Clarifying the ABA Comparison and Equivalence Claims in Schaaf et al. (2025).
A 30-hour clinic ABA package is not the same as full community ABA, so equivalence claims need a harder look.
01Research in Context
What this study did
Wen-Pin (2026) looked at a recent trial that claimed occupational therapy and ABA work the same. The paper says the trial used too few kids and gave ABA only 30 hours in a clinic. That dose is far below the 20-40 hours a week families usually get in the community.
The author warns that weak ABA packages can make other treatments look equal when they are not.
What they found
The study found that the trial cannot prove equivalence. Low power and the skinny dose mean the comparison is unfair. Saying OT and ABA are equal based on that data is, in the author’s words, “overstated.”
How this fits with other research
Shea (2004) raised a similar red flag twenty years earlier. That review showed the famous “47 % recovery” figure from Lovaas EIBI was shaky because the control group was weak. Both papers tell us to check the fine print before buying big claims.
Leaf et al. (2021) also warn BCBAs to scrutinize evidence lists. Their critique of the NCAEP 2020 report and Wen-Pin’s critique of the Schaaf trial both say the same thing: flashy headlines can hide thin methods.
Davison et al. (1995) shows a real-world gap. Adult programs often skip key tactics that research praises. Wen-Pin adds a new gap: research itself can use watered-down ABA and still call it “ABA.”
Why it matters
Before you tell a parent “studies show ABA and OT are equal,” read the dose table. If the ABA group got only clinic hours, point that out. Ask, “Is this the same intensity we recommend?” Push for trials that mirror real-life dosage. Your scrutiny keeps the evidence base honest and protects families from false choices.
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02At a glance
03Original abstract
I am writing to express concerns regarding Schaaf et al.'s article, “A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children” (Schaaf et al. 2025). Considering the potential impact this study has on service recommendations, I would like to discuss the concerns that, in my opinion, hinder the conclusions that can be drawn. First, the “Applied Behavior Analysis (ABA)” arm appears to represent a brief, focused behavioral skills training (30 one-hour sessions over several months in a clinic room). This protocol, however, is not a comprehensive, high-intensity ABA model implemented in practice following contemporary practice guidelines (typically 20–40 h per week across settings and domains, Council of Autism Service Providers (CASP) 2024). To extrapolate from this low-dose, limited protocol to what ABA normally enacts in practice is to risk overstating both the scope and the evidence for ABA. Second, the trial was powered only to detect very large effects, yet the non-significant between-group difference on the pre-specified primary outcome (PEDI-CAT Daily Activities) is interpreted as evidence that OT-ASI and ABA achieved “comparable” improvements. According to the CONSORT guidance on noninferiority and equivalence trials (Piaggio et al. 2012), clearly stated, failure to show superiority in an underpowered study does not establish equivalence. Third, the more positive finding in Schaaf et al. relies heavily on Goal Attainment Scaling (GAS), an individualized, caregiver-reported outcome obtained post-treatment. Although valuable, GAS is more vulnerable to expectancy and allegiance effects than the blinded, standardized primary outcome, a limitation that is not emphasized in the discussion. I appreciate the authors' efforts to undertake a complex randomized trial. However, I would encourage a more cautious discussion of the equivalence between OT-ASI and ABA and a broader recognition that the ABA condition as administered in their study is not equivalent to how average ABA programs in clinical practice are delivered. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Autism research : official journal of the International Society for Autism Research, 2026 · doi:10.1002/aur.70184