“First Do No Harm”: How SLPs Who Ignore Coregulation Reduce Children’s Access to Authentic Communication
Many speech-language pathologists do not think of sensory, emotional, or cognitive regulation as a part of their area of practice. In actuality, though, all communication originates from the need for regulation, and it is impossible to support a child’s communication skills or language development without understanding and supporting their regulation needs.
I am used to my stuttering and I wish everyone else would get used to it too. My reactions and my feelings about stuttering are relative to how you, the listener, react. I am only uncomfortable because you are uncomfortable. I am uncomfortable FOR you.
I was called “unethical” by a professional colleague today.
The reason may surprise you—I said “ABA is abuse”. My peer was naturally taken aback because they are an SLP-BCBA and “would never dream of abusing a child.” I always find this rebuttal interesting because we usually don’t hear about people walking around admitting to abusing people; even overt predators somehow convince themselves that they are helping their victim. The sanctimonious SLP-BCBA told me that it was the “old ABA” and not “new ABA” that was harmful, and then only a small fraction of the time. She accused me of “throwing the baby out with the bathwater” (I still don’t really understand how this idiomatic expression applies here) and she further went on to insist that there is “no way ABA could cause PTSD in people with Autism.” (She really meant “Autistic people,” I am sure.)
Today in a virtual Zoom therapy session, the parent asked me why I don’t use PECS® in speech therapy (with non-speaking or minimally speaking Autistic children). After watching her child laugh, dance, and have fun during therapy, after watching them imitate action verbs, and spontaneously communicate a desire, spontaneously point to my assistant and me on the screen, and smile at us all, it became clear to this parent that there are different kinds of therapy sessions. This kind isn’t all about compliance.
With 3,794 participants, this is the largest study ever conducted of ABA effectiveness. The 31-page report entitled, “The Department of Defense Comprehensive Autism Care Demonstration Annual Report 2020” concluded that “ABA services are not working.”
Our autistic female students are constantly mimicking and copying behaviors of peers so they can hide their autism. We, as clinicians, teach them to do this because we were taught that autism must be hidden and masked through the therapy we provide. We are licensed, credentialed ableists, “therapizing: our autistic students to learn to be in a constant state of making in order to be acceptable, to be worthy, to be liked.
“Good job!” is a phrase used frequently during treatment sessions with autistic children. What message does a child receive from hearing, “Good Job!”? We hope they hear our interest, encouragement and approval. However, when “Good Job!” becomes a habit, is it still successful in conveying this meaning? Or, does it simply signal that the adult is in control, with specific goals in mind and is directing the child towards those behaviors, regardless of the child’s intention? Can frequent “Good Job!” responses undermine a child’s initiative, creativity and broader learning? Does it interfere with a more robust engagement?
As a Speech-Language Pathologist (SLP), I often find myself trying to explain what I do. Our scope of practice is broad and not well understood by the general public. As an SLP specializing in feeding disorders, my work is even harder to explain! To educate the public about what SLPs (and Audiologists) do, the month of May has been designated as Better Hearing & Speech Month.
TBI in Service Members – Real-life effects & the need for Empathetic, Compassionate & Trauma-informed Care:
Beginning in around the year 2000, the field of Applied Behavior Analysis (ABA) has included Traumatic Brain Injury (TBI) among their ever-increasing scope of practice, claiming that ABA is “one of the most effective treatments for managing mood, behavioral and other mental disorders associated with brain damage”.3 ABA, in its simplest form, treats the behavior associated with TBI, rather than treating the underlying neurological reasons for that behavior.
Why Perspective-Taking and Neurodiversity Acceptance? (Part 2 of “Training” Social Skills is Dehumanizing: The One with the Therapy Goals)
Wasted years upon years of endlessly drilling autistic children and adolescents to memorize and parrot “appropriate” rote phrases for specific social situations will not lead to their peers perceiving them as more likable. Social skills training is not a “cure” for autism despite what the ABA industry would like for us all to believe. All “social skills training’ does is to teach autistic people how to mask their autism. And the potential harms of masking (exhaustion, anxiety, depression, frustration, decreased self-esteem suicidal ideation) are significant.
Now let’s talk about one of the recent episodes, “The Reckoning.” There’s a loving montage of a character Kuiil rehabbing a droid, named IG-11, who’d been killed. Kuiil rebuilt the droid from scratch after “Its neural network was almost completely gone.” He had to piece IG-11 together, which may be a little beyond our day-to-day job, but the recovery process is certainly something many of us speech-language pathologists have participated in.
PECS® uses Operant Conditioning, which is a behavior technique that can be used to target and increase a behavior by pairing performance of the target behavior with a positive or rewarding outcome. Per Andy Bondy, inventor of PECS, “Skinner’s analysis of Verbal Behavior forms the basis for teaching particular skills at specific points in the training sequence and also provides guidelines for how best to design the teaching strategies.” PECS uses picture-based prompting and reinforcement tied to error correction in order to teach language skills. The method allows the trainer to artificially cause frustration through the withholding of highly desired objects or food until the targeted behavior is achieved, even if the communicator becomes upset or angry. It is not a natural or nice way to teach language.
Dictating how a neurodivergent person is expected to communicate in specific social situations takes away their self-determination. Training people as one trains animals is appalling. SLP Neurodiversity Collective believes in respecting the authentic social communication of all people, rather than compelling compliance for neurotypical expectations through a system of rewards and punishments.
ASHA has guidelines in our ethics code for “collaboration” and “interpersonal professional practice” (IPP), which are two terms ABA practitioners often use in order to attempt to intimidate or gaslight both CCC-SLPs and ASHA into believing that speech-language pathologists are being unethical if we dare to voice negative opinions against the use of ABA practices and/or BCBA and RBT incompetency (as they dangerously or inadequately provide speech therapy services for which BCBAs and RBTs are not educated or trained).