours of onboarding I could treat and work with kids for nearly two months before I had any formal certification.

As someone who is a late-diagnosed autistic person, when completing my training I felt uncomfortable by the approach that was being used and the implications that I imagined it had on the clients. I began to do more research and decided that this wasnt going to be the path for me as it felt like I was forcing someone to mold to societies expectations instead of building abilities and confidence in my clients. I agreed with Shkedy et al. (2021) in that clients may become dependent on the therapists and caregivers for prompting specific actions. This prompt dependence doesnt always go away like the profession claims, and may ultimately lead to worse outcomes for the client.

Overall, I have since steered away from this treatment method because as a provider I want to build up and support my client to be independent and to engage functionally in their lives rather than try and disparage their behaviors and hide their symptoms for the comfortability of those around them.

Shkedy, G., Shkedy, D. & Sandoval-Norton, A.H. Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane. Advances Neurodevelopmental Disorders 5, 126–134 (2021). https://doi.org/10.1007/s41252-021-00201-1