Applied Behavior Analysis (ABA) services have become a cornerstone in the support and development of children with autism spectrum disorder (ASD) over the past few decades. ABA encompasses a variety of techniques grounded in behavioral therapy principles, most notably positive reinforcement. This intensive approach aims to cultivate essential skills that autistic children may not naturally acquire and to decrease behaviors that could be harmful, such as self-injury. To gain a deeper understanding of the different types of ABA, further resources are available.
However, as ABA’s prevalence has grown, so too has scrutiny from parents and autism advocates. Concerns have been raised regarding its methodologies and implementation by certain practitioners.
One key point of contention arises from the historical roots of ABA. Developed in the 1960s by Dr. O. Ivaar Lovaas, the earliest form, Discrete Trial Training (DTT), didn’t solely rely on positive reinforcement. Dr. Susan Epstein, a clinical neuropsychologist, clarifies, “Dr. Lovaas used principles of both positive reinforcement and punishment to reduce self-injurious behaviors in residential settings, treating severely impaired persons.” It’s crucial to note that the aversive reinforcement methods, including electric shocks, used in the past are now widely considered unethical and unacceptable.
Is ABA Therapy Too Demanding for Children?
While aversive methods are largely a thing of the past, some critics still argue that ABA therapy, characterized by its repetitive nature, can be overly demanding for children. Furthermore, there are questions about whether the skills acquired in therapy effectively transfer to real-world situations.
The stereotypical image of ABA therapists might be that of strict disciplinarians. However, Dr. Catherine Lord, a respected autism researcher and clinician at UCLA, points out that modern ABA therapists are generally trained to be highly engaging and enthusiastic. “If anything,” she observes, “they’re over the top. Sometimes you do see someone who is just humorless. But that’s just bad teaching, not ABA.”
Moreover, contemporary ABA therapy has largely moved away from the DTT format, where children were primarily seated at a table. Play-based ABA is now a common approach. Sara Germansky, a Board Certified Behavior Analyst (BCBA), the highest certification in ABA, illustrates this shift:
“I might set up something where we’re playing with cars, and if I’m working on colors with a kid I might have two cars in front of me — one that’s red and one that’s yellow. And he’ll say, ‘Can I have a car?’ And I’ll say ‘Oh, do you want the red car or the yellow car?’ And then he’ll have to expand his language by saying ‘I want the red car.’ And then I’ll say, ‘Which one’s red?’ And he’ll have to identify the color. So there are ways of manipulating the environment so that kids are more naturalistically learning these skills.”
Alt text: In a play-based ABA therapy session, a child and therapist engage with toy cars to teach color recognition and language skills.
Germansky emphasizes that skills learned in naturalistic settings are more likely to generalize beyond therapy sessions, enabling children to apply them in everyday life. Additionally, intensive ABA therapy at 40 hours per week, as initially suggested by Dr. Lovaas, is now rare. Germansky, who works directly with young children in New York City, states, “Most kids are either given 10 hours a week or 20 hours a week… The more severe the behavior or delays the more hours they’re given. I will see kids usually every weekday for about two hours.”
Is ABA Services Overly Focused on Behavior Elimination?
Another criticism leveled against Aba Services is that some practitioners may prioritize behavior reduction over skill development. Tameika Meadows, a BCBA based in Atlanta, has observed this issue during school consultations on ABA implementation.
Meadows highlights the importance of focusing on skill-building: “What are the students learning to do? What are they supposed to do instead of tantruming, or instead of trying to escape the building during the day?” It’s crucial to address not just unwanted behaviors, but also to teach replacement behaviors and functional skills.
Ari Ne’eman, a prominent autistic self-advocate, objects to ABA’s historical emphasis on making autistic individuals appear “indistinguishable from their peers,” a phrase attributed to Dr. Lovaas. Ne’eman argues that this approach can suppress behaviors without considering their underlying emotional significance.
“The emphasis on things like eye contact or sitting still or not stimming” – self-stimulatory behaviors like hand flapping – “is oriented around trying to create the trappings of the typical child,” Ne’eman explains, “without acknowledging the reality that different children have different needs. It can be actively harmful when we teach people from a very early age that the way they act, the way they move is fundamentally wrong.”
Alt text: A person engages in hand-flapping, a common stimming behavior in autistic individuals, highlighting neurodiversity.
While Ne’eman, president and co-founder of the Autistic Self Advocacy Network, supports structured early intervention, he suggests that interventions focused on speech and language development might be more beneficial, particularly for nonverbal children for whom behavior can be a form of communication. He points out that the limited recognition and reimbursement of only ABA treatment by some states and insurance companies can hinder access to other potentially valuable therapies, like speech-language pathology. This may result, he argues, in children becoming “more controllable but worse off than they were before.”
Does ABA Therapy Seek to Erase Neurodiversity?
Defenders of ABA services contend that the goal is not to diminish autistic children’s neurodiversity but to foster independence and improve their quality of life.
Germansky clarifies, “ABA is based on the premise of manipulating environmental variables to bring about behavior change, so we aren’t trying to change the person, we aren’t trying to change how they think, we aren’t trying to change how they feel.” The focus is on modifying behaviors to facilitate learning and adaptation to the environment.
Stephanie Kenniburg’s experience with her 6-year-old son Holden’s ABA therapy aligns with this perspective. “What I like is that they’re trying to help him live as independently as possible but they’re not trying to take his autism away,” she says. “Like there are certain parts of his autism — the way his brain works, the way he thinks — and they’re not looking at that as something negative that needs to go away. They’re looking at it as ‘this is how he thinks so this is how we’re going to teach him how to live in the world.’ ”
Kenniburg emphasizes the family-centered approach of ABA, noting that the entire family has learned to support Holden’s skill development. “I like that they’ve accepted his neurodiversity and that they’ve accepted him as a person,” she adds. “They’ve really helped us as a family teach him how to be more independent.”
Empowering Children with Choices and Joy through ABA Services
Dr. Lord acknowledges the historical context of ABA, noting its initial focus on conformity to a “typical ideal.” “ABA was created with a sort of model that there is a perfect way to be, and we know what that is and we’re going to teach you how to be that perfect way.”
However, she emphasizes the evolution of ABA towards a more individualized approach, while still maintaining therapeutic goals. “One of the hard things of working with children is always that you do have to make assumptions of what is going to be best for this child.”
Dr. Lord concurs with Ari Ne’eman on the importance of intensive early intervention for young children on the spectrum. For children with less significant autism impacts, the specific type of intervention (ABA or other) may be less critical. However, she highlights ABA’s proven track record in improving verbal communication for children at risk of being nonverbal.
Ultimately, Dr. Lord emphasizes that the hallmark of a quality therapist, regardless of their approach (ABA or non-ABA), is their ability to “try to figure out ways that build on an individual child’s strengths, that use their interests, but that allow them to participate in society and that will give them the most choices. That’s what we want. We don’t want just the best-behaved person, we want a person who can do as much as possible, and get as much joy as possible out of the world.” Finding a good therapist is crucial for effective intervention.
Frequently Asked Questions about ABA Services
Is ABA therapy harmful?
Opinions on the potential harm of ABA therapy are divided. Some believe ABA therapy is beneficial as it aids autistic children in developing communication skills and greater autonomy. Others express concern that ABA therapy may be harmful due to its potential to suppress behaviors considered natural for autistic individuals.
What does ABA stand for?
ABA stands for Applied Behavior Analysis.
