Plenty of policies and programs limit our ability to do right by children. But perhaps the most restrictive virtual straitjacket that educators face is behaviorism — a psychological theory that would have us focus exclusively on what can be seen and measured, that ignores or dismisses inner experience and reduces wholes to parts. It also suggests that everything people do can be explained as a quest for reinforcement — and, by implication, that we can control others by rewarding them selectively.
Allow me, then, to propose this rule of thumb: The value of any book, article, or presentation intended for teachers (or parents) is inversely related to the number of times the word “behavior” appears in it. The more our attention is fixed on the surface, the more we slight students’ underlying motives, values, and needs.
It’s been decades since academic psychology took seriously the orthodox behaviorism of John B. Watson and B.F. Skinner, which by now has shrunk to a cult-like clan of “behavior analysts.” But, alas, its reductionist influence lives on — in classroom (and schoolwide) management programs like PBIS and Class Dojo, in scripted curricula and the reduction of children’s learning to “data,” in grades and rubrics, in “competency”- and “proficiency”-based approaches to instruction, in standardized assessments, in reading incentives and merit pay for teachers.
Trainers are rejecting behaviorism because it harms animals emotionally and psychologically. What does that say about classrooms that embrace it?
This “science-driven” mantra has been seen before through eugenics.
Therefore, eugenics is an erasure of identity through force, whereas radical behaviorism is an erasure of identity through “correction.” This all assumes a dominant culture that one strives to unquestionably maintain.
A square red peg hammered into a round hole surrounded by small pieces of the peg. Hammer in background.
“Once we have arranged the particular type of consequence called a reinforcement,“ Skinner wrote in ”The Science of Learning and the Art of Teaching“ (1954), ”our techniques permit us to shape the behavior of an organism almost at will. It has become a routine exercise to demonstrate this in classes in elementary psychology by conditioning such an organism as a pigeon.”
“…Such an organism as a pigeon.” We often speak of “lab rats” as shorthand for the animals used in scientific experiments. We use the phrase too to describe people who work in labs, who are completely absorbed in performing their tasks again and again and again.
In education and in education technology, students are also the subjects of experimentation and conditioning. But in Skinner’s framework, they are not rats; they are pigeons.
All these elements were part of Skinner’s teaching machines: the elimination of inefficiencies of the teacher, the delivery of immediate feedback, the ability for students to move through standardized content at their own pace.
Today’s ed-tech proponents call this “personalization.”
The behaviorist strategies caused a fracturing of identity and mental health problems.
Our non-compliance is not intended to be rebellious. We simply do not comply with things that harm us. But since a great number of things that harm us are not harmful to most neurotypicals, we are viewed as untamed and in need of straightening up. One of my favorite anecdotes from Asperger’s thesis is when he asks an autistic boy in his clinic if he believes in God. “I don’t like to say I’m not religious,” the boy replies, “I just don’t have any proof of God.” That anecdote shows an appreciation of autistic non-compliance, which Asperger and his colleagues felt was as much a part of their patients’ autism as the challenges they faced. Asperger even anticipated in the 1970s that autistic adults who “valued their freedom” would object to behaviorist training, and that has turned out to be true.
The Effects of Behavior-Based Models on Neurodevelopment and Learning
Behaviorism is a repudiation, an almost willful dismissal, of subjective experience. — Alfie Kohn
This is a child’s heart in fight or flight mode, constantly, that is being bombarded with all these instructions and prompting. — Professor Elizabeth Torres
Behaviorism is a repudiation, an almost willful dismissal, of subjective experience.
Alfie Kohn
This is a child’s heart in fight or flight mode, constantly, that is being bombarded with all these instructions and prompting.
Professor Elizabeth Torres
Please complete this simple task
Push the buttons just like we ask
This step first and that step last
Over and over and do it fast
I’m watching everyone, feeling like a simpleton
Why can’t I get it done? I just want to scream and run
I don’t think like you
But I’m the one that’s called abnormal
This construct
Was built by petty tyrants
Am I on the level yet? (Level yet)
How did I do on your little test?
Get my brain to reset (Reset)
'Cause everything you say is static
Do I make a good pet? (Good pet)
Obey the commands or get the back of the hand
'Cause the world wasn’t built for a brain like mine
Change my mind, change my mind, change my mind
This construct
Was built and can be dismantled
We stand together
We think apart
We stand together
We think apart
-- Neurodivergent by Rabbit Junk
But even more compelling is the testimony of young people who understand the reality of this approach better than anyone because they’ve been on the receiving end of it. It is nothing short of stunning to learn just how widely and intensely ABA is loathed by autistic adults who are able to describe their experience with it. Frankly, I’m embarrassed that, until about a year ago, I was completely unaware of all the websites, articles, scholarly essays, blog posts, Facebook pages, and Twitter groups featuring the voices of autistic men and women, all overwhelmingly critical of ABA and eloquent in describing the trauma that is its primary legacy.
How is it possible that their voices have not transformed the entire discussion? Suppose you participated in implementing a widely used strategy for dealing with homelessness, only to learn that the most outspoken critics of that intervention were homeless people. Would that not stop you in your tracks? What would it say about you if it didn’t? And yet the consistent, emphatic objections of autistic people don’t seem to trouble ABA practitioners at all. Indeed, one critical analysis of ethics in this field notes that “autistics have been excluded from all committees, panels, boards, etc., charged with developing, directing, and assessing ABA research and treatment programs.”
Nearly half (46 percent) of the ABA-exposed respondents met the diagnostic threshold for PTSD, and extreme levels of severity were recorded in 47 percent of the affected subgroup. Respondents of all ages who were exposed to ABA were 86 percent more likely to meet the PTSD criteria than respondents who were not exposed to ABA. Adults and children both had increased chances (41 and 130 percent, respectively) of meeting the PTSD criteria if they were exposed to ABA. Both adults and children without ABA exposure had a 72 percent chance of reporting no PTSS (see Figure 1). At the time of the study, 41 percent of the caregivers reported using ABA-based interventions.
These accompanied significant discrepancies in reporting bias between caregivers and ABA-exposed individuals, which highlight the need for the inclusion of the adult autistic voice in future intervention design. Based on the findings, the author predicts that nearly half of ABA-exposed autistic children will be expected to meet the PTSD criteria four weeks after commencing the intervention; if ABA intervention persists, there will tend to be an increase in parent satisfaction despite no decrease in PTSS severity.
This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder (ASD). However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis (ABA), which is widely taken to be far-and-away the best “treatment” for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but often exacerbate them. Warnings of the perils of ABA are not original to us—autism advocates have been ringing this bell for some years. However, their pleas have been largely unheeded, and ABA continues to be offered to and quite frequently pushed upon parents as the appropriate treatment for autistic children. Our contribution is to argue that, from a bioethical perspective, autism advocates are fully justified in their concerns—the rights of autistic children and their parents are being regularly infringed upon. Specifically, we will argue that employing ABA violates the principles of justice and nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well.
While parents whose children have received ABA sing its praises and describe it as the therapy that saved their child, the adult autistic community seems to feel differently.
I discovered that autistic adults consider it abusive, and many who were subjected to it as children claim to have been emotionally damaged.
Some preliminary studies even suggest that adults who received ABA as children are at an increased risk of suicide and PTSD.
And quite commonly on Twitter, I’ve seen people call ABA “dog training for children.”
When I see that, I tend to go on Twitter rants in reply to it, because from everything I have read and seen of ABA, it is NOT “dog training” for children.
Pretty much everything an autistic child does, says, doesn't do or doesn't say is pathologised and made into a way to invent a 'therapy' for it. It's actually hell to experience. We should stop doing this and start learning about autism. Thank you for listening.
— Ann Memmott PgC MA (She/They) (@AnnMemmott) July 8, 2018
Assuming for the sake of argument that ABA is effective at changing people’s behavior, it either does so via changing their underlying thought structures or values (“deep change”), or it does not (“superficial change”). If ABA is “successful” by way of deep change, then ABA violates autonomy insofar as it coercively closes off certain paths of identity formation. If ABA is “successful” by way of superficial change, then ABA violates autonomy by coercively modifying children’s patterns of behavior to be misaligned with their preferences, passions, and pursuits. Such superficial change is a pervasive form of interference that compromises children’s present and future autonomy.
"Employing ABA violates the principles of justice & nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well"… The authors offer a dilemma: If ABA changes children's "underlying thought structures or values…
In passing, the authors also point out that the pronouncement that autistic children "need to learn to talk is really just a declaration that we will not listen to the perfectly good ways they already communicate."
The underpinnings of that ideology include: a focus only on observable behaviors that can be quantified, a reduction of wholes to parts, the assumption that everything people do can be explained as a quest for reinforcement, and the creation of methods for selectively reinforcing whichever behaviors are preferred by the person with the power. Behaviorists ignore, or actively dismiss, subjective experience – the perceptions, needs, values, and complex motives of the human beings who engage in behaviors.
The late Herb Lovett used to say that there are only two problems with “special education” in America: It’s not special and it sure as hell isn’t education. The field continues to be marinated in behaviorist assumptions and practices despite the fact that numerous resources for teachers, therapists, and parents offer alternatives to behavior control. These alternatives are based on a commitment to care and to understand. By “care,” I mean that our relationship with the child is what matters most. He or she is not a passive object to be manipulated but a subject, a center of experience, a person with agency, with needs and rights. And by “understand,” I mean that we have an obligation to look beneath the behavior, in part by imaginatively trying to adopt that person’s point of view, attempting to understand the whys rather than just tabulating the frequency of the whats. As Norm Kunc and Emma Van der Klift urged us in their Credo for Support: “Be still and listen. What you define as inappropriate may be my attempt to communicate with you in the only way I can….[or] the only way I can exert some control over my life….Do not work on me. Work with me.”
It is nothing short of stunning to learn just how widely and intensely ABA is loathed by autistic adults who are able to describe their experience with it.
While some may perceive ABA as misinterpreted (Morris, 2009), argument stems from experiences of intervention and the impact of forced behavioural intervention has upon the processes and development of self-perception. Adapting autistic behaviour and identity to meet those of typically developing (TD) peers is at the core of ABA opposition. Indeed, current research has suggested ABA as causing a severe level of trauma from childhood participation (Kupferstein, 2018). Autistic individuals continue to highlight the suffering felt through ABA’s inability to acknowledge the negativity inflicted through forceful coercion (see, for example, Kedar, 2011; “My experiences with ABA”, 2017). Such a conclusion raises further doubt as to both the efficacy of early intervention as well as the long-term implications and impact on participants. While arguments put to those who oppose ABA claim methods and approaches have changed (“The Controversy Around ABA”, 2019), opposition to ‘current’ ABA mirrors autistic attitudes to intervention (Klein, 2002) and ‘cures’ (Harmon, 2004) from nearly two decades ago. So many coming forward and indicating the harms for autistic children, which they themselves have experienced, to improve for the next generation is indicative of a disparity. Yet, with many being ignored or dismissed as ‘radicals’, ‘too autistic’ or ‘not autistic enough’ to speak for their own community, the bridge between academia and community is further fractured. To begin re-building these bridges, we seek to work alongside autistic reflections of ABA in order to bring voice into empirical constructs. Translating voice into academic comprehension of ABA in terms reflected by the autistic community addresses a vitally unaddressed gap in current research knowledge.
I’m not sure I’ve ever seen a harsher abstract. Genuinely spectacular. “The research utilized in the response does not pertain to the population discussed, does not present any neuroscientific research, and does not address intrinsic motivation, elevated levels of anxiety” etc
Also: love how their earlier paper was titled “How much compliance is too much compliance: Is long-term ABA therapy abuse?” Their response to the ABA researchers’ response settles the question. Yes: “Long-term ABA Therapy Is Abusive”. Having evaluated the counterarguments: YES.
Despite decades of usage as the primary method for this population worldwide, ABA has never been shown to be even slightly efficacious for the nonverbal Autism population.
The research utilized in the response does not pertain to the population discussed, does not present any neuroscientific research, and does not address intrinsic motivation, elevated levels of anxiety, or various other pertinent issues associated with the nonverbal autism population.
Research in ABA continues to neglect the structure of the autistic brain, the overstimulation of the autistic brain, the trajectory of child development, or the complex nature of human psychology, as all of these factors were ignored in the response and are ignored in ABA practice itself. Providing a treatment that causes pain in exchange for no benefit, even if unknowingly, is tantamount to torture and violates the most basic requirement of any therapy: to do no harm. Lastly, there is also no discussion in the response on internal motivation and how the conditions created by ABA foster psychological ill-being. If paraprofessionals and professionals refuse to engage in critical thinking, refuse to become experts at the thing they treat, continue to practice outside of scope, and continue to ignore pertinent research, the future of Autism and other conditions ABA professes to treat is very bleak.
Meanwhile, the autistic adults I saw who were ABA recipients–as well as several families I encountered in community advocacy whose autistic adult children had been in ABA programs–fared only marginally better in functioning, and presented with one or more of anxiety, depression, OCD, insomnia, and Post-Traumatic Stress Syndrome.
However, with so many independent personal accounts from autistic individuals and families, as well as a new scientific movement, any reasonable observer cannot confidently deny that ABA is negatively affecting the autistic population.
In 2019, a neuropsychologist released a co-authored article with a parent and service provider citing research that shows the unsuitability of ABA for autistic individuals, the current lack of scientific testing regarding ABA’s effect on “lower-functioning” and nonverbal autistic people, and highlighting the drivers of expanded use, including the potential current market size of $17 billion annually.
So, many families don’t realize they’re putting their loved ones through a costly and traumatic program because they feel this is the best care they can get and the outcomes they hope for are the closest to an idealized normal.
All I’m asking for is a SINGLE study that provides any evidence that ABA is any more effective than kids spending equivalent time with someone who knows nothing about ABA.
If they can’t show that, how on Earth do they think they can justify a multi-billion dollar industry? What?
ABA’s monopoly is maintained by the scientific community’s lack of research into and investment in alternative techniques that address autism as both a cognitive and existential experience rather than just a behavioral one–an approach adult autistics who have undergone ABA have described as violating the fundamental tenets of bioethics, as well as the United Nation’s Convention on the Rights of Persons with Disabilities.
Until ABA updates its scientific methods, its functions of behavior, and incorporates modern day psychology – including neurology, child development, educational psychology, and other vital research – it cannot be considered to be a safe, effective, or ethical field.
But I don't need a cure for me
I don't need it
No, I don't need a cure for me
I don't need it
No, I don't need a cure for me
I don't need it
I don't need it
Please, no cure for me
Please, no cure for me
--Cure for Me by AURORA
“Cure for Me” is very much inspired by conversion therapy.
I just wanted to make an anthem for people to sing along with that they know they don’t need a cure.
It doesn’t take much before the world tells you that you’re different, and that you should change yourself to be the same as everybody else, which is very sad.
*whispers* You can’t. In many ways, the impulse to repress transgender people from expressing their true identity is rooted in the same impulse that makes people want to stop #ActuallyAutistic people from flapping their hands https://t.co/8TMKxnc7Va
“The fascinating part to me was to observe persons with eyes and ears, teeth and toenails, walking around yet presenting few of the behaviors that one would call social or human,” he wrote. “Now, I had the chance to build language and other social and intellectual behaviors where none had existed, a good test of how much help a learning-based approach could offer.” He explained to Psychology Today, “You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense— they have hair, a nose, and a mouth— but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person.”
A brief thread about why the fates of LGBTQ+ and #ActuallyAutistic people are intertwined (to say nothing of LGBTQ+ autistic people). This right here is Ole Ivar Lovaas, the father of modern-day Applied Behavioral Analysis.
For the first week of #Pride2022: a brief thread about why the fates of LGBTQ+ and #ActuallyAutistic people are intertwined (to say nothing of LGBTQ+ autistic people). This right here is Ole Ivar Lovaas, the father of modern-day Applied Behavioral Analysis. 1/
Lovaas ran a clinic at UCLA, where autistic children were slapped, administered shock therapy. LIFE Magazine profiled his practices in 1965, showing how one girl was taken to a “shock room” when she made little progress.
When children behaved well, they were given food and affection. Children were initially not given regular meals and only spoonfuls of food at first.
Lovaas had an extremely low opinion of his autistic patients. In a 1974 interview, he demeaned autistic people stimming (which we now know is a means of soothing). He also called them “little monsters.”
But Lovaas’s practice did not just end when it came to autistic children. As @stevesilberman wrote in his book #NeuroTribes, he also assisted with UCLA’s Feminine Boy Project, which sought to cure boys of atypical sexuality, including homosexuality.
Lovaas collaborated with a researcher named George Rekers and co-authored four papers on homosexuality and other behaviors. One of their main test subjects was a boy named Kirk Murphy, whom they called “Craig.”
Lovaas and Rekers’ practices bore stunning similarities to Lovaas’s practices on autistic children. Poor Kirk’s parents were instructed to use poker chips. Blue poker chips were used as a reward to get candy while red chips meant he would be spanked.
CW suicide: The red poker chips were given when he displayed feminine behavior. The whippings were so unbearable that Kirk’s brother would hide the red chips. Kirk later joined the US Armed forced before he later died from suicide.
All the while, Rekers and Lovaas’s research was used to show that conversion therapy worked. Rekers would co-found the Family Research Council, which opposes LGBTQ+ rights. More on Kirk’s tragic end here.
Poor Kirk Murphy and Pamela, the girl who was subjected to shock therapy shared a similar fate because the adults in charge of them punished them for who were.
People might wonder why I, a cisgender heterosexual from the suburbs of Southern California, included queer history in a book about autism. THIS is why. The same people who want to stop queer kids from being themselves are the same ones who want to stop me from flapping my hands
Conversely, when I first moved to Washington, the gay community openly embraced me and getting to know gay people helped me shed my own homophobia AND my internalized ableism. It’s why transphobia also bugs me so much.
Learning about the shared DNA of gay conversion therapy and ABA reaffirmed what Martin Luther King wrote in 1963 “We are caught in an inescapable network of mutuality, tied in a single garment of destiny.”
…plenty of autistic people are LGBTQ and experience a double portion of discrimination. The desire to eliminate the traits that make autistic people unique is rooted in the same impulse to suppress people from affirming their gender identity or sexuality.
Behaviorism is harmful for vulnerable children, including those with developmental delays, neuro-diversities (ADHD, Autism, etc.), mental health concerns (anxiety, depression, etc.).
The concept of Positive Behavior Intervention and Supports is not the issue. The promotion of behaviorism is the issue. PBIS.org focuses only on surface behavior, what one can observe. Whether this is due to lack of understanding of the complexity or an intentional omission is unknown. The focus on surface behavior, without seeming to understand or be concerned about the complexity, or even the simple dichotomy of volitional versus autonomic (stress response) and the use of outdated, compliance based, animal based behaviorism (which has no record of long term benefits) continues to fail our country’s students.
The documents on PBIS.org imply that all behavior is willful. There is no acknowledgement in the PBIS.org literature that behaviors can be stress responses (fight-flight-freeze responses). This is a profound omission that does great harm to children whose brains and bodies have highly sensitive neuroception of danger. To be punished for a stress response is harmful and traumatic.
The second concern about teaching replacement behaviors goes back to the lack of distinction between willful behaviors and stress behaviors. Teaching replacement behaviors is not possible for stress responses since they are automatic responses that occur beneath the level of conscious thought.
Rewards and consequences, even for children who have the capacity to meet the expectations, are short-term solutions that do not solve the root causes for behaviors and create additional problems, including decreased internal motivation, loss of interest in activities that had been interesting, competition between students, shame for students unable to meet the expectations, and more.
Rather than determining whether the behavior isvolitional or a stress response, or even if the behavior could be a result of an expectation that is beyond the child’s capacity to meet, there is simply a decision between managing the behavior in the classroom or sending the child to the office. This is a false choice which misses the point of helping a vulnerable child who is having difficulty meeting an expectation.
There is no question that behavior is a form of communication. It does serve a function. However, the range of possible functions is much wider than simply trying to get out of something or trying to get something. This reduction of the function to a simple either/or option negates all the other equally possible explanations, including nonvolitional behavior and behaviors that were beyond the child’s skill level, trauma flashbacks, and more. The FBA involves analyzing the antecedent – what happened immediately before the behavior in question and what happened after the behavior and drawing conclusions based on what function the behavior was like to have served. The people participating in the analysis include the teacher, the behavioral specialist and any other adults working with the child. **There are several problems with this approach. It does not include the child’s perspective. It does not consider that many factors that are unseen, including sensitivity to light, sound, movement; or internal pain; or trauma flashbacks, worry about a grandparent who had a stroke last night, fear because he doesn’t know how to do the assignment he was just given, or a myriad of other potential factors not visible to the evaluators. **The FBA and indeed the entire positive behavior intervention and supports framework focuses on behavior, not on root causes.
The information from the national Behavior Technical Assistance Center (PBIS.org) is contributing to the misunderstanding school leaders, teachers, and support staff have about behavior. Specifically, the repeated assertion that students use their behavior to get something or to get out of something, along with the lack of information about autonomic reactions (stress responses) is incorrect and results in children being misunderstood and punished for behaviors that are not within their volitional control.
Another major concern is the heavy reliance on rewards and punishment. Though the name, Positive Behavior Intervention and Supports, sounds nice, the children with or without IEPs who need support to help with their behavioral struggles are not getting those supports, and instead are being blamed for their behavior. Children are being punished (and shamed) through dojos and color charts, and by being left out of class celebrations and school activities, by being secluded and restrained, by being moved to more restrictive schools, or by being suspended, expelled, or referred to juvenile justice. Some are being handcuffed at school by police.
Based on countless reports from families on social media groups, newspaper reports, government accounts and personal accounts, many of the disciplinary actions directed toward students with disabilities are for behaviors that are flight-fight-freeze behaviors. Teachers, paraprofessionals, school resource officers, and other school personnel do not recognize the difference between willful and involuntary stress responses – and it is **HURTING **our children.
…& my reminder that my colleagues & I in @AT_Autism, and wider colleagues/contacts across the autism fields, would prefer it wasn't used on people with intellectual disabilities either. It's an outdated & problematic approach. Much better understandings are now available.
— Ann Memmott PgC MA (She/They) (@AnnMemmott) July 8, 2022
With hundreds of votes, this snip showing a poll from 2020 gives the opinion of those autistic people voting: A strong majority 'no' to PBS. It's no use teams claiming autistic people don't know what's good for us. They simply shouldn't be using it any more. pic.twitter.com/kWn4FCrt4K
— Ann Memmott PgC MA (She/They) (@AnnMemmott) July 8, 2022
Thank you to all who took part in this poll on whether autism charity schools should be using Positive Behaviour Support on autistic pupils. A strong vote for 'no'. This may be helpful for the charities in question. Depends if they think autistic views are valid, of course… https://t.co/UR2UaFapPN
— Ann Memmott PgC MA (She/They) (@AnnMemmott) August 2, 2022
Poll for autistic people. Should schools run by autism charities still be using Positive Behaviour Support for their autistic pupils? Polls are anonymous. Only you know how you voted. Feel free to retweet/comment below.
— Ann Memmott PgC MA (She/They) (@AnnMemmott) August 1, 2022
Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.
The cluster RCT evaluated the clinical outcomes of training health professionals – who are specialists in working with adults with intellectual disability – in PBS to reduce challenging behaviour. It did not detect significant reductions in carer-reported challenging behaviour in the intervention plus TAU (Treatment As Usual) arm compared with the TAU arm alone over 12 months. Secondary outcomes were also similar between the two arms over 12 months, including the proportion of participants on psychotropic medication. Given the high statistical power, the findings suggest that training the community intellectual disability services staff in PBS, as delivered in this study, was no more effective than TAU in reducing challenging behaviour.
Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.
The present analysis using data from a cluster randomised trial of staff training in delivering PBS suggests that the intervention did not reduce challenging behaviour in ASD+ participants.
These findings are in keeping with the main trial findings, which showed no effect of staff training in PBS on reducing challenging behaviour.
Important reading for my #autism and disability rights peeps – the late @OliverSacks' marginalia on behaviorist modeling as a "therapy of terror." https://t.co/ki2NqFkpMY
The bigger problem is using mummified science to treat a complex neurological condition.
ABA therapy is badly out of date, scientifically speaking.
Behaviorism as a science predates penicillin and the light bulb. Psychology moved beyond it and into the realm of neuroscience and cognition before we even landed on the moon.
Psychology just doesn’t consider behaviorism relevant in contemporary practice and research.
If the entirety of human knowledge on the mind and its workings were represented as a tree, behaviorism wouldn’t even be a branch. It would be a root at best, or maybe an acorn.
The problems associated with ABA run very deep. It is a human rights violation to continue to ignore and discount the voices of Autistic people about deeply traumatising and harmful "therapies" such as ABA https://t.co/ogeI3e55x9. https://t.co/rXFUNYWPEq
— @jornbettin prefers the peaceful elephant .social (@jornbettin) May 14, 2022
The problems associated with ABA run very deep. It is a human rights violation to continue to ignore and discount the voices of Autistic people about deeply traumatising and harmful “therapies” such as ABA.
Review authors examined and compared the results of all five studies. They found weak evidence that children receiving the EIBI treatment performed better than children in the comparison groups after about two years of treatment on scales of adaptive behavior, intelligence tests, expressive language (spoken language), and receptive language (the ability to understand what is said). Differences were not found for the severity of autism symptoms or a child’s problem behavior.
There is weak evidence that EIBI (Early Intensive Behavioral Intervention) may be an effective behavioral treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design. Due to the inclusion of non-randomized studies, there is a high risk of bias and we rated the overall quality of evidence as ‘low’ or ‘very low’ using the GRADE system, meaning further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
When effect size estimation was limited to studies with randomized controlled trial (RCT) designs, evidence of positive summary effects existed only for developmental and NDBI intervention types. This was also the case when outcomes measured by parent report were excluded. Finally, when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Based on outcome measures data for this reporting quarter, 76 percent of TRICARE beneficiaries in the ACD had little to no change in symptom presentation over the course of 12 months of applied behavior analysis (ABA) services, with an additional 9 percent demonstrating worsening symptoms.
The findings from this analysis continue to demonstrate concern with overall outcomes of beneficiaries participating in the ACD. While the change scores demonstrated small but statistically significant improvements after 12 and 18 months of rendered ABA services, and that most baseline severity scores and most ages demonstrated some percent change in scores from baseline, there was no comparison group (no treatment or another type or of treatment) to determine the attribution of these changes. It is also not clear if these changes are clinically significant. Subsequently, there is no way to know if the relatively small change observed here is the result of ABA services, other services received, or if this simply a result of maturation. However, the findings are clear that the number of hours of ABA services rendered did not improve symptom presentation of ASD based on the PAC scores. This finding strongly suggests that the small changes noted are not related to ABA services. As a result of this analysis, it is imperative that DHA take a deeper look into why TRICARE beneficiaries are not seeing more improvement over time. The findings that the outcomes do not correlate to treatment intensity, and that the overall results show limited clinical improvement, support a needed change to the ACD.
An additional continued concern with this program is the ongoing fraud, waste, and abuse by ABA providers and the improper billing and payments for ABA services. Government offices continue to identify improper activities by TRICARE ABA providers and practices that has resulted in millions of dollars of restitution, settlements, and recoupments.
This review found limited evidence that early intensive applied behaviour analysis-based interventions improve cognitive ability and adaptive behaviour in autistic children, but the long-term impact of the interventions remains unknown.
So, how on earth have we ended up with this many myths continuing painfully from one decade to the next?
I’m afraid the answer is that too much of the training has been stuck in the 1940s. Too much is done by non-autistic people, often ones who happen to know an autistic person in some way (maybe a relative) but seemingly have never asked them about life. I mean ‘asked’ in any communication sense, not just speech. Over a million autistic people in the UK, and too often, such trainers have none of them as personal friends, none of them as colleagues. Isn’t that odd?
Such trainers pass on the ancient myths, generation after generation. They write them down, put them on Powerpoint presentations, and deliver them to you as if they are fact. Research based in part on materials from the 1990s and 1980s, which was based largely on watching groups of profoundly disabled young men in a care home, as far back as the 1940s. As far removed from a balanced view of autism as one can get, in fact.
Worse still, they often expect you to pay for this. It might look slick, with excellent graphics, and the trainer might look like they could pose for a fashion magazine . But…are you really wanting 1940s material?
But the enduring lesson for educators isn’t just that “positive reinforcement” turns out to be anything but positive. It also concerns the conceptual dead-end of behaviorism more generally. Every day, and with every child, we need to keep in mind that behaviors are just the protruding tip of the proverbial iceberg. What matters more than “What?” or “How much?” is “How come?”
Throughout all of this, Applied Behavior Analysis has stuck with their babyish ABCs of behavior, teaching the psychology equivalent of preschool to an ever-increasing number of people… and making a lot of money while doing it.
Unfortunately, treating autism makes big money. For all I’ve been talking about how real Psychology considers behaviorism to be a museum piece, there are plenty of colleges ready to rake in the cash and resurrect it.
Behaviorism only looks at observable behavior which can be measured. It doesn’t take into account thoughts, genetics, anxiety, trauma, health, or emotions because those things cannot be measured.
Until ABA updates its scientific methods, its functions of behavior, and incorporates modern day psychology – including neurology, child development, educational psychology, and other vital research – it cannot be considered to be a safe, effective, or ethical field.
I make the right mistakes
And I say what I mean
Spare Me From The Mold
--Spare Me From The Mold by Gossip
Abuse and silencing is a constant, pervasive theme in the lives of autistic people, and for many people it is best expressed by that old, familiar phrase from special education: quiet hands! Loud hands means resisting. Loud Hands means speaking, however we do, anyway—and doing so in a way that can be very obviously Autistic. It means finding ways to talk and think about ourselves on our own terms. There is room for all of us to play our part. And whatever we do, however we do it, we can do it with ‘loud hands’ and ‘loud voices,’ and loud whatever else we need, in whatever way that works for us individually or collectively. Let us be our real autistic selves, loud and proud, and show the world what we truly are.
