Receiving a child’s autism diagnosis can be an intimidating time for parents. So much uncertainty. So much information to decipher, from acronyms to opinions on next steps, including therapy options. The encouraging news is there’s more choice and accessibility than ever to great therapies.
The most common approaches are applied behavior analysis (ABA) and developmental relationship-based interventions (DRBI). Both aim to help autistic children grow and thrive, but they work toward the goal in different ways. Behavioral approaches like ABA generally focus on teaching specific skills and reducing barriers to learning. Developmental approaches emphasize relationships, emotional regulation, communication and problem solving through meaningful interactions. Choosing one approach doesn’t necessarily mean rejecting another. Many children benefit from a combination of strategies tailored to their own strengths, challenges and family values. Here are some key differences in focus, goals and methods from the perspective of Baltimore-area therapy providers using each approach.
Early intervention matters
In both ABA and DRBI therapies, early intervention is valued.
“Developmental gaps in language and other skills widen over time if untreated, so the window from 1 to 6 is when we can make the most difference,” says Ashley Williams, Ph.D., LBA, BCBA-D, a therapist for center-based Columbia ABA provider Little Leaves Behavioral Services, which serves young children.
Joshua Feder, M.D., executive medical director of Positive Development, which serves Baltimore and the DMV with in-home DRBI services, agrees.
“We can bend their developmental trajectory more easily the earlier we find people,” he says.
But Positive Development also serves age groups through adolescence — and often sees older kids. “Often, they’ve had other care approaches that weren’t helping. We don’t put a ceiling on somebody doing better over time, whatever their age.”
ABA builds skills
Applied Behavior Analysis (ABA) is one of the longest-established autism therapies. It’s faced criticism for punitive measures used in its early days in the 1960s, and in the last decade, for concerns over behavior suppression and compliance-based skills that can be hard to retain.
But more recently, there’s been a shift to positive reinforcement and respect for individual preferences.
According to Williams, modern ABA looks different from the highly structured versions of the past. “The field of ABA has shifted from a narrow approach to care toward a more contemporary, naturalistic approach that focuses on building communication, independence and quality of life, with much more attention to the child’s own interests and pace,” she explains.
A typical ABA session includes one-on-one work with a trained behavior technician in a child-friendly setting and blending structured skill-building with play, alongside group activities for social skills. Sessions are individualized and data-driven, and a Board-Certified Behavior Analyst (BCBA) regularly adjusts the plan. ABA is often particularly effective when families are targeting specific skills or safety concerns. Williams cites communication delays, toilet training, transition difficulties, self-injurious behavior, aggression and social skills development as areas where ABA can make a measurable difference.
Importantly, she says the focus of modern ABA is not on changing who a child is or eliminating differences. “We individualize every goal with the family and never aim to suppress who a child is,” Williams says. “We focus on building skills that expand a child’s choices and quality of life.”
DRBI builds relationships
Developmental relationship-based interventions (DRBI) take a different starting point to shared goals of improving outcomes. Rather than focusing primarily on observable behaviors, DRBI approaches emphasize relationships, emotional development, communication, sensory experiences and a child’s internal experience. Criticism of this approach has reflected concerns with developmental approaches in general — being new and less studied, with questions of how easily they can be replicated or maintained. But there’s been a positive trend in the last few years for DRBI, with more evidence to support its success and adaptations to support caregiver-mediated services.
“Our Positive Development Model is a caregiver-mediated approach that improves your relationship with your child so that they learn how to problem-solve, communicate, regulate themselves and connect in meaningful interaction,” says Feder. The approach encourages and teaches parents to slow down, observe and follow their child’s lead. “We look for golden moments that we want to build upon,” he says. “If there’s a flash of a moment that was connected and meaningful, we think about how we can make it happen more.”
Therapists coach caregivers to join children in activities they already find meaningful, then gradually expand those interactions to support richer communication, emotional growth and learning. Positive Development also uses paraprofessional Developmental Play Partners (DPPs) to help children practice engaging with a wider range of people and settings. “This helps a child get out in the world and be more able to function with peers, teachers, coaches and others,” Feder says.
Response to behaviors
One distinction between approaches is how they view challenging or repetitive behaviors.
In ABA, therapists seek to understand the function of a behavior. A child may be attempting to communicate, escape a difficult task, gain attention or meet a sensory need. Once the reason is understood, therapists aim to teach or train safer, functional ways to meet those needs, reinforcing the new skills over time.
DRBI explores the child’s experience behind the behavior. Feder relates that an autistic child who repeatedly watches light pass through their fingers may be enjoying a sensory experience rather than engaging in a behavior that needs to be stopped. “We start by trying to understand the behavior,” he says. “Lots of times people do this because they love it. It helps them feel calm and regulated.”
In another example, if a child experiences a tantrum, Feder notes that developmental therapists focus on co-regulation and connection. “We empathize. We might talk quietly. We address the sensory needs or other challenges that are going on. We stay with them.” Over time, kids tend to tantrum less and become more engaged in problem solving.
Team effort
One common theme in both approaches is that parents are essential to success.
Because DRBI is fundamentally caregiver-mediated, parent participation is woven into every aspect of treatment. “We’re teaching the parent, caregiver, grandparent, teacher and others to be able to do these things throughout the day,” Feder says.
Growing emphasis on caregiver involvement is part of ABA as well. “We provide regular caregiver training so families can carry strategies into daily routines, not just the center,” Williams says. “Parents and caregivers are the most important part of the team.”
Both providers also emphasize collaboration with speech therapists, occupational therapists, mental health professionals and other specialists.
Focus on fit
In recent years, the American Academy of Pediatrics, American Medical Association and American Academy of Child & Adolescent Psychiatry have all endorsed DRBI alongside ABA as valuable therapies, and insurance and Medicaid now afford families more opportunities to choose.
Parents are encouraged to consider which approach matches their child’s needs, their family’s values and their outcome priorities. If goals include developing specific skills, increasing independence, learning alternative forms of communication or addressing safety concerns, ABA may be a strong fit. If parents want to focus on social connection, emotional regulation, problem solving and relationship-focused growth, DRBI may feel more aligned with their values.
Feder’s DRBI goal is simple: “Observe what the child is doing, join them in meaningful interaction and build on those interactions in a way that helps the child function more.”
Williams says ABA success banks on finding that right rapport. “Real meaningful progress can happen when strong partnerships are built between caregivers and their therapy team.”
One size does not fit all, but trust the right fit is out there, ready to help support your family and prepare your child for the brightest future possible!
