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?
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.
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.
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 5 Things You Didn’t Know About 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. This post Should I Use Natural Environment Teaching (NET) or Discrete Trial Training (DTT)? explains when DTT might be the right 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.
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 Understanding Stereotypies and When to Intervene 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.
In this video I talk to Cindy, a woman with autism who also has a daughter with autism. We originally connected because of her concerns about ABA therapy, however through our discussion we both learned a lot.
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!