Disclaimer: Although ABA-based models are the ones with the most empirical evidence for addressing autism, it is common to find “Stop ABA” movements on social networks, composed mostly of autistic adults.
Below are the arguments of an autistic woman about ABA, who uses it to address her son. If one of the premises around autism is that we must listen to autistic people, being consistent with this position implies listening to both sides of the bell, and not just the one that confirms our previous opinions.
“You are torturing your child with ABA therapy.”
Much like society at large, the autism community is not unified in its beliefs about autism. The first time I mentioned ABA (Applied Behavior Analysis) therapy on my blog, it only took a few minutes before someone told me, “You are torturing your child with ABA therapy.” This was not a surprise. Even before Charlie was diagnosed with autism, I searched the web for therapy options and discovered that ABA was not everyone’s cup of tea. ABA is the number one therapy recommended by medical experts for children on the autism spectrum, yet many autistics reject that conclusion. As an autistic adult, I see both sides of the argument, but overall I am in favor of ABA therapy.
ABA therapy then and now
A little context is necessary here. ABA therapy has evolved tremendously over the years. It is not the same as 60 years ago when Dr. O. Ivar Lovaas designed the first implementations of ABA to help autistic people. He did so based on principles developed by the famous psychologist BF Skinner, found in his book, published in 1938, The behavior of organisms. Back then, they used robotic repetition of learning tests conducted in clean rooms and administered punishments to help autistic people learn new and appropriate skills. In early behaviorism, rewards and punishments were used equally. Later, it became clear that rewards worked better than punishment, and punishment, while it might have encouraged learning for some, also produced fear. The methods used to help people with autism today have changed so much since Lovaas’s initial experiments that it is unfair that they even bear the same name.
Note from the “translator”: Even the model derived from Lovaas has changed significantly over the years, updating its way of teaching, removing punishments from its teachings and basing them on positive reinforcement. The term reward, on the other hand, is not theoretically correct. Yes, it is, however, reinforcement.
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Play-based ABA therapy
Charlie’s ABA therapy is play-based. There are no punishments. Therapists may give Charlie a consequence by taking away a toy if she hits or yells at them, but most parents do that with their children, whether they are autistic or not.
ABA is not “one size fits all” and a good BCBA (certified behavior analyst) will work hard to develop the best program for a child. For example, we wanted Charlie to gain more independence, so our BCBA designed a program to teach him how to brush his teeth and another to teach him how to dress himself. There is no punishment if he can’t do it, but if he does, he gets whatever reward interests him at the time. Some weeks that might be his tablet. Other weeks it might be a teaspoon of Nutella or a cookie.
Is ABA therapy ableist?
The biggest criticism of ABA therapy is ableism, discrimination in favor of able-bodied people. I don’t agree that ABA therapy is ableist. You can help someone without changing who they are. Charlie is not in ABA therapy because we want him to be normal. We want him to be confident, independent and learn to communicate, to reduce his, and yes, our frustration. We want to fade less functional and dangerous behaviors, like playing in the cat litter box, swallowing rocks, and running down the street, to give them a better chance at life. I am not trying to “fix” Charlie’s autism.
Therapy is here to make your life easier by giving you ways to communicate and, most importantly, keeping you safe. If giving him a cookie is necessary for him to stop these dangerous behaviors and learn to care for himself as well as communicate, then I’m okay with that.
ABA and horror stories
Everyone who works with Charlie is amazing. But not all BCBAs, therapists, and therapy centers are great. Some of them are poorly managed and the methods used are imprecise and almost abusive. Although this is becoming less common, it may explain the most current ABA horror stories you read on the Internet. It’s important for parents to choose an ABA center that aligns with their values, a place where therapists and BCBAs will listen to them when they have concerns or don’t feel comfortable with the way a specific skill is taught.
ABA therapy and stimming (self-stimulation)
On the other hand, there is a part of me that sees how ABA therapy can sometimes be harmful to autistic people. For example, some ABA therapists may prevent a child from flapping his or her hands or swaying. For me, there is nothing wrong with these self-stimulations as long as they don’t get in the way of learning. At school, hopefully the teachers will teach the other kids what it means, rather than trying to get Charlie to stop because the other kids don’t understand it.
But I also get it, constant stimulation can prevent a child from concentrating in class. I don’t think we autistic people should change to fit in with neurotypical people, but I also want Charlie to have every opportunity she can get to learn, and maybe that means preventing him from learning in certain situations. The balance between wanting people to accept the non-harmful behaviors that autistics tend to emit and wanting Charlie to be accepted and able to concentrate in real-life situations is sometimes difficult to find.
Yes to ABA therapy with certain conditions
ABA therapy has been a great help to Charlie and us. It saddens me how little importance is given to parents of autistic children. I get that sickening feeling in my stomach when people tell me that I’m torturing Charlie with ABA and that learning to communicate and develop self-care skills isn’t important because what matters is that he’s happy. Charlie is perfectly happy playing in the cat’s litter box. Charlie is happily banging his head against the wall. Charlie is happy running in the street in front of cars.
What about Charlie’s safety? And as a mother, should I let my son put himself in danger because he is happy? Charlie is also not happy when he cannot communicate or be heard. Thanks to his ABA therapists, Charlie can now communicate his basic needs with an app on his iPad called .
I was lost before ABA therapy came into our lives. There is no way I could have accomplished what Charlie’s therapists did for him, on my own. An autistic child grows up in a world made up almost entirely of neurotypical people, and they have to learn to function within it. The ultimate goal of ABA is to help autistic people live independent, safe, and happy lives in this world, and I think that’s wonderful. While I understand some of the concerns with ABA therapy, in my opinion, when done well, administered by caring people who are open to criticism and who have the child’s best interest in mind, ABA is the best therapy for children in the autism spectrum.
Does ABA cause PTSD? No, you can read about how that one study is flawed and was discredited.
Translator’s note: You can also read this one published in in Spanish on the same topic.
Fountain: