How do communication targets in speech therapy differ from behaviour targets in ABA for autism? 

According to the NHS, autism is a lifelong developmental difference that affects communication, social interaction, flexible thinking and sensory processing, and many autistic children need tailored support with communication, behaviour and daily life. Guidance from NICE recommends play-based social-communication interventions and functional behaviour support, but it does not endorse Applied Behaviour Analysis (ABA) or Speech and Language Therapy (SLT) as branded programmes instead, it embeds their underlying principles into multidisciplinary care. 

Understanding the concept 

In UK services, speech and language therapy is about helping a child communicate in ways that are meaningful and workable for them whether that is speech, signs, symbols, communication devices or a combination. The autism SLT team at Newcastle Hospitals describes its overall goal as developing “real life (functional) communication skills” and giving children “an accessible and effective means of communicating their feelings, needs and wishes.” 

ABA, by contrast, is a behavioural framework that targets observable behaviours including some communication behaviours using learning principles like reinforcement, prompting and shaping. In ABA programmes, “communication” is often broken down into discrete behaviour units (for example, asking for something, labelling an item, answering a question), each with clear teaching steps and mastery criteria. 

The NHS and NICE both stress that support should focus on helping autistic children understand and be understood, participate in family and school life, and feel safer and less overwhelmed – rather than simply increasing compliance. 

Evidence and impact 

Speech- and language-therapy–aligned interventions such as PACT focus on social-communication targets: parent–child interaction, shared attention and child communicative initiations. In the original PACT trial, children whose parents received PACT-based coaching showed improved parent responsiveness and child communication initiations; long-term follow-up (at around age 10) found a sustained reduction in autism social-communication symptom severity compared with the control group. These findings support the idea that changing how adults and autistic children communicate together can have lasting effects on social interaction and participation. 

Parent-implemented communication programmes such as “Hanen More Than Words” have also been used, especially for younger or minimally verbal children, with some reports of improved functional communication when parents consistently respond to their child’s interest and communicative attempts. While high-tech augmentative and alternative communication (AAC) approaches (e.g. picture-based systems, devices) can support communication in minimally verbal children, evidence for long-term generalisation and social participation remains limited. 

Evidence for early intensive behavioural interventions (ABA / EIBI) presents a different pattern. Meta-analyses and systematic reviews of EIBI (e.g. early interventions beginning in preschool years) report moderate-to-large average gains in IQ and adaptive behaviour compared with treatment-as-usual or eclectic early-years services, though results are more variable for language and core autism symptom severity. A stricter analysis of controlled and comparative studies found that while some expressive and receptive language gains occurred, outcomes for adaptive behaviour and socialisation were inconsistent, highlighting considerable variability in communication and daily-living outcomes. 

In short: speech/communication-oriented and parent-mediated programmes like PACT show good evidence for improving social-communication and sustaining symptom reduction over time. Behaviour-based early interventions (ABA/EIBI) offer stronger aggregate evidence for cognitive and adaptive functioning gains, but communication outcomes remain less reliable and more variable. This suggests that combining communication-focused supports with adaptive-behaviour interventions may better support broader development, rather than relying on a single approach. 

Practical support and approaches 

The NHS advises families to use simple language, break instructions into steps, allow extra processing time and use pictures or visual timetables to support understanding. It also recommends asking for a referral to speech and language therapy if there are concerns about speech, language or social communication. 

In a typical SLT-based plan, communication targets might include: 

• Understanding everyday words and instructions 

• Building early vocabulary and short phrases 

• Learning to request, reject, comment and ask for help 

• Developing joint attention, turn-taking and conversation 

• Using AAC (for example, PECS, symbols or a communication device) if speech is limited 

These targets are usually embedded in play, daily routines and interaction with familiar people, and they are measured not only by test scores but also by how well a child can communicate in real-life situations. 

In ABA programmes, whether using discrete trial teaching or more naturalistic variants, behaviour targets might include: 

• Increasing the number of successful “mands” (requests) per session 

• Teaching a set number of new labels for objects or actions 

• Increasing cooperation with adult-led tasks 

• Reducing self-injury, aggression or bolting based on functional behaviour assessment 

Progress is recorded as frequencies, percentages of correct responses, and changes in standardised scores across domains such as communication, socialisation and daily living skills. 

The National Autistic Society (NAS) reminds families that all forms of communication – speech, signs, typing, symbols – are valid, and that the aim of any communication support is to reduce barriers and enable equal participation, not to force one “normal” style. 

Challenges and considerations 

A key challenge is that SLT and ABA do not always “aim” at the same thing, even when both include communication goals. 

• SLT communication targets are inherently relational: they ask, “Can this child get their needs met, express themselves and connect with others in ways that feel manageable?” 

• ABA behaviour targets ask, “Can this behaviour be observed, measured and changed with reinforcement?” which may include communication, but also often includes compliance and reduction of behaviours that challenge. 

The NHS and NAS both emphasise that behaviour which looks “challenging” is often linked to sensory overload, anxiety or not having an accessible way to communicate. Positive Behaviour Support (PBS), promoted by NAS and reflected in NICE guidance, encourages understanding the function of behaviour and improving quality of life, while avoiding punishment and interventions that try to make someone “less autistic”. 

Evidence gaps also matter. There are no randomised trials directly comparing SLT-only communication interventions with ABA-based programmes for communication outcomes, meaning that any comparison is indirect. ABA meta-analyses often include broad “communication” composites, while SLT trials focus more tightly on interaction and social-communication, making “like-for-like” comparisons difficult. 

How services can help 

In UK pathways, SLT is a standard commissioned service: autistic children are routinely referred to speech and language therapists for assessment and support with communication, and many local services offer parent workshops, social-communication groups and AAC support as part of autism pathways. This reflects the central role of communication targets in routine care. 

ABA-based intensive programmes, by contrast, are not routinely commissioned within NHS autism pathways. The NIHR review of early intensive ABA-based interventions concluded that more research is needed to clarify long-term benefits and cost-effectiveness, and NICE has kept its recommendations principle-based – focusing on social-communication interventions and functional behaviour support, rather than endorsing particular ABA packages. 

The NHS England early autism pathway guidance reinforces this, highlighting parent-mediated, communication-focused support, multi-agency working and family wellbeing as core goals. 

Takeaway 

For autistic children, speech and language therapy and ABA can both involve “targets”, but they are not aiming at the same thing. SLT focuses on communication as a meaningful, relational activity: helping children understand, be understood and participate, using whatever mix of speech and AAC works for them. ABA focuses on observable behaviours – including some communication behaviours – that can be taught and reinforced, with its strongest evidence in cognitive and adaptive domains and more variable effects on communication. Within UK practice, NHS and NICE put communication support, family involvement and functional, rights-based behaviour support at the centre of autism care, rather than any single branded programme. 

If you or someone you support would benefit from early identification or structured autism guidance, visit Autism Detect, a UK-based platform offering professional assessment tools and evidence-informed support for autistic individuals and families.