ABA

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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.

54 thoughts on “ABA

  1. Thank you for this. This is concise and well-thought. We used ABA with our son (and I still use some of the processes to analyse his behavior). We included it in a comprehensive treatment program. We did NOT follow Lovaas’ original methods, but the the methods of ABA that have grown and evolved based on Evidence Based Practice. I would not psychoanalyze anyone today using Freud’s theories either, but that doesn’t mean certain parts of psychoanalysis aren’t useful in the evaluations and therapies practiced today.

    Therapy builds on itself. You find something that works, and you continue to use it. You see something that is harmful, or negative, and you disassociate with it. The pool of study for Autism was very small in the past; the increasing numbers of children being diagnosed today means we have a need for more study of Autism and more practitioners of treatments and therapies. This builds in the opportunity to learn more about not only the effectiveness of those therapies, but about the way Autism affects each individual. I’m personally thankful for the way ABA entered our lives (very gently, applied by learned and experienced practitioners).

  2. I love this post. I am an educator and an ABA therapist. I am also a parent of a child who has not been diagnosed. I have been told that he has a “not-yet-known syndrome with autistic-like features”. I am highly sensitive to the fact that many therapists can forget that individuals with autism are human, not case study animals. I appreciate your post because it puts into words how I feel in my heart 🙂 Thank you!

  3. What i learned, going from a terrible psychologist to a good one, is that: no one therapy fits all people. Any counselor or therapist should tailor their approach to fit the individual; they should not force the individual to fit their approach. When I hear about ABA harming people, it’s almost always because it just brutally forces people to conform to some idea, which is an awful, traumatic thing to do. Rigidity and inflexibility in a therapist is a pretty good indication that…quite frankly…they suck, and can cause real harm. A therapist who is patient, and does not claim to have all the answers: far more likely to generate a positive outcome.

    When I come across truly fraudulent therapies, the quacks, the one thing they all have in common: across the board, they’re the ones with the answers! They’ll insist that they basically have it all figured out; they know how autism works, they know the best treatment.

    Point being: with ABA or any other therapy, the biggest red flag in the world is certainty. If someone has all the answers, run the other way.

    • This:

      “…the biggest red flag in the world is certainty. If someone has all the answers, run the other way.”

      Oh my god.

      LOVE.

    • This is an excellent insight…and I agree. If someone or some group has it all figured out, chances are it is NOT for us. I love it when our BCBA says she is stumped…and we work together to formulate a program and plan for my son’s therapy.

      • Lisa, I had a similar experience…i visited with one psychologist who had the answers very quickly…and they were terrible. the next one i went to: i asked her what her plan was…she shrugged and said, “let’s figure that out together.” had a very positive experience after that. i like your description of the BCBA being stumped…maybe that is a key trait of any good therapist…if they can be stumped, that alone is a positive sign. If they can’t be stumped: bad sign.

    • When we were looking for a kindergarten for our son, we visited a school that billed itself as pure ABA, “the only scientifically proven method of helping autistic children.” Well, we couldn’t even make it through the opening presentation, the school was so depressing. It was the only time in our *exhaustive* search when I actively felt like something was terribly wrong, rather than just not being the right fit for my son. That said, we use techniques similar to ABA occasionally to help our son at home, and they’ve been beneficial. Which I guess leads me to the line that compelled me to post a reply: “the biggest red flag in the world is certainty.” AMEN.

  4. Hi Awesome Jess! A while back I write a post called something like Labels, and Intense Teaching Is Real…in it, I go into very graphic detail with concrete examples about using the useful tools that do have historical roots in behaviorism without falling into the harmful moral traps that cause trouble. I think it sounds like what you and others do instinctively, but it might be a useful source for your readers as a breakdown. It is one of the ones my readers say they consider useful. xx Love, Ib

  5. Thank you, Jess, and thank you M, for your words. We’ve been lucky in my son not needing ABA. I didn’t really know about it till recently – and then I read Loud Hands and cried, several times. I’ve recently joined several LinkedIn groups re. autism, and some posts reference ABA. I want to address them in a gentle way, and make them aware of the pain that was caused in the past. I want to ask them to consider how it might be avoided in the future, and to find ways to avoid repeating these mistakes. (I feel awkward about being so bold because I don’t have personal experience with it….)

    I don’t know if you or your readers have thoughts on this, but I’d appreciate it – because those who work with our autistic family and friends need this:
    Awareness –> Understanding –> Value –> Support –> Celebration.

    Thank you very much.

    • Dear PK, I’m not on Linked In, but you could send ’em to me (I’m the link Jess put in the thread right above you there, tinygracenotes) or to Jess herself. On my blog i often custom answer questions. Also, I superlove your flowchart! xx Love, Ib (Elizabeth Grace, in Loud Hands)

  6. You have a very big platform these days with Diary. So I feel like I should chime in on the point you make that “…ABA is particularly dangerous.”

    I have numerous friends pursuing all different types of therapy (RDI, R&R and ABA) here in urban Canada. And I have not heard of anything dangerous going on in their therapy. The only danger I’ve witnessed is that of unqualified practioners, in therapies that do not require any certification, taking up valuable learning months and years without providing any real support or seeing any progress for children.

    I don’t have all the answers. But I do think any fear mongering – by Autism Speaks about autism or by others about therapy modalities – just strikes fear in the hearts of already confused and anxious parents.

    Like any health regime or exercise regime or educational process, many are prescribed or lead by human beings and the experience and results are only as good as the human(s) putting that modality into practice. Chemo can be dangerous. Perscription drugs can be dangerous. Cross-fit training can be dangerous. Weight-loss can be dangerous. We all need to be mindful consumers – all the time.

    If our children are happy and our children are growing and progressing and blooming in a way our heart knows to be “progress” for them, that’s the test. You’re on the right track.

    • While I absolutely agree that there is danger in any therapy that relies on human beings for its implementation, I would also caution against dismissing the particular dangers inherent in a therapy that was designed around the premise that behavior could, and should, be modified for social acceptability. Yes, it has largely evolved a great deal, and I’m thrilled that you haven’t seen, or don’t think you’ve seen, it abused, but that does not negate the fact that autistics have raised their voices again and again to say that this type of therapy was harmful to them. We have a responsibility to listen and to change what’s being done to ensure that it is compassionate. And yeah, it can be scary to hear that the therapy that is being recommended for your kid has a pretty scary and largely abusive history, but being aware of its pitfalls is the only way to keep our children safe from them.

      For various reasons, I don’t want to get into the specifics of our experiences here, but please believe me when I tell you, ABA is far too often still inhumanely applied.

      • Typing fast, excuse typos etc:

        I am taking Jess’ use of the term “dangerous” to include emotional danger, and I wholeheartedly agree. I, too, am in urban Canada (Toronto). Our first experience with ABA was well-researched and the provider was a former government employee who wrote ABA programs for use in funded clinics. She wanted to open her own clinic to use her knowledge and training to help kids. She was lovely and I liked her immediately. My son was 3yo (this was just 6 years ago).

        The first time she corrected how my son blew a kiss to me as I left him in her care, my gut twitched. He did it “wrong”, apparently, and she used hand over hand to help him do it “right”. His little face drooped, as he was fairly non-verbal at this time and saying goodbye to me was something he was proud of. I smiled weakly as I waved and left. And then I cried. THIS was the evidence based best therapy?

        The time she corrected how he lifted his arms when she asked him to “show me your arms”, my gut twitched again. When I asked her about it, she said, “Don’t you want him to do it right, and quickly, every time? All his classmates will. He will be left behind.” The guilt was huge. But no, I didn’t want him to do it right and quickly every time. That just wasn’t him, and I was (am) ok with that.

        I pulled him out after 4 weeks. Never looked back. RDI with other strategies has been right for us. He’s an awesome autistic 9 year old.

        Was the ABA therapy “dangerous”? I’m sure many would say no, and certainly it’s NOTHING compared to what many kids/adults endured. But ABA was not right for my sensitive little guy. The message is to be cautious. Go with your gut.

      • I am truly sorry that you and others have had negative experiences with ABA therapists. I wonder if that happens less in home-based programs than in centre based program when parents are not there, and there are sometimes more children to manage, more turn over of staff, etc. I’m surmising. Anyway, I know mostly home based programs, with compassionate consultants, and they are successful.

        And just as anti-autistism rhetoric (veiled as cure-searching or wholly unveiled) needs to evolve and move on, I think anti-ABA rhetoric is an outdated and inappropriate overgeneralization that does more harm than good. I don’t believe that ABA therapy “was designed around the premise that behavior could, and should, be modified for social acceptability”. I have never heard that. I know you tried to find the grey in your post Jess, by mentioning B benefits from some ABA-based principles, but it is mostly and anti-ABA tone and that seems unfair (and unbalanced).

        ABA is a way of analysis, not a methodology. ABA is flexible, and inherent in that flexibility is the ability to use for abuse. ABA does not choose goals, the therapists and parents do. In my limited experience, in my small corner of the world, ABA therapy has been focussed on communication, conversation, self-regulation and self-calming, attention sharing, and helpful skill development (toileting, writing, cutting, etc). Maybe, as parents, therapists and society evolve, so too will the goals and methodologies associated with ABA.

        I go back to my main point: that parents and therapists should be held accountable, not a way of analysis. As always, go with your gut.

      • Andy Mummy,

        There’s a lot I want to respond to in this, and I have limited time, so please forgive me if it appears brusque; it’s not meant to.

        Firstly, you address one of the the same points that Stephanie did earlier. As I said to her in my comment below, ”Your point is well taken that ABA is the science and not the practices derived from it – I was indeed conflating the two and I appreciate you pointing out that error.”

        As for the origins of ABA, its history is easy enough to research, but, when it was brought to the fore by BF Skinner in the 30s it was originally called Behavior Modification. From Wikipedia – “[Behavior Modification] has since come to refer mainly to techniques for increasing adaptive behavior through reinforcement and decreasing maladaptive behavior through extinction or punishment (with emphasis on the former). Behavior modification is a form of Behavior therapy now known as Applied behavior analysis.”

        Secondly, to call this post “anti-ABA rhetoric” is, I think a very misleading representation of what I wrote. I devoted nearly half the space in the post to extolling its virtue for Brooke. I’d say that half a post is far more than a “mention.”
        Lastly, you say that my tone, as you interpret it, is unfair and unbalanced. Although, as I just explained, I take issue with your premise that it’s unfair because it’s anti-ABA, because I don’t think that it is, even if it were, I’m not a reporter. I’m not here to present a balanced news story. I’m a mom writing a blog (called, aptly, a diary of a mom) based on my experiences. This entire post was, as I made very clear up front, a response to the question asked this morning on Diary’s Facebook page: “Jess, how do you feel about ABA?” Heck, the question wasn’t even what I think but how I feel. That said, I did not “try to find the grey” in my post, as you assert, I simply answered the question from my heart, relying on my experience and observations and my conversations with numerous others over the years, including but not limited to autistic adults and practitioners.

        Jess

      • I hope my reply goes in the right place, after andymummy’s reply — because I want to say that we ended our posts in exactly the same way, and I love that. I think you make some really good points, and I will be careful about my comments regarding ABA. None of us wants to see our kids hurt, especially our very vulnerable kids. If it helps, I’ve actually hugely evolved regarding my thoughts on ABA since my son’s experience years ago, and I certainly don’t cringe when a parent tells me they are starting ABA. Gosh, this stuff is so hard, isn’t it? We just want these kids to be celebrated, not tampered down. And kind, informed people (therapists, educators, AND parents) will do so.

      • A.D., if my children had blown me a kiss good-bye and someone corrected them, I would also cry. We interviewed 3 BCBA’s in our home when our son was 2.5 and just starting therapy. The first didn’t even try to speak to him, and when he did come by, she tried to smooth down his hair. I was like “WTF? That was what was important to you in the first moment you met him?” He immediately ran off, never to talk to her again.

        The one we chose, in response to me saying he can go a whole day without looking at me said “If he likes dinosaurs, I will show up here every day in a dinosaur suit until he wants to play with me and look at me”. Both my children adore our consultant. She never wore the dinosaur suit. I adore her too. That’s probably why I’m a bit defensive about ABA.

        “…this stuff is so hard, isn’t it”… aint that the truth.

        (Best wishes to you in T.O, A.D., I’m in Vancouver. 🙂 )

      • A bit brusque maybe, Jess, but likely warranted.

        I did some heartbreaking reading today. Thanks for that. (No really, I needed to). I read about hands glued to tables to prevent flapping. Sitting on hands. Withholding all food, all sustenance, to get a response. Arms or limbs in full restraints. Cruel and abhorrent treatment.

        This is not our ABA. This shouldn’t be anyone’s ABA.

        I wish there was a term for good ABA versus bad ABA… it’s unfortunate that such polar opposites of therapy exist within the same modality. ABA. I guess when you’ve seen one ABA program, or met one ABA consultant, you’ve seen or met but one.

        On the topic of journalism and responsibility, I agree you are not bound by journalistic ethics, nor is anyone writing an editorial, blog etc. You do, however, have a platform of 25,000 adoring readers, who tell their 100,000 loving friends, family, teachers, clients and team members about what they learn here. There is some social responsibility inherent in building and using that platform, no matter the unassuming title. A responsibility I think you live up to, always.

        I thought you were trying to find the grey, the middle ground, in a positive way because you often write about things being messy and not black and white – and I thought the article was showing both the black and the white (the good and the bad) of ABA, with a little more oomph on the bad. But that’s just one opinion. Many people loved the article.

        Social media can be a bit of an echo chamber, with like opinions compounding on each other, and it’s hard to provide dissenting views. I was just sharing how I felt about the article (er, post).

      • I do indeed have a tremendous platform, for which I am grateful, by which I am humbled, and the responsibility of which I take extremely seriously. Ask my husband how many nights I’ve slept through in the past two years.

        The truth be told, I determined long ago that my accountability on diary is to our children. Not to big advocacy organizations, not to the individuals with the loudest online voices, not to the many easily bruised egos or constantly ruffled feathers on these here interwebz, but to our children. And if helping to get the word out that parents need to be critical and careful consumers of a therapy that can be absolutely life savingsly fabulous when done right but can also easily veer into abusive and inhumane territory scares some parents enough to do just that to protect their kids and involve themselves fully in the design of the programs, well, I think I’m using that platform well enough to just maybe sleep through a night.

      • Hi Jess,

        I took a few days to reply, because I didn’t want to cause you any upset. That’s not what anyone needs or deserves, least of all you. I’m sorry you have sleepless nights over DOAM. I can’t imagine the responsibility you feel and have. Just know that you are doing SO much good. I can’t tell you how many friends I have who follow you (but don’t officially “follow you”) because you show up by extension in their newsfeed.

        Here’s my last gasp on this ABA quagmire… I agree we need to focus on keeping our children safe from harm. Absolutely. Harm comes in the form of maltreatment, but also in the form of “no treatment”. Where there is no funding, there is often no treatment. Where there is no diagnosis, there is usually no treatment. And when there is no conviction or clarity about what one should or could do, there may be no treatment / therapy. [I had a few friends and family members read the post – they felt the tone was overwhelmingly anti-ABA. (I didn’t tell them what I thought first). I offer that because you disagreed. While there is less space on the page devoted to the anti-ABA but it is far more passionate. And you write passionate well.]

        I think this is important because at the end of the day we are all trying to do the best for our kids and all other children we know, on the spectrum or off. ABA isn’t for everyone, but I am worried about the kids that don’t receive useful therapy. I am worried about parents getting steered away from something, that when done well, can really, really help their children to be happy and fulfilled. You said that “there are bits and pieces of ABA that are helpful”… in my limited experience, when done well and for the right children, there is a lot more than bits and pieces of ABA that can be helpful.

        Autism Daddy wrote a good post called something like Autism is like a cough… in it he says what helps your cough may not help mine (I’m paraphrasing). I thought this was a great analogy. For the right “cough”, ABA can be a godsend. Hoping all parents know that.

        Best to you.

  7. I worked in an autism classroom that was strictly aba and honestly it was horrible……. everything was reward based and the kids couldn’t perform outside of the aba structure…. I mean it was basically 8 hours of these kids using pecs to request things or doing menial tasks unrelated to anything funtional all to get candy….. I mean even lunch was part of that structure and they had no down time and we’re never ever allowed to stim if they did they were punished by more menial tasks specifically set a side for behavior modification (mostly doing a puzzle over and over again until calm)…. they even went so far as to deny a student her preferred form of communication (asl) because only pecs was allowed in class….. I now have 2 autistic children as well as a diagnosis myself and I will not go anywhere near aba

  8. We had our guys in an ABA therapy program that started out okay but quickly got horrible. We were told horrific predictions about our sons, their IQs, their potential, and what they were able to do. Open communication wasn’t there. My children were sad and had worsening behaviors. Methods were used that were undignified. So, we moved them (but not as quickly as I should have, which I very much regret). The ABA therapy they receive now is wonderful, with caring therapists, child-led programs, and 100% open communication. My boys are flourishing, and so happy. Choosing the right ABA therapist/center IS so important. Knowing there are options is essential. These conversations, while difficult, have to continue, because before I read autistic adults’ stories about ABA and before I read what respectful ways ABA methods can be implemented, I didn’t know to question the experts and look into other options. My biggest “red flag” with the first therapy center was when I saw that universally, they would talk around my children when others were around, rather than talking with my children. If you’re acting like my child “isn’t there,” that tells me a great deal about your attitudes about autism in general.

  9. We have had the most wonderful experience with ABA and with the therapist that implement it. They do nothing but absolutely love my daughter and want the best for her- and us as a family. It breaks my heart that people have had bad experiences with it. My daughter’s world is brighter and she is so happy and I could write about all the wonderful differences it has made in her life for days. I personally would recommend looking into the ABA therapy, doing your research on the therapists and getting referrals like you would for any type of medical treatment.

  10. ABA hurts my heart. When I first heard the recommendation of hours of therapy Q would need weekly, and it was in the double digits, not only was I immediately skeptical, I was angry. Not only as a mom and a therapist do I not agree with a LOT of ABA, here was a doctor recommending that it take over our lives. It felt hopeless. First off, I live in a really rural area, so good luck finding someone to come out to BFE to provide the service. 20+ hours a week? Is this person going to be paying rent? Oh, good, another person who is going to tell me everything I’m doing wrong with my child before they even meet us. Yay. YAY! Feed my insecurities even more!

    NO. I refused. Parenting, period, is trial by fire. You find stuff that works and stuff that doesn’t. You creat your own toolkit, specifically for your kid(s), and you make your own magic. My non-verbal son speak through behaviors, behaviors ABA would eliminate. He speaks through stims, stims that may not be “socially appropriate”. I am willing to speak his language, since I expect him to listen to mine.

    I just feel ABA, in general, is so stifling; my job as a parent and advocate is to get people to look outside the box where my son is concerned, not to allow therapists (or whoever) to stick him in another one.

    Whoo! Sorry for the rant, Jess.

  11. Jess, as a Board Certified Behavior Analyst and a new parent, I really love your blog for providing a perspective that, as a practitioner, I often miss (likely through my own fault). You do a wonderful job of sharing your experience navigating the murky waters of autism, and helping your daughter to overcome challenges while still maintaining her dignity and the qualities that make her…her.

    I do not typically comment on blog posts, as I find it difficult to succinctly convey my thoughts in a relatively short response, but I am going to attempt to do so in this case (bear with me; as I mentioned above, I am a new parent and as such am just a tad bit sleep deprived).

    I think your concern with the Lovaas method is understandable, particularly as a parent who has presumably had some experience with the (somewhat outdated) “traditional” practice of discrete trial learning (i.e. focus entirely on drills with edible reinforcers). I can even understand the perspective that (again, very outdated) “traditional’ methods of applying the principles of behavior analysis to people were inhumane.

    However, and this may just be a semantic distinction, I think it’s unfair – and perhaps even harmful – to suggest that “ABA is particularly dangerous”. “ABA” is a very broad term referring to the science of identifying environmental variables that influence behavior, and taking advantage of those variables to make socially significant changes (**by this I do not mean socially acceptable changes; I agree wholeheartedly that just because something is socially “unacceptable” does not mean that it is a behavior that necessitates change or extinction – ie stimming). It is not a single methodology, nor is it synonymous with the Lovaas method.

    Most practitioners with whom I have worked utilize a variety of teaching methods, all of which are based in the science of ABA. These include shaping, fading and chaining, all of which appear to be effective with your daughter (per your own report). Do they also include discrete trial teaching, reminiscent of the Lovaas method? Yes – and I would argue that there are certain people for whom certain skills are best taught in this manner. Do they also include the use of positive punishment (i.e. aversives)? In very extreme cases, yes – but this is always used in conjunction with positive reinforcement, is very closely monitored, and is truly a last resort in situations in which a behavior is very dangerous.

    My point being that “ABA” is not a dangerous practice, mainly because ABA is a science from which teaching methodologies are derived. As you mentioned, at this time ABA is the gold standard in the field, at least in the eyes of insurance companies. I think it’s important to make the distinction between the use of a treatment package designed by a certified behavior analyst comprising a variety of technologies and a “traditional Lovaas method” approach.

    It seems to me that misinformation on this front may lead to confusion and, ultimately, parents being wary of “ABA therapy” as a whole and therefore receiving no treatment.

    • Thank you for you thoughtful response, especially on little sleep 🙂

      Your point is well taken that ABA is the science and not the practices derived from it – I was indeed conflating the two and I appreciate you pointing out that error. However, given our own experiences, reports from others (both autistic and non-), the fact that Lovaas-like methods do persist and that the continued (and, in my experience extremely pervasive) high value placed on social acceptability throughout the field, I maintain that parents being wary and critical consumers of ABA, or any other therapy for that matter, is not just healthy, but wise.

      • I agree – being a critical consumer is important in all aspects of life, therapy related or otherwise. It’s certainly important to discuss the different methodologies, I just worry that when ABA is billed as the Lovaas method – from which you can take bits and pieces if you are careful – it tends to scare rather than inform.

        I’ve seen many families go into therapy with a very narrow, and rightfully skeptical, idea of what their child would be doing, only to be shocked (and, I hope, pleased) that they weren’t sitting at a table across from a therapist for hours on end, being drilled for m&ms, or having harmless stereotypies blocked.

        Discussing the downfalls of one (or several) methodologies, while also discussing the benefits of others – and acknowledging that, just as there is no one autism, there is also no one “ABA” – seems more likely to lead to informed decision making with regard to provider searches, identifying providers with similar philosophies, etc.

        I actually find your discussions of social acceptability to be some of the most interesting on your blog. The idea of extinguishing behaviors just because they weren’t socially acceptable never sat particularly well with me, and I think you do a great job of showing just why we should stray far from that (Brooke’s ability to reach years back into scripts and apply them to current situations is truly amazing!).

        But, in my experience, it is often parents who request that self-stims be extinguished and replaced with “normal” behaviors – you and your readers are a unique, if rather large group! It may be that the value placed on social acceptability stems in part from the commonality of these requests – as providers, we become accustomed to reducing hand flapping, scripting, etc. and, in turn, it becomes a focus of subsequent treatment. I am certainly not trying to place blame on parents, nor am I saying that it should become just another checkbox on a canned treatment package, but it’s something I’ve thought a lot about over the years.

        For the benefit of both parents and practitioners, I think it’s really great to continue stressing that “quirks” are what make us us, and that they need not be replaced.

        Ahhh, now that I’ve rambled on for far too long…perhaps it’s time for another cup of coffee 🙂

    • It’s mostly that ABA is particularly dangerous *because* it is part of such an enormous array of therapy methods. It’s like a doctor who says “I’ll give you a painkiller”, and you have no idea from just the word painkiller whether she’s going to give you a paracetamol, or pure morphine. It’s dangerous because you don’t know what you’re going to get.

      And that reflects what Jess says: be alert, be careful, be critical, and only accept those methods that actually help your child grow into a happy adult. (Compliance training may feel like moving forward, but is incredibly harmful).

    • Hi Jess & Stephanie,
      My understanding of ABA is evolving. I think a common misconception, and one that I held for quite a long time, is what the “Analysis” part of ABA means. My current understanding is that Analysis in this context does not mean investigate, etc. In fact, it means that the practitioner is able to control the behavior through the (positive or negative) reinforcement. If I am right…and I think I am according to the article, “Some Current Dimensions of Applied Behavior Analysis”… As such, it is my understanding that the ultimate objective, according to the science is to in fact, quite literally, control behavior.

      This has ethical implications which I feel are quite obvious when we are not talking about a behavior that is harmful/illegal. So to me, the actual science is ethically flawed from that standpoint. Further flawed, when Science asks fallible humans to make judgments about socially significant behaviors.

      My other question/comment is that much of what is being called ABA doesn’t even fall under a teaching method derived from the science. Especially if we are to accept the definition of Analysis that is provided by the Baer, Wolf, and Risley article I just mentioned. For instance, in her blog post, Jess mentioned ABC. That isn’t actually a teaching method if I understand it correctly. It is an observation method. As such, it isn’t an ABA methodology but merely an observation technique. Since there is not Analytic in ABC… my conclusion is that while ABC may be widely used to assess function, it is not actually a teaching/therapy methodology derived from ABA. So if I am right, you’re not doing an ABA method, Jess, when you use this observation technique.

      By the same token, you’re not doing ABA methodology when you modify the antecedents. You’re not attempting to control the behavior, you’re changing the environment.

      So much misunderstand seems to come from the fact that some people “think” they are practicing ABA methods, when they aren’t. And over understanding of what ABA actually is and isn’t.

      Ahhhh, I could go on and on. But I don’t want to commandeer your post or discussion.– Beth

  12. i love how you thoughtfully share and allow for ideas to evolve. i know that i’m not the same parent i was when my boy was first diagnosed just as my boy is not the same boy. we started out overwhelmed and in a whirlwind of information. we spent days just trying to make it through. we made mistakes but we also learned from them and moved forward. today, we’re in a different place an exciting and hopeful place (most days). there is so much more peace here. we’ve learned to listen better, not just to the words but to all the other ways that he communicates. we’ve become better at problem solving and picking the right tools. i know a huge part of this growth is due to being part of such a supportive community.

  13. I love the comment that if someone says their way is the only way, you should run.. So true!

    Please know that ABA, which is a wonderful intervention for some, is not the only therapy covered by insurance. The autism insurance laws passed around the country generally include evidence based behavioral health treatments, including but not limited to ABA as well as therapies like speech, OT, PT, related equipment, etc.

    Speech therapy (covered by our insurance now) has played a huge role in the integration of augmentative communication for Jack. What’s been truly fantastic is that the BCBA and speech pathologist are working together with Jack (and with his loving entourage) to make things as consistent as possible for him. It’s all about the individual and what works best for them.

    • ha! J, I made it into a graphic. It’s on Diary’s FB page!! 🙂 And thank you for the additional info, and for fighting so hard to get ALL of those things covered for our kiddos!

  14. My first exposure to ABA was through a provider found through Early Intervention. The young woman we were paired with set the bar so high, I do not think I could find another provider who gets the need for individualized, compassionate, and functional care half so well. She never once cut cookies with my son: She looked at the person before her, all his strengths and weaknesses, and she set about to polishing up his best self with what tools she had at her disposal.

    She still helps me, on her own time, and for that I am grateful. I am being intensely pressured to engage in more intensive ABA for my son but I am reticent. He needs time to be a child, not a patient. He needs to be matched with people who will respect this, so if I do trudge down that road… It’ll be a lengthy interview process.

    The fact you wrote this post, and the way you spelled everything out, is a buoy to me. It’s very easy to feel pressured and to feel second guessed in terms of your own instincts as to what is best for your child and your family. When you hear or read someone else asking the same questions, seeing the same things, and bringing the truth behind the answers and realities… It’s amazing. Thank you for what you write for us who are back at the early part of this journey!

  15. Reblogged this on Spectrum Perspectives and commented:
    In my meanderings through the blogosphere and Facebook, I found that ABA is a huge hot-button topic. I haven’t had experience with it, personally, but have found that among autistic bloggers/writers, it was used in such a way that they were incredibly harmed by it and suffered greatly. This post from Diary of a Mom seeks addresses the issue from personal experience, and from experiences shared with her by autistic adults. For those who practice non-manipulative ABA – who are child-centered/led and who use analysis to understand and help, thank you.

    Behavior is communication – children who are non-verbal can tell us with their actions that something is unsafe/unhealthy. We have to listen. I highly recommend the book Loud Hands Anthology for those seeking a variety of autistic voices and perspectives.

    • When done well (not the original Lovaas way) ABA is incredibly effective. It changes lives. I don’t find the new ways ABA is used to be “dangerous”. In fact it is the opposite. All inclusive, including communication, self help, daily living, learning to learn, and other functional skills. With proper training anyone can implement it, making it especially consistent. It is also modified to meet the need of each individual. Like anything else it is important to do your research and find a clinic that does it right and does it well. If a therapist doesn’t immediately address communication as a possible function (unless it is clearly not….such as self stim for the purpose of just self stim) then I would highly recommend a new clinic.

      ABA has changed a lot from the lovaas method and it deserves a chance to make a comeback. Especially since it’s known to work in changing extreme behaviors. And I disagree that ABA is meant to make behaviors more “palatable” for others. The bedrock of ABA (good ABA anyway) is to increase the individual’s independence.

      • I wish there was a way to differentiate Lovaas from the newer child-led. The old school practice really did a lot of damage. If you get a chance, check out Loud Hands. Perhaps practitioners of he child led methodology can create a change from “inside” to differentiate… It’s great to have professionals like you 🙂

  16. Wouldn’t that be the same as saying that speech therapy is dangerous? Or that OT is dangerous? If a child has a language delay, and is referred to an SLP, that SLP will assess current skill level and decide what approach to use, from the vast array within their toolbox – ASL, modified ASL, PECS, Echoic –> vocal transfer, physical therapy, etc. Likewise, of a child has a generalized learning and language deficit, and is referred to a BCBA, that BCBA will assess the current skill level and develop a treatment plan tailored to that child.

    Don’t get me wrong – I do understand the concern about not knowing what you’re going to get – but it seems to me that is more of a provider issue than an “ABA” issue. In my experience, many people are only familiar with Lovaas-style therapy. If this is the case for a family, and they interview a provider who focuses entirely on DTT, compliance training, etc., they wouldn’t know to find someone else.

    To me, it seems important to discuss the distinction between Lovaas-style, and the use of ABA (the science) to design an effectively tailored treatment package. I think this also goes hand in hand with what Jess is saying – be alert, be critical, accept only what works for you – but it shines a light on what ABA really is rather than making it into this terrible, dangerous option.

    Obviously my view is a bit different. I’m a provider, and have chosen to make this my career. I clearly see benefits and am confident that I practice in a way that utilizes the principles of behavior analysis while respecting the person. I do understand the concerns, and think they are valid, I just see a lot of unfortunate misinformation about what “ABA” is.

  17. I work with children with autism in a school and have lots of experience with those with autism. This article has been really great to read. I personally believe that all children are so extremely different, it seems illogical to me to prescribe one methodology or approach to all children. Some schools are specifically and entirely ABA, for example. I think some aspects of ABA could work on SOME children, and some children respond well to ABA in certain contexts.

    However, to use a blanket approach for children with vast and varied needs and personalities is not appropriate, or moral. I do not use ABA in my work as I do not believe that it is the best approach to facilitating growth in children with autism. I believe the best approach to facilitating growth and development in children is love and acceptance.

    I write a blog on my work with a boy with autism if you want to have a look: http://mysonnydays.wordpress.com

  18. My feelings on it are this … any “part” of ABA that could be found useful can be found in something that is not ABA. Or it can just be understood completely separately as it’s own philosophy without having to tact it to a fancy name paired with a damaging therapy. Watching your kids behavior and figuring out its source? Really doesn’t need to be called ABA. So why not take the step to divorce yourself entirely from a historically and still fundamentally harmful method?

    Just as an example of the former, the TEACCH method, which as an autistic person is my most personally endorsed method, developed the concept of the “culture of autism” and “behavior is communication” is certainly implied in that understanding. Fundamental to the TEACCH method is watching and understanding the source of autistic behaviors, through a far more sanitary perspective of understanding autism as it’s own “culture” or way of processing and learning.

    But you could even divorce that understanding from TEACCH if you wanted to.

    For me, saying any “part” of ABA might be okay opens the door for people to justify other “parts” that are harmful. ABA is any notion scares me as an autistic person and advocate because it is at it’s core based in such harmful and dangerous philosophies. In much the same way Autism $peaks may have a scholarship to provide kids with AAC devices but I will not support them in any form because of their base philosophies.

    I was at an advocacy and leadership conference with ASAN last week and we talked a lot about how to bend and dice up our language to make concepts more digestible to the public, even if they didn’t reflect our exact understanding. But we also talked about how on some things we need absolutes. We are absolutely against institutionalization. We are absolutely against Autism $peaks. We are absolutely against ABA. If it comes down to “well let’s debate about how this is -sometimes- okay” we will say no.

    I feel that way emphatically about ABA.

    And you can watch and understand behavior without attaching it to ABA. And I would find it a much less clinical understanding also. As a human being I do not want my behavior to be “analyzed”. I am a person, not a test subject. I just want to be understood.

  19. This hurts my heart. ABA is a science, not a methodology. ABA is everywhere. It is in environmental sustainability and how often paychecks are distributed and improving morale in fortune 500 companies. It is part of general education classrooms both for teaching skills and modifying behavior. It is part of sports teams and university boards. It is a key part of gerontology, addiction treatment, and OBM. It is excruciating to me that people throw out the core behavioral principles of ABA because of Lovaas. Lovaas was an @$$. Lovaas was an idiot. Lovass was abusive and cruel and is an embarrassment to the field of ABA. Lovaas practiced DTT, discrete trial training, with a punishment component, utilizing aversives, something we do not often see in the US in the twenty-first century. Lovaas did not apply ABA the way it was meant to be implemented, and for some reason, people insist that his inappropriate methods were the preferred example of ABA – it’s simply not true. People who believe that ABA = Lovaas are misinformed. As a BCBA with 15 years experience across several states and two countries, and an autistic sibling, I would say the key components of ABA are reinforcement, communication and the three term contingency (or ABC as you referred to it). The point of ABA is to analyse behavior. We then modify it, using reinforcement techniques, to increase communication and functional skills, to meet the needs of the client in his or her environment. Family is always (or should be) involved as well as the client to the best of his/her ability, and the driving force of what changes they would like to see. Most BCBAs I know rely on natural enviroment teaching, contingencies of reinforcement, student-led interest and choice — these are the exact same principles that exist in floor time or son rise or TEAACH and others under different labels. To say that anything “positive” from ABA exists outside of ABA befuddles the mind. ABA is everywhere, in autism education and in regular education and in corporations and companies because BEHAVIOR is everywhere. ABA is the science of behavior. It is not a methodology. DTT is a methodology. We do not use DTT with punishment, the way Lovass did, anymore – have not for years as a general, ethical, rule. The same way that spanking has disappeared — because it doesn’t work and it’s because it’s hurtful, shaming and wrong. Moreover, even without the punishment component, every BCBA I know is aware that DTT will not work for everyone. (It is also not at all different from learning math facts in a general education classroom.) Any practitioner, whether BCBA or intern, who is using only tabletop DTT has only a superficial understanding of ABA. I work full time in ABA and the amount of time I use for a version of DTT in 60 hours/week is approximately 2-3 hours total per week — using a variety of student-led activities to provide repeated sensory based access to learning math facts and letter sounds — skills that are taught in any elementary classroom. GOOD ABA doesn’t look like what you describe. In fact, I feel 100% confident and often tell the parents and teachers I work with that all good parents and educators are using ABA skills – they simply don’t realize it. I am so sorry you had negative experiences with “ABA” for your child. Please don’t throw the baby out with the bathwater. I have yet to meet a BCBA, BCaBA, or RBT who feels otherwise, and most that I know would not use punishment techniques at all, though I freely acknowledge there are lousy practictioners – of ABA, or floor time, or RDI, of general education, of general psychotherapy – out there. Just like there are lousy teachers and even parents who shame and bully and, yes, punish students, traumatizing them for years into adulthood in the name of behavior modification without ever knowing the term. Please please please understand that Lovaas is NOT the purest form of ABA. Nobody who practices ABA would agree with that. History does not agree with that. Lovass himself would not agree with that. It is a very misguided statement.

    Also, most public schools are forbidden from using ABA — this despite the fact that ALL schools use ABA — under different names. PBIS is a branch of ABA. Precision teaching is a branch of ABA. Tutoring is a branch of ABA. Modeling in a branch of ABA. Positive reinforcement is the biggest component of ABA. ABA is always used when teaching math, reading, social studies or science, though most educators aren’t aware of it because it’s called by different names.

    I’m not trying to convince you of anything and I’m happy that you’ve found a program that works for your child and your family. I’m willing to bet that most of it does actually rest of ABA principles, though you may not realize it. All good education, management, and parenting does, though most, including those with a superficial “knowledge” of ABA, don’t realize it. All I ask is that in the future, you not say that ABA in it’s purest form is Lovass, or DTT with punishment or even simply DTT. That is simply, completely not factually true and it’s an insult to those of us who practice ethical, genuine ABA. It is rare to find a BCBA who utilizes aversives or punishments or even uses solely DTT without aversives in the 21st century. It’s just not an effective use of the science, and ABA is a science.

    I wish you the best of luck and continued peace for your family and child.

  20. Breaking things down is a pretty common way to teach stuff, but training compliance is pretty exclusively ABA and some animal training methods.

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  23. I would be hesitant to use a platform to so openly negate a therapy without knowing the changing of ABA. ABA is a concept developed mainly by Skinner. Lovaas did practice ABA in some horrifying ways that when we learned about in our studies, the discussion was just that. No one recommends his methods. No child should have any therapy for 40 hours a week or sit at a table and do flash cards, that’s not developmentally appropriate. Additionally, literally the first concept we are taught is that all behavior is communication. So I am sorry and it hurts me to hear about negative experiences however, I just encourage further inquiry and discovery.

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