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Illustration by
Scott Bakal

The controversy over autism’s most common therapy

Applied behavioral analysis is the most widely used therapy for autism, but some people say its drills and routines are cruel, and its aims misguided.

by  /  10 August 2016
illustration by:
Scott Bakal

When Lisa Quinones-Fontanez’s son Norrin was diagnosed with autism at age 2, she and her husband did what most parents in their position do — they scrambled to form a plan to help their child.

Ultimately, they followed the experts’ advice. They put Norrin in a school that used applied behavioral analysis, or ABA, the longest-standing and best-established form of therapy for children with autism. They also hired an ABA therapist to direct a home program.

ABA involves as much as 40 hours a week of one-on-one therapy. Certified therapists deliver or oversee the regimen, organized around the child’s individual needs — developing social skills, for instance, and learning to write a name or use the bathroom. The approach breaks desirable behaviors down into steps and rewards the child for completing each step along the way.

ABA was tough on everyone at first, says Quinones-Fontanez: “He would cry sitting at the table during those sessions, hysterically cry. I would have to walk out of the room and turn on the faucet to tune it out because I couldn’t hear him cry.”

But once her son got settled into the routine of it, things improved, she says. Before he began therapy, Norrin did not speak. But within a few weeks, the ABA therapist had Norrin pointing his fingers at letters. Eventually, he learned to write letters, his name and other words on a dry-erase board. He could communicate.

Norrin, now 10, has been receiving 15 hours a week of ABA therapy at home ever since. He is still in an ABA-based school. His therapists help him to practice age-appropriate conversation and social skills, and to memorize his address and his parents’ names and phone numbers.

“I credit ABA with helping him in a way that I could not,” Quinones-Fontanez says. “Especially in those first few years, I don’t even know where we would have been without ABA therapy.”

But in recent years, Quinones-Fontanez and parents like her have had cause to question ABA therapy, largely because of a fiercely articulate and vocal community of adults with autism. These advocates, many of them childhood recipients of ABA, say that the therapy is harmful. They contend that ABA is based on a cruel premise — of trying to make people with autism ‘normal,’ a goal articulated in the 1960s by psychologist Ole Ivar Lovaas, who developed ABA for autism. What they advocate for, instead, is acceptance of 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.

“ABA has a predatory approach to parents,” says Ari Ne’eman, president of the Autistic Self Advocacy Network and a prominent leader in the neurodiversity movement. The message is that “if you don’t work with an ABA provider, your child has no hope.”

What’s more, the therapy has a corner on the market, says Ne’eman. Most states cover autism therapy, including, often, ABA — perhaps because of its long history. But in California, for example, parents who want to pursue something else must fund it themselves.

These criticisms haven’t made Quinones-Fontanez want to ditch Norrin’s ABA therapy, but they confuse her. She says she can see what the advocates are saying on some level; she does not want her son to become a ‘robot,’ merely repeating socially acceptable phrases on command because they make him seem like everyone else. Sometimes Norrin will approach friendly people on the street and say, “Hello, what’s your name?” as he’s been taught, but not wait around for the answer, because he really doesn’t understand why he’s saying it. “He just knows to do his part,” she says.

The message that ABA might be damaging distresses her. “I’m trying to do the best I can. I would never do anything to hurt my child,” she says. “This is what works for him; I’ve seen it work.”

Whether ABA is helpful or harmful has become a highly contentious topic — such a flashpoint that few people who aren’t already advocates are willing to speak about it publicly. Many who were asked to be interviewed for this article declined, saying they anticipate negative feedback no matter which side they are on. One woman who blogs with her daughter who has autism says she had to shut down comments on a post that was critical of their experience with an intensive ABA program because the volume of comments — many from ABA therapists defending the therapy — was so high. Shannon Des Roches Rosa, co-founder of the influential advocacy group Thinking Person’s Guide to Autism, says that when she posts about ABA on the group’s Facebook page, she must set aside days to moderate comments.

Strong opinions on both sides of the issue abound. Meanwhile, parents like Quinones-Fontanez are caught in the middle. There’s no doubt that everyone wants what is right for these children. But what is that?

A new view:

Before the 1960s, when autism was still poorly understood, some children with the condition were treated with traditional talk therapy. Those who had severe symptoms or also had intellectual disability were mostly relegated to institutions and a grim future.

Against this backdrop, ABA at first seemed miraculous. Early on, Lovaas also relied on a psychotherapeutic approach, but quickly saw its futility and abandoned it. It wasn’t until Lovaas became a student of Sidney Bijou, a behaviorist at the University of Washington in Seattle — who had himself been a student of the legendary experimental psychologist B.F. Skinner — that things began to click.

Skinner had used behavioral methodologies to, for instance, train rats to push a bar that prompted the release of food pellets. Until they mastered that goal, any step they made toward it was rewarded with a pellet. The animals repeated the exercise until they got it right.

Bijou contemplated using similar strategies in people, judging that verbal rewards — saying “good job,” for instance — would serve as adequate motivation. But it was Lovaas who would put this idea into practice.

In 1970, Lovaas launched the Young Autism Project at the University of California, Los Angeles, with the aim of applying behaviorist methods to children with autism. The project established the methods and goals that grew into ABA. Part of the agenda was to make the child as ‘normal’ as possible, by teaching behaviors such as hugging and looking someone in the eye for a sustained period of time — both of which children with autism tend to avoid, making them visibly different.

20160810-ABA-844

Lovaas’ other focus was on behaviors that are overtly autism-like. His approach discouraged — often harshly — stimming, a set of repetitive behaviors such as hand-flapping that children with autism use to dispel energy and anxiety. The therapists following Lovaas’ program slapped, shouted at or even gave an electrical shock to a child to dissuade one of these behaviors. The children had to repeat the drills day after day, hour after hour. Videos of these early exercises show therapists holding pieces of food to prompt children to look at them, and then rewarding the children with the morsels of food.

Despite its regimented nature, the therapy looked like a better alternative for parents than the institutionalization their children faced. In Lovaas’ first study on his patients, in 1973, 20 children with severe autism received 14 months of therapy at his institution. During the therapy, the children’s inappropriate behaviors decreased, and appropriate behaviors, such as speech, play and social nonverbal behavior, improved, according to Lovaas’ report. Some children began to spontaneously socialize and use language. Their intelligence quotients (IQs) also improved during treatment.

When he followed up with the children one to four years later, Lovaas found that the children who went home, where their parents could apply the therapy to some degree, did better than those who went to another institution. Although the children who went through ABA didn’t become indistinguishable from their peers as Lovaas had intended, they did appear to benefit.

In 1987, Lovaas reported surprisingly successful results from his treatments. His study included 19 children with autism treated with ABA for more than 40 hours per week — “during most of their waking hours for many years,” he wrote — and a control group of 19 children with autism who received 10 hours or less of ABA.

Nine of the children in the treatment group achieved typical intellectual and educational milestones, such as successful first-grade performance in a public school. Eight passed first grade in classes for those who are language or learning disabled and obtained an average IQ of 70. Two children with IQ scores in the profoundly impaired range moved to a more advanced classroom setting, but remained severely impaired. In comparison, only one child in a control group achieved typical educational and intellectual functioning. A follow-up study six years later found little difference in these outcomes.

The methods promised parents something that no one else had: hope of a ‘normal’ life for their children. Parents began to demand the therapy, and soon it became the default option for families with newly diagnosed autism.

“ABA has a predatory approach to parents.” Ari Ne’eman

A touchstone:

Lovaas’ ABA was formulaic, a one-size-fits-all therapy in which all children for the most part started on the same lesson, no matter what their developmental age.

Michael Powers, director of the Center for Children With Special Needs in Glastonbury, Connecticut, started his career working at a school for children with autism in New Jersey in the 1970s. The therapist would sit on one side of a table, the child on the other. Together, they went through a scripted process to teach a given skill — over and over until the child had mastered it.

“We were doing that because it was the only thing that worked at the time,” Powers says. “The techniques of teaching autistic kids hadn’t evolved enough to branch out yet.” Looking back, he sees flaws, such as requiring children to maintain eye contact for an uncomfortably long period of time. “Five seconds. That was one skill we were trying to establish, as if that was the pivotal skill,” he says. But it was artificial: “The last time I looked someone in the eye for five consecutive seconds, I proposed.”

Doubts grew about how useful these skills were in the real world — whether children could transfer what they’d learned with a therapist to a natural environment. A child might know when to look a therapist in the eye at the table, especially with prompts and a reward, but still not know what to do in a social situation.

The aversive training components of the therapy also drew criticism. Many found the idea of punishing children for ‘bad’ behavior such as hand-flapping and vocal outbursts hard to stomach.

Over the years, ABA has become more of a touchstone — an approach based on breaking down a skill and reinforcing through reward, that is applied more flexibly. It’s a broad umbrella that covers many different styles of therapy.

Among the many variations now in practice include pivotal response training, a play-based interactive model that sidesteps the one-behavior-at-a-time practice of traditional ABA to target what research shows to be ‘pivotal’ areas of a child’s development, such as motivation, self-management and social initiations. Another is the Early Start Denver Model (ESDM), a play-based therapy focused on children between the ages 1 and 4 that takes place in a more natural environment — a play mat, for example, rather than the standard therapist-across-from-child setup. These innovations have in part stemmed from the trend toward earlier diagnosis and the need for a therapy that could be applied to young children.

Each type of ABA is often packaged with other treatments, such as speech or occupational therapy, so that no two children’s programs may look alike. “It’s like a Chinese buffet,” says Fred Volkmar, Irving B. Harris Professor of Child Psychiatry, Pediatrics and Psychology at the Yale University Child Study Center and lead author of “Evidence-Based Practices and Treatments for Children with Autism,” a book many consider the go-to reference for ABA.

As a result, when asked whether ABA works, many experts respond: “It depends on the individual child.”

Today, Lovaas is viewed with the same kind of respectful ambivalence afforded Sigmund Freud. He’s credited with shifting the paradigm from hopeless to treatable. “Lovaas, may he rest in peace, was really on the forefront; 30 years ago, he said we can treat kids with autism and make a difference,” says Susan Levy, a member of the Center for Autism Research at the Children’s Hospital of Philadelphia. Without his passion, says Levy, many generations of children with autism might have been institutionalized. “He has to get credit for going out on a limb and saying we can make a difference.”

Testing ABA:

Given the diversity of treatments, it’s hard to get a handle on the evidence base of ABA. There is no one study that proves it works. It’s difficult to enroll children with autism in a study to test a new therapy, and especially to enroll them in control groups. Most parents are eager to begin treating their children with the therapy that is the standard of care.

There is a large body of research on ABA, but few studies meet the gold standard of the randomized trial. In fact, the first randomized trial of any version of ABA after Lovaas’ 1987 paper wasn’t published until 2010. It found that toddlers who received ESDM therapy for 20 hours a week over a two-year period made significant gains over those who got the usual care available in the community.

That year, a report from the U.S. Department of Education’s What Works Clearinghouse, a source of scientific evidence for education practices, found that of 58 studies on Lovaas’ ABA model, only 1 met its standards, and another met them only with reservations.

Those two studies found that Lovaas-style ABA leads to small improvements in cognitive development, communication and language competencies, social-emotional development, behavior and functional abilities. Neither of the high-standard studies evaluated children in literacy, math competency or physical well-being.

The following year, the U.S. Agency for Healthcare Research and Quality commissioned a stringent review of studies on therapies for children with autism spectrum disorders, with similar results. Of 159 studies, it deemed only 13 to be of good quality; for ABA-style therapies, the review focused on two-year, 20-hour-a-week interventions.

The review concluded that early intensive behavioral and developmental therapies, including the Lovaas model and ESDM, are effective for improving cognitive performance, language skills and adaptive behavior in some children. The results for intensive intervention with ESDM in children under the age of 2 were “preliminary but promising.” There was little evidence to assess other behavioral therapies, the review’s authors wrote, and information was lacking on what factors might influence effectiveness and whether improvements could carry over outside of the treatment setting.

Levy, who served on the review’s expert panel, says although the evidence in favor of ABA is not all of the highest quality, the consensus in the field is that ABA-based therapy works.

“There is a lot of good clinical evidence that it is effective in helping little kids learn new skills and can appropriately intervene with behaviors or characteristics that may interfere with progress,” says Levy. There are also other types of ABA that might be more appropriate for older children who need less support, she says.

Broadly speaking, the body of research over the past 30 years supports the use of ABA, agrees Volkmar. “It works especially well with more classically challenged kids,” Volkmar says — those who may not be able to speak or function on their own. These are, however, exactly the people that anti-ABA activists say need protection from the therapy.

Most experts acknowledge that there is a segment of children for whom ABA might be less appropriate — say, those who don’t need much support. One active area of research is scanning the brains of children to try to understand who responds and why. “Probably, as we go further down this path, we’ll see kids whose brains don’t change in response to treatment. They’re going to emerge as an important group,” says Volkmar. “We don’t know enough about them.”

20160810-ABA.844

Being able to identify those children who don’t have the expected neurological response — or being able to classify those who do into meaningful groups — might make it possible to fine-tune therapy.

“One day, it would be nice to match the treatment approach based on more information from these profiles rather than one-model-fits-all treatment,” says Karen Pierce, co-director of the Autism Center of Excellence at the University of California, San Diego, who uses imaging to study people with autism. “If we’re more informed, the treatment will be more successful.”

The pushback:

In December 2007, a series of signs in the style of ransom notes started appearing around New York City. One read, in part, “We have your son. We will make sure he will not be able to care for himself or interact socially as long as he lives.” It was signed “Autism.” The sign and others were part of a provocative ad campaign by New York University’s Child Study Center.

The campaign unintentionally provoked an onslaught of criticism and rage from some advocacy groups against the center, which offers ABA. Many of the vocal activists once received ABA, and they reject both the therapy’s methods and its goals.

Ne’eman, then a college student, was at the forefront of the pushback. One major criticism of ABA: the continued use of aversive therapy including pain, such as electric shock, to deter behaviors such as self-injury. Ne’eman cites a 2008 survey of leaders and scholars in the field of ‘positive behavior interventions’ — ABA techniques that emphasize desirable behaviors instead of punishing disruptive ones. Even among these experts, more than one-quarter regarded electric shock as sometimes acceptable, and more than one-third said they would consider using sensory punishment — bad smells, foul-tasting substances or loud or harsh sounds, for example. Ne’eman calls these numbers “disturbing.”

He and others also reject what they say was Lovaas’ underlying goal: to make children with autism ‘normal.’ Ne’eman says that agenda is still alive and well among ABA therapists, often encouraged by parents who want their children to fit into society. But, “those aren’t necessarily consistent with the goals people have for themselves,” he says.

The core problem with ABA is that “the focus is placed on changing behaviors to make an autistic child appear non-autistic, instead of trying to figure out why an individual is exhibiting a certain behavior,” says Reid, a young man with autism who had the therapy between ages 2 and age 5. (Because of the controversial nature of ABA and to protect his privacy, he asked that his full name not be used.) The therapy was effective for Reid. In fact, it worked so well that he was mainstreamed into kindergarten without being told he had once had the diagnosis. But he was bullied and picked on in school, and always felt different from the other children for reasons he didn’t understand, until he learned in his early teens about his diagnosis. He had been taught to be ashamed of his repetitive behaviors by his therapists, and later by his parents, who he assumes just followed the experts’ advice. He never realized these were signs of his autism.

Reid says he worries ABA forces children with autism to hide their true nature in order to fit in. “It’s taken me a long time to not be ashamed of being autistic, and that only came because I got the chance to learn from other autistic people to be proud of who I am,” he says.

“There is a lot of good clinical evidence that it is effective in helping little kids learn new skills.” Susan Levy

The middle ground:

There might be middle ground between critics and supporters of ABA, says John Elder Robison, bestselling author of “Look Me In The Eye,” who was diagnosed with Asperger syndrome at age 40.

Because of his late diagnosis, Robison did not receive ABA himself, but he has become involved in the issue on behalf of those who did. He envisions a place for ABA for people with autism — as long as it’s done well. That means a focus on teaching skills, rather than efforts toward normalization or suppressing autism-related behaviors: helping a child who could not communicate begin to talk and engage with other kids at school, for instance. “That is life-changing in a good way,” he says. Ditto an ABA therapist who helps a high school or college student become more organized. The emphasis should be on learning to function in areas the individual chooses, not on changing who she is, Robison says.

This approach will require oversight from people with autism, says Robison. “ABA programs and practitioners are going to need to accept guidance from adult versions of people they propose to treat,” he says. “What was not clear in the past is that we are the clients; we [should] have a say in what happens.”

Advocates say scientists also need to be open to the fact that ABA might not work for all. There is increasing evidence, for example, that children with apraxia, or motor planning difficulties, can sometimes understand instructions or a request, but may not be able to mentally plan a physical response to a verbal request.

Ido Kedar, who at 16 published his own memoir, “Ido in Autismland: Climbing out of Autism’s Silent Prison” writes on his blog that he spent the first half of his life “completely trapped in silence.” Kedar received 40 hours a week of traditional ABA therapy, in addition to speech therapy, occupational therapy and music therapy. But he still could not speak, communicate nonverbally, follow instructions or control his behavior when asked, for instance, to pick up the correct number of sticks. Kedar understood the request, but was unable to coordinate his knowledge with his physical movement. He was humiliated when the ABA therapist reported that he had “no number sense.”

Many researchers who study ABA welcome input of voices like Kedar’s. “I feel like it is the most wonderful, amazing thing to be able to talk with adults with autism about their experiences,” says Annette Estes, professor of speech and hearing sciences at the University of Washington in Seattle. “We all have a lot to learn from each other.” Estes led two studies of ESDM for children with early signs of autism. She says the worst stories she has heard are not from people who had traumatizing therapy, but from those who got no therapy at all.

“They have horrible memories of being bullied at school and [having] no one to help them or include them or help them make friends or handle tricky social situations,” she says. “I get letters from people begging us to expand services to adults to help them learn how to date and be less lonely and isolated.”

There is not likely to be an easy end to this discussion, and in the meantime, parents must do the best they can. Quinones-Fontanez says she understands the anti-ABA argument, but she wonders how much the perspective of those who don’t need a lot of support applies to her son. ABA, she says, works for him: “I don’t find it to be abusive.”

“I am his advocate, and I will advocate for him because he’s not able to do that for himself,” she says. “I try to understand him as best I can.”


  • CriticalDune

    A demonstrably small group of “fiercely articulate” neurodiversity activists wants to curtail access to ABA and other intensive behavioral interventions by peddling falsehoods and using scary language like “harmful” and “cruel”. No surprise there. What is surprising is the weight Spectrum gives to their scientifically unqualified, extreme, and ideologically driven views. Keep in mind that to a good number of neurodiversity leaders, including Mr. Ne’eman, Simons funded genomic research initiatives equate to eugenics and should, like ABA, be stopped or sharply limited.

    • Andi

      You should really try actually LISTENING to some adult “graduates” of ABA programs. There were no falsehoods in this article. SOME ABA is “harmful” and “cruel.” If someone has PTSD because they were forced to do things that HURT them in the name of “therapy,” that’s both harmful and cruel, and there are adult autistic people out there who had that exact experience.

    • Christopher Brooks

      Exactly what else would you call research whose ultimate aim according to its proponents is the elimination of a certain type of person BUT a form of eugenics? The research itself is neutral and not equal to eugenics but the proposed aim of it certainly is.

      • CriticalDune

        “Proposed aim” follows. “About SFARI
        Launched in 2003, SFARI is a scientific initiative within the Simons Foundation’s suite of programs. SFARI’s mission is to improve the understanding, diagnosis and treatment of autism spectrum disorders by funding innovative research of the highest quality and relevance.”

  • YuDe Davis-Hester

    Why don’t you call Lovaas’ aversives what they are? Abusive. Likewise, explain what they do to curtail non-harmful behaviors: hold hands or body down in a “normal position”. This is like grabbing a non-autistic child’s face whenever they smile or frown.

    • Laney Chandler

      People should read the Life Magazine article from 1966 on his methods to know the pedigree of ABA, and then stop to consider that if you replace electric shock (although even that is still used) with withdrawal of engagement (social rejection) as an aversive, is that any kinder? Autistic people are subjected to intense rejection – I would argue that it is literally exploiting the autist’s greates vulnerability. “Getting used to” ABA or “Getting into the swing of it” could just as easily be described as having one’s resistances worn down by punishment.

  • rjgwood

    ABA doesn’t have to be that way – I use it to understand motivation and focus on strengths and interests to help my clients reach their goals – not to make the neurotypical – but to empower them to be themselves and reach their potential! Oftentimes it is the parents, schools and environments that get my attention as I push to make changes that allow for greater accommodation AND I focus heavily on self advocacy. I am a BCBA and a provider of ABA. We do not do discreet trial training or repetitive drills – we do supportive problem solving in the natural environment and focus on helping the individual become adept and communicating their wants and needs. I also self-ID as on the spectrum so that probably makes a big difference – no focusing on eye contact or eliminating stimming here!

    I also think the field needs to acknowledge abuse that has occurred/continues to occur and I work to educate about harmful practices and trauma-informed approaches.

    Unfortunately, I don’t know anyone else practicing this way.

  • jl

    ABA saved my life, thank God I found the best therapy and quality programs. diversity is huge on the spectrum. The article missed the real history of ABA. I know hundreds of kids, adults, recovered and then the numero-diverse group…ABA with quality is based on Positive Behavioral Plans …I raised two severe believe me there was no Lovas techniques. Do me a favor stop talking about our severe autism children who our loved by there mothers and fathers. It has nothing to do with so called neurodiversity. You are not my children now adults. And if you utilize the lack of validity in this article as some sort of science or fact I pray you do not have a child with severe autism and dual diagnosed. Be careful where you reach you are out of your league.

    • Andi

      You have a gross misunderstanding of what neurodiversity actually is if you think it doesn’t apply equally to your “severe autism and dual diagnosed” kids and to adults on the spectrum, many of who used to look a lot like your kids. All the “neurodiversity movement” wants is more acceptance for autistic children and adults. It doesn’t reject treatment or therapy UNLESS it’s the sort that is going to cause harm to the people it’s trying to help. The “real history” of ABA includes some good things and ALSO quite a few bad ones. Lovass-style aversive ABA therapy is not helpful, and in many cases is actively harmful, even if it appears from the outside that the kids being “treated” are improving. Those of us advocating for autistic kids to have the best treatment and therapy that will help THEM be as successful and happy in their lives as possible are also wary of ABA methods that hurt the kids they’re trying to help. It’s fantastic that your children had good outcomes from ABA. That IS NOT the case for all autistic children.

      • jl

        Sorry Lovas is dead and it never was my choice..Historically, Lovas used others work and created a program go hid own and called it Lovas. There are some non educated participants in ABA that use those practices especially west coast and spotted areas. You really are kicking down an old road this is such old news do some research and seek the best I will recommend some info to you later for I am traveling now…Quality …ABA ….is not always available. However, I believe this is what you might consider advocating for with all due respect…

  • anne borden

    Ari Nee’ma is right. ABA providers do take an aggressively predatory approach, falsely claiming they are the only “evidence-based” practice and falsely claiming that without intensive ABA children will fail. But anyone with a basic understanding of the brain – or who is a critical thinker themselves – can see through it. ABA providers simply want to corner the market using fear … and until now they have. It’s about making $$$ dollars, it’s not about kids 🙁

    • So scary

      Yup. You’re right ABA therapy is all about scaring people ?. We should just let kids headbang until they are dead or cause brain damage because stimming is more important. That’s not scary at all ?. Genius ??

      • Lacey

        Right. I have worked in this field for quite a while now and I have never seen anyone use a punisher. They are against policy even. Whenever other professionals come (speech and occupational) into the home, they don’t either.

  • David Mandell

    Unfortunately this article unintentionally contributes to confusion and controversy around ABA rather than illuminating it. The article confuses therapies based on the principles of applied behavior analysis with discrete trial training, sometimes referred to as the Lovaas method. Applied behavior analysis is a process of systematically applying interventions based upon the principles of learning theory to meaningfully change behaviors that cause distress and impairment. Learning theory offers a conceptual framework for how people learn. This framework is constantly expanding as we learn more about human behavior, cognition and motivation. Most autism interventionists who use ABA-based techniques view Lovaas as having made important contributions to getting people with autism out of institutions through therapy, but as having had a very narrow and sometimes harmful definition of learning theory. Discrete trial training is very scripted and very much teacher led. More recent evidence-based ABA-based interventions, such as pivotal response therapy and the strategies use in the Early Start Denver Model or Project ImPACT or Early Social Interaction, are much more naturalistic and child led in their approach. They rely on activities that are intrinsically motivating to children, like games they like to play and routines they enjoy, rather than rewards that are external to the activities (e.g., do three math problems correctly and get an m&m). Modern ABA-based therapies also take into account recent advances in developmental science, and try to address critical components of social communication. Most people who watch a PRT session would not recognize it as in the same family of intervention as discrete trial training, but they very much are.

    Just like there are ineffective and even harmful people in every profession, there are autism therapists who make very bad decisions about which behaviors to try to change and how to change them. They pick things like repetitive behaviors, which may be distressing to the people around the person with autism, but not to the person with autism. Therapists should be giving the person with autism tools to help with behaviors and situations that are distressing to the person with autism or that inhibit the person’s ability to accomplish what they want to accomplish. When that person is a small child or when communication is difficult, the therapist, in partnership with the parents, will have to make some guesses about which things are distressing and could benefit from change.

    ABA offers a set of tools for figuring out what is causing an impairing behavior, helping to change it, and collecting data to make sure that things are moving in the right direction. Like any set of tools, it can be used for good or for ill. Our mission should be to make sure that therapists are well-trained in the use of the most recent iteration of these tools and have the insight, patience, creativity and humility to use these tools only for the benefit of the person with autism.

    • Amanda Jackson-Pierce

      I agree with David Mandell’s comments. My experience has been that ABA was done really well with our child. Our kid loves his ABA sessions gets very excited when he sees the therapists, laughs and really enjoys himself during his sessions. The initial settling in period was challenging for the first few weeks until we all learnt more effective ways to communicate with our son and that he learnt new ways to communicate generally.

      An important area that is often missed in social media discussions about ABA is that all parents and caregivers of the child also need to learn alongside the child. There is no point focusing on the needs of the child when the entire world the kid lives in remains ignorant of how to communicate effectively too. ABA has opened my eyes about how to empower my marriage and generally parent better. ABA is not about autism, its a learning and teaching method that happens to be very effective for many people – when it is done by qualified people and done well.

      • Peter Lloyd-Thomas

        Amanda, you are totally right, the whole family have to understand and apply ABA, then it can work really well. We also funded our own ABA program and even had to train the therapists. ABA was fun for our son. Clearly if applied badly or by someone who is not child-friendly, the result could be very different

        ABA is a teaching method not a “cure” for autism. Many people respond very well, but in some it just does not have an impact.

  • TH

    ABA is better than nothing but it is a Neurotypical ‘solution’ to a Neurotypical perceived problem. Listening to autistics about autism is vital. Ronald Davis – autistic and dyslexic has created a cognitive framework that allows an autistic person to interact with the Neurotypical world more easily; if they choose to and without taking away their autism. http://www.davisautism.com

  • R Bazylak

    I have worked with people with intellectual disabilities and severe behavioural challenges for over twenty years. Behavioural science represents the core of my practice. This article saddens me.

    Please, do not blame the science, blame the poorly trained and inexperienced practicioners who misuse it. There is no reason to cause such distress to a child or anyone else. Behavioural science should be customized to encourage each person’s strengths and overcome obstacles to success. Success should be collaboratively defined using goals set by the person and their loved ones.

    If your consultant is not treating your child well, fire them. There are many other consultants. I am yet to encounter a situation that cannot be effectively improved with kindness and respect.

  • Elizabeth B Torres

    My response to this as a scientist and as a member of the human spectrum that respects the right to free will:
    https://www.researchgate.net/publication/303102973_Turning_the_Tables_Autism_Shows_the_Social_Deficit_of_Our_Society

  • MK

    This article in many ways is very disappointing. It continues to perpetuate a stereotype about ABA that continues to place barriers to families pursuing effective treatment. What is referred to as ABA throughout the article is discreet trial which is a small fragment of the ABA universe. While it can be effective, there is much more than that one principal. The article mostly focusing on discreet trial as ABA is like saying the earth is the only thing that exists in our solar system. There is so much more to ABA. This type of treatment is extremely individualized which allows itself to be respectful of the individual.
    Parents forming opinions, please consider the source and don’t be distracted by uneducated views. Pursue information from experts in the field such as Susan Levy who is referenced in the article. These are doctors and researchers that don’t monetarily benefit from ABA in any way. They are trying to help others pursue what truly is effective treatment. Research supported treatment is essential.

  • Sal

    BCBA’s and these ABA programs/schools have NO clue how to teach language and communication. They are fine with understanding how to teach ADL’s but when it comes to teaching language and reducing behaviors by giving a child true communication…. forget it. Look into RPM and run from ABA if you feel your child’s language and communication is going nowhere and you spend hours, days and years discussing with these BCBA’s how to reduce behaviors. BTW, most of the ABA centers are out to make a buck imo. They just keep increasing and increasing in size and number of kids, giving too little supervision and training of their therapists and they are basically wellness centers or glorified babysitters for parents ignorant to good intervention.

    • Craig

      Sal. You accuse ABA of being money hungry, yet the RPM lady charges thousands to train parents in an unsubstantiated “therapy”. Come on.

  • Brenda Anderson-Bradshaw

    My recommendation is to just use certified occupational therapists, physical therapists and speech/language therapists to help your child learn skills. These therapies are much more quality, humane, and can do anything ABA can do. Plus, they are already covered by most health insurance, at least in part. ABA is NOT NEEDED. I’m all for defunding it.

    • Craig

      How would any of those therapists go about teaching a child not to bash their face in against the floor when told “No?” Maybe have them bounce in a medicine ball for 30 minutes a day?

  • BJ

    I am a BCBA and this article makes some good points. I think that ABA therapy may not be the best fit for every individual. However, this really depends on the desired outcomes that SHOULD be discussed with the family prior to treatment. My approach has never been to “normalize” my clients, but to reduce interfering behaviors so they are available to learn adaptive skills. For all of the criticism ABA is getting, I have seen many OT’s and SLP’s running repetitive drills, using aversive techniques, and using punishment, all while the child was punching themselves in the face. The thing with Autism is that is does not present the same in every individual, therefore, it should not be treated the same in every individual. These blanket statements about “abusive” and “cruel” sessions are ridiculous from my experience. Neurodiversity is well and good, but what is your solution for the child who breaks his eye sockets when you tell him “no” or the child who runs from the house without warning? These concerns are very real and those preaching a hands-off approach to treating dangerous behaviors are living in a fantasy world. Acceptance and understanding those on the spectrum is very important, but training a child to not behave in a way that lands them in jail is more important.

    As for the shock therapy, I have never once heard of this being used and its more concerning that, as rational people, you can’t imagine how a quarter of specialist can fathom a situation when they would use shock therapy. Just because they can think of the scenario, does not mean that it would be their 1st, 2nd, or 3rd choice for treatment.

    Just for clarification, what do the Neurodiversity Activists suggest we do with these individuals exhibiting severe behaviors? Genuinely curious. I don’t want to cause any harm to my clients, and if there is a scientifically proven middle-ground, I am all ears.

  • Adrianne

    I am a BCBA and a mother of a 8 year old with autism. I entered the field because at the time of his diagnosis we had no therapy coverage at all. The last thing I want to see is my child being bullied, not respected, need support all his life, or worse institutionalized. I have the same heart for any children on the spectrum with whom I work with. ABA is a very broad field. DTT structured drill is not the only format. I use PVT as you mentioned, EDSM, Natural Environment Teaching, verbal behavior as well as DTT to fit with children of different interest and abilities. A good therapist should be able to adopt various methodologies that fit the child and promote generalization of skills, and respect the child as an individual. With over 50 years of research and development, it is evident that ABA-based interventions are the most effective, with respect and consideration of the child’s sensory profile and individuality. But ABA must be implemented ethically. As a therapist and as a mother, I only want the best for the children with ASD. This is what I believe.

  • Jess pena

    My son had ABA 40 hours per week. We had to stop after he came home with a dozen bruises the third time and started to habitually self-harm. The BCBA said they would solve the problem. The solution was to send a person to show how to restrain my son without causing the bruises.

    No, my son did not have a behavioral issue before the therapy. He was nonverbal. He was not aggressive.

    ABA has a one size fit all view. My son is developmentally slower than the other autistic kids in his class even though he got the most hours and the highest quality therapies. I’ve learned that he matures when he matures. However, the ABA therapists thought that they yanked his lunch every 10 seconds from his hands and make him do work for three to five minutes in between, that would make him better.

    I still get anxiety attacks whenever I hire someone new who has had ABA training.

  • When ABA principles are used to make people on the spectrum “indistinguishable” from nuerotypicals, rather than a way to teach communication or understand the “why” of challenging behavior, it can be abusive and more harmful than helpful.

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