Sorry if this comes off ignorant, I don’t mean it… My son is 4 1/2 and was diagnosed two years ago. I try to do the best I can and let him be him 💕 but while he’s in speech therapy (he’s still moving into the idea of talking), schools in the area (private) push ABA for students with autism. But I see young adults like yourself saying ABA is NOT good. I’m more inclined to listen to someone on the spectrum than those not, but what is the issue with ABA?

thewraithofketterdam:

strangerdarkerbetter:

First, I want to say that I am so glad that you are turning to the autistic community for help. This isn’t an ignorant question at all. There is so much conflicting information out there about ABA that it can be hard to even know where to begin. It sounds like you really want to help your son as best you can which is admirable. 

To start off, not all therapy labeled as ABA is actually ABA. I’m going to explain what the issues are with true ABA and then explain how to figure out if the therapy they are trying to push on your son is ABA or not. 

ABA stands for Applied Behavioral Analysis. It is a scientific method that involves observing the individual in order to identify “target behaviors,” i.e. behaviors that are undesirable to the parents/therapist. Next, aversives, rewards, and operant conditioning is used to eliminate these behaviors and encourage wanted behaviors. Overall, this may not sound like a bad thing, so let’s get into why this therapy is harmful. 

The groundwork of ABA therapy is the idea that autistic people are broken and in need of fixing. Our natural, non-harmful behaviors, such as stimming or lack of eye contact, are targeted as behaviors in need of fixing. The main focus of ABA is making a child “indistinguishable from peers,” i.e. to make the child seem “normal.” 

This often includes things like getting rid of stimming (often with the phrase “quiet hands”) and forcing eye contact in order to make the child less noticeably autistic. The problem with this is that stimming is a coping mechanism for autistic people. We stim to regulate our emotions/senses, cope with stress, and express ourselves. Eye contact can be uncomfortable or even painful for us and being forced to perform it can be just awful. 

Further, changing these behaviors does nothing that is truly beneficial for the child. Instead of being trained out of behaviors that are non-harmful, an autistic child should be taught ways to manage their autistic traits in a way that is useful and productive for the child. For instance, if a child is uncomfortable making eye contact, learning to look at a person’s forehead or nose is a great alternative as most people can’t tell the difference. 

Further, due to the focus on making a child indistinguishable from peers, there is often a push towards verbal speech even when atypical methods of communication like sign language or AAC would work better for the child. 

ABA therapy operates by using rewards/reinforces and punishments/aversives to train a child to perform wanted behaviors and to stop unwanted behaviors. Rewards are withheld until the wanted behavior is performed and aversives are used when an unwanted behavior is performed. Often, foods, such as gummy bears, candy, or other tasty treats, are used as rewards as well as praise or affection, access to a comfort object, break time, stickers or stamps that can be traded for privileges/rewards, or access to a special interest. Additionally, some therapists make use of a clicker, a device that makes a loud click sound originally used for training animals, to indicate that a wanted behavior has been performed and that a reward is coming. 

For aversives, the removal of a comfort object, withholding of snacks, removal of reward items, or prevention of engagement in a special interest are often used. Some therapists also use “taste aversives” like pickle juice, vinegar, hot sauce, or other bad tasting edibles, as well as “tactile aversives” which would be making the child touch something that sets off tactile defensiveness or distress. Withholding praise or affection is also used as an aversive. 

In DTT (Discrete Trial Training), a form of ABA that is considered to be kinder than other versions of ABA, the therapist will not look at, engage with, or respond to the autistic child until the desired behavior is performed. Similar methods are employed when unwanted behaviors are displayed. 

As a treatment, ABA is centered around compliance training, in other words, making a child compliant to the desires of the adults in their lives. Rather than focusing on how to help a child live the best autistic life they can, the focus is put on making the child seem “normal” no matter what the cost to the child. This serves only to make parents more comfortable and does little to help the autistic child as they progress through life. 

Using aversives on a child ranges from bad to cruel depending on the aversive used. Withholding rewards from the child, particularly when those rewards are food or other necessities, creates insecurity in the child. Further, by training a child in this way, the child becomes more vulnerable to victimization. When you are told by all the adults in your life that you must ignore your own pain and discomfort for the sake of adults, how is a child to know when they are being abused? How is a child to know that the adult touching them in that way is wrong when they are forced into hugs which are painful for them? 

You may have noticed that what was described here sounds an awful lot like dog training, and that’s because it is. ABA trains a child in the same way you would train an animal which is dehumanizing. Autistic children are not animals whose behavior should be crafted to suit those around them. Autistic children are unique individuals who need support and care. 

Finally, ABA therapy is often a full time job for the autistic child. Often, 40 hours a week or more of therapy is recommended for optimal results. It is ridiculous to put a child through such a strenuous routine. 

So what are you to do instead? Obviously you want to help your child live the best life possible which is wonderful. There are plenty of therapies that can be very helpful to autistic children. Speech therapy, which you’re already doing, can be great for children who are struggling with verbal speech, though methods of AAC should be provided until the child is able to communicate verbally (and even then, AAC should still be available for times when the child goes nonverbal/semiverbal). 

Occupational therapy to help with sensory integration or motor difficulties or other areas in which the child is struggling. There are also play-based therapies like floor time which can be very beneficial to autistic children. No matter which therapies you utilize to help your child there are a few things to keep in mind. 

First, therapy should be supplemental according to the child’s need rather than the central aspect of their life. If the therapy schedule would be exhausting for an adult, it’s not appropriate for the child. Next, does this therapy help the child live the best autistic life they can or does it focus on making the child appear to be “normal”? Normalization is for the benefit of parents while good therapy focuses on helping the child with things that the child finds problematic such as learning to cope with sensory issues or learning better communication (whether that’s verbal communication or AAC). 

So how do you figure out is what is being presented to you is true ABA or something else masquerading as ABA? There are some questions you can ask to help sort this out. First, though, we need to go over why there are therapies that aren’t ABA calling themselves ABA. In the US, most insurance plans will ONLY cover ABA for autistic children. As such, many therapists who perform other therapies have resorted to labeling themselves ABA in order to be covered by insurance. This allows them to work with children that otherwise wouldn’t be able to access these therapies. As such, what is being pushed for your child may not be true ABA. 

Here are some questions to ask:

• What is the goal of the therapy? As we’ve discussed, ABA focuses on making the child “indistinguishable from peers” or normalization. If you hear that phrase, turn away and don’t look back. Even if the therapy isn’t ABA, the goal of making a child appear “normal” is not a useful goal for the child and can be detrimental. 
• Does the therapy make use of rewards and aversives? We’ve discussed why aversives and rewards can be damaging to a child. A good therapy for your child will use other means to discourage harmful behavior. 
• Does the therapy emphasize compliance? Compliance makes for a “well-behaved” child but does not lead to a healthy, independent adult (which I’m sure is what you’re hoping for in your child’s future). Therapies should focus on helping a child manage any harmful traits they have without forcing them to be compliant to an adults wishes. Just like all children, autistic children will not always be obedient or follow adults’ wishes. This is how it is supposed to be. Children need the space to make their own mistakes and learn and grow. Compliance teaches a child to shutdown their own needs and desires to fit the desires of another. 
• Does this therapy discourage non-harmful behaviors? Autistic children will sometimes engage in behaviors that are harmful to themselves or others. These behaviors definitely need to be addressed and worked on. For instance, a child’s stims may physically hurt another person such as grabbing onto other people to stim. This behavior is not ok and a parent/therapist should work with the child to redirect the behavior. However, ABA often focuses on stopping behaviors that are not harmful. For instance, most stimming does not hurt anyone. It may be atypical behavior, but it generally does not hurt the child or anyone else. If a child is being bullied for their stims, that should be addressed with the school to change the harmful behavior of the other students rather than stopping the child from engaging in behaviors that are useful for self-regulation and expression. A good therapy will focus only on discouraging harmful behaviors. 
• Are you allowed to observe the therapy as you please? In non-harmful therapies, you will generally be allowed to observe the therapy whenever you wish as they have nothing to hide. If a therapy will not allow you to observe what is being done, then it may be harmful to your child. However, even some therapies that are harmful may allow observation, so, when you do observe, make sure to really pay attention to how they treat your child. 

If the therapy being presented to you passes all of these questions, then it is not true ABA and could potentially be helpful for your child. As we’ve discussed, there are many therapies that can be beneficial to autistic children. Some useful goals of therapy could include:

• Changing harmful behaviors– if a child is causing harm to themselves or others, the behavior needs to be addressed and the child should be provided with alternatives to help redirect the behavior. For instance, if a child is playing with their own poop, the child needs to be taught that this is unsanitary and provided with playdoh or other sensory tools to use to redirect the need for sensory input. Similarly, if the child hits others while melting down, one alternative may be providing the child with a pillow or stuffed animal to hit instead. 
• Communication– While many therapies focus on speech, the true goal should be improved communication. This may include speech as a goal if that is within the child’s abilities, but it should also include forms of AAC to be used for communication either until the child is able to learn verbal speech or instead of verbal speech if speech is too difficult for the child. AAC can include letter boards, picture boards, text to speech apps, among others. Sign language can also be useful in facilitating communication. 
• Managing Sensory Input– Many autistic children are hyposensitive and/or hypersensitive to sensory input. As such, it is important to teach the child ways to manage their sensory sensitivities. This may include managing their sensory diet by setting aside time for sensory play, use of sensory defenders like headphones/ear defenders/ear plugs, sunglasses, or other methods of regulating sensory input, and stimming as a method of regulating sensory input. 
• Anything that causes the child distress– If a child is struggling in an area and it causes them distress, that is a good thing to work on in therapy. For instance, if the child is having frequent meltdowns, one of the goals of therapy should be to figure out why the child is having so many meltdowns and find ways to accommodate the child to prevent meltdowns. Similarly, if the child struggles with socializing with other children and is upset by this, social skills classes may be beneficial. If something is upsetting for the child, then it is likely a good goal for therapy. However, if the child is not bothered by something, therapy likely isn’t necessary (unless it is causing harm to the child or others).

So this got super long. I hope I’ve addressed everything you needed covered. If you have anymore questions, you are welcome to send me more asks or check out @autism-asks to get more info about autism. 

Finally, I’m going to leave you with some links that cover ABA from other perspectives:

• ABA Masterpost
• Why I Oppose ABA as a Method of Instruction
• ABA 101
• Trauma and Autism
• What ABA Is Like From the Point of View of a Former Therapist
• Why I Left ABA

I hope this helps you and your son! 

-Sabrina

@fixitpixie