Autism comes with many challenges. Brian understands this as both an autist, teacher, and therapist. These are some of his insights.
There is a strange lie, or perhaps it is better to say a half truth, that autistics and the autism community hate Applied Behavior Analysis (ABA). This little lie is responsible for preventing children who could have access to highly effective early interventions to not get the support that they need. This lie perpetuates falsehoods, half truths, and complete failure to understand what ABA is. And this lie is not supported by evidence because there are plenty of autistics who favor ABA, but there are vocal groups that try to censor our disagreement with their opinions on social media.
But first, some basics.
The reason why there is such vocal opposition to ABA is because of some realities that aren't talked about often. One of them is that there is a history with ABA and autism. Autism was for a very long time a very misunderstood thing. The history of this is a book in and of itself, and since that book already exists, I just recommend that you read Neurotribes: The Legacy of Autism and the Future of Neurodiversity by Steve Silberman. A short summary, however, of this is that if Hans Asperger's research had been not been suppressed due to a combination of factors from language barriers, WW2, and the pride of a certain American psychologist, the way autism had been addressed by our society as a whole would have been very different. The result when it comes to ABA and autism is that there was a dark phase were punishment was the norm and the way autistics were treated was in a very inhumane manner. Those practices are now no longer acceptable, and the Behavior Analysis Certification Board has made it clear that the ethics of using punishment in behavior analysis is that is must be of last resort and only if the safety of the individual and/or others is at risk. An attitude that has been embrace by the majority if not all of the behavior analysis community.
The second basic information that should be known is that there is a fundamental misunderstanding of what autism is. I'm not even going into the common societal failures of comprehension. I am instead referring to the difference between the neurotype and autism spectrum disorder.
A neurotype is essentially the physiological structure of the neurological network within an individual that predisposes them towards preferring certain types of stimuli over others. It is observable with the right technology (FMRIs) and it turns out that some "disorders" are actually just different neurotypes. Autism is one of these, and ADHD, or extreme multitasker as I prefer to call it, is another.
Where the disorder arises is when the neurotype does not get what it needs to develop normally. In comes the concept of autism spectrum disorder (ASD). ASD is the combination of what was previously separately diagnosed as autism and Asperger's Syndrome. A disorder is something that interferes with the function of the individual. Depression, for example, is a disorder that a lot of people deal with. Autistics are certainly no stranger to this. If there are behavior sets that interfere in the individual's ability to develop and function, then this is a disorder.
Of course, there is also the issue of societal norms. Autistics such as myself struggle with these on the regular. Some norms are sort of important, all be it frustrating. Politeness is one of these that is necessary. Of course, it is frustrating for us when "normal" people break this rule all the time then expect us to follow it, but that is yet another topic. On the other than, one societal norm that is not so great focused on something call stimming.
Stimming is short of self-stimulatory behavior. This is a stereotyped movement such as rocking, flapping, head or hand movements, etc, but is not limited to those actions. For example, verbal stimming might be the enjoyment of wordplay. Other forms of stimming can include repetitive internal or external verbal obsession over a topic, event, etc.
The issue with societal norms is when stimming that is not harmful to the individual or to others is targeted. The reality is that societal norms change, and many a skilled expert or great person has had unique quarks that were overlooked because of their abilities. So what is the problem with a person rocking while they are thinking? I and other autistics and our allies argue that there is nothing. But this is where I depart from those others in many ways. If it is harmful to themselves or others then I argue that it is socially significant to that person and should be addressed. But this is ONLY if the question of real harm comes into play. Not social discomfort because the other person doesn't understand. They can get over discomfort. The unfortunate result of suppression of the neurotype aspects of autism is masking. Masking leads to heightened anxiety responses and depression because of feeling of isolation.
The Wrong and Right Approaches to ABA
So there is a wrong approach to ABA for autism, and there is a right approach.
The wrong approach is trying to cure autism. If this approach is take it is based in ignorance of what autism is.
On the other hand, if the approach is to teach skills, then that is the correct approach. The core of ABA is understanding that every behavior can be broken down into discrete, observable steps. For example, a common aspect of autism and one that I have struggled with my entire life is reading body language. Yet when I was taught how to read body language in a step by step method, and I received reinforcement for each correct use, I suddenly was able to see non-verbal language were before I was blind to it. Knowing how to read body language does not make me less autistic. Far from it. It actually means I am better able to communicate the uniqueness that comes from my neurotype.
The factions I see that oppose ABA are a few camps.
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1) The people who suffered through the abusive phase of ABA.
2) People who are concerned about ABA trying to cure autism.
3) People who don't understand what ABA is and assume information rather than understanding before opposing it.
4) People who make up their minds that ABA is wrong because of a combination of the other 3 groups instead of learning about ABA from multiple prospective.
This faction has a legitimate beef with those practices. Thankfully, ABA has changed and those practices not only are not allowed anymore, but there is research that consistently indicates that reinforcement is far more effective than punishment. ABA is actually one of the biggest proponents for ending the use of corporal punishment such as spanking. This factions concerns should not be dismissed because such behaviors on the part of ABA should NEVER be allowed to return. Period.
Likewise, this second faction has a legitimate concern. The approach of trying to cure autism is not effective and does and will cause harm. As of the time of this writing I have been in the ABA community for less than a year, yet I have had a significant number of ABA professionals reach out to me and ask me, as an autistic, what my thoughts and opinions are. Every single one of these people has accepted what I have told them about the neurotype vas the disorder and are trying to apply this new information in their practices. In contrast, I have been a special education teacher for 7 years. The response to my efforts to education on this topic in education has been the occasional step forward here or there followed by a whole lot of back sliding. There are certainly individual teachers who were the exception rather than the rule, but this is consistent from what I have heard from peers. There is actually a very strong community of autistic ABA practitioners, and we all are working together to spread this important information. Not surprising to me is that the reactions they have received from the ABA and education communities is almost identical to mine.
These are the people who will find fault with ABA no matter what. They use words like brainwash, love bomb, manipulate and more to describe ABA. They make claims that ABA does practices that are either no longer used or were never in use.
Of course, my favorite tactic that I see them use is talking about an ABA practice and making it out to be something it is not. A perfect example of this is Discrete Trial Training (DTT). This is were a learner is taught simple, straight forward steps in a repetitive way that reduces the likelihood of error. Here is a script of how DTT might work:
The objective is for the learn to be able to echo what the therapist is saying.
Therapist: Great job!
Therapist: Nice repeating! *delivers preferred reinforcer*
And the process keeps going. In this example, echoing is a key part of language. It is a basic skill that makes it easier for language to be learned. Some autistics struggle in this area (this is the disorder aspect) and so the skills are taught in small steps. But DTT has its limitations, so it is not the only tool used in ABA. In fact, it is just a basic tool.
But DTT is not just used in ABA. In fact, if you have ever played a video game, you have participated in DTT. In most games you learn a combination of button pushes that results in a move. Programmers design smaller challenges or enemies that force you to practice that more over and over. Eventually you master the move, and new moves are introduced. Eventually you come up against a harder challenge or boss. This is when those smaller skills get combined together to be used to defeat that challenge or boss. That is not abuse. That is learning.
This is the most frustrating group to me. When someone makes up their mind without education on the topic, I am very frustrated. There isn't much I can say to address this group other than please to look at all the information before you come to a conclusion.
So this article rambles a bit, but I think I have achieved my objective, which is to try to educate on neurotype vs disorder, address legitimate concerns about ABA, and correct misconceptions about ABA.
To this I will add, ABA is not perfect. It has never claimed to be. It does need improvement, and I have been impressed by the caliber of people I have had the privilege of getting to know through the community. There is always room for improvement, and one of my objectives is to make sure that #ActuallyAutistic people have a voice so that those improvements can keeping coming.
I will be doing individual articles addressing different practices within ABA as well as how and why they work, so stay tuned.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 Brian Middleton
Melanie R Jones on May 13, 2019:
I am autistic, diagnosed since 1970. This article completely misses the point.
I am in favor of learning social skills and manners, of understanding non-autistics and of learning how to achieve some degree of communication with non autistics. But that is not what ABA does.
Much of the damage done by ABA is because they focus upon behavior and conformity to the wishes and actions of everyone else.
At its core ABA teaches autistics that we will never be accepted for who we are, and that to be allowed to exist we must somehow pretend to be non-autistic. We are taught that our needs don't matter, and our survival depends upon doing everything others tell us to do, without any consideration for our needs and/or abilities.
ABA forces us to try to appear non-autistic while at the same time removing our ability to respond effectively to our environment when it becomes overwhelming and painful. It teaches us that we are not allowed to choose ANYTHING, but must ALWAYS submit to whatever others tell us to do, whether or not it causes pain or difficulty for us.
ABA makes us more susceptible to bullying, manipulation and co-dependency or worse, and over the long term inevitably causes burnout and depression AT BEST.
Patty Correll on May 12, 2019:
Really interesting to get your perspective and first time I have come across an explanation if autism neurotype differentiated from disorder. Really resonated.
I am curious, does ABA require 20-40hrs intherapy per week? I have heard this and it sounds extreme.
What ages are considered appropriate for ABA interventions?
Lynn on May 12, 2019:
Thank you for pointing out that ABA is learning. The same way we all learn from our environment, only more concentrated to increase success. You are a rock star.
Denise M. on May 12, 2019:
Thank you for adding your voice to this “debate”. It was much needed. Your perspective is just as important and valid. How you broke down what ABA is and isn’t, why it works and when it doesn’t, was a great read.
To the naysayers - practice what you preach about inclusivity.
Cristina Leonardis on May 12, 2019:
Great article! Thank you for sharing!
Martin Theis on May 11, 2019:
A brilliant read, thank you.
I've been a teacher for many years and ABA is an excellent teaching approach, and for some learners the only approach that enables progress. A lot of teachers draw on the principles intuitively, but watching a skilled ABA practitioner can be quite magical. Exclusions and the consequent misery could be massively reduced if quality ABA were widely available in schools - for children with and without autism.
Jane McCready on May 11, 2019:
Great article. Thank you on behalf of me and my beloved son, who has benefited so much from ABA via kind, dedicated practitioners such as yourself