Is every kind of ABA therapy abusive?
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This is going to get me so much hate but I've never been very good at keeping my mouth shut so, here goes.
No.
I am not an ABA professional. I am the father of a young autistic man who has received ABA therapy over the years and I have direct experience with the theory and application of ABA. I am not an expert, but I consider myself an informed lay-person. Everybody's experience is different, my opinions are mine and mine alone.
ABA is an educational philosophy and method that has been used extensively with autistic people, especially the very young. As a philosophy of education and a therapy, it has no moral value. That is not to say that it cannot be applied incorrectly or from a misunderstanding of principles. Therapists have done some very bad things in the name of ABA over the years which has given it a very bad reputation in much of the neurodiversity community. I don't dispute that or deny it or mean to minimize anyone else's experience AT ALL.
In any argument over ABA, the names Pavlov and Skinner inevitably come up. What Pavlov and Skinner did was operant conditioning, or, the manipulation of behavior by punishment and/or reward. They both demonstrated that an organism can be trained to display a desired behavior as the result of a carefully applied stimulus: an electric shock, a tone, or a food reward. Some of the methods they used are viewed with disgust and horror today, and, in many cases, rightfully so. But what Pavlov and Skinner did was not ABA. They were doing psychological research that was not, nor was ever intended to be, therapeutic. While it is true that many concepts of ABA can be traced back to operant conditioning, to say that the ABA and operant conditioning are the same thing is misinformed at best and out right dishonest at worst.
Ivaar Lovass, the man who more or less created Applied Behavioral Analysis, was not a perfect man either. He used punishment and reward to model behavior in autistic children in the early years of developing ABA. He, along with most other ABA therapists, moved away from punishment (aka "aversives") in later years, not just because of the moral implications and controversy but also because it was found to be far less effective than reward (aka "reinforcement"). Many ABA therapists today completely disavow aversives. Some will still use very limited aversives in therapy but will only do so in an effort to extinguish or mitigate a behavior that is dangerous or harmful to the client.
*Aversive*: an unpleasant stimulus intended to discourage a behavior. Examples include, but are not limited to: electric shock, a slap, standing in a corner, the word "no." Aversives are generally agreed upon by good ABA therapists as being of limited value for many reasons, and are generally not used.
*Reinforcement*: a pleasant stimulus meant to reward and shape a desirable behavior. Examples vary, but the most powerful reinforcers are personally meaningful to the individual. Can include snacks, a toy, a play break, tickling or other playful interaction. Reinforcement of desirable behaviors is far less stressful for clients and therapists.
**So, what is ABA?**
ABA, or *Applied Behavioral Analysis*, is the detailed observation and analysis of behaviors with the goal of understanding and modifying or extinguishing them. ABA therapists focus on the function of a behavior for an individual. In other words: why do you do this? What do you get out of it? Is it beneficial, detrimental or benign? And, if it is detrimental, how can we modify it?
ABA therapists will talk about behaviors as being "functional" or "non functional".
*Functional behaviors* are behaviors that meet a task or a goal in a way that is generally beneficial for the autistic person. Examples include: stating a choice between food choices; asking for assistance; indicating pain or illness.
*Non-functional behaviors* are behaviors that, if allowed to persist, can put the autistic person at risk of harm; darting out into the street, self-injury, wandering.
It is important to distinguish "functional" and "non-functional" from "good" and "bad" or "right" and "wrong". When determining functional vs. non-functional, one must be as objective as possible when analyzing a particular behavior.
Understand, "non-functional" behaviors may successfully meet a task or goal for the client, but they do it in a way that is unacceptable for reasons of safety or welfare. Asking for a break is a functional way to get away from work for a while. Socking your co-worker in the mouth achieves the same goal but in a very non-functional manner.
A big misconception I often see is the idea that the goal of ABA is "curing autism." I admit, this misconception is well-based in fact. Twenty years ago we used to talk about kids who had been "recovered" from autism through ABA, meaning that after ABA these children were behaviorally indistinguishable from their neurotypical peers. While this was demonstrated for some children, it was dramatically overhyped by mainstream media and well less than half of children receiving ABA showed the same dramatic progress. Turns out, therapeutic response follows a bell curve and popular attention focused far too sharply on those few on one extreme, giving the general public an inaccurate view of the real potential of ABA.
A perceptual problem was created by this talk of "recovered" kids: the idea that autism is something to be cured was (unintentionally, I believe) reinforced in the general public, to the detriment of ABA as a useful therapy. Keep in mind, however, that twenty years ago the diagnostic criteria for autism was different and many of the verbal, independent, and quite vocal advocates you see on the ASD spectrum today would not have been considered autistic. More importantly: those same "high-functioning" autistics are precisely the sort of people who generally don't need ABA.
Much of the controversy surrounding ABA comes from a lack of understanding of the goals and motivations of ABA. Some see it as "brainwashing" or "personality murder." And, if the stated goal of ABA was, truly, to make autistic people "normal", then I would agree. But I have never worked with an ABA therapist who promised anything of the sort. To be sure, they're out there, I've even met one or two, and I wouldn't let them in the same room with my son.
Much like autism is not a disease, ABA is not a cure. It is a *therapy*. Just like teaching a blind child to read braile doesn't cure blindness, ABA doesn't cure autism. An autistic person who participates in a well-run, professionally supervised and documented ABA program will, at the conclusion of the program, still be autistic. Anyone who says differently is misinformed or lying, including persons who represent themselves as ABA professionals. I've worked with a few over the last two decades, some better than others, and not one ever told me that we were going to cure my son. In fact, they were all generally careful to *understate* their goals.
Our first therapist advised "picking your battles." What he meant was: good ABA therapists analyze behaviors in terms of benefit and risk and only concern themselves with behaviors at the extremes. For instance: many autistic people flap their hands. I don't know why my son does this, but it seems to be associated with excitement and happiness. A poor therapist may try to extinguish this behavior, reasoning that it is for the child's good so that they don't "look weird." A good therapist will see the function in the behavior (Stress relief? Excitement?) and will be aware that it does no harm and may actually be beneficial.
*Extinguish*: to eliminate a behavior. Often not a realistic goal. Good therapists will attempt to redirect or modify a behavior rather than eliminate it. The rationale is that the specific behavior meets a need for that person and it is better to substitute a functional behavior for a non-functional one rather than just eliminate the non-functional behavior. Example: my son self-injures when he hears sirens. It is unrealistic to expect that we can make him stop hitting himself and just not react when we have no control over the noxious stimulus that elicits the response. At the moment we are working on redirection to a calming exercise, like a meditation break. We also provide noise barriers (closed windows, hearing protectors, noise generators) when feasible.
Other behaviors have to be taken in context. For example, again, my son has, for lack of a better description, "energy bursts" where he will go from sitting or lying quietly to explosively jumping, laughing, hand flapping, and jargoning. In most contexts, this is another harmless behavior and there's no reason to stop him from doing it, particularly when it seems to serve a purpose for him. However, there are some contexts where it is not appropriate, like a movie theater or the edge of a train platform. In those contexts, we gently redirect his behavior.
Then there are the non-functional behaviors: taking dad by the hand into the kitchen and standing there. Are you hungry? Thirsty? Do you have a headache? Teaching language, whether verbal or otherwise, is a pretty functional behavior for people to have in order to live independently.
My experience is that most people who equate ABA with abuse have little to no direct experience with ABA and don't fully understand the theory and principles. Put simply: ABA is nothing more than a carefully documented and rigorously applied method of the way everyone raises their kids.
No, *really*.
When a baby smiles at her mother and that mother coos and smiles back, that's ABA in a nutshell. Child engages in a behavior: smiling. Mother reinforces behavior with attention. If you're a student of early childhood behavior, you'll see this behavior/reinforcer pattern *everywhere*. The critical difference between autistic persons and neurotypicals is that autistics don't respond in the same ways.
When my son was small, verbal praise or a smile meant nothing to him and he didn't want to be hugged. But picking him up and spinning him around was the best thing EVER. And, to be clear, we never used aversives. Never, EVER. We didn't even use the word "no" during therapy trials. That was something my wife and I agreed on from the start.
My son has a serious language deficit. In fact, I am pressed to recall him ever saying anything prior to ABA. His receptive speech was (and is still) good. He generally understood what people were saying but never said anything himself. Today his expressive language is still mostly limited to single words, jargon, and some written expression, though he has a great deal of difficulty putting words together in an easily interpretable fashion. I firmly believe that, if not for ABA, my son would not have what language he does have. He's still autistic, but now he's autistic with the ability to say his name and my phone number. That's *huge*.
At any rate, that's my experience. I don't expect it to be anyone else's (though I am quite sure I will hear about them). Apologies for long-windedness and poor structure but my eyes are starting to cross. I reserve the right to be wrong.
*Disclaimer* The following post is a just a summary of some facts I've picked up and my own personal opinion about them, which I'm presenting purely for your reference. How you feel about the subject yourself is entirely your opinion and I would never suggest that either opinion is any more valid or ethically sound. All I would ask is that you ensure you do enough research yourself to be completely satisfied that your opinion is valid, and conversely, I am always open to taking a look at new research and thinking that would impact on mine.
First up, ABA or Applied Behaviour Analysis is a form of therapy that applies behaviour conditioning techniques and analysis to bring about a change in behaviour.
So what is behaviourism and behaviour conditioning?
Stripped right back to basics, Behaviourism suggests that any behaviour that any living entity exhibits, is an involuntary process (involving no control or concious thought) which happens after a person or animal is conditioned to perform that behaviour.
The most popular example of this is Pavlov's famous dog experiment, in which a bell was rung every time food was presented to a group of dogs. Eventually, after being conditioned, the dogs would salivate and expect food any time they heard a bell ring, regardless of how hungry or how recently they had been actually fed before, and even if no food was actually presented to them.
As an aside; some historical evidence has also been turned up that he continued his experiments with orphaned children, by drilling holes into their heads, to measure saliva production... funny how that one gets swept under the carpet.
Anyhoo's moving on, however, there have been a number of experiments that are well documented in the west where kids have been experimented on in the name of "science" in order to investigate behavioural conditioning. In the 1920's, for example, John Watson, (of John Hopkins University, not Baker Street) conducted what are referred to as the "Little Albert" studies in which a young child was trained to have a phobic reaction to white mice at 9months old, by scaring the hell out of him with sudden loud noises every time the mouse approached.
More recently in the 1950's and 60's, the Behaviourist B.F. Skinner famously applied his earlier research with Pidgeons and his "skinner boxes" and conducted a number of studies, including on his own kids, on conditioning techniques to modify child behaviour and learning.
But anyhoo's enough of the horror stories and history lesson. Suffice to say that over the years, behaviourists have conducted a lot of studies and become quite expert in changing peoples behaviour by using both positive and negative feed back techniques (eg, giving treats, or providing punishment of some kind for performing certain behaviours)
Moving on... we have these techniques, but what are we using them for in ABA.
That really depends on your point of view. If, like me you agree that for the most part, a person is at least partially defined by their behaviours and the way they react to stimuli in their environment, regardless of the reason for it, ABA techniques represent a pretty vile, manipulative, biological cut and paste, in which aspects of a person are identified and removed, to be replaced with more desirable behaviour.
I for example, am very sensetive to heat, and so my behaviour is to avoid hot places. As a result I prefer to go on holidays to cold places, I prefer winter sports to summer ones, and I'd rather go camping in the rain than lie around on a beach in the sun. To break it down into behaviour and conditioning for you -
Heat is a negative stimulus for me, this causes me to feel uncomfortable, which results in a me being conditioned to dislike warm places.
If you used behaviourist techniques, either to reward me when I expose myself to warm places, or to punish me when I go to cold ones, then I "might" become conditioned to prefer warm places.
In so doing you would have changed a significant aspect of my being and very identity. I'd no longer be the guy that likes to go on holiday in the snow, and I'd be someone that enjoys activities and places I would normally have done my very best to avoid.
If we were talking about something physical, rather than something based in personality and someones psyche, it'd almost be like a real life invasion of the body snatchers, in which you take "me" away and kill them off, and substitute a more desirable version of your own.
I find the idea of rewriting a persons personality in that way pretty abhorrent.
However that's my opinion and not necessarily reflective of your own. If you don't feel that way, you may find you agree with the behaviourists instead, and believe that behaviours exhibited by a person are involuntary, and determined by conditioning alone.
Unfortunately for you, morally, you're probably on even shakier ground than before.
Why's that you ask?
Because then you are suggesting that a person is totally, completely and utterly not responsible for behaviours they exhibit, and that it is purely down to luck, coincidence and the way that they happened to end up being conditioned. In essence they are innocent.
And then you are using scientifically developed techniques to either manipulate or punish them in order to performing in a manner that you now control. Another term for using punishment or manipulation in order to illicit a favorable response is torture, which was, the last time I checked, illegal in most countries. And you're doing it to people you already know are innocent.
To many torturing the innocent is probably even more abhorrent to just killing them.
Ultimately, it depends on how you view the techniques and the impact of those techniques upon the person exposed to them, and how deeply you intend on looking.
At a cursory, skin deep level, if all you are willing to see/consider is the actual activities on hand, then certainly, I grant you some techniques can probably seem quite benign or even incredibly loving, caring thing. Who wouldn't like to be given cake every time they smile and acknowledge a person when they start talking to you? To be honest, most of us can agree, there is always time for a little more cake, or chocolate, or hugs, toys, whatever.. Give us the things and make us happy.. We can all learn to perform and be "better people" (by which i mean, more acceptable) with enough cuddles and chocolate.
If that's as far as you choose to look, then sure, there's nothing wrong at all.
If you chose, however, to consider the whole person, including the one behind the eyes, then in my honest opinion you are on incredibly shaky ground, morally speaking, as you start looking to change the very person they are, which by extension means taking away from the person they were.
In extreme, and I mean extreme, situations, it might be argued that it'd be ethically correct to assist someone in modifying their behaviour in order to correct a problem that poses a significant threat to their overall health. A stress reaction that could lead to, or involves, physical injury (eg biting/cutting/etc) might be grounds to argue that a persons overall well being will be improved and that conditioning them to stop performing the behaviour is a good thing.
I personnally would argue that you'd be better off helping them to manage their stress more effectively, reduce or eliminate forms of stress that provide a trigger in their environment, and essentially, assist them in gaining control of their behaviour, instead of just slicing it out and substituting something else.
To put it in more day to day terms...
You wouldn't give an alcoholic an electric shock every time they had an argument in the office and reached for the bottle to calm down and feel better. You'd encourage them to actively avoid the bottle in the first place. You'd possibly suggest they work with their employer to work on the environment in their office and to help with the interpersonal communication instead.
Beating the alcoholic up every time they relapse will only make them feel worse, and potentially see them less able to avoid the bottle in future. Giving them a present every time they have an arguement and don't drink is just as likely to encourage them to have arguements as it is to encourage the "not drinking" part.
But we'll happily discuss doing all that and more, figuratively speaking, for a kid that has trouble looking people in the eyes, or likes to wave their hands around in the air every now and again to relax.
We're a disposable society, we like a quick fix and when things are broken we throw them away. People and personalities are not disposable, and we shouldn't be so quick to just cut off the bits we don't like and throw them in the recycling. Granted, ABA probably does produce results. But they are lazy results that inevitably deprive the recipient of some aspect of who they are. We would do a lot better if we helped give people control over themselves, their environment and stressors than simply reaching for the proverbial scalpel and whittling bits off. Then you're empowering the person, instead of condemning them.
Right, I've gone on long enough, and veered dangerously close to turning an opinion into a rant.
I hope it proves helpful to some, or that it at least gives you a reason to pause and think a little.
Applied Behavior Analysis, or ABA, is the biggest autism therapy in existence. Experts highly recommend it be used as early as possible for the best results. Parents talk about how it’s helped their children improve. Autism organizations—including us at the Autism Site—have spoken about it, funded it, and even petitioned for it.
But for such a widespread therapy, it can be surprisingly controversial. For the sake of the autism community that has grown so close to my heart, I want to tell you about it. I understand this may upset you, and I’m sorry if it does. But there’s something you need to know about ABA: like just about any other therapy, it has a potential dark side. Many adults with autism are speaking out about negative experiences with ABA—experiences that were even abusive or traumatic for them. And as they are the ones with the firsthand experience, autism parents, teachers, and therapists must listen to them; for the sake of our precious and beloved children, we must be careful when choosing a therapy or therapist. And we’re going to help you do that.
Absolutely.
I am an actual Autistic person and a victim of psychiatric abuse, and my Autistic opinion matters infinitely more than the amount of Autistic children you have or how many degrees you have or how long you’ve been working with Autistic children. ABA is abusive. Abuse under doctors and therapists under the name or ‘treatment’ and ‘normalization’ is abuse. When nearly all Autistic people come to a consensus and say its abuse. It’s abuse. Period.
There is no defense to ABA. I don’t care how nice the therapists are or how petty you think the things you are taking away from an Autistic child are. To be punished for being Autistic. Such an awful thing. Me stimming or making noises happens when I’m overwhelmed and in pain. I use it to feel better. So do your Autistic children and ‘clients’. Imagine if someone punished you whenever you cried when you were hurt or sad. Imagine if someone took away things in your life that made you feel better when you were hurt and uncomfortable and overwhelmed.
I’m so sorry I’m such a burden on you and I look funny but it’s time for you to get over it. You will never know what it feels like to have a body and a mind that doesn’t belong to you. Autistic people’s bodies and minds belong to doctors and therapists. We can’t move how we want to we can’t think how we want to. When doctors grab my hands to keep me from stimming they’re taking my body away from me and telling me it’s not actually my body, I can’t do what I want with it, it’s theirs. I have to do what makes me look normal. I get punished for moving. I have people who watch me and reward me when I look the way I want them to and when I don’t…. you don’t want to know.
ABA causes PTSD and it’s proven. Sorry.
I don’t care how ‘humane’ you’re being about this, taking Autistic people’s bodies and minds from them and treating them like animals that do tricks is vile and disgusting.
Suzanne Fortin , this isn’t about punishing your children over something petty and not giving your child a dessert. This is about punishing your children for being Autistic and for looking Autistic and giving them treats for when they look ‘normal’ like when you want them too and punishing them when they don’t. Your Autistic children aren’t dogs and they aren’t animals. Stop treating them like animals. I understand you want the best for your children but this isn’t it. All the ABA practitioners that tell you how good it is want to make money off your good-intentioned wants for your Autistic children. They live to scare you so that you will pay to make your child ‘normal’.
Darrin Blankenship I don’t even know what to say to you because you clearly know why Autistic people hate this and yet you continue. I pray for your Autistic son because this is an awful thing to do to him. He is a person. This is not how you treat people. Especially not Autistic people. If you ever did this to a non-Autistic person this would be considered abuse by everyone. But your son is Autistic, so it’s okay, apparently.
Emily Patwell Winston Grace I don’t care how much you say you care for Autistic people, I don’t care how many degrees you have, you’re here for one reason and that’s to make money. I suggest you majorly reevaluate your career paths. Also I forgot which one of y’all brought up the ‘ABC’ method but you’re basically straight out admitting here that Autistic people get ‘consequences’ for being Autistic and acting Autistic. I hope y’all feel guilty for traumatizing and controlling Autistic people and treating them like circus animals (and while I’m on it, I’m sure you’re all against animals being treated the way they are in circuses, but Autistic people being treated the same way by therapists in the name of treatment? Who cares apparently. We’re Autistic. We’re treated worse than animals. And no one cares.)
And if y’all all feel extremely defensive and angry right now: it’s the guilt. Guilt does that sometimes. But I’m giving you all a chance to back away from this because this is horrible business and you can stop this and take your Autistic children out of ABA and see them become much happier. You can stop being an ABA therapist and stop contributing to our abuse. You can advocate against it. Or you can keep on and keep feeling guilty deep down and try and cover it and continue to hurt people like me and promote through your actions the abuse and hatred of Autistic people.
Also don’t spend too much time trying to find the names of the couple Autistic people who do support ABA because for each person you do find, I can give you hundreds of people who don’t.
Sorry Autistic people are such an inconvenience to you and such a burden to you. I cry for your Autistic children and clients because they’ll be punished for doing it themselves.
Note: if you also think all your Autistic children and clients seem so happy under ABA, it’s because they’ll be punished for seeming otherwise.
Look, parents use the basic principles of ABA without knowing it. You want dessert? You have to finish your supper. You don't finish supper? You don't get dessert.
Is that abuse?
Two of my daughters have had ABA therapy. One was so she could learn to play by herself, and another was to help her improve her social skills. If she kept on task, she would be able to socialize with her playmate.
ABA could probably be abused like anything else. It doesn't make it bad in itself.
ABA is a life-saver for many parents. Sometimes a kid has to be able to stop or exhibit a certain behaviour, and ABA is the only thing that works. If your kid is smearing feces on the wall, and you can't get him to stop, ABA is a godsend.
That being said, I'm not an ABA enthusiast. It has its uses, but to brand it "abuse" is non-sense.
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