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Applied Behavior Analysis is currently the most common method of treatment that is prescribed by physicians for autism spectrum disorders and other behavioral disorders. It has often been referred to as the “gold standard” treatment for children with autism and other developmental conditions.
This reputation has been established over time as ABA has collected decades of data-based evidence of its effectiveness with children who have received ABA treatment. The evidence consistently shows increased communication skills, improved attention, decreased problem behaviors, improved attention skills, and improved social skills – to name a few. But, just like anything “good for you” or “popular” or even something factual that has a proven history attached to it, there will always be opposition to counter all of the claims in favor of….ABA in this case.
The History of ABA Therapy: Where the Controversy Started
What are the controversies that surround ABA therapy? What is it about applied behavior analysis that people are opposed to? To put it simply, the biggest complaint from the opposition is that ABA is an overwhelming and cruel attempt to force children with autism to appear or behave “normal”. Those who oppose ABA would prefer to promote neurodiversity, “ the idea that people with autism or, say, attention deficit hyperactivity disorder or Tourette syndrome, should be respected as naturally different rather than abnormal and needing to be fixed.”
It helps to understand some of the histories behind ABA. Dr. Lovaas, one of the founding fathers of ABA, had a mission to make people with autism “indistinguishable” from their typical peers. There was a time when behavior therapy practices included treatment methods that are not acceptable norms in behavioral therapy today.
Electric shock therapy is one example of an aversive reinforcement method that was used to eliminate behaviors that were difficult to resolve with positive reinforcement. Behaviors that were self-injurious or harmful to others were often treated with punitive measures like shock therapy. However, as behavioral sciences have evolved and patient rights gained more attention, these methods were replaced with more acceptable and positive reinforcement methods.
Many people with autism use these outdated practices to speak out against ABA therapy. They cite Dr. Lovaas’ goal of making autistic people “indistinguishable” from their peers as an implication that autistic people are “broken” and need to be fixed. Many autistic people take offense to this notion and call this a human rights violation that strips people with autism of their dignity.
Why Are Some Advocates Against ABA Therapy?
One of the criticisms that are commonly heard is that ABA is too tough on children with autism spectrum disorders. Much of this opinion stems from the early 1960’s principles of applied behavior analysis and the use of Discrete Trial Training (DTT). Discrete trials were done in a clinical setting by requiring a child to sit at a table while a therapist presented the instruction (stimulus) in a formal teaching manner and waited for the child to respond. For example, the therapist would present two-color cards (yellow and red) and say “touch yellow”. The child would then respond correctly by touching the yellow card. If the child touched the wrong color card or failed to respond or left his/her seat- then that would be an incorrect response.
Depending on how the child responded, the therapist would deliver reinforcement or correction and repeat the procedure for a predetermined number of times.
In addition to the lack of consideration for the autistic viewpoint, the following misconceptions are often offered as rationale for the contempt of ABA.
- ABA benefits people around the autistic person rather than the person with autism.
- ABA does not accept the differences in autistic people within society and aims to “normalize” autistic people – even if they never asked to be “normalized”. Many people with autism like who they are, and they do not wish to change.
- ABA ignores emotions by not responding to “unacceptable” behaviors. Some of the “unacceptable” behaviors (like meltdowns or eloping) are a response to the overwhelm that an autistic person feels when they are forced to do something they do not want to do. The question becomes, who is the behavior “unacceptable” to?
Additional Controversial Claims
If you have ever heard that ABA therapists are “robotic” and that they lack emotion during therapy then you are probably speaking with someone who had a bad therapist. Discrete trial training (a repetitive step-by-step process of teaching) can be boring and tedious if you don’t put some fun and momentum into it.
Discrete trials go something like this: The teacher (therapist) presents something to the child to provoke a correct response, the child responds (no response is also a response) and then there is a consequence to the response (reinforcement or no response if the child did not respond correctly). Therapists are trained to give an enthusiastic positive response to the correct answers and to quietly move on without response when the child answers incorrectly. This can easily be misconstrued as an emotionless response to the child. It isn’t meant to be emotionless. It is simply in contrast to the exciting positive reinforcement that is given when the child answers correctly. Children with autism need that clear distinction and there is a method at work here.
The same method is used for tantrums when the function of the tantrum is attention. If the child throws themself down on the floor for attention because two adults are talking, then it is in the best interest of the two adults talking to ignore the child until the child understands that the tantrum is not the best method for getting attention. Then the child will perhaps try something else. If they say “excuse me” then positively reinforce that with immediate attention! “Yes? What do you need?” Many people in the autistic community would argue that this approach lacks empathy. ABA therapists know that the evidence shows that this helps to shape positive behaviors while reducing negative behaviors.
Is ABA Abusive?
The term abuse implies a misuse of something, maltreatment of someone, or forcing someone to do something against his/her will. ABA therapy does not do any of the following:
- ABA does not seek to force anyone to do things against his/her will. When properly practiced, ABA motivates or encourages a child with autism to practice a new, appropriate behavior or to stop a behavior that is interfering with daily living.
- ABA therapy should never be conducted in a way that brings harm or maltreatment to an autistic person.
- ABA should never be misused to teach or persuade a child with autism to do anything for the benefit of someone else. Every skill they learn should benefit the autistic child first.
The reality is that the benefits of ABA far outnumber and outweigh the complaints against the therapy. ABA is a well-established, evidence-based science that has helped many families to teach children early functional skills. Skills such as toileting, dressing, communicating, playing, and holding utensils or writing tools are all skills that children with autism will need in school and in real-world settings.
In addition to functional skills, ABA therapy is important for social skills as it helps to reduce behaviors that hinder social interactions and increases the ability to make and maintain friendships. Making friends is an important aspect of life, and children with autism often need assistance to understand which behaviors are acceptable and unacceptable in making and establishing friendships.
ABA also promotes independence in children with autism. The earlier these children learn independence, the more likely they will succeed in school and in the workplace as an adult. ABA teaches children how to be the absolute best version of themselves. Most importantly, ABA is family-centered and teaches parents their important role on how to help their own children with their difficulties or disabilities.
Is ABA Therapy Too Tough on Children with Autism?
Therapy is not easy in any situation. It is challenging to work with a young child that may have difficulty with communication and sensory issues. Everything that an autistic child does has a purpose. They may pace, flap hands, vocalize or cry from anxiety or frustration, and their behaviors may bring relief.
If a therapist arrives and blocks these stress-relieving behaviors, the anxiety and frustration will rise. Yes, ABA is tough; therefore, it is essential to consider some of the points that are brought up by the autistic community:
- Who is the therapy going to benefit?
- Will eliminating certain behaviors improve learning and living for the child?
- Will eliminating certain behaviors cause more stress and additional disruptive or inappropriate behaviors in the child?
If ABA is beneficial to the person with autism, then it may take some hard work – and yes, it may be tough; but sometimes it takes hard work to reach a goal that will help improve someone’s life.
On the Topic of Reducing or Eliminating Behaviors
Most parents are seeking ABA services for the purpose of eliminating socially awkward or inappropriate behaviors. However, as time has progressed and some of the patients of ABA have grown up to voice their own opinions, it has become increasingly clear that there is a population of people who do not appreciate being forced to hide their autism.
The opinions and feelings from the parents and the grown children with autism range from mildly irritated over the feeling of being overly compliant, to claims of outright abuse and PTSD over being forced to make eye contact or feeling controlled.
ABA therapy is never about force or control. ABA therapy is about teaching a child with autism the skills that they will need to communicate and to be able to do what their peers are doing. It is never the goal to remove someone’s identity or to cause anyone to feel less valuable because of a label or a disorder. The goal of ABA is to work in conjunction with a family that is seeking help because the child and the family are struggling with daily living.
Helping a person with autism to communicate a want or a need should not be torturous. Teaching eye contact should not be something that feels like a control issue. There are opportunities when a child will make eye contact and it is at those times that the therapist will use positive reinforcement to praise the child in hopes that they will repeat the eye contact again. There is no need to grab their face and demand that they look at you. Seeking opportunities to praise them is enough.
Stimming (flapping, clapping, waving, or any other repetitive movement or vocal tic) is another area that people with autism take issue with. Many former ABA clients have spoken out against being taught how to control their stimming behaviors in public. This is an automatic behavior that helps people with autism to regulate emotions and by teaching them to withhold this behavior, many people with autism struggle with frustration and anxiety. There is a running sentiment from a segment of the autistic community that wants to be appreciated for their neurodiversity. This part of the community does not want to be “fixed”.
Modern Day ABA Therapy Practices
Positive reinforcement is at the core of everything we do in ABA therapy. The sterile clinical environment is in the past where it belongs. Unregulated behavioral modification programs are also in the past where they belong.
There may be times when it is appropriate for a child and their therapist to sit at a table in a clinical setting and do some work, but when it is obvious that a child can no longer focus their attention on the work then it is the responsibility of the therapist to give the child a break and keep frustration from settling in. It is also worth mentioning that a clinic back in the 1960s and 1970s looked much different than what we see now.
When you walk into an ABA center today, such as ours at Circle Care Services New Jersey, you are likely to see a room filled with equipment that is specifically designed for children who have sensory issues. There are hammock swings that squeeze a child into a fetal position while they swing, crash pads for children who need to bang their head or other body parts into people or objects, weighted medicine balls for children who tend to throw objects due to frustration, yoga balls to sit and bounce on, pads and balls to roll over and on the child who likes to feel squeezing or pressing for relief and much more.
By keeping things fun and by keeping sessions highly reinforcing with positive reinforcement, there should be little need for punishment procedures. If there is a need to use them, the positive reinforcement and redirecting of the child back to appropriate behavior would far outweigh any of the punishment procedures mentioned above (reprimands, overcorrections, response cost, and response blocking).
At Circle Care Services, we understand the concerns that parents have about finding the right team of professionals to help their children. If ABA is new to you and your family, it can be overwhelming trying to sift through the vast amount of information that is available online. The lingering controversies of the past can leave parents of a newly diagnosed child with autism feel conflicted and anxious. We have a great team of professionals at Circle Care Services who can answer any questions or concerns you may have regarding ABA therapy and practices. We also encourage building community with other families in New Jersey who are experiencing some of the same joys and challenges with their children.
Don’t let website controversies overshadow the overwhelming scientific evidence that ABA has provided for the last five decades. At Circle Care, we are not here to “fix” your child. We are here to teach and help children and families that are struggling with daily living skills and academics due to autism or other behavioral disorders. We appreciate everyone in all of their diversity and uniqueness and we want everyone to have skills for success. If you have any questions for our trained professionals at Circle Care, please feel free to contact us today. We offer free consultations and would be more than happy to answer any questions about ABA therapy.