You may not even be aware, but there is a raging debate over whether ABA is harmful or hurtful. There are compelling arguments on both sides. Everyone who pursues a career in ABA does so with the intention of helping, not hurting those they serve. So how is it possible that there’s even a discussion about ABA being harmful?
It’s critical that as professionals in ABA we understand both sides of this debate. We must be aware of and responsive to the concerns of those who fear ABA. We must continue to drive the field toward more sensitive, positive practices. There will never be a time where everyone agrees on the subject. However, as professionals we must listen to the opinions of those people who we are trying to help and respond to their concerns.
What Are the Concerns?
The field of ABA contains a variety of practitioners and therapists. Although the techniques used are largely universal, how they are applied varies dramatically depending on the person administering the strategies. It is more the application of the ABA techniques than the strategies themselves at the core of the debate, although not everyone is aware of this distinction.
Those on either side of the debate generalize as if all ABA therapist share the same beliefs in this application. However it is the distinction between these therapists that will eventually help lead to change in the practices most heavily contested.
So, what are the concerns?
Neurodiversity
Our culture shares a growing awareness of diversity. We are beginning to acknowledge the need to accept others as they are instead of forcing them to fit a mold. The same argument is being made for acceptance of neurodiversity.
Those arguing against ABA push for the acceptance of the symptoms and behaviors of individuals with autism as a normal expression of a neurodiverse population. Advocates for neurodiversity argue that ABA attempts to alter the core of who the individual is.
Unfortunately, even in a more inclusive society there are still practitioners of ABA who believe it’s in the child’s best interest to appear “normal.” While this is a shrinking minority it will take time before those protesting against ABA recognize this shift.
Extreme Interventions
Alongside the perspective of neurodiversity is the notion that interventions used in ABA are manipulative, degrading and even dangerous. Opponents of ABA question methods from withholding rewards (using reinforcement) to discrete trial training.
Withholding Rewards
Reinforcement is a key strategy in ABA, however critics of ABA find the use of reinforcers degrading to the person with autism. The use of reinforcement (and withholding rewards when expectations aren’t met) is a crucial element of ABA. However, it’s equally important that this be done with respect.
The concept of reinforcement isn’t unique to ABA. Earning rewards is an essential component of being part of society. If you don’t go to work, you don’t get rewarded with your paycheck. If the 5th grader doesn’t complete her homework, she doesn’t earn a good grade. While many children learn this intuitively, children with autism often need to be taught that different behaviors will receive different results.
Reinforcement should always meet the following criteria:
- The individual should know what they can do to earn the reward.
- It should be well within their abilities to accomplish that task.
- Certain primary reinforcers shouldn’t be withheld.
While it’s important that the child you’re working with not receive the rewards until she earns them, not everything should be withheld for a reward. She should have access to the basics of life (food needed for good nutrition, shelter, warmth, affection, clothing, etc.), non contingently. As you work with parents, ensure you communicate this clearly so they understand the difference.
Discrete Trial Training
Discrete Trial Training (DTT), which is included in many ABA programs, is another point of contention. This therapy is an intensive intervention where a child sits with a therapist for extended periods of time practicing rote skill after rote skill in rapid succession. Read the post Should I Use Natural Environment Teaching (NET) or Discrete Trial Training (DTT)? to learn more about DTT.
There are many concerns about this type of intervention if not implemented carefully. However, there are times when DTT is an appropriate therapy. The post referenced above explains when DTT may be a good choice.
A primary concern is that children learn the skill in this situation and then is unable to replicate it in other areas (generalization). If you include DTT in your services, you must also generalize the skills that are being taught.
For an example of DTT and how one organization generalizes this teaching, watch Discrete Trial | Training Video by Cornerstone Autism Center:
Eliminating Stereotypies
Traditional ABA focused on teaching children with autism to be “normal.” Even today, some ABA programs seek to eliminate “stim” behavior, called stereotypies, because it makes the child “look” different. These behaviors are highly common among individuals with autism and generally are not problematic for the individual. If stereotypic behavior is not problematic for the individual, professionals should not target these behaviors for reduction. Read our post What is Autism? Understanding ASD to better serve your clients for more on this topic.
For many individuals, stereotypies are a method of self-regulation. They may engage in the behavior when excited or anxious or when in need of sensory stimulation. If you’ve ever tapped your fingers on your desk or jiggled your foot while sitting in a meeting, you’ve engaged in stereotypic behavior. Individuals without autism learn to control these impulses and instead regulate emotion and sensory needs in other ways.
Individuals with autism often present with higher sensory needs than their non-autistic counterparts. This leads to a higher rate of stereotypic behavior. By attempting to eliminate this behavior in those with autism, you may be removing an essential tool for the individual.
The stereotypies demonstrated by the children in Autism Stimming Examples by Autism Family show stereotypies that are in general not problematic or harmful to the child and therefore should not be eliminated:
What Do Individuals with Autism Think?
Like everyone else, individuals with autism fall on both sides of the debate.
Many speak out against ABA. As professionals dedicated to helping these individuals, we must listen to their concerns. Their perspective is valuable and can serve to shape ABA in the future. By adjusting treatment based on their concerns, we can turn a controversial method of helping individuals with autism into a strategy that maintains the autonomy and dignity of the individuals we seek to help.
On the other side, are those with autism who credit ABA with providing them life-changing skills. The needs of individuals vary along the spectrum. Also, like anyone, needs are unique for each person regardless of where they fall on the spectrum. What is right for individuals at one end of the spectrum is not what is best for those at the other. The strategies that one individual responds to best are not necessarily the best for another.
You can apply ABA techniques when working with anyone. However, they work especially well for those who are unable to learn in traditional ways. In fact, those who benefit most may be the very people who can’t speak for themselves to give us their opinion of ABA therapy.
Talking to Parents
Parents are tasked with doing what they feel is best for their child, even if their child verbally disagrees with the parent’s decision. As professionals we are tasked to provide services requested by the parent. However, you should also be aware of the feelings of the child. Be sure to discuss these feelings with the parents and continue to treat the child with the respect he deserves. Many children become excited to attend well-run ABA programming.
Although there are many children who would prefer to stay home and watch TV or play video games, when ABA is utilized effectively, most children want to participate. The program should be both fun and motivating to the individual. Parents should play a role in understanding and facilitating this.
In addition, many parents of children with autism worry about harming their child. They may read about this debate online. They might worry that they have made a horrible mistake in choosing ABA for their child. Don’t assume that parents will just take you at your word when you tell them that ABA is what’s best for their child.
Talk to them about both sides of the debate. Highlight and acknowledge that the concerns of the autism community are valid. Tell parents how you plan to address each of these concerns when providing services to their child.
Is ABA Harmful or Helpful?
It’s now widely accepted that the original aim of ABA – to teach those with autism to appear “normal” – is harmful for individuals with autism. Yet there remain professionals who hold true to this philosophy. Despite this, the principles of ABA are still one of the most effective ways to teach many children with autism. We must assist parents in being informed consumers of ABA services and help them identify quality programs.
ABA, when practiced with a high standard for ethics and an understanding of the perspectives of individuals with autism, can result in life-changing results for the participants. While ABA is a data-driven practice, it’s essential that practitioners don’t forget to involve their heart in their practice.
Ask those with whom you work who are able to speak what they want to achieve. Never lose sight of the fact that each person is a unique, individual human, not a test subject.
The techniques used in ABA work. It’s up to us as professionals to use them in ways that teach critical skills while maintaining the rights of the individual.
Don’t avoid the debate or act like it doesn’t exist. Listen to those who are shouting their concerns. Be the catalyst for change in the field!
Ethical Considerations About the Debate About ABA
The table below highlights some additional potential concerns about ABA and its potential for harm. The table includes some important action steps you can take to ensure you practice in an ethical way.
| Concern | Description | Action Steps for Ethical Practice |
|---|---|---|
| Lack of Autonomy and Choice | ABA interventions may limit the autonomy and choice of autistic learners by imposing predetermined goals and reinforcing compliance. | – Respect and promote the autonomy and self-determination of autistic learners. – Involve autistic learners in the goal-setting process and prioritize their preferences and interests. |
| Overemphasis on Normalization | ABA may prioritize conformity to neurotypical standards, potentially neglecting and devaluing autistic identity and neurodiversity. | – Embrace a neurodiversity perspective that acknowledges and values the unique strengths and characteristics of autistic learners. – Promote self-acceptance and self-advocacy for autistic learners. |
| Potential for Emotional and Psychological Harm | ABA techniques that focus on behavior modification and compliance may lead to emotional distress, anxiety, and a negative self-concept in autistic learners. | – Prioritize the emotional well-being and mental health of autistic learners. – Use positive and strength-based approaches that foster self-esteem and positive self-image. |
| Insufficient Focus on Communication and Social Skills | ABA programs may place disproportionate emphasis on compliance and rote learning, potentially overlooking critical areas such as communication and social interaction. | – Prioritize the development of functional communication skills and social competence. – Incorporate peer-mediated interventions and naturalistic teaching strategies. |
| Potential for Punitive Practices | ABA approaches may rely on aversive procedures and punishment, which can be harmful and violate ethical guidelines. | – Promote positive and proactive strategies that focus on reinforcement and reward systems. – Emphasize positive behavioral supports and functional behavior assessment. |
| Lack of Cultural Sensitivity | ABA interventions may not adequately consider and respect the cultural values, beliefs, and practices of diverse autistic individuals and their families. | – Embrace cultural competence and strive for culturally sensitive and inclusive interventions. – Collaborate with families and communities to understand and incorporate cultural perspectives. |
| Power Imbalances and Coercion | ABA interventions may reinforce power imbalances between practitioners and autistic learners, potentially leading to coercive practices. | – Establish collaborative relationships built on trust and mutual respect. – Empower autistic learners to actively participate in decision-making and advocate for their needs and rights. |
| Lack of Long-Term Outcomes Research | The long-term effectiveness and outcomes of ABA interventions on autistic individuals’ well-being, independence, and quality of life are still under-researched and not well understood. | – Conduct long-term follow-up studies to assess the impact of ABA interventions on overall well-being, independence, and life satisfaction. – Utilize multiple assessment measures to capture a comprehensive understanding of outcomes. |
| Parental Pressure and Expectations | ABA interventions may reinforce societal and parental pressure for autistic individuals to conform to neurotypical standards, potentially disregarding their unique abilities and strengths. | – Collaborate with parents and caregivers to establish realistic and individualized expectations for their child’s progress. – Educate parents about neurodiversity and encourage acceptance of their child’s unique traits. |
| Limited Focus on Self-Advocacy Skills | ABA interventions may not adequately prioritize the development of self-advocacy skills, potentially hindering autistic individuals’ ability to advocate for their needs and rights. | – Incorporate self-advocacy training and empower autistic learners to express their preferences, needs, and boundaries. – Provide opportunities for self-determination and decision-making in intervention planning. |
| Potential for Over-reliance on Compliance | ABA programs may inadvertently emphasize compliance at the expense of critical thinking skills, creativity, and independent problem-solving abilities. | – Foster critical thinking and problem-solving skills through engaging and meaningful activities. – Encourage autonomy and initiative in learning and decision-making processes. |
| Lack of Input from Autistic Advocates | The voices and perspectives of autistic advocates and self-advocates may be overlooked or excluded in the development and implementation of ABA interventions. | – Actively seek input from autistic individuals, autistic-led organizations, and self-advocates in designing and evaluating ABA programs. – Ensure that autistic individuals are represented in decision-making processes. |
These action steps serve as general guidance and should be adapted to specific contexts and the unique needs of autistic learners. Consulting with professionals experienced in ethical practice and involving autistic individuals and their families in decision-making processes is crucial to ensure ethical implementation of ABA interventions.
Related Research Regarding the Debate About ABA
Here is a table summarizing research articles related to the debate about the potential harmful effects of ABA. The table includes important action steps to help you put these ideas into practice.
| Article Title | Summary | Action Steps for Application |
|---|---|---|
| ABA and the rights of autistic people: A response to the myth of the “scientific consensus.” . | The article discusses the controversy surrounding Applied Behavior Analysis (ABA) and challenges the notion of a “scientific consensus” in favor of ABA. It argues that ABA is not universally accepted by autistic individuals and raises concerns about the potential harm caused by compliance-focused approaches. | – Engage in open and respectful dialogue between ABA practitioners, autistic individuals, and their advocates to understand differing perspectives. – Prioritize the rights and autonomy of autistic individuals in the development and implementation of interventions. |
| Ethics in autism treatment: A review of the literature | The article provides a comprehensive review of the ethical considerations in autism treatment, including ABA. It highlights concerns such as potential harm, lack of individualization, and insufficient focus on quality of life. It emphasizes the need for person-centered approaches, informed consent, and ongoing evaluation of treatment outcomes. | – Ensure that interventions are based on individualized goals, preferences, and strengths. – Obtain informed consent from autistic individuals and their families, providing clear information about the goals, procedures, and potential risks of the intervention. – Continuously monitor and evaluate the impact of the intervention on overall quality of life and well-being. |
| “Respect the way I need to communicate with you”: Healthcare experiences of adults on the autism spectrum | The article explores the healthcare experiences of autistic adults, shedding light on their perspectives and challenges. It discusses the potential harm caused by communication barriers, lack of understanding, and the pressure to conform to neurotypical norms. | – Provide healthcare professionals with training on autism awareness, communication strategies, and sensory considerations. – Create a supportive and accommodating healthcare environment that respects and accommodates diverse communication styles. – Involve autistic individuals in the decision-making process regarding their healthcare. |
| What should autism research focus upon? Community views and priorities from the United Kingdom | The article presents findings from a survey that sought the views of autistic individuals, parents, and practitioners about priorities in autism research. It highlights the need for research to address the quality of life, well-being, and social inclusion of autistic individuals. | – Align research priorities with the voices and perspectives of autistic individuals, their families, and the wider autism community. – Emphasize research on interventions that promote self-determination, social inclusion, and well-being for autistic individuals. – Involve autistic individuals as active partners in research design, implementation, and dissemination. |
| Autism as culture | The article explores the concept of autism as a culture rather than a disorder, challenging prevailing medical perspectives. It highlights the importance of recognizing and valuing autistic individuals’ unique strengths, perspectives, and contributions. | – Promote a cultural understanding of autism that values neurodiversity and embraces autistic individuals’ strengths and perspectives. – Encourage inclusive and accepting environments that accommodate and celebrate the diversity of autistic individuals. |
| A systematic review of the medical and allied health literature on intervention targets for children with autism. | The article presents a systematic review of the literature to identify intervention targets commonly addressed in ABA and other interventions for children with autism. It highlights the need for a broader focus on social-communication skills, adaptive functioning, and mental health rather than solely targeting surface-level behaviors. | – Expand intervention goals beyond the modification of surface-level behaviors to include social-communication skills, adaptive functioning, and mental health. – Implement comprehensive assessments to identify individualized intervention targets and prioritize holistic development. – Incorporate strategies and interventions that promote social interaction, emotional well-being, and adaptive skills. |
| Autistic expertise: A critical reflection on the production of knowledge in autism studies | The article critically examines the production of knowledge in autism studies and highlights the need for including autistic individuals as active participants and contributors in research. It emphasizes the value of autistic expertise and challenges the dominance of non-autistic perspectives in shaping the understanding of autism. | – Involve autistic individuals as active participants in research, ensuring their perspectives, experiences, and expertise are central. – Promote participatory research approaches that engage autistic individuals in all stages of the research process. – Respect and value the knowledge and contributions of autistic individuals in shaping autism research and interventions. |
| The language of disability in applied behavior analysis research: A content analysis of the Journal of Applied Behavior Analysis | The article analyzes the language used in the Journal of Applied Behavior Analysis to discuss disability, highlighting potential concerns related to dehumanizing and pathologizing language. It emphasizes the importance of respectful and inclusive language that promotes dignity and recognizes the rights of individuals with disabilities. | – Use respectful and inclusive language when discussing individuals with disabilities, including autistic individuals. – Promote awareness and understanding of the impact of language on perceptions and attitudes towards disability. – Encourage the use of person-first language and identity-first language based on individual preferences. |
| Bridging autism, science and society: Moving toward an ethically informed approach to autism research | The article discusses the ethical considerations in autism research and calls for an approach that acknowledges the social, cultural, and ethical dimensions of autism. It emphasizes the need for inclusive and collaborative research practices that involve autistic individuals and their families as partners. | – Foster collaborative research partnerships that involve autistic individuals, families, and diverse stakeholders in the research process. – Consider the social and cultural implications of research findings and their impact on the autism community. – Ensure research practices align with ethical principles, including informed consent, privacy, and confidentiality. |
| Why I dislike “person first” language | The article challenges the prevailing use of person-first language in discussing autism and argues for the use of identity-first language. It emphasizes that autistic individuals perceive autism as an integral part of their identity and reject the notion that it needs to be separated from the person. | – Respect individual preferences regarding language use, including the use of identity-first language by autistic individuals. – Promote dialogue and understanding regarding language preferences in the autism community. – Acknowledge and honor the diverse perspectives and experiences of autistic individuals in discussions about language and identity. |
These action steps provide general guidance for considering ethical practice and incorporating diverse perspectives. They should be adapted to specific contexts and the unique needs and preferences of autistic individuals. Engaging in ongoing dialogue, promoting inclusivity, and respecting the autonomy of autistic individuals are key principles for ethical and person-centered interventions.
References and Related Reading
Hensel, M., Eldevik, S., & Fletcher-Watson, S. (2020). A systematic review of the medical and allied health literature on intervention targets for children with autism. Autism, 24(1), 34-45.
Milton, D. E. (2017). Autistic expertise: A critical reflection on the production of knowledge in autism studies. Autism, 21(4), 419-428.
Moulton, E., & Barton, E. E. (2020). The language of disability in applied behavior analysis research: A content analysis of the Journal of Applied Behavior Analysis. Journal of Applied Behavior Analysis, 53(4), 1861-1878.
Ne’eman, A. (2017). ABA and the rights of autistic people: A response to the myth of the “scientific consensus.” Autism, 21(6), 707-709.
Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Ashkenazy, E., Boisclair, W. C., … & Baggs, A. E. (2019). “Respect the way I need to communicate with you”: Healthcare experiences of adults on the autism spectrum. Autism, 23(4), 1111-1123.
Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18(7), 756-770.
Pellicano, E., & Stears, M. (2011). Bridging autism, science and society: Moving toward an ethically informed approach to autism research. Autism Research, 4(4), 271-282.
Shepley, S. B., & Durand, V. M. (2019). Ethics in autism treatment: A review of the literature. Research in Autism Spectrum Disorders, 57, 105-116.
Sinclair, J. (1999). Why I dislike “person first” language. Autism Network International.
Williams, D. (2016). Autism as culture. Cognition, 150, 201-206.
