A clinician has suggested therapy. They’ve used three letters — OT, ABA, SLT — and you nodded along. Now you’re home, trying to figure out what they actually meant.

Three modalities, three different jobs, and a lot of overlap in what parents read about them online. This article is here to make the differences clear.

The thirty-second version

  • Occupational Therapy (OT) works on the foundations a child uses every day — motor skills (fine and gross), sensory processing, daily routines.
  • Applied Behaviour Analysis (ABA) works on specific behaviours — building new ones, reducing ones that are getting in the way — by breaking them into small, learnable parts.
  • Speech & Language Therapy (SLT) works on communication — from foundational pre-language skills, through articulation, through pragmatic conversation.

Many children benefit from more than one. Some need only one. The right combination depends on what’s actually getting in your child’s way.

Occupational Therapy — when it’s the right starting point

OT is often the broadest of the three. Despite the name, it has little to do with vocations. The “occupation” of a child is to be a child — to eat, dress, play, learn, move, regulate. OT addresses what gets in the way of any of that.

OT is likely right if your child:

  • Struggles with motor coordination — handwriting, scissors, bike-riding, ball skills
  • Has sensory sensitivities — textures, sounds, certain foods, haircuts, nail-cutting
  • Seeks intense sensory input — crashes, spins, mouths objects, needs constant movement
  • Has trouble with self-regulation — moves from calm to overwhelm faster than expected
  • Has trouble with everyday routines — dressing, mealtime, transitions
  • Has low muscle tone, poor core strength, or balance issues

OT happens largely in a sensory gym — swings, climbing structures, weighted toys, balance equipment. To a child it looks like play. To a therapist it’s a carefully chosen toolkit, each piece selected to address a specific aspect of the child’s sensory or motor system.

OT tends to be a “first-line” therapy for many children with developmental concerns, because so many other things — speech, behaviour, learning — sit on top of motor and sensory foundations.

Speech & Language Therapy — when it’s the right starting point

SLT is what most parents think they need first, because speech is what’s most visible. A child who isn’t talking at the expected age is the most easily named concern.

But “speech therapy” is much broader than just teaching words. It covers:

  • Pre-language skills — joint attention, imitation, turn-taking (for very young children)
  • Articulation — making the sounds clearly
  • Expressive language — putting words and sentences together
  • Receptive language — understanding what others say
  • Pragmatic language — using language socially (turn-taking in conversation, reading tone, picking up on what’s implied)
  • Augmentative and Alternative Communication (AAC) — for children who benefit from picture systems, communication boards, or devices alongside speech

SLT is likely right if your child:

  • Is 2+ and has fewer words than expected
  • Speech is hard to understand
  • Has words but struggles to put them into sentences
  • Understands less than expected
  • Speaks well but struggles in conversation (especially in older children)
  • Is non-verbal or minimally verbal

A common misunderstanding: SLT isn’t only for children who don’t speak. Some of our busiest SLT practice involves school-age children with fluent speech but pragmatic challenges.

Applied Behaviour Analysis (ABA) — when it’s the right starting point

ABA is the most often misunderstood of the three. We’ve written more on this in the ABA service page, but the short version:

ABA is a methodology for understanding how a child learns, and then using that understanding to teach specific skills or reduce specific behaviours that are getting in the way.

It’s most commonly associated with autism, where it’s used to teach communication, social, daily-living, and academic skills, and to address behaviours like aggression, severe self-injury, or extreme withdrawal. But ABA techniques are used much more broadly than autism alone.

ABA is likely worth considering if your child:

  • Has an autism diagnosis and a clinician has suggested it
  • Has very challenging behaviours that other approaches aren’t reaching
  • Needs to learn specific, structured skills that are not coming through general developmental support
  • Benefits from highly structured, measurable, data-driven approaches

Modern, ethical ABA is centred on the child, uses positive reinforcement (not punishment), respects the child’s autonomy, and is led by senior therapists who know when not to push. Older versions of ABA had real problems; the field has evolved. If you have concerns about ABA, bring them — they deserve a real conversation, not a brochure answer.

How they work together

Most children we see at Arambh are in more than one modality. Common combinations:

  • OT + SLT — for a young child with motor and language delays. Common in early intervention.
  • OT + ABA — for an autistic child with sensory needs and challenging behaviours.
  • SLT + ABA — when language development is being targeted through behavioural techniques alongside conventional speech work.
  • OT + SLT + ABA — for a child with comprehensive developmental needs, especially early in life.

When more than one therapist is involved, what matters most is co-ordination. The senior therapist who leads your child’s primary modality should be talking to the others — sharing goals, observations, adjustments — so that the plan is one plan, not three.

At Arambh this co-ordination is built in. Senior therapists meet regularly. Reports are integrated. Parent connects cover the whole plan, not just one modality. We don’t believe in handing parents three separate appointment cards and asking them to manage the integration.

How to decide where to start

If you’ve been recommended two or three modalities and you’re not sure where to begin, here’s how to think about it:

Start with what’s most foundational. If your child has both motor and language concerns, OT is often the right place to begin — communication often opens up when the underlying sensory and motor systems are better regulated.

Start with what’s most affecting daily life. If a child is melting down twenty times a day, addressing the regulation issues (often through OT) is often more urgent than the language goals, even if both are real.

Start with what your child can engage in. A very young, dysregulated child often can’t sit for structured ABA tables. Building regulation through OT and play first creates the conditions for more structured work later.

Be honest about how much your family can sustain. Three therapies a week is a heavier lift than one. Better to do one thing well than three things partially. Many families step up volume over time as routines settle.

The right person to help you decide isn’t a website. It’s a senior therapist who can see your child, talk with you, and recommend a small starting point that you can build from. Most ethical practitioners recommend starting with less than you think you need — and adding once you’ve seen what works.

What to ask in your first consultation

When you talk to a centre or therapist about starting therapy, useful questions:

  • Who will my child’s primary therapist be? Will it always be the same person?
  • What level of seniority do they have?
  • How often will I get progress reports? Will they include data?
  • How will modalities co-ordinate with each other?
  • How do you decide when a modality is no longer needed?
  • What’s your view on [ABA / a specific approach you’ve read about]?
  • What do you not do, and why?

A good answer to most of these is direct and specific. A vague or marketing-flavoured answer is a signal to ask more, or to look elsewhere.