Another post: what’s wrong with modern ABA?

I see this question asked on autism-related forums at least once every few days. In the wake of some recent reforms in ABA- most notably, a shift away from the use of aversives, and a nominal, half-assed tolerance for some forms of stimming, some parents like to argue that “new ABA is different.” And maybe it is. I hope it is, because ABA has a terrible history and an even worse theoretical foundation. If you don’t know about all that, I’d recommend this piece here. I’d like to take a moment to point out, though, that even while ABA therapy may not look like it used to, nobody has ever either acknowledged or apologised for the harm done to autistic people under the “Old Regime”. And that says a lot.

There are other, better articles about why, because of those theoretical foundations, even the new, perky ABA is still harmful and abusive. Here is a good one that often comes up in discussions, and it’s a great place to start. My worry, though, is that without specific examples of exactly what is being done to these children, it’s hard to make a clear case against ABA therapy. Far too often, conversations about ABA stay vague, devolving into defensiveness, personal attacks, and “I’m sorry you had that experience.” So I went looking on the internet for forums for ABA practitioners, and found a bunch of posts written by therapists themselves, asking for advice or venting about their autistic clients. I provide a link below, but I advise any person who may be uncomfortable reading about ABA sessions in detail, to either stop reading now, or wait until a time that they feel able to cope with this kind of material.

The story I’m about to describe is the very first one I came across. It’s nothing hugely dramatic, but is very clearly problematic. The emphasis is mine, and you can read the full text here:

“I have a pre-k SPED (Special Education) student in an early childhood class. He will get “stuck” during daily classroom activities, waiting for the teacher to physically prompt him to complete the tasks. After observing and trying SEVERAL different things. I’ve determined the function (purpose of the behaviour) is escape from demands but also attention from teachers.

In other words, the therapist infers that this kid is a) trying to get out of doing the tasks, and b) doing so to get attention.

So far, what problems do we have? No punishments are mentioned, so that’s a plus, right? The therapist describes reinforcing task completion with attention and access to tangibles (desired toys, for instance). So, the kid has to do some work, and then he can have fun afterwards. No harm, no foul?

As an autistic person, and having read Ido Kedar’s book(Ido in Autismland) describing ABA from the point of view of an autistic child, I can see that this therapist and her behaviour management plan are 100% wrong. Ido talks about situations almost exactly like this, where he was dependent on someone else to physically to prompt him before he was able to start doing an action or sequence of actions. Even when he desperately, desperately wanted to communicate, even when his motivation was sky-high, he still needed his communication partner to touch his arm or lean on his shoulder.

This is executive dysfunction- a core characteristic of autism. I struggle in this area every single day, from planning dinner to filling out forms to driving a car. One aspect of executive functioning is initiating tasks; here is a definition of what difficulty in this area might look like, taken from the Autism Awareness Centre:

Initiation is the ability to start an activity, plan, or task. For those with executive function difficulties with initiation, they may want to play a certain game, do their homework, or play an instrument, but unless the activity is initiated by someone else it doesn’t happen. It has nothing to do with desire, or “want” — it is about lacking the function of “just doing it”.

The therapist goes on to say that the child she’s working with will stand still, or “stuck”, for 3 hours if he is not prompted. She writes:

“He is unable to function in the environment without full hand over hand prompting. It’s hard to explain everything over a thread like this, but to be more clear, he will not complete the task while smirking and looking at you out of the side of his eye. He’s also demonstrated he CAN complete the tasks, but just won’t.”

I’m sorry, but you think a kid would rather stand still for 3 HOURS than complete a task they can apparently easily do?? Every single day??

Ido Kedar talks about this too. He talks about how on some days, when he felt less pressured or just had the kind of day when his body “wanted to listen” to him, he could do the things he was being asked to do. On the flip side, he describes other days when those abilities suddenly disappeared, or became trapped within him, resulting in outward unresponsiveness and inner frustration. It is well-known across the autism and academic communities that the skills exhibited by autistic people are prone to fluctuation, sometimes blocked by sensory events, and other times by anxiety or stress. This is one of the reasons many autistic people don’t like functioning labels- you can read about this here.

And while I wouldn’t blame this kid if he did smirk and give the side-eye, don’t we all know that autistic facial expressions don’t mean what neurotypicals think they mean? Or that we have trouble controlling our facial movements? Here is an article about it.

So let’s sum this up. We have plentiful examples of ignorance, which are hardly excusable given that I was able to find information on the internet to counter some of the therapist’s statements in just a few minutes. But that’s not the biggest problem here. The biggest problem is the functional assessment. The part where a neurotypical person gets to watch an autistic child interact in an early childhood setting and decide what his goals are! Out of nowhere, based on random observations, “trying a bunch of things”, and a projection of neurotypical motivations: attention-seeking and task avoidance. If that’s not speaking for autistic people, I don’t know what is.

The therapist’s mistaken assumptions become the basis for that little boy’s entire day/week/year- however long it takes him to master what he’s being asked to do. Everything he does around those tasks is now seen in terms of attention and/or escape. Only these “functions”, only these needs, will be considered in the therapist’s behaviour plan. And whatever he is really trying to say through his behaviour- probably that he needs help getting started, will be lost in that narrative. The functional assessment now speaks over the only communication he has.

No, she can’t ask the little boy why he’s not doing what he’s been told to do. She can only guess, because he isn’t speaking yet- although I sure as hell bet he understands EVERYTHING these people are saying to him. From where I’m sitting, though, that is even more reason not to use these kinds of techniques on vulnerable, autistic children. You are going to guess wrong! You are going to waste your time. You are going to waste his time, and his childhood, and make him miserable, and make him stand in a classroom for 3 hours until he follows your goddamn demand. You are going to deprive him of attention, and the “tangibles” you speak of, until he complies and performs a task his body might not be up for right now! This. Is. Not. Okay.

I read more examples on this forum. Some of the other things mentioned were planned ignoring, which I think has been covered enough in other articles on this topic, and conducting “preference assessments” to find out what a child likes best, before taking it away to be used as a reinforcer. Here is a direct quote describing the kinds of reinforcement used. As you can see, the key point is that the therapist controls access to the things the child loves.

“Bring your own {toys}, just make sure to take them with you when you leave. If they are the homeowners items, they should be put away and only brought out during your sessions. If you notice otherwise, you can kindly explain to the family, “my sessions with your child will be much more productive if you remember to please put these away until I get here”. If it’s a preferred food or edible, he should only be offered this only by you. It doesn’t have to be M&Ms, crackers, or cereal. It can be a small spoon of applesauce/pudding, a bit of a PB&J sandwich, or a lick from a lollipop.”

That is beyond dehumanizing, most definitely messes with the child’s already sensitive relationship with food, and completely destroys the idea of enjoyment for its own sake- you know, fun? But autistic kids don’t need fun, they just need to behave better and stop embarrassing their parents, right?

I realize this is a bit of a ramble, and a lengthy one at that, but I plan on lurking around on the interwebs and writing more often about ABA stories that stick out to me. Maybe one day I’ll tie it all together in a more systematic way. I haven’t even touched on the primary problem with ABA: that it is compliance training through operant conditioning, although again this has been discussed elsewhere. Anyway, if you’d like to read more about this, please feel free to visit the reddit page I linked above, or follow my Medium account, as I’m sure I’ll get there eventually.