Applied Behaviour Analysis and Autism
(ABA is a very controversial topic in the autistic community and some of the following content may be upsetting.)
The history of ABA
ABA stands for Applied Behaviour Analysis and was developed in the 60’s and 70’s by a Norwegian-American clinical psychologist called Ole Ivar Lovaas. Lovaas’ aim was to make autistic children indistinguishable from their non-autistic peers because, at the time, autistic children who were obviously autistic tended to be locked away in institutions and were thought (by society and medical practitioners) to be ‘beyond help’.
While Lovaas’ desire to give autistic children a chance at life outside an institution (not pleasant places in the 60’s and 70’s) might have come from a good place, his methods were overtly abusive by current standards. As well as giving positive feedback to autistic children when they displayed behaviours Lovaas deemed good or appropriate, Lovaas also ‘discouraged’ behaviours he deemed negative or inappropriate (like stimming or avoiding eye contact). This ‘discouragement’ took the form of slapping, shouting and even giving the autistic children electric shocks.
Despite the brutal nature of ABA, it was highly sought after by parents of autistic children because at the time it was considered the only resource available that gave the hope of their children being able to live in society alongside their peers.
As time passed, some ABA practitioners started to recognise some of the abusive elements inherent in ABA and dropped many of the ‘discouragements’. The term ‘ABA’ is often avoided these days and other therapies that are extensions of ABA are often given another name like ‘Positive Behaviour Support’ (PBS), despite having the same goals and techniques.
Modern-day ABA practitioners (or PBS practitioners or any of the many therapies that have been derived from ABA) assert that they use techniques that are ‘fun’ and ‘flexible’ and nothing like the techniques of the past. The emphasis is usually on the fact that all intervention is tailored to the specific individual needs of each child.
ABA practitioners tend to focus on the ‘ABC Model’ in their sessions. ABC stands for ‘Antecedent, Behaviour, Consequence’ and involves looking at the cause (or ‘antecedent’) of each behaviour displayed by an autistic person as well as the ‘consequence’ of the behaviour.
Both the ‘antecedent’ and ‘consequence’ in this model can be engineered by the practitioner. For instance, the practitioner asking the child to make eye contact despite it being uncomfortable or painful for the child (the ‘antecedent’), child reluctantly maintains eye contact (the behaviour), practitioner rewards child with praise or a sticker or screen time etc. (the consequence).
ABA practitioners say this is simply taking the natural way children interact with the world already and adapting it to teach the child. An example of the ABC model occurring ‘naturally’ may be that the child is thirsty (the antecedent), so asks for a drink (the behaviour) and receives one (the consequence). Or it could be that there’s a loud noise that overloads the child (the antecedent) so the child has a meltdown and throws a toy (the behaviour) and the toy is broken (the consequence).
ABA practitioners use this model to try to change autistic children’s behaviour in a variety of ways. Some of the more worrying aims can be to stop the child from stimming or force them to make eye contact.
Why Even Modern ABA is Controversial
Given the fact the ‘punishment’ part of the ‘consequence’ in ABA has largely been dropped (in the UK, at least), some people might wonder what objections could still be made against ABA. Unfortunately, there are quite a lot of reasons ABA is still considered extremely harmful.
1) ABA does not work
Several large-scale studies have shown ABA to be ineffective and, in some cases, worsens skills. While many practitioners claim ABA is evidence based, when you look at who is funding this research it is often someone with a conflict of interests in this area. The US Department of Defence reported in both 2019 and 2020 that ABA is ineffective and the failure of ABA is not affected by increasing the hours of therapy.
2) Some practitioners do not have good aims
The worrying aims of some practitioners, mentioned above, is one of the problems with ABA. There are still many misinformed people who wrongly think we should be forcing autistic children to make eye contact, for example. Not only is eye contact often uncomfortable (and even painful) for some autistic people but it can stop us from being able to even listen and process information properly. Given this, forcing eye contact often achieves the opposite to the practitioner’s aim (the autistic child listening to what is being said to them). Other practitioners still try to stop autistic children from stimming, which is a natural autistic activity with many benefits (see our page on stimming).
3) We should not be made to ‘act non-autistic’
Even when stimming is not stopped or discouraged and eye contact isn’t forced, one of the biggest complaints about ABA is simply that its goal is to make autistic people appear neurotypical. Being autistic means our brains are literally physically different to non-autistics. We do not have broken neurotypical brains and there is no way to ‘fix’ our brains so that we stop being autistic. In fact, many of us don’t want to stop being autistic, even if that was an option.
Having a goal of trying to stop autistic people from appearing autistic is hugely offensive and stigmatising. There is nothing wrong with being autistic, which means there is also nothing wrong with behaving like an autistic person. While it can be helpful for some autistic people to learn about non-autistic communication and socialising alongside many other useful things, the goal of making an autistic person seem non-autistic (as Lovaas wanted when he first created ABA) is extremely troubling. Also, it is important for non-autistic people to learn about autistic communication styles and this can be just as helpful as autistic people learning non-autistic communication styles.
4) Too much emphasis is placed on an immediate ‘antecedent’
Another problem with ABA is its limited scope when looking at the ‘antecedent’ part of the ABC model. Many texts talking about ABC only talk about one antecedent or only look at what happened immediately before the ‘behaviour’, which goes against everything we know about people, behaviour and autism.
Typically, there is not any one thing that causes a behaviour. I remember once breaking a glass and then having a meltdown. Anyone watching me would probably have concluded that breaking the glass caused the meltdown…and they would be completely wrong. I have broken many glasses in my life and have almost never had a meltdown because of it. However, on that occasion I had also recently moved house so was dealing with a lot of change. I had been out that morning into busy and noisy traffic and had spent time with lots of other people at university, so I was already overloaded from sensory input.
Breaking the glass had very little to do with my meltdown. It was likely I would have had a meltdown that day at some point and the supposed ‘antecedent’ could have been anything from burning my toast to being unable to find the scarf I wanted to wear. The real cause of the meltdown was the weeks of stress surrounding a big move, the uncertainty I felt at living away from my parents for the first time, and the sensory overload I experienced at living in a busy city for the first time. The meltdown had been building for weeks and the glass really had nothing to do with it whatsoever.
So, how helpful would it have been to have someone work with me over my response to glassware breaking? Not at all helpful. And it would have completely overlooked all the actual problems I was having.
It is exactly the same when ABA practitioners focus solely on the things that happen to children immediately before a ‘behaviour’ without taking the wider context and child’s experiences for the last few days or weeks into account. I know from the courses I have been on that generally the ABC model only really focuses on what immediately precedes a behaviour, even if lip-service is paid to the idea that other things might have added to the behaviour.
5) High rates of PTSD in autistic people who have had ABA
One of the most compelling arguments against the use of ABA for autistic people is the evidence that suggests autistic people who have had ABA therapy are at considerably increased risk of PTSD. A paper published in 2018 looked at the rates of PTSD in autistic people who had undergone ABA compared to those who had not. The paper found that the autistic children and adults who had been exposed to ABA were 86% more likely to meet the criteria to be diagnosed with PTSD than those who were not.
It seems parents/carers were unaware and largely reported satisfaction with the therapy, almost certainly not realising it had traumatised the child.
6) ABA conditions already vulnerable people to obey without question
Another terrifying side-effect reported by many adults who have been through ABA is that it strips autistic people of their ability to set boundaries, leaving them more susceptible to abuse. When a practitioner consistently stops a child from following their natural instincts and instead teaches them to blindly follow instructions that make them uncomfortable, this conditions them to accept other people pushing their boundaries and making them do things they don’t want to do. Many autistic adults feel they were abused later in life because ABA as a child skewed their ability to set and enforce boundaries.
We understand that parents might want to look into all possible therapies but we do need to consider whether the point in the therapy is to help the child or make the life of the adults around them easier. If you are worried about a behaviour being inappropriate, you may want to consider why you feel that way. Is the behaviour harmful, or is it just different? There are lots of autistic-led organisations, including One Stop Shop Aberdeen, who are happy to help you explore whether certain therapies are appropriate or needed.
Whatever therapy you decide to look into for yourself or a child, there are some very important things to think about covered here.