Hi Diary,
Before coming to Beijing, I had heard reservations from some speech-language therapists about Applied Behavior Analysis (ABA). If ABA therapists were also teaching children to request, follow instructions and use language, were they taking over the work of speech therapy?
Working alongside ABA colleagues in Beijing has helped me see another possibility. For children developing early communication skills and needing substantial support to participate in everyday life, our perspectives can help us build more complete support together.
These are reflections on my current working environment. They cannot represent every ABA or speech therapy service, but they have changed how I understand collaboration.
Different questions about the same child
My ABA colleagues also care about functional communication. They use tools such as the VB-MAPP to understand children's skills and learning barriers, and examine what happens before a behaviour and how the response that follows may influence its recurrence.
The VB-MAPP itself draws on both verbal behaviour analysis and developmental milestones, and includes play and social domains. Dividing our professions into “ABA looks at behaviour; speech therapy looks at development” would therefore be too simple.[1]
What I find useful about the behavioural perspective is its attention to the conditions around communication. Why does the child communicate at this moment? What response do they receive? Will they want to use that approach again?
Reinforcement can come from communication itself. A request for help leads to assistance; a request for “more” allows an enjoyable game to continue. It reminds me that we want children to discover that expressing themselves can make a meaningful difference.
What can speech therapy contribute to the next step?
As a speech-language therapist, I want to bring linguistic and communication-development analysis into our shared discussions. Does a child's understanding match what they express? Are they communicating spontaneously or repeating an adult's prompt? Can they use a word with different people, objects and situations?
Once a child starts requesting, the next goal need not simply be lengthening “want” into “I want something.” We can also consider “no,” “help,” “stop” and “break,” alongside sharing interests, attracting attention and commenting. Sentence length is one dimension; the range of meanings a child can express matters too.
Developmental milestones inform my thinking, while goals also need to reflect the child's current abilities, everyday needs, family languages and interests. For some children, an accessible way to say “stop” may be more useful than a longer sentence that depends on prompting.
Augmentative and alternative communication (AAC) is another important part of collaboration. Gestures, pictures, communication boards and speech-generating devices can all offer ways to express a message. There are no prerequisite skills a child must demonstrate before AAC can be considered or introduced.[2] In a shared plan, I want us to recognise the child's available communication modes, including ways to say both “yes” and “no.”
Using the Communication Matrix to notice progress beyond speech
In speech therapy, I also use the Communication Matrix to document communication in greater detail while children are at its earliest stages. Across seven developmental levels, it considers four broad purposes—refusing, obtaining, social interaction, and providing or seeking information—and recognises body movements, sounds, gestures, symbols and language.[7]
I can distinguish emerging skills from mastered ones: Does the child still need prompting? Can they communicate independently across people and situations? Comparing assessments over time helps capture changes beyond the number of spoken words.[8]
For example, a child might use pictures to request preferred items but still lack an accessible way to refuse or ask for help. That uneven profile gives the team a more useful starting point for choosing meaningful goals than describing the child simply as “verbal” or “nonverbal.”
The Communication Matrix is not exclusive to speech therapists; families, teachers and other professionals can contribute observations. I see it as complementary to VB-MAPP findings and other assessment information, rather than a replacement for comprehensive speech and language assessment. Successful communication through gesture or AAC is an achievement in its own right, without waiting for fluent speech.
Building play and early communication together
I also want to bring observations about play and interaction to the team. How does the child explore toys? Which activities do they welcome an adult into? How could a simple action develop into a back-and-forth exchange, shared attention or shared enjoyment?
These are often called pre-verbal skills, although a child using gestures, facial expressions or AAC is already communicating. Supporting their development can happen alongside access to communication tools.
My ABA colleagues' ways of breaking skills into observable steps, recording support levels and planning to fade prompts have also inspired me. I can then consider whether those steps preserve the enjoyment of play, the child's initiative and the purpose of the interaction.
Play is not exclusive to speech therapy, and ABA colleagues vary in their training and experience. I want to understand what each colleague brings and connect our observations.
What collaboration could look like
The following is a hypothetical illustration, not a record of an individual child's treatment.
Imagine a child who shouts or pushes an adult away when a toy box will not open. Together, we could explore whether the child wants help, wants to stop or is becoming frustrated. We would also consider whether the demands or environment need to change.
An ABA colleague could help analyse the events surrounding the behaviour and patterns in adult responses. A speech therapist could analyse the message the child needs to convey and help identify accessible words, gestures or AAC. Together, we could agree on modelling, responding and reducing prompts.
If the child communicates “help” through a gesture or picture, the adult helps open the box. If they communicate “stop,” that message also needs a response. We could then discuss with the family how to offer similar support during other everyday activities.
Our shared observations could include whether the child requests help or refuses more independently, needs fewer prompts, and communicates with different adults or during different activities. We would also look at participation and comfort. These outcomes would tell me more about communication progress than a count of shouting alone.
Learning from ABA while evaluating each strategy
Planned ignoring is one concept that prompted me to think more carefully about adult responses. Sometimes, attention we provide unintentionally may help maintain a behaviour.
Its limits need to be clear. Withholding attention may be relevant to a specifically assessed, attention-maintained behaviour; it does not follow that all crying is an attempt to obtain attention. Professional discussion has also highlighted the risks of vague instructions to “ignore.”[3]
For me, understanding pain, fear, sensory load, communication difficulties and requests for support comes first. Danger, self-injury and clear distress require a response. A child's request for help should not be disregarded because they have not used a prescribed phrase. Any related strategy needs individual assessment, a clear team plan and ongoing monitoring, alongside an accessible alternative way to communicate.
The lesson I take is to respond more thoughtfully and make effective communication both accessible and worth using.
NET and EMT: finding common ground in everyday activities
Teaching in natural contexts offers another point of connection.
ABA includes approaches such as Natural Environment Teaching (NET), alongside Discrete Trial Teaching (DTT).[4] Naturalistic approaches have a long history; they are not simply a recent development.[5]
I see common ground with Enhanced Milieu Teaching (EMT), which uses children's interests and initiations as opportunities to model and support language in everyday interactions.[6]
NET and EMT are distinct approaches, and neither belongs exclusively to one profession. However, they help me frame a shared question with colleagues: How can we create meaningful opportunities to learn within activities the child wants to join?
Playing with cars, building with blocks or taking part in familiar routines can give us a setting for shared goals. When considering structured or naturalistic teaching, I want to know whether the child is engaged, whether the learning is meaningful and whether it can be used beyond the therapy room.
Rethinking subtraction and addition
Initially, I wanted to describe our collaboration through a simple metaphor: ABA does the subtraction, while speech therapy does the addition.
I would now make that metaphor more complete:
Together, we reduce barriers to safety, participation and communication, while increasing children's ways to express themselves, make choices and exercise agency.
ABA colleagues also teach new skills; speech therapy can also help reduce frustration and conflict by improving communication.[4] Our work overlaps, and that overlap needs shared goals, clear roles and ongoing discussion.
Since coming to Beijing, I have begun to see the value of this collaboration more concretely. Meaningful progress might be a child finding it easier to let someone know what they need. It might also be an adult becoming better able to understand and respond.
I hope our work together gives children more opportunities to be understood and more choices in their own lives.
References
These sources support the professional concepts discussed above. The personal reflections and hypothetical illustration are not research findings.
- Official VB-MAPP protocol excerpt
- ASHA: Augmentative and Alternative Communication in Early Intervention
- Recommendations Regarding Use of the Term “Ignore” in Applied Behavior Analysis
- ASHA/NJC: Applied Behavior Analysis and Communication Services
- Schreibman et al. (2015): Naturalistic Developmental Behavioral Interventions
- Vanderbilt KidTalk: What is EMT?
- Communication Matrix: Research Basis
- Communication Matrix: Using the Matrix
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