The Therapist Neurodiversity Collectives firmly believes that if a person has the ability to do well, they will do well.

In other words, if a person were equipped with the necessary skills to exhibit adaptive behavior in a specific situation, they would not be exhibiting challenging behavior. That’s because doing well is always preferable to not doing well.

Per Dr. Ross Green, Ph.D., “challenging behavior usually occurs in response to predictable triggers, circumstances, or unsolved problems.” Often, humans operating in a position of authority (therapists, educators, parents, medical staff, and support staff) have a strong tendency to automatically apply consequences to a child’s, patient’s, client’s, or student’s challenging behavior. Whether of the natural or artificial variety, consequences do not teach lagging cognitive skills or help people solve problems.”
(Adapted from Dr. Ross Green, Ph.D.: “Kids Do Well If They Can” 
 Ross Greene, Kids Do Well If They Can, Phi Delta Kappan, Vol. 90, No. 03, November 2008, pp. 160-167)

Five Reasons to Stop Saying “Good Job!” By Alfie Kohn

(Summarized. Click here or on the above link to read the full article.)

1. Manipulating children.
2. Creating praise junkies.
3. Stealing a child’s pleasure.
4. Losing interest.
5. Reducing achievement.

PBS, PBIS, and Positive Reinforcement are all forms of ABA. 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.

Therapist Neurodiversity Collective understands that PBS and PBIS are used in public school systems internationally and that employees must follow employee guidelines and policies. In therapy sessions, however, clinical judgment allows the ability for the therapist to use therapy practices that do not implement positive reinforcement. 

What this looks like: If a therapist is providing a special treat at the end of the session, all students receive the special treat, regardless of on-task behavior. 

Our Collective base our respectful and empathetic practice models on the research and works of Alfie Kohn, Ross Greene Ph.D., Dr. Damian Milton, and the research fields of Autistic Masking/Camouflaging, The Double Empathy Problem, and Diversity in Social Intelligence.

It is primarily Alfie Kohn’s work that shapes the Therapist Neurodiversity Collective’s position on no use of behavior modification through PBS, PBIS, and positive reinforcement, or as he eloquently states, “control by seduction”. 

Criticisms of ABA: Alfie Kohn (2020)

• Dehumanizing and infantilizing.
• Ignores internal realities.
• Undermines intrinsic motivation.
• It’s all about compliance.
• It creates dependence.
• It communicates conditional acceptance.

Resources:

Alfie Kohn:
Punished by Rewards: Twenty-fifth Anniversary Edition: The Trouble with Gold Stars, Incentive Plans, A’s, Praise, and Other Bribes

“Our basic strategy for raising children, teaching students, and managing workers can be summed up in six words: Do this and you’ll get that. We dangle goodies (from candy bars to sales commissions) in front of people in the same way that we train the family pet. Since its publication in 1993, this groundbreaking book has persuaded countless parents, teachers, and managers that attempts to manipulate people with incentives may seem to work in the short run, but they ultimately fail and even do lasting harm. Drawing from hundreds of studies, Kohn demonstrates that we actually do inferior work when we are enticed with money, grades, or other incentives—and are apt to lose interest in whatever we were bribed to do. Promising goodies to children for good behavior, meanwhile, can never produce anything more than temporary obedience. Even praise can become a verbal bribe that gets kids hooked on our approval. Rewards and punishments are two sides of the same coin—and the coin doesn’t buy much. What is needed, Kohn explains, is an alternative to both ways of controlling people. Hence, he offers practical strategies for parents, teachers, and managers to replace carrots and sticks. Seasoned with humor and familiar examples, Punished by Rewards presents an argument that is unsettling to hear but impossible to dismiss.”

The Risks of Rewards – Alfie Kohn

Punished by Rewards? – Alfie Kohn

Rewards Are Still Bad News (25 Years Later) – Alfie Kohn

Autism and Behaviorism – New Research Adds to an Already Compelling Case Against ABA – Alfie Kohn

Five Reasons to Stop Saying “Good Job!” – Alfie Kohn

Dr. Damian E M Milton
Applied Behavioural Analysis and the autistic community: time to listen
“Criticisms made of Applied Behavioural Analysis (ABA) and Positive Behavioural Support (PBS) and its implementation with autistic people.”
Milton, Damian (2020) Applied Behavioural Analysis and the autistic community: time to listen.
In: Are We Asking the Right Questions About Behaviour? Studio3 Web Conference, 21 Oct 2020, Online. (Unpublished) (KAR id:83599)

Dr. Ross Greene, Ph.D.:
Collaborative & Proactive Solutions (CPS) is the model of care Dr. Greene originated and describes in his various books.

“The CPS model is based on the premise that challenging behavior occurs when the demands and expectations being placed on a kid exceed the kid’s capacity to respond adaptively…” “…the goal is to help them solve those problems, rather than trying to modify their behavior through application of rewards and punishments.”

For Further Reading:

Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

Conclusions: “No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes. Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.”
Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I., Crabtree, J., . . . Crawford, M. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: Cluster randomised controlled trial. The British Journal of Psychiatry, 212(3), 161-168. doi:10.1192/bjp.2017.34

Avoiding the “Good Job!” Habit
Therapist Neurodiversity Collective, Diane Cullinane, M.D.

Definitions of PBS, PBIS, and Positive Reinforcement:

“Positive behavior support may best be described as an individualized, problem-solving process grounded in ABA principles.
“Hieneman M. Positive Behavior Support for Individuals with Behavior Challenges. Behav Anal Pract. 2015;8(1):101-108. Published 2015 Apr 23. doi:10.1007/s40617-015-0051-6

“Positive behavior support (also referred to as positive behavioral support or positive behavioral interventions and supports) emerged from the controversy surrounding the use of aversive consequences with people with developmental disabilities.” Positive Behavior Support is ABA.
Johnston JM, Foxx RM, Jacobson JW, Green G, Mulick JA. Positive behavior support and applied behavior analysis. Behav Anal. 2006;29(1):51-74. doi:10.1007/BF03392117

“Evidence-based, initiatives designed to address this dilemma in the US since the late 1990s, using PBS (Positive Behaviour Support) and also SWPBS (School-Wide Positive Behaviour Support) are outlined but the conclusion is reached that these efforts do not appear to have been successful.”

School-wide Positive Behavioral Interventions and Supports (PBIS) is an example of applied behavior analysis.
Horner RH, Sugai G. School-wide PBIS: An Example of Applied Behavior Analysis Implemented at a Scale of Social Importance. Behav Anal Pract. 2015;8(1):80-85. Published 2015 Feb 24. doi:10.1007/s40617-015-0045-4

Positive reinforcement is a form of Applied Behavioral Analysis (ABA) that uses motivation through rewards. It is considered the cornerstone of Applied Behavior Analysis (ABA), especially ‘new’ ABA, ‘naturalistic ABA,’ and ‘motivational based play therapy.’ Positive reinforcement is a form of “Operant Conditioning” which is behavior manipulation through external forces. 

Negative effects of positive reinforcement
“Theoretically, the distinction between positive and negative reinforcement has proven difficult (some would say the distinction is untenable). When the distinction is made purely in operational terms, experiments reveal that positive reinforcement has aversive functions. On a practical level, positive reinforcement can lead to deleterious effects, and it is implicated in a range of personal and societal problems. These issues challenge us to identify other criteria for judging behavioral procedures.”

Note: The author of this paper is a behaviorist and has served as president of ABAI, SABA, SEAB, and SEABA. As he discusses the harms of using positive reinforcement on human beings in the paper, he then concludes that “The forms of behavioral control we call “posi­tive” and “negative” are inextricably linked. Thus, decisions about “good” and “bad” methods of control must be decided quite apart from the questions of whether the methods meet the tech­nical specification of “positive rein­forcement” or “aversive” control. We need to seek a higher standard, one that emphasizes outcomes more than pro­cedures. Our chief concern should not be whether the contingencies involve the processes of positive reinforce­ment, negative reinforcement, or pun­ishment. Instead, we should emphasize the ability of the contingencies to fos­ter behavior in the long-term interest of the individual.”***
Perone M. Negative effects of positive reinforcement. Behav Anal. 2003;26(1):1-14. doi:10.1007/BF03392064

*** Therapist Neurodiversity Collective believes that emphasizing clinical outcomes at the expense of the emotional well-being of the human on the receiving end of the treatment is unethical and ableist.