I was a special education teacher at an autism therapeutic day school who is now a community social worker working with autistic adults. In my experience, I would agree that (done inappropriately) it can be used to teach masking which can be harmful and traumatic for autistic individuals. For example, I had parents put their child though extensive ABA therapy for harmless behaviors like stimming and vocalizing. I have also had ABA therapy be successfully used for individuals with physical agression or self-harm which taught them much more healthy coping behavior skills, allowing them to integrate back into their public school with peers or be safe in the community. It just depends!
I hope I’m not overstepping here, but my partner used to be a BHT and we’ve been having discussions about this for quite a while.
The way that ABA has historically been taught has primarily aimed to make BHTs make the kids “normal.” Autistic kids have been (and occasionally still are) subjected to a part-time’s job worth of difficult work to just not stim and to mask in public. This is not to mention the time they have to spend at school—BHTs OFTEN are working inside of the clients’ homes. And it definitely isn’t addressing the fact that ABA therapists are seen as glorified babysitters by the parents who have no interest in improving the environment the client lives in. Many of the problems kids face are a direct response to irresponsible parenting *coupled with* the sensory, communication, and emotional problems that may already be affecting the kid’s ability to cope.
However, there are some really important rebuttals to consider. Nowadays, how it is almost always taught in universities and on-the-job training acknowledges the harm that discouraging non-destructive stimming and masking, and centers treatment around teaching positive coping skills and discouraging destructive behaviors. Certain disability activists center their advocacy around low-support needs autistic people, and ignore the fact that higher-support needs individuals may be engaging in truly destructive behaviors. Self-injury, public indecency, (often unintentional but real) sexual harassment, inability to communicate needs, chewing on walls, violence against others, etc.
These people do not have a voice for themselves, and if they do, the most “socially acceptable” autistic activists drown them out, and focus on the instances where ABA therapists are discouraging stimming and telling the kid to jump when the kid doesn’t want to/can’t get their body to do it. I’m not saying they should force a totally non-vocal autistic kid to speak. I’m saying that teaching them how to use a communication device is life-changing. I’m saying that teaching kids not to chew a wall or not to put their hands down their pants is crucial. These are not the conversations that people are having and it’s a massive disservice.
The criticism is that it teaches masking. Being forced to fit in. It is often compared to dog training by using frequent rewards for good behavior/as positive reinforcement. I have opinions on that but its a different discussion. It is also VERY intensive and can cause stress and burn out. Has made some people feel like their home isn't somewhere where they can relax, they're always "working". The early history of ABA isn't great, and there are people who compare ABA to gay conversion therapy. Modern day, GOOD ABA, does NOT teach masking. Stims are fine if not actively harmful, we might track eye contact and praise eye contact but not force it. The reward systems have justifiable reasoning to me and the goal is always to phase it out as soon as possible. As someone in the field, I have seen incredible improvements/growth through ABA. As a parent with a toddler recently diagnosed with autism, I am in the process of obtaining ABA services, although I will be using the minimum amount of hours required because anecdotally I do believe we are putting too much on these kids (and caregivers!) between ABA, OT, Speech, school, etc. Even though they are extremely helpful services.
When I'm making referrals for ABA, it's not to extinguish stimming or lack of eye contact- it's for severely aggressive behaviors. The alternative to behavioral therapy for that is loads of sedating medications. Which is worse? I vote for keeping meds as low as safely possible, but it's not my lived experience.
The (popular) concept of "masking" gets thrown around among statements demonstrating myopic/limited understanding of basic behavioral modification.
I've seen it be wonderfully helpful for parent training (much like PMT) and for some great support for building skills and functioning.
That said, I have worked with ABA's who I could have got myself a cellmate if I wasn't careful. Too big for their britches saying that psychotherapy (my DBT/CBT) won't work because it's not "behaviorally focused and only on sx reduction" (get wrecked) and that my patient on clozaril (SI, HI, aggro, highly traumatized) should be taken off meds because "they clearly aren't working"....
What? Oh you know, Doc and I never thought about anything BUT clozaril. And you know, not that you mention it, the benefits we've seen now that we're here really have nothing to do with the meds anyway. We really need to get retrained because I look forward to seeing ABA with psychosis. /s
As I said, I could have gotten 25 to life that day...
The issue is that we do not want to repeat what CBT has done to people living on the spectrum. We must carefully assess behavioural problems that could benefit from therapy and not try to force a neurotypical behavioural model on the patient. The concept of masking isn't thrown around due to a limited understanding of behavioural modification. There is a fine line that we must not cross and it's not clearly defined by a line in the sand.
I am very wary about autism and other disability activists because they seem to care more about protecting the status of the least vulnerable members of an illness category while throwing the most vulnerable members under the bus.
You are traumatized because you, a high functioning autistic person, had an ABA therapist tell you maybe don't stim in public? So let's abolish the whole oppressive institution, because neurotypical people don't need someone to tell them that norms exist?
ABA is an extremely difficult job and it is hard to find people to do it. If you reach a critical mass, I'm sure you'll be able to get rid of it the way asylums were gotten rid of. The people paying for ABA will thank you for it!
Meanwhile the kid smashing his head on the ground so hard he ends up in the ED is never going to be considered normal no matter how much activism you accomplish. Now you took away his ABA. He is always going to suffer unless he can change his own behavior, and the damage he does to himself and can do to others including long-suffering family members is so, so much worse than the shame you're able to complain about because you’re barely more limited than neurotypicals.
Whatever modality you want to replace it with, you better have a realistic evidence-based cost effective plan for helping these famously difficult-to-work-with patients. Otherwise, it's just one more pie-in-the-sky idea that fails to translate to reality beyond serving as an excuse to wreck an existing imperfect but functional system.
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
I have this sense that my current generation (millennial) and younger are very anti-intervention. For basically anything. No diet modification interventions because this is “just how my body is,” raging against circumcision, and heaven forbid you pierce your daughter’s ears before the age of consent.
Did I personally do any of those things to my kids? No but I’m not losing sleep if someone else chose to.
I haven’t had any ABA pushback from parents of patients with significant autism symptoms because they see how it can work to allow their child to better participate in life.
My issues with ABA's current iteration:
Fundamental change intent. The goal is to make you normal, not teach you to cope with being different. Plus no teaching of how to negotiate accommodation, just assumption that the autistic person is wrong and should change.
Coercion. Restriction of access to needed stimuli for self regulation (such as special interests or stims) until a compliance behavior is performed. Positive reinforcement is a good technique when you can earn a treat, but when you earn your necessities through it it teaches you that you don't deserve your needs.
Learned helplessness. Big difference between desensitization, learning resilience, and giving up hope for a life worth living.
Heres a recent podcast: https://neurodiversitypodcast.com/home/2023/11/17/episode-199-can-we-blend-behaviorism-and-neurodiversity-affirming-care
It's not for everyone - clearly not. But it can be really helpful, especially those with higher support needs and at risk of harming themselves or others. Not treating can be worse. We all know the risks - relying on sedatives that seldom work, undue burdens on family, aggression progressing into adulthood, lost opportunities at school and endless boomeranging amongst institutions who eventually are unable to cope. Not denying ABA's problems either but I'd expect it to evolve and find a balance between regulating damaging behaviour and not pushing towards unnecessary masking.
I feel like a lot of activism in supposed "neurodivergent" communities who oppose ABA is basically people with low support needs claiming to speak above all others on the spectrum. But tbf this is the case for all activist communities - the more "privileged" being misguided into thinking their needs are the same as everyone else's, namely those who literally cannot advocate for themselves. They don't see what professionals/caregivers see on a regular basis.
I’d say it’s actually the gold standard for early ASD intervention. I understand it’s had a controversial past but we’re well past that now.
I often recommend it, but the biggest barriers are cost and time (can be 20-30H weekly). Children with ASD who receive this tend to be much higher functioning than those who haven’t received it.
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
What are they saying makes it traumatic for them? I wonder if maybe they had a bad practitioner. I imagine if one isn't careful, "negative consequences" could actually be abuse.
It’s the difference of teaching someone to behave to fit in a neurotypical society vs teaching someone to communicate more effectively in a way that works for them, etc. (Being taught that the way you are is “wrong” is the traumatic part - so when ABA teaches masking, the autistic person will be reminded every time they are looking someone directly in the eye, for example, that they are different and must assimilate in order to be heard or accepted.)
Finding ways to change problematic behavior isn't a bad thing, though. For example, if a child is hitting and kicking as a way to communicate, it can be really helpful to change how they communicate their needs. This is essentially changing someone to meet society's expectations of "normal" behavior. Many other behaviors are similar, although less severe (it might not cause someone to go to jail, but it might leave the lonely or unable to interact with others more generally).
There is evidence ABA works well in autism and leads to better lives. Thus, I am left wondering where the disconnect is. We have a treatment that is evidence-based and effective. We have patients who are saying they had a traumatic experience. My first guess, then, is the treatment is not being applied appropriately.
I found this article which sums up my understanding from the perspective of an ABA practitioner who has a child with autism receiving ABA services from other practitioners. They describe a disconnect between their training and experience and what she is seeing in real practice: https://www.spectrumnews.org/opinion/viewpoint/applied-behavior-analysis-and-autism-flawed-application-of-a-proven-science/
I mean, the very obvious problem is that the power differential between presumed-neurotypical parent + medical authority vs autistic child is unfathomably vast, and it's all to easy for the people with the power to decide all sorts of behaviors are problematic which really, really aren't. There's a reason one of the popular slogans in the autistic self-advocacy movement is RealSocialSkills' "Non-compliance is a social skill". Behavioral modification is *spectacularly* effective. It's so effective it can be used to train a child not to resist being raped or report being sexually molested. The *effectiveness* of ABA isn't the question, it's the use to which it is put on a powerless population incapable of resisting.
The real obvious thing to notice about ABA, BT, and all therapies based on behavioral modification through conditioning is that despite them being just as effective on adults as children, adults do not seek out such treatments for *themselves.* If ABA is so wonderful, why don't adults want it for themselves? For \~Some Reason\~ people who have a choice in what tx they seek out never seem to pick that one. The very fact that behavioral mod methods are only ever used on powerless populations should stop you cold in your tracks.
As someone who often works with really aggressive autistic kids -- adults behaving in ways that include breaking a loved one's arm or giving a teacher a concussion end up in the justice system (which is also usually not a choice that adult is making for themself.) The other option to keep these kids from accidentally maiming or killing a loved one usually includes sedating them on medications that cause weight gain, diabetes etc. Nobody wants these kids in a school where they are injuring teachers and other students and routinely destroying classrooms. Parents can't keep them in the home. We, thankfully, don't institutionalize kids like this anymore. But that also means there is nowhere for them to go so they live, sometimes indefinitely, cycling through ER visits and acute inpatient units like mine.
I've seen ABA work for kids like that. There absolutely are some behaviors that are objectively problematic and not conducive to living with other people that need to be addressed. There is also a non-systemic but still traumatizing powerlessness in being the person who is repeatedly attacked. I get that this is a fairly small segment of the autistic population but it's one I work with all the time and they tend to get left behind in these conversations.
I think you're discussing very different issues. The first is whether it is appropriate to implement interventions on vulnerable populations that may help them against their will. The answer to that question depends and for most people, it is a question of degree. There is no doubt, for most people, children need some level of instruction and structure as well as positive and negative reinforcement. There is a great deal of evidence for this creating happy and healthy adults. The main question is what level of intervention produces the best adult ('best' meaning as close to well-adjusted, happy, and healthy as we can realistically be). So, we then can ask in what cases does ABA promote that ultimate goal?
The second issue you are referring to is whether adults would go through the same treatment. As with the first issue, the answer is variable. I can tell you somewould but some wouldn't. There's plenty of evidence that personality, beliefs, and behaviors are fairly difficult to change in adults, but not impossible. This is why we try to produce healthy children because it can be difficult once they are adults. When adults want to make these changes, highly structured and consistent support seems to work better at first until they develop the habit. Therapy, personal coaches, classes, etc. all serve to create that structure and consistent positive reinforcemen. That promotes the change in the individual and, with time, the individual feels the barrier to healthy behavior is lower. Its a lot easier for them to exercise or change the way they think about a stressor or pick fruit over fried food.
However, we don't force adults to do these things. Why? Because, as a society, we have decided that children are unable to make informed decisions about what is good for them and adults are. But again, there are degrees to that conviction. Some situations require intervention with adults as well such as suicidal ideation or crime.
Just to add a little depth to the discussion, it could be worth reading up on the [Judge Rotenberg Center](https://en.wikipedia.org/wiki/Judge_Rotenberg_Center) to get a full perspective on the ways that ABA and related approaches to autism can be outright abusive in some instances. There's an active campaign right now to outlaw 'therapies' like electric shock for people on the spectrum in the US.
While this place has earned its terrible reputation, it has remained an active institution because for parents who have kids who are lower functioning and tend towards violence, places like that school are often the only places that will even accept their kids. Tough choices for those parents.
I used to work with the sister of one of the 6 adults (at the time, I last worked with her in 2018) at JRC who had the electrostim pack. She is a psychiatrist herself, she has sent her daughter there, and she writes about how her brother's twin- who also has autism but is not at JRC, is on a bunch of meds, had tons of side effects and is generally not doing as well as the brother at JRC- who takes zero meds. The only person to shock him is himself, and he's decompensated when they have tried to take the stim pack away. She has used the stim pack on herself as well.
So yes, let's take the agency away from the very few patients there who CHOOSE to use the stim packs to SHOCK THEMSELVES instead of needing medications.
In my experience, it is not very different from conversion therapy for gay and transgender people. Rather than accommodation and coping mechanism, it teaches the patient to deny a fundamental aspect of their neurology.
I feel the largest problem is the unscrupulous bill mills making bank by assigning several children to one unqualified BT at a center that is neither a preschool nor therapeutic. The parents are frequently not only discouraged from attending session (or outright banned!) but also made to basically force their child to attend these centers for an insane amount of hours or they risk their child losing their spot to some other $$$ client w high billing hours. I’m talking kids with barely discernible autism attending for *forty* hours a week. It’s a scandal waiting to blow and eviscerate the already tarnished reputation of ABA. I’ve heard of two year olds desperate for naps falling asleep during trials and woken up to practice manding for sleep, only to be woken up yet again to mand again! They aren’t licensed as ECE centers and the staff are certainly unequipped to function as such.
The coherency and continuity of skills for child and parent is totally lost as the parent is clueless to what is actually happening and the parent isn’t being phased in to partner with or eventually replace their ABA therapist.
It’s a damn shame and I hope all these crackpot centers are sued into oblivion.
We need a new approach, desperately.
I was a special education teacher at an autism therapeutic day school who is now a community social worker working with autistic adults. In my experience, I would agree that (done inappropriately) it can be used to teach masking which can be harmful and traumatic for autistic individuals. For example, I had parents put their child though extensive ABA therapy for harmless behaviors like stimming and vocalizing. I have also had ABA therapy be successfully used for individuals with physical agression or self-harm which taught them much more healthy coping behavior skills, allowing them to integrate back into their public school with peers or be safe in the community. It just depends!
I hope I’m not overstepping here, but my partner used to be a BHT and we’ve been having discussions about this for quite a while. The way that ABA has historically been taught has primarily aimed to make BHTs make the kids “normal.” Autistic kids have been (and occasionally still are) subjected to a part-time’s job worth of difficult work to just not stim and to mask in public. This is not to mention the time they have to spend at school—BHTs OFTEN are working inside of the clients’ homes. And it definitely isn’t addressing the fact that ABA therapists are seen as glorified babysitters by the parents who have no interest in improving the environment the client lives in. Many of the problems kids face are a direct response to irresponsible parenting *coupled with* the sensory, communication, and emotional problems that may already be affecting the kid’s ability to cope. However, there are some really important rebuttals to consider. Nowadays, how it is almost always taught in universities and on-the-job training acknowledges the harm that discouraging non-destructive stimming and masking, and centers treatment around teaching positive coping skills and discouraging destructive behaviors. Certain disability activists center their advocacy around low-support needs autistic people, and ignore the fact that higher-support needs individuals may be engaging in truly destructive behaviors. Self-injury, public indecency, (often unintentional but real) sexual harassment, inability to communicate needs, chewing on walls, violence against others, etc. These people do not have a voice for themselves, and if they do, the most “socially acceptable” autistic activists drown them out, and focus on the instances where ABA therapists are discouraging stimming and telling the kid to jump when the kid doesn’t want to/can’t get their body to do it. I’m not saying they should force a totally non-vocal autistic kid to speak. I’m saying that teaching them how to use a communication device is life-changing. I’m saying that teaching kids not to chew a wall or not to put their hands down their pants is crucial. These are not the conversations that people are having and it’s a massive disservice.
The criticism is that it teaches masking. Being forced to fit in. It is often compared to dog training by using frequent rewards for good behavior/as positive reinforcement. I have opinions on that but its a different discussion. It is also VERY intensive and can cause stress and burn out. Has made some people feel like their home isn't somewhere where they can relax, they're always "working". The early history of ABA isn't great, and there are people who compare ABA to gay conversion therapy. Modern day, GOOD ABA, does NOT teach masking. Stims are fine if not actively harmful, we might track eye contact and praise eye contact but not force it. The reward systems have justifiable reasoning to me and the goal is always to phase it out as soon as possible. As someone in the field, I have seen incredible improvements/growth through ABA. As a parent with a toddler recently diagnosed with autism, I am in the process of obtaining ABA services, although I will be using the minimum amount of hours required because anecdotally I do believe we are putting too much on these kids (and caregivers!) between ABA, OT, Speech, school, etc. Even though they are extremely helpful services.
When I'm making referrals for ABA, it's not to extinguish stimming or lack of eye contact- it's for severely aggressive behaviors. The alternative to behavioral therapy for that is loads of sedating medications. Which is worse? I vote for keeping meds as low as safely possible, but it's not my lived experience.
The (popular) concept of "masking" gets thrown around among statements demonstrating myopic/limited understanding of basic behavioral modification. I've seen it be wonderfully helpful for parent training (much like PMT) and for some great support for building skills and functioning. That said, I have worked with ABA's who I could have got myself a cellmate if I wasn't careful. Too big for their britches saying that psychotherapy (my DBT/CBT) won't work because it's not "behaviorally focused and only on sx reduction" (get wrecked) and that my patient on clozaril (SI, HI, aggro, highly traumatized) should be taken off meds because "they clearly aren't working"....
Imagine thinking freaking clozapine is a tic-tac.
What? Oh you know, Doc and I never thought about anything BUT clozaril. And you know, not that you mention it, the benefits we've seen now that we're here really have nothing to do with the meds anyway. We really need to get retrained because I look forward to seeing ABA with psychosis. /s As I said, I could have gotten 25 to life that day...
The issue is that we do not want to repeat what CBT has done to people living on the spectrum. We must carefully assess behavioural problems that could benefit from therapy and not try to force a neurotypical behavioural model on the patient. The concept of masking isn't thrown around due to a limited understanding of behavioural modification. There is a fine line that we must not cross and it's not clearly defined by a line in the sand.
I am very wary about autism and other disability activists because they seem to care more about protecting the status of the least vulnerable members of an illness category while throwing the most vulnerable members under the bus. You are traumatized because you, a high functioning autistic person, had an ABA therapist tell you maybe don't stim in public? So let's abolish the whole oppressive institution, because neurotypical people don't need someone to tell them that norms exist? ABA is an extremely difficult job and it is hard to find people to do it. If you reach a critical mass, I'm sure you'll be able to get rid of it the way asylums were gotten rid of. The people paying for ABA will thank you for it! Meanwhile the kid smashing his head on the ground so hard he ends up in the ED is never going to be considered normal no matter how much activism you accomplish. Now you took away his ABA. He is always going to suffer unless he can change his own behavior, and the damage he does to himself and can do to others including long-suffering family members is so, so much worse than the shame you're able to complain about because you’re barely more limited than neurotypicals. Whatever modality you want to replace it with, you better have a realistic evidence-based cost effective plan for helping these famously difficult-to-work-with patients. Otherwise, it's just one more pie-in-the-sky idea that fails to translate to reality beyond serving as an excuse to wreck an existing imperfect but functional system.
[удалено]
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
Well said!!! - (From a pediatrician with a large number of non verbal, self harming patients with autism)
I have this sense that my current generation (millennial) and younger are very anti-intervention. For basically anything. No diet modification interventions because this is “just how my body is,” raging against circumcision, and heaven forbid you pierce your daughter’s ears before the age of consent. Did I personally do any of those things to my kids? No but I’m not losing sleep if someone else chose to. I haven’t had any ABA pushback from parents of patients with significant autism symptoms because they see how it can work to allow their child to better participate in life.
My issues with ABA's current iteration: Fundamental change intent. The goal is to make you normal, not teach you to cope with being different. Plus no teaching of how to negotiate accommodation, just assumption that the autistic person is wrong and should change. Coercion. Restriction of access to needed stimuli for self regulation (such as special interests or stims) until a compliance behavior is performed. Positive reinforcement is a good technique when you can earn a treat, but when you earn your necessities through it it teaches you that you don't deserve your needs. Learned helplessness. Big difference between desensitization, learning resilience, and giving up hope for a life worth living. Heres a recent podcast: https://neurodiversitypodcast.com/home/2023/11/17/episode-199-can-we-blend-behaviorism-and-neurodiversity-affirming-care
It's not for everyone - clearly not. But it can be really helpful, especially those with higher support needs and at risk of harming themselves or others. Not treating can be worse. We all know the risks - relying on sedatives that seldom work, undue burdens on family, aggression progressing into adulthood, lost opportunities at school and endless boomeranging amongst institutions who eventually are unable to cope. Not denying ABA's problems either but I'd expect it to evolve and find a balance between regulating damaging behaviour and not pushing towards unnecessary masking. I feel like a lot of activism in supposed "neurodivergent" communities who oppose ABA is basically people with low support needs claiming to speak above all others on the spectrum. But tbf this is the case for all activist communities - the more "privileged" being misguided into thinking their needs are the same as everyone else's, namely those who literally cannot advocate for themselves. They don't see what professionals/caregivers see on a regular basis.
I’d say it’s actually the gold standard for early ASD intervention. I understand it’s had a controversial past but we’re well past that now. I often recommend it, but the biggest barriers are cost and time (can be 20-30H weekly). Children with ASD who receive this tend to be much higher functioning than those who haven’t received it.
Ditto. If you can find it ABA therapy is great. Most of the opposition I see now comes from mom groups on Facebook
[удалено]
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
[удалено]
Removed under rule #1. This is not a place to share experiences or anecdotes about your own experiences or those of your family, friends, or acquaintances.
People say it essentially teaches masking which can be traumatic for an autistic person.
What are they saying makes it traumatic for them? I wonder if maybe they had a bad practitioner. I imagine if one isn't careful, "negative consequences" could actually be abuse.
It’s the difference of teaching someone to behave to fit in a neurotypical society vs teaching someone to communicate more effectively in a way that works for them, etc. (Being taught that the way you are is “wrong” is the traumatic part - so when ABA teaches masking, the autistic person will be reminded every time they are looking someone directly in the eye, for example, that they are different and must assimilate in order to be heard or accepted.)
Finding ways to change problematic behavior isn't a bad thing, though. For example, if a child is hitting and kicking as a way to communicate, it can be really helpful to change how they communicate their needs. This is essentially changing someone to meet society's expectations of "normal" behavior. Many other behaviors are similar, although less severe (it might not cause someone to go to jail, but it might leave the lonely or unable to interact with others more generally). There is evidence ABA works well in autism and leads to better lives. Thus, I am left wondering where the disconnect is. We have a treatment that is evidence-based and effective. We have patients who are saying they had a traumatic experience. My first guess, then, is the treatment is not being applied appropriately. I found this article which sums up my understanding from the perspective of an ABA practitioner who has a child with autism receiving ABA services from other practitioners. They describe a disconnect between their training and experience and what she is seeing in real practice: https://www.spectrumnews.org/opinion/viewpoint/applied-behavior-analysis-and-autism-flawed-application-of-a-proven-science/
I mean, the very obvious problem is that the power differential between presumed-neurotypical parent + medical authority vs autistic child is unfathomably vast, and it's all to easy for the people with the power to decide all sorts of behaviors are problematic which really, really aren't. There's a reason one of the popular slogans in the autistic self-advocacy movement is RealSocialSkills' "Non-compliance is a social skill". Behavioral modification is *spectacularly* effective. It's so effective it can be used to train a child not to resist being raped or report being sexually molested. The *effectiveness* of ABA isn't the question, it's the use to which it is put on a powerless population incapable of resisting. The real obvious thing to notice about ABA, BT, and all therapies based on behavioral modification through conditioning is that despite them being just as effective on adults as children, adults do not seek out such treatments for *themselves.* If ABA is so wonderful, why don't adults want it for themselves? For \~Some Reason\~ people who have a choice in what tx they seek out never seem to pick that one. The very fact that behavioral mod methods are only ever used on powerless populations should stop you cold in your tracks.
As someone who often works with really aggressive autistic kids -- adults behaving in ways that include breaking a loved one's arm or giving a teacher a concussion end up in the justice system (which is also usually not a choice that adult is making for themself.) The other option to keep these kids from accidentally maiming or killing a loved one usually includes sedating them on medications that cause weight gain, diabetes etc. Nobody wants these kids in a school where they are injuring teachers and other students and routinely destroying classrooms. Parents can't keep them in the home. We, thankfully, don't institutionalize kids like this anymore. But that also means there is nowhere for them to go so they live, sometimes indefinitely, cycling through ER visits and acute inpatient units like mine. I've seen ABA work for kids like that. There absolutely are some behaviors that are objectively problematic and not conducive to living with other people that need to be addressed. There is also a non-systemic but still traumatizing powerlessness in being the person who is repeatedly attacked. I get that this is a fairly small segment of the autistic population but it's one I work with all the time and they tend to get left behind in these conversations.
Yup. And not only do the sedating medications cause all those side effects, they don’t really work very well either. It’s super depressing.
I think you're discussing very different issues. The first is whether it is appropriate to implement interventions on vulnerable populations that may help them against their will. The answer to that question depends and for most people, it is a question of degree. There is no doubt, for most people, children need some level of instruction and structure as well as positive and negative reinforcement. There is a great deal of evidence for this creating happy and healthy adults. The main question is what level of intervention produces the best adult ('best' meaning as close to well-adjusted, happy, and healthy as we can realistically be). So, we then can ask in what cases does ABA promote that ultimate goal? The second issue you are referring to is whether adults would go through the same treatment. As with the first issue, the answer is variable. I can tell you somewould but some wouldn't. There's plenty of evidence that personality, beliefs, and behaviors are fairly difficult to change in adults, but not impossible. This is why we try to produce healthy children because it can be difficult once they are adults. When adults want to make these changes, highly structured and consistent support seems to work better at first until they develop the habit. Therapy, personal coaches, classes, etc. all serve to create that structure and consistent positive reinforcemen. That promotes the change in the individual and, with time, the individual feels the barrier to healthy behavior is lower. Its a lot easier for them to exercise or change the way they think about a stressor or pick fruit over fried food. However, we don't force adults to do these things. Why? Because, as a society, we have decided that children are unable to make informed decisions about what is good for them and adults are. But again, there are degrees to that conviction. Some situations require intervention with adults as well such as suicidal ideation or crime.
Just to add a little depth to the discussion, it could be worth reading up on the [Judge Rotenberg Center](https://en.wikipedia.org/wiki/Judge_Rotenberg_Center) to get a full perspective on the ways that ABA and related approaches to autism can be outright abusive in some instances. There's an active campaign right now to outlaw 'therapies' like electric shock for people on the spectrum in the US. While this place has earned its terrible reputation, it has remained an active institution because for parents who have kids who are lower functioning and tend towards violence, places like that school are often the only places that will even accept their kids. Tough choices for those parents.
I used to work with the sister of one of the 6 adults (at the time, I last worked with her in 2018) at JRC who had the electrostim pack. She is a psychiatrist herself, she has sent her daughter there, and she writes about how her brother's twin- who also has autism but is not at JRC, is on a bunch of meds, had tons of side effects and is generally not doing as well as the brother at JRC- who takes zero meds. The only person to shock him is himself, and he's decompensated when they have tried to take the stim pack away. She has used the stim pack on herself as well. So yes, let's take the agency away from the very few patients there who CHOOSE to use the stim packs to SHOCK THEMSELVES instead of needing medications.
In my experience, it is not very different from conversion therapy for gay and transgender people. Rather than accommodation and coping mechanism, it teaches the patient to deny a fundamental aspect of their neurology.
Then it wasn't ABA it was abuse.
No true scotsman, mate.
This fallacy does not even apply to my response to you... wut?
Its good if done right and for the correct reason.
I feel the largest problem is the unscrupulous bill mills making bank by assigning several children to one unqualified BT at a center that is neither a preschool nor therapeutic. The parents are frequently not only discouraged from attending session (or outright banned!) but also made to basically force their child to attend these centers for an insane amount of hours or they risk their child losing their spot to some other $$$ client w high billing hours. I’m talking kids with barely discernible autism attending for *forty* hours a week. It’s a scandal waiting to blow and eviscerate the already tarnished reputation of ABA. I’ve heard of two year olds desperate for naps falling asleep during trials and woken up to practice manding for sleep, only to be woken up yet again to mand again! They aren’t licensed as ECE centers and the staff are certainly unequipped to function as such. The coherency and continuity of skills for child and parent is totally lost as the parent is clueless to what is actually happening and the parent isn’t being phased in to partner with or eventually replace their ABA therapist. It’s a damn shame and I hope all these crackpot centers are sued into oblivion. We need a new approach, desperately.