ABA therapists are at it again

As I blogged about here, advocates for Applied Behaviour Analysis like to claim that their field has reformed, leaving its abusive history (and Lovaas) behind. It seems they like BF Skinner, master manipulator of rats and pigeons, instead now. For more on this, see my last article, or this fantastic article here . As much as I’d really love to believe that things have changed, my sources say they haven’t. And how can they, given that the very premises of ABA completely erase the person-hood of the “client” by reducing them to their “observable behaviours” and the inferences of a (usually) NT therapist?

I found another post by an ABA therapist that I thought provided some interesting talking points, written on behalf of the poster’s “friend”. Apparently this friend is dealing with a 4 year old client that “head-bangs and head-butts her in the stomach and face”. His parents, of course, are totally awful because they “spoil him rotten and will end therapy if he cries/tantrums longer than 15 minutes.” The ABA therapist complains that he “will start headbanging out of nowhere” if he wants to stop doing therapy, and “only wants to play by himself”. What a nightmare, right?

Before we even get started on the advice this therapist received from her fellow ABA therapists, there is so much wrong with the original post I could write an entire article just on that. First, there is the part where the therapist decides that this behaviour is the client “trying to get attention”. Not, I dunno, feeling overwhelmed/miserable/fucking pissed off with the whole therapy situation. Not the fact that he might feel trapped working with this person who doesn’t even seem to like him, on things are most likely far beneath his actual abilities, presumably for 40 hours a week. Not that he might actually want to be alone? Nope, he’s definitely attention seeking because that’s what neurotypical kids do (supposedly. I think connection-seeking is a more accurate term, but that’s not what’s going on here either).

Then, there is the therapist’s complaint about the parents. The parents are bad parents because they LISTEN to their son? Because they hear that he’s upset and he hates this and it probably scares the shit out of him, too, and eventually, they stop it for the day? I just wish they’d listen to themselves, too, because they probably know that ABA therapy is. not. working. An ABA therapist would label all of the feelings I described above “escape from tasks”. And their only response, as described below, is to coerce the client into participating anyway by changing the kind of carrot they’re dangling in front of him, and how often they dangle it.

Now we can get into the comments. The first comment, which describes another ABA therapist’s work with a similar client, provides quite an interesting example of how ABA typically looks in the day-to-day. Apparently, after jumping on the trampoline with the client for a month to “pair” (establish the therapeutic relationship before starting any actual work), the therapy sessions moved to the client’s indoor swing. The therapist would put the child in the swing, give the demand (referred to as the SD), and let go of the swing if the child responded correctly. He’d then get to swing for a few seconds, before the whole thing would repeat.

There are a couple of things that stick out to me about this. The first is that the “pairing” process seems to take a very long time- this isn’t the only time I’ve heard ABA therapists talking about “just playing” with a client, doing things they enjoy, for the first few weeks of working with them. So I’d like to say, to any parents who watched their child’s first sessions of ABA and then decided that everything looked great and their child was having fun, the actual ABA therapy probably hadn’t even started yet. The therapist does not use any formal coercive tactics during “pairing”, so this phase cannot be seen as characteristic of therapy sessions down the line, nor does it tell you anything about how the therapist will treat your child if they do not comply with demands.

The second point, which has been made by a lot of autistic adults and constitutes one of our major concerns with ABA, is that this is nothing but compliance training. And it’s disturbing and unethical. Is it okay to teach a child to associate something that they love (swinging) with doing what the therapist asks them to do? The therapist’s demands can be as arbitrary as “touch your nose”. What the child learns from this is not just the concept/word “nose”, but that whenever they do what they’re told, they get to feel happiness, enjoyment, freedom. Over and over again, probably hundreds of times an hour. If that’s not mind control, what is?

Another comment that stuck out to me is a different therapist’s advice that “punishment is sometimes acceptable…for behaviour modification as long as it is short in duration”. When questioned (by an actually autistic person, yay!), the ABA therapist responds that “mild punishment procedures are more effective in treating self-injurious behaviour” because they are “faster”. This is likened to giving a child a “shot” to prevent them from getting an illness. Apparently, this is the best, research-based treatment for self-injurious behaviour. It’s important to note, though, that in ABA, “best” means most efficient at changing the behaviour, not “best” in terms of the long range well-being of the client.

So that was illuminating. Clearly ABA is *not* done with aversives and/or negative punishments like ignoring behaviour, as many therapists like to claim. And yet, those measures are never necessary, even if the person is in real danger of harming themselves. As the autistic poster on the original thread says, when we understand that self-injurious behaviour is (obviously) a sign of distress and pain, we shift our focus to hearing the messages behind it. All behaviour is communication, even if it’s just another way of saying, “I wish I could talk and tell people what’s bothering me”. There is always a reason,and if you lived your whole life without anybody really hearing you, you might hurt yourself too.

The autistic poster goes on to comment that “if the child no longer wants to do therapy then their wish should be respected.” This is immediately met with the classic behaviourist response. “If you allow the child to end a therapy session by engaging in a behaviour then the child associates tantrums with getting away with anything.” Alarmist rhetoric follows- soon, the child will be “using tantrums” to get whatever they want, like “take a year long vacation, fuck school, and smoke weed.”

As Dr. Mona Delahooke points out, this kind of reasoning demonstrates a fundamental misunderstanding of children’s behaviour-namely, that it is purposeful, incentivized, and under the child’s control. Children are impulsive. They also struggle to regulate their emotions; for autistic children, already overwhelmed by a world that often feels like ‘too much’, emotional regulation can be even more of a challenge. It is completely ridiculous to assume that children who act out are “trying it on”, performing a social experiment while in the throes of their emotions. It is also ridiculous to assume that the child will generalise the outcome of a particular situation to other situations, becoming a “master manipulator”. Rather, tantrums, meltdowns, aggressive outbursts, and other similar ‘behaviours’ are a sign of stress. They show us that a child is not coping with whatever is going on around them, that they need support.

As the autistic commentor rightly points out, the child in this story is asking to stop. In fact, he isn’t asking, he’s screaming STOP with the loudest behaviour he has. And the ABA therapist working with him knows this- at the very beginning of the post, she noted that “he doesn’t want to do therapy anymore.” But as evidenced in both the comments and the original post in this scenario, an autistic child’s “stop” doesn’t count. Apparently, “a child is a child”, and this “behaviour is impeding learning”. This child needs to “sit at the table and learn to read”, because parents “seek therapy for real problems”.

Parents, is this “good ABA”? Is this the respectful, natural, play-based therapy that you’re hearing about on the internet, that “doesn’t change the autistic person”? Is this the same thing as other forms of positive reinforcement in society, like paying people to go to work? Is this just “celebrating with a person who is no longer hurting themselves?”. Is this a child laughing and having fun?

ABA, in all its not so variable forms, is abuse. And it is not blindly so, either. The ABA therapists quoted in this post, which was written this week, at the end of 2019, are fully aware that they are over-riding and silencing the voices of the children they work with. “A child is a child”, they say, “it’s only temporary discomfort.” In ABA, your child is just a child, and their “stop” doesn’t count.