Reader Note: This is the first in a series of articles written by a practicing speech-language pathologist who was previously employed as an ABA behavior technician. The author prefers to remain anonymous due to the significant and sometimes career-ending stigma SLP professionals experience when advocating for an end to the use of ABA (applied behavioral analysis) with autistic and other disabled children.

Content warning for ABA-related trauma, including ABA provider restraint, descriptions of ABA shock treatment, as well as appalling descriptions of autistic children.

Part 1: (un)Qualified: What is a behavior “therapist”?

It was the Spring of 2016, and I was 24 years old. I was one class away from completing an MA in Secondary English Education, but I was having serious doubts about my career choice. 

I was deeply troubled by the educational inequities I saw between disabled students and their neurotypical peers during my student teaching stints, and I hoped that becoming a speech-language pathologist would allow me to provide the targeted communication support to students that I was beginning to realize I wouldn’t be able to provide as a classroom teacher. As the school year came to a close, I made the decision to withdraw from my teacher prep program, and apply for a post-bac program in communication sciences. Then I scoured the internet for work and volunteer opportunities that would help me learn more about how to work with kids who have communication disorders. 

It didn’t take long before I saw an ad to work in a summer camp for autistic and other disabled children. I submitted an application and was offered an interview. It turned out that the owner of the nonprofit organization running the camp also worked at a local ABA clinic. At that time, I had no idea what ABA was. I came to the interview thinking I was interviewing for a position as a counselor at the camp, but during the interview, the interviewer suggested a different idea. Instead of working at the camp, she proposed that my ambition to become a therapist, as well as my experience, would be better matched with the ABA clinic she worked for. She suggested I join her for a few sessions to see if I’d want to apply for a job as a behavior therapist. Who knows? Maybe I’d “like it better than becoming a speech-language pathologist”, she said. 

I went home that evening and Googled “What is ABA therapy?”

In my preliminary research, I read that it was recommended as the “gold standard” treatment for autism by several seemingly reputable sources like Autism Speaks. I didn’t know yet that autism, in itself, is not something to be treated. I didn know back then that Autism Speaks stifles autistic voices, or that Ivar Lovaas, an integral figure in the development of ABA therapy, held beliefs about autistic people that make me ill. 

Ivar Lovaas: You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense — they have hair, a nose and a mouth — but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but l you have to build the person.

Lovaas: Autistic children are severely disturbed. People seem to be no more than objects to them. They show no signs of warmth toward others; they do not appear to enjoy being held. They don’t play with other children. Their parents often think that they are deaf because they don’t respond to noise or verbal commands. Sometimes parents think the child is visually impaired because they walk into objects as though they don’t see them, and because they don’t look into your eyes.

Lovaas: Yes. They have tantrums, and believe me they are monsters, little monsters. And they spend a lot of time in repetitive behaviors that we call self-stimulatory behaviors. For example, they rock themselves back and forth or they spin around in a circle. All kids have tantrums and engage in self-stimulatory behaviors, but with autistic kids it is extreme; they can do it for hours. Before you can get very far with developing normal social behaviors, you have to eliminate these aberrant behaviors.

Lovaas: Yes. They have tantrums, and believe me they are monsters, little monsters. And they spend a lot of time in repetitive behaviors that we call self-stimulatory behaviors. For example, they rock themselves back and forth or they spin around in a circle. All kids have tantrums and engage in self-stimulatory behaviors, but with autistic kids it is extreme; they can do it for hours. Before you can get very far with developing normal social behaviors, you have to eliminate these aberrant behaviors.

Lovaas: Right. We stay close to them and when they hurt themselves we scream “no” as loud as we can and we look furious and at the same time we shock them. What typically happens is this — we shock the child once and he stops for about 30 seconds and then he tries it again. It is as though he says, “I have to replicate this to be sure.” Like a scientist. He tries it once more and we punish again and that is pretty much it. So we can cure self-destructive behavior — even long-standing, self-destructive behavior — in a matter of minutes.

Psychology Today, 1974

Needless to say, I was completely clueless about the history of ABA, the quality (or lack thereof) of the research behind it, and what the purpose of ABA really is – to manipulate or extinguish the autistic person’s behavior so that they are indistinguishable from neurotypical peers. 

I just wanted to help kids!

And from my Google search on the internet, it seemed that ABA was all about helping kids.  At nearly every turn in my search, doctors, psychologists, parents, and even ASHA touted that ABA had a large evidence base, and the initial summaries of articles I read seemed to support that. So I decided to go ahead and apply for a position at the ABA clinic. 

Somehow, my B.A. in English Literature, my incomplete master’s in secondary education, and my woeful lack of knowledge about the needs of autistic people qualified me to work as a behavior therapist, so I got the job. 

I was told that there was a 40 hour online training course that I’d need to take to become a registered behavior technician (RBT), but I didn’t have to worry about that right away.  There were kids who needed therapy now and there would be plenty of time to work on the course later. 

After a few observation sessions with the BCaBA (Board Certified Assistant Behavior Analyst) and several RBTs at the clinic, I was given a list of goals and an iPad to document performance on those targets, and I was handed my first client. Needless to say, I was NOT prepared. 

What is an RBT?

To become an RBT and work in an ABA clinic with clients, the only requirements are:
1) Be at least 18 years old
2) Have a high school diploma or GED
3) Complete a 40 hour RBT training program, usually via video training
4) Have a training supervisor sign off that you are competent

RBTs make up most of the labor force in the ABA industry with nearly 100,000 RBTs registered as of April 2021 according to the Behavior Analyst Certification Board (BACB), the certifying body for ABA. No information is available regarding the experience level, amount of additional training, or educational attainment of RBTs because the BACB doesn’t collect that information. 

RBTs only receive 40 hours of video training, yet do the bulk of ABA intervention! I started working with kids before I even completed the training.

I typically do not place much stock in the research and literature produced by those in the ABA industry because they do not consider modern research in psychology or neuroscience, rarely include longitudinal data on their interventions, and are rife with undisclosed conflicts of interest (see Bottema-Beutel. K. & Crowley, S., 2021). However, I believe it is notable that, even within the ABA literature, people working within the ABA industry have voiced concerns about the quality of the RBT certification. 

After the RBT credential became available in 2014, a team of BCBAs and other ABA-aligned individuals cited their concerns including:

“The training hours requirement for the RBT does not appear to be extensive nor does it appear to be consistent with the current body of research”

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., Freeman, B. J., Mountjoy, T., Parker, T., Streff, T., Volkmar, F. R., & Waks, A. (2016). Concerns About the Registered Behavior Technician™ in Relation to Effective Autism Intervention. Behavior analysis in practice, 10(2), 154–163. https://doi.org/10.1007/s40617-016-0145-9

“Previous literature on staff trainings brings into question whether an 18 year old with just a high school diploma . . . has enough of an educational background and level of maturity to understand the basics of child development, principles of applied behavior analysis, . . . and characteristics of individuals diagnosed with ASD from a single week of training”

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., Freeman, B. J., Mountjoy, T., Parker, T., Streff, T., Volkmar, F. R., & Waks, A. (2016). Concerns About the Registered Behavior Technician™ in Relation to Effective Autism Intervention. Behavior analysis in practice, 10(2), 154–163. https://doi.org/10.1007/s40617-016-0145-9

The article goes on to state that, in addition to a litany of other concerns, RBT training does not even require the RBT to demonstrate competency performing central tasks such as data interpretation, which drives current and future interventions for each client. Many authors in the ABA literature have a vested professional and financial interest in touting the efficacy of their interventions, so the above article which expresses some doubts is a startling departure from the norm. 

BCBAs, graduate-level independent practitioners who supervise RBTs in the ABA field, regularly write and target goals in areas for which they have little to no training and are sometimes dangerously unqualified, including feeding, motor planning, fluency, language acquisition, reading, and handwriting.

Therefore, for ABA professionals to recognize the potential problems inherent within the limited training provided to RBTs demonstrates a rare moment of insight. 

Meanwhile, physical therapy assistants (PTAs) and certified occupational therapy assistants (COTAs), must meet the following requirements to become licensed:

3 – 8 hours a day of ABA. All children deserve to have a childhood.
  1. Complete an accredited PTA or COTA program
    1. Programs are typically 2 years (5 semesters)
    2. Typically include at least 16 weeks of full-time clinical practica 
  2. Pass a national certification examination

As one can see, there is a huge disparity between the preparation that physical therapy and occupational therapy assistants complete compared to RBTs. This is especially disconcerting given the fact that RBTs are typically spending much more time with clients than therapy assistants in other disciplines, and are often providing services without a BCBA even present for the majority of service hours, as is the case in many home-based programs.

While a COTA or PTA may see a client for 45 minutes or an hour, RBTs are often spending 3 to 8 hours with a client per session. Some kids get ABA five days per week. It’s no wonder I wasn’t prepared.

I was not prepared.

What does an ABA tech actually do?

While many autistic children are receiving ABA in full-time center-based programs for up to eight hours a day, most of my sessions were 3-5 hours long. Either way, that’s a lot of time to spend one on one, especially for a four-year-old. 

Actual ABA clinic advertisement, 2021

(Reader note: ABA therapy starts as young 18 months old. A quick Google search will verify this.)

As an ABA tech, I was with my clients the entire time they were in the center or I was working with them at their home. While we took breaks to play and “pair” (more about that in a future article), I was always interacting with them. As a neurodivergent adult myself (who didn’t yet realize their neurodivergence), this constant interaction was draining for me and I often found myself crashing into bed, exhausted at the end of the day. Looking back, I can only imagine how stressful and exhausting these long therapy days were for my little clients.

Many of us who challenge ABA practices often think of Discrete Trial Training (DTT) when we think of ABA, but most of my ABA therapy wasn’t drill-based at the table. It was just as manipulative, but it was far more subtle. I practiced the “good ABA,” also known as “modern ABA” or “play-based ABA” depending on the marketing language the clinic is using. 

“Contriving Situations” – An adult purposely antagonizes and frustrates a child to reinforce a “desired” behavior.

Through the guise of play, I often contrived stressful and frustrating situations and placed consistent demands on very small children. For instance, one of my kid’s goals was something like this: The client will engage in 3 turn-taking exchanges by relinquishing to their play partner, waiting while their play partner takes a turn, and then requesting a turn with ___ # of prompts.

Now, of course, as a practicing speech-language pathologist, I see so many problems with these kinds of ABA goals. For one, is this child even interested in playing this game and, if so, do they want to play with a peer or adult right now? And don’t get me started on that “relinquishing” piece of this goal. In a future post, I’ll be further dissecting some common ABA goals and the ways in which they conflict with the research regarding autistic communication, language development, and self-determination. For now, I’d like to reveal more about the “play-based” ABA I provided. 

As a behavior tech, I had no training in typical or atypical child development, autistic communication, or recognizing signs of sensory dysregulation. But I was trained in the applications of physical restraint, and, because I lacked the aforementioned knowledge, I often caused my clients to become so frustrated and dysregulated that I felt restraint was my only option when they inevitably began to self-harm or try to harm me. (More about that in future articles in this series.)

When providing “play-based ABA, I was incredibly focused on neurotypical styles of play. While I “permitted” my clients to engage in autistic play like lining things up or twirling strings in the air, I generally saw this as a means to an end. They’d earned their tokens so they could do what they wanted until the timer went off and it was time to “work” again. When the timer went off, I’d withhold the objects they’d been playing with, and it would be time to “play” my way, the neurotypical way.

Working for tokens. All-day long.

They knew the drill: earn all of your five smiley faces on your token board and then you can do what you want for a few minutes. Until then, I was the keeper of tokens and, to the kids, it must have seemed like I was rather arbitrary with how I chose to dispense those tokens. In fact, it was arbitrary since I was often using a variable-ratio schedule for reinforcement. You know, like slot machines and dog trainers use. 

Sometimes, to get data on other goals, I’d let the child pick the game.
Did they preface their mand with “I want”? Check.  

Sometimes, I’d pick a game that they didn’t like on purpose to see what they would do.
Did they protest using an “appropriate” tone of voice? Minus. 

No matter what I was working on, the goal was never really about anything meaningful to the child. It wasn’t about enjoying an activity or truly connecting with another person. That would’ve required me to value them as an individual, seek to understand them, and integrate their perspective into our activities. But, unsurprisingly, the RBT training course doesn’t include information on the Double Empathy Problem

ABA, even “play-based” ABA isn’t about teaching a child skills to engage in activities that they enjoy or learn to request, initiate, or continue preferred activities. 

It isn’t about them learning to advocate for what they want in their interaction with their play partner and get their needs met.

Instead, ABA is all about teaching the child to comply with a target neurotypical social script and hoping that, with enough tokens and the right reinforcement schedule, they’ll learn to mask some of their autistic traits so we could move onto the next compliance goal in their program.

No wonder so many kids never “graduate” from ABA! When you’re treating normal autistic traits as a pathology, a problem to be fixed, there’s ALWAYS another behavior to “shape,” another behavior to “extinguish.” Autism is a neurological difference. Autistic people are people with autistic brains – they are people – not a set of behaviors to extinguish. 

As a behavior tech, I was also following a script, a protocol. Like the kids I was working with, I didn’t understand my script either. How could I?
Behavior techs receive very little training and support to do their jobs, yet, the ABA industry can’t exist, or profit, without them. The ABA Industrial Complex is a multibillion-dollar industry and RBTs are its bread and butter. For a brief time, early in my career, the ABA industry profited from my ignorance and my desire to make kids’ lives better. Now, I’m devoting much of my career to exposing the truth about ABA and providing ethical, affirming, and evidence-based therapy to help kids get their wants and needs met, and meet their goals.

Stay tuned for the next article in this series – “Confessions of a Previous ABA Technician”


Citations:
Bottema-Beutel, Kristen & Crowley, Shannon. (2021). Pervasive Undisclosed Conflicts of Interest in Applied Behavior Analysis Autism Literature. 10.31234/osf.io/zh64e. 
Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., Freeman, B. J., Mountjoy, T., Parker, T., Streff, T., Volkmar, F. R., & Waks, A. (2016). Concerns About the Registered Behavior Technician™ in Relation to Effective Autism Intervention. Behavior analysis in practice, 10(2), 154–163. https://doi.org/10.1007/s40617-016-0145-9


2 Responses

  1. Made the switch from ABA tech to SLPA because of eerily similar experiences. Even down to “maybe you’ll like it more than being an SLP”. When I quit my RBT job I was told I was making a mistake and would never make a difference in the short sessions I’d be allowed.

    Thank you for sharing your experience.

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