A reader asked a question this morning on Diary’s Facebook page. “Jess,” she asked, “how do you feel about ABA?”
I let out a heavy sigh when I saw it. I almost wrote, “I think it’s a hot-button topic and I don’t want to go near your question with a ten-foot pole, but hey, thank for asking!”
But, yeah. Here we are. Me and my ten-foot pole.
ABA has hurt a lot of people. Hell, just talking about it can hurt people who have suffered at its hand. And I don’t want to hurt people. Especially those I really care about. But it’s a valid question and I do think that the conversation matters. So here we go.
I think that, while ABA in its purest form (ie Lovaas), is desperately inhumane, I also think that there are *PARTS* of its more modern methodology that can be applied as *part* of a helpful and compassionate support plan.
I wrote the following here in September ..
ABA has long been one of the tools in Brooke’s toolbox. We have found that its method of breaking the world into digestible pieces is well-suited to Brooke’s learning style. But we are extremely (and have become increasingly) careful in the way in which we, and anyone who works with her, applies it, because we know that it can, when taken to the extremes, be anything but helpful.
ABA’s name implies its true purpose for us – Applied Behavior Analysis. (Note: not Modification, Analysis.) You’ve heard me say a thousand times over that behavior is communication, right? Well, when it’s the only form of communication that your kiddo’s got, you might need some help in figuring out what s/he is trying to tell you. It’s not always so easy. So we collect data (either formally or not) in order to analyze her behavior so that we can figure out what she is trying to tell us.
We used, and still use, the ABC method –
Look at the Antecedent to the behavior – what was happening right before the behavior that might have caused or contributed to it?
Look at the Behavior itself – this is especially relevant in stimming as it might well be its own reward (and, unless it’s patently harmful, should be left alone)
Look at the Consequence – what happens directly following the behavior that my child might be seeking?
It has been immensely helpful for us in determining what Brooke needs and how we can help her to mitigate the challenges that her environment presents. It also allows us to see when it is OUR behavior that is triggering or exacerbating hers.
But ABA can also be harmful. When it is used for the purposes of behavior modification without regard for communication. When it is used indiscriminately. When it is used to change behavior in order to make it more palatable to us rather than more effective for our children. And, in the worst cases, when it veers into aversives.
If you’re interested, you can read the whole post here, but be warned, it’s about a mother who attempted to murder her autistic daughter and gets into Lovaas in detail, so it’s no picnic to read.
The bottom line is that I’m pretty convinced that no one course of therapy, executed in a vacuum, will ever work for us. No philosophy, resolute in its absolutism as they tend to be, will ever suffice. Because my child is not absolute. She’s human.
In Welcome to the Club, I wrote,
You will find the tools that you need. You will take bits and pieces of different theories and practices. You’ll talk to parents and doctors and therapists. You’ll take something from each of them. You’ll even find value in those you don’t agree with at all. Sometimes the most. From the scraps that you gather, you will start to sew your child’s quilt. A little of this, a little of that, a lot of love.
Of course, if I were writing that now, I would include “those who are like your child” in the group of those to whom you will talk, but the salient point here remains the same – there are bits and pieces of ABA that are helpful. There are bits and pieces of Floortime and RDI and unschooling and, and, and .. that are helpful. But none of them are worth a damn if they’re not critically and thoughtfully used as one of many tools.
I absolutely, positively acknowledge that ABA is particularly dangerous. I would never allow it to be applied as it was originally intended. But, back to where I started, I do see some benefit in PARTS of its methodology.
All of that said, this is why I’ve said again and again that I desperately want us, as a community, to start prioritizing research into the long-term efficacy (and side-effects) of various methods of therapy. If PTSD shows up as a side effect of a therapy, as it reportedly does for so many adults on the spectrum with whom pure ABA was practiced, then for the love of God, it’s got to be radically changed and it’s practitioners rigorously educated, regulated and monitored.
On the flip side, if something’s working – effectively and compassionately helping our kids to effectively communicate their needs without harm — let’s do the research necessary to give it a scientific stamp of approval so that ABA is no longer the default ‘gold standard’ just because there are no sufficiently tested alternatives.
This matters. It has to matter.
Because right now, ABA is really the only government-sanctioned option for our kids. Meaning it’s the only therapy covered by insurance. And the only real teaching method available in the public schools (if anything is available at all). And no matter what I or you or anyone may think of ABA, that’s not okay. Because everyone should be able to sew the quilt that works for them.