There are better ways than Applied Behavior Analysis – ABA to address difficult behaviors!
Despite some industry changes in applied behavioral analysis practices and therapy models, ABA practices will always be based upon a foundation of compliance, coercion, and behaviorist principles. It is impossible to practice ABA even gently or playfully, without attempting to control and manipulate a person’s behavior.
The fundamental goal of ABA is compliance with the will of the person in the position of authority; this is completely counter-intuitive to self-advocacy, self-determination, and upholding human rights and dignity.
“ASAN’s objection is fundamentally an ethical one. The stated end goal of ABA is an autistic child who is “indistinguishable from their peers”—an autistic child who can pass as neurotypical. We don’t think that’s an acceptable goal. The end goal of all services, supports, interventions, and therapies an autistic child receives should be to support them in growing up into an autistic adult who is happy, healthy, and living a self-determined life.”
– Julia Bascom, Executive Director, Autistic Self Advocacy Network
This is ABA in 2022
The Shocking School: The Judge Rotenberg Center, a Massachusetts school, still uses electric shock therapy to punish disabled students. How can an entire field of mental health accept this as fine?
Summers, J. (2021, December 22). The Shocking School. Boston Review.
ABA is a multibillion-dollar industry, preying upon the concept of “autism as commodity”…
As Private Equity Comes to Dominate Autism Services… It’s time to ask ourselves how long we want to keep rewarding bad behavior.
Summers, J. (2021, April 2). As private equity comes to dominate autism services… The Nation. https://www.thenation.com/article/society/private-equity-autism-aba/
The role of private equity and lobbying in ABA funding: Talking with investigative journalist John Summers
Borden King, A. (Ed.). (2021, August 24). The role of private equity and lobbying in ABA funding: Talking with investigative journalist John Summers. Noncompliant – The Podcase.
Broderick, A. A., & Roscigno, R. (2021). Autism, Inc.: The Autism Industrial Complex, Journal of Disability Studies in Education (published online ahead of print 2021). doi: https://doi.org/10.1163/25888803-bja10008
There are many ethical and human rights concerns to consider regarding the use of ABA on human beings. This includes the use of ABA-derived therapy models such as Naturalistic Developmental Behavioral Interventions and relationship-based therapy models paired with ABA on non-consenting human beings.
We are appalled that to this day the Judge Rotenburg Center uses painful electrical stimulation devices (ESDs) on human beings, a practice which the United Nations has deemed torture, and are appalled that the Association for Behavioral Analysis International (ABAI) continues to feature JRC as a presenter at their annual conferences year after year.
We are disturbed that ABA is used on pediatric, adult, and elderly populations without consent from the humans on the receiving end.
We are horrified that the BACB condones the use of punishment in the treatment of neurodivergent, autistic, and intellectually disabled humans. We want the public to understand that The Behavioral Analysis Certification Board’s Ethics Compliance Code has published guidelines (4.08 Considerations Regarding Punishment Procedures) for the application of aversion procedures (punishment) that certified ABA providers must follow when treating clients. We believe the use of punishment to manipulate human behavior is a violation of human rights.
Ethical, empathetic, and respectful practices would never encompass the following:
- Training human behavior compliance through rewards, such as the earning of snacks, check-marks, behavior charts, stickers, access to favorite or personal items and objects, activities, or similar.
- Withholding attention or affection, food, drink, activities, or objects, personal belongings, favored hobbies, etc. until compliance is gained, or the therapy outcome is achieved.
- Humans training other humans as they would whales, chickens or dogs.
- Compliance training, which sets up children for current and future victimization*, “specifically, more property crime, maltreatment, teasing/emotional bullying, and sexual assault by peers.”
* Weiss JA, Fardella MA. Victimization and Perpetration Experiences of Adults With Autism. Front Psychiatry. 2018;9:203. Published 2018 May 25. doi:10.3389/fpsyt.2018.00203
Trauma-informed, research-based alternatives to ABA and behavior-based treatments for autistic and otherwise disabled people:
Speech-Language Pathologists and Speech-Language Therapists have the unique, necessary training and education in anatomy, physiology, neurology, and neurological based conditions, language development, and motor development to address self and/or other-harming client behaviors through the investigation of the underlying causes. Trained SLP/SLTs and their SLP-Assistants teach clients to self-advocate through functional communication, thereby ensuring that they retain the inherent human right of self-determination.
Occupational Therapists focus on a person’s ability to function independently rather than the “function” of any particular “behavior”. What guides the practice of an Occupational Therapist is what is of most importance to the client – personal goals, hobbies, and occupations. Occupational Therapists teach the skills for the job of living, using a broad knowledge-base of anatomy and physiology, neuroscience, psychology, and activity analysis to help people achieve their highest level of independence with the activities of daily living that are most meaningful to the client. Additionally, and importantly, occupational therapists address client environments, especially the social, physical, and policy aspects, to promote social participation and inclusion.
Shifting Focus From Impairment to Inclusion: Expanding Occupational Therapy for Neurodivergent Students to Address School Environments
Yu-Lun Chen, Kristie Patten; Shifting Focus From Impairment to Inclusion: Expanding Occupational Therapy for Neurodivergent Students to Address School Environments. Am J Occup Ther May/June 2021, Vol. 75(3), 7503347010. doi: https://doi.org/10.5014/ajot.2020.040618
Therapist Neurodiversity Collective believes that therapists should listen to and respect Autistic and other Neurodivergent voices. A neurodivergent-affirming therapist does not “treat autism.” Coercing a neurodivergent person to “normalize” through ABA and/or other masking therapy models is disrespectful and can cause substantial trauma.
We recommend that families seek out therapists who commit to providing therapy in manners that uphold the dignity of the individual while promoting self-determination.
You might not know your therapy program is ABA...
- “Play-based” ABA
- ABA + relationship-based therapy (a therapy framework where ABA is used in conjunction with DIRFloortime, SCERTS, Hanen, or similar.)
- Verbal Behavior (VB)
- The Lovaas Approach
- Pivot Response Treatment (PRT)
- Natural Language Paradigm ® (NLP)
- Early Start Denver Model (ESDM)
- Discrete Trial Training (DTT)
- Gemiini Systems
- Incidental Teaching
- Early Intensive Behavioral Intervention (EIBI)
- Intensive Behavioral Intervention (IBI)
- ABA Derived “Errorless Learning” Therapy Models
- Intensive Behavioral Intervention (IBI)
- Joint AttentionSymbolic Play, Engagement, and Regulation (JASPER)
- Positive Behavior Support (PBS)
- Positive Behavioral Interventions and Supports (PBIS)
- PCIT – Parent-Child Interaction Therapy
- The PEERS® program
- Project Improving Parents as Communication Teachers (Project ImPACT
“Research in ABA continues to neglect the structure the autistic brain, the overstimulation of the autistic brain, the trajectory of child development, or the complex nature of human psychology, as all of these factors were ignored in the response and are ignored in ABA practice itself. Providing a treatment that causes pain in exchange for no benefit, even if unknowingly, is tantamount to torture and violates the most basic requirement of any therapy, to do no harm. “
Sandoval-Norton, A.H., Shkedy, G. & Shkedy, D. Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane. Adv Neurodev Disord 5, 126–134 (2021). https://doi.org/10.1007/s41252-021-00201-1
June 25, 2020: Report to the Committee on Armed Services of the Senate and House of Representatives on TRICARE and ABA:
Two well-respected medical literature review services, external to DHA, continue to find the evidence for ABA services (Intensive Behavior Intervention) for the diagnosis of (Autism) is weak, noting, “An overall low-quality body of evidence mainly from poor-quality studies suggests that Intensive Behavior Intervention (IBI) improves intelligence or cognitive skills, visual-spatial skills, language skills, and adaptive behavior compared with baseline levels or other treatments.
“The research literature available regarding ABA services predominantly consists of single-case design studies which does not meet criteria for “reliable evidence” under TRICARE standards. There are still methodological concerns limiting the strength of the research such as identified characteristics of children (including symptom severity), rendering providers, and types of treatment for positive outcomes. These limitations include: “dose-response” (frequency, intensity, and duration), treatment fidelity, few studies which use a control group, few longitudinal studies which demonstrate long-term effectiveness, and no replication of similar in well-designed studies.”
“Reflections from 10 participants were indicative of a predominantly detrimental impact of ABA. Reflections gave rise to a core theme ‘‘recalling hidden harms of childhood experiences of ABA’’. Outcomes are discussed in relation to the impact on autistic identity, current research and progressing understanding of the impacts of early intervention from the autistic perspective.”
McGill, O. and Robinson, A. (2021), “Recalling hidden harms”: autistic experiences of childhood applied behavioural analysis (ABA)”, Advances in Autism, Vol. 7 No. 4, pp. 269-282. https://doi.org/10.1108/AIA-04-2020-0025
“This article discusses the prevalence of (Autism) with specific regard to the most ubiquitous current treatment, Applied Behavior Analysis (ABA). A discussion of some of the issues with the underlying theory of ABA in its current application is conducted, especially with regard to “lower functioning” and nonverbal autistic individuals; namely, the curtailing of soothing “stimming” behaviors, operant conditioning, behaviorist principles that research has continued to prove it is not apt for usage with autistic individuals, as well as the unintended but damaging consequences, such as prompt dependency, psychological abuse and compliance that tend to pose high costs on former ABA students as they move into adulthood.”
Sandoval-Norton, Aileen & Shkedy, Gary. (2019). How Much Compliance is Too Much Compliance: Is Long-Term ABA Therapy Abuse?. Cogent Psychology. 6. 10.1080/23311908.2019.1641258.
This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of (Autism). However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis (ABA), which is widely taken to be far-and-away the best “treatment” for (Autism), manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but often exacerbate them. Warnings of the perils of ABA are not original to us-autism advocates have been ringing this bell for some years. However, their pleas have been largely unheeded, and ABA continues to be offered to and quite frequently pushed upon parents as the appropriate treatment for autistic children. Our contribution is to argue that, from a bioethical perspective, autism advocates are fully justified in their concerns-the rights of autistic children and their parents are being regularly infringed upon. Specifically, we will argue that employing ABA violates the principles of justice and nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well.”
Wilkenfeld DA, McCarthy AM. Ethical Concerns with Applied Behavior Analysis for Autism Spectrum “Disorder”. Kennedy Inst Ethics J. 2020;30(1):31-69. doi: 10.1353/ken.2020.0000. PMID: 32336692.
“When disability is defined by behavior, researchers and clinicians struggle to identify appropriate measures to assess clinical progress. Some choose the reduction or elimination of diagnostic traits, implicitly defining typical appearance as the goal of service provision. Such an approach often interferes with more meaningful, person-centered goals; causes harm to people with disabilities; and is unnecessary for dealing with traits that are intrinsically harmful or personally distressing, such as self-injury. “
Dawson M, Fletcher-Watson S. When autism researchers disregard harms: A commentary. Autism. 2021 Jul 22:13623613211031403. doi: 10.1177/13623613211031403. Epub ahead of print. PMID: 34291651.
“Neurodiversity is best considered a lens through which to evaluate the goals of autism interventions. Does an intervention seek to modify a given trait solely because it is autistic? Or does it proceed more modestly, only targeting that which is intrinsically harmful? This approach is consistent with addressing self-injury or promoting communication. Just as surgically shaping the eyes of people with Down syndrome to look normal is now considered barbaric, neurodiversity requires us to recognize as unethical measures to enforce typical appearance solely to avoid stigma. Suppressing autistic traits in order to promote typical appearance is problematic regardless of level of impairment, while reducing personally distressing or harmful behaviors or developing skills is not.”
AMA J Ethics. When Disability Is Defined by Behavior, Outcome Measures Should Not Promote “Passing” 2021;23(7):E569-575. doi: 10.1001/amajethics.2021.569.
The Department of Defense reported to Congress on Oct 25, 2019, about Comprehensive Autism Care that after one year of ABA treatment, 76% of those with autism had no change in symptoms, and 9% WORSENED by more than a full standard deviation. This reaffirms Navy Capt. Edward Simmer, Chief Clinical Officer of the Tricare Health Plan, stated in November 2018 that the effectiveness of applied behavioral techniques for autism remains unproven.
OFFICE OF THE UNDER SECRETARY OF DEFENSE – October 2019 TRICARE-Autism-Report_
For Further Reading
Therapist Neurodiversity Collective
Neurodiversity and Autism Intervention (ABA) can’t be reconciled.
Confessions of a Previous ABA Technician
Confessions of a Previous ABA Technician – 2
The Problem with PECS®
Why We Model Language and Honor All Communication, instead of Using PECS®
ABA Therapy and PTSD
ABA: Modern-Day Brainwashing
ABA is NOT Effective: So says the Latest Report from the Department of Defense
Rebuttal to critique of “ABA is NOT Effective: So says the Latest Report from the Department of Defense”
Fundamental Research Problems with the ASHA Board Certified Specialist in Autism Spectrum Disorders (BCS-ASD)
Medical Neglect – Physician and Court Ordered ABA for Autistic Children
TBI in Service Members – Real-life effects & the need for Empathetic, Compassionate & Trauma-informed Care
Avoiding the “Good Job!” Habit
More Reading Resources
First-Hand Perspectives on Behavioral Interventions for Autistic People and People with other Developmental Disabilities – Autistic Self Advocacy Network (ASAN)
Access to Communication Services and Supports: Concerns Regarding the Application of Restrictive “Eligibility” Policies – National Joint Committee for the Communication Needs of Persons With Severe Disabilities
Autism and Behaviorism -New Research Adds to an Already Compelling Case Against ABA
“When a common practice isn’t necessary or useful even under presumably optimal conditions, it’s time to question whether that practice makes sense at all.”
The Hidden Potential of Autistic Kids – Scientific American
The Great Big ABA Opposition Resource List – Ask an Autistic
5 Important Reasons Even “New ABA” is Problematic – Kaylene George
Research-Based Approaches to Autistic Ways of Learning – Karla McLaren
Autistic Conversion Therapy – Amy Sequenzia
DOES ABA HARM AUTISTIC PEOPLE? – AUTISTIC UK CIC