Because these voices need to be heard.
Last night, I fell asleep with a mild fever. My life chased me into my dreams.
In my dream, my client breaks something while I struggle to help his mother in the kitchen. His ABA team makes him stay up all night cleaning, and in the morning a troop of therapists convenes to discuss how he needs even more ABA. I’ve met many of them before, but I’m having trouble telling them apart, and can’t decide which of them might be sympathetic to my objections.
I argue passionately for less ABA, more communication training. A supervisor sneeringly asks if I mean that faked “facilitated communication” nonsense. The scientists in the room shake their heads sadly. I respond that RPM leads to completely independent typing– look it up! I also point out that a lot of different things fall under the category of “facilitated communication,” mentioning a video I’ve seen in which the only “facilitation” necessary is a gentle hand on the back of the person typing. You can’t control what someone types that way, I insist– just try it! I volunteer to type while a scientist tries to control my typing with a hand on my shoulder. She cheats abominably, but still can’t force me to type what she wants.
The room grows fuller, as adults with physical disabilities arrive to make the point that being a disabled adult is not a horrible sentence. Almost every hand in the room is raised with points to make, and I have more to say but despair of being called on any time in the next hour…
Yesterday, in my real life, an ABA tech mentioned children who were getting 40 hours a week, plus other therapies.
I asked if she didn’t find that tragically sad– the idea of small children having to work more than 40 hours a week. She said she’d rather they had to do 40 hours a week now, and grow up to be functional members of society. (There was a time when I would have agreed with her. The ABA industry mixes up some strong Kool-Aid.)
I didn’t have a way to put my disagreements into words then– there were so many of them crowding my brain. I think I can do so now, though,
1) False dichotomy. There is plenty of evidence (some of it even in ABA studies) that ABA is neither necessary or sufficient for independent adulthood. In less technical terms: Some kids get lots of ABA and grow up to be independent adults. Some kids get lots of ABA and do not grow up to be independent adults. Some kids get no ABA and do grow up to be independent adults.
2) If you’re going to argue that ABA at least gives a better chance that the kid will grow up to be an independent adult, you’ll have to show me some darn good math. You’ll also have to take into account that scientific studies on autistic kids who grow up without ABA barely exist at all, and you can’t make a logical argument that one condition is better than another when you’ve only researched one of the two.
3) I’m also going to lay down some serious objections to the idea that a person needs to be a “functional member of society” in order to have a valuable and meaningful life. There are many people in my life who have inspired me, made my life better, or loved me, or who I have loved. None of those things has ever hinged on whether or not the person could earn a living, speak verbally, live independently, or pass as “normal.”
4) Even if I accepted the premise that ABA=independent adulthood, I would still object. Because, “functionality” at what price? The price of a childhood? An individual’s personality? Their self-esteem? Their happiness? I would not sacrifice any one of those things, and I have known and read about autistic adults who believe that ABA stole those things from them. That alone should give anyone pause– and I do think that if most parents and therapists and ABA techs were truly aware that this was the potential trade-off, they’d hesitate, too.
There’s more to becoming a well-rounded adult human being than learning to sit still or tie one’s own shoes or participate in social niceties. There’s emotional development, and I believe that childhood– an unfettered, exploratory, play-filled childhood– is an integral and irreplaceable part of that development. For counterexamples, look at the emotional damage done to children who lost their childhoods too early– to abuse, to war, to parental drug abuse, to any of the things that make children grow up too fast. There are an uncanny number of similarities between adults from abusive childhoods and adult autistics– and all too often, those are one and the same. And frequently, that abuse has, at least in part, taken the form of a relentless battle on the part of adults to turn the autistic child into something they are not and can never be– a non-autistic adult.
So, if those are my options, I will happily volunteer to change an autistic person’s diaper every day for the rest of my life, or cook their meals, do their shopping, help them cross the street, or whatever other “functional adult” tasks they can’t do alone. Because I love the children I work with, exactly the way they are. And while I do want to help them acquire as many skills as possible, I wouldn’t do it at the price of changing who they are, losing their sense of fun and humor, or making them feel that they aren’t good enough, or teaching them that behavioral control is more important than their comfort, their safety, their right to communicate naturally, and their happiness.
Here’s the flip side to my last post. Here’s what makes this job worthwhile.
Yesterday, an autistic child whose average attention span is about 30 seconds curled up next to me on the couch and let me read almost 30 pages of “The Reason I Jump” out loud.
Yesterday, a girl who generally insists on my undivided attention and loses her temper at the drop of a hat let her sister select several songs in a row without resorting to violence.
Yesterday, a mother who is very strict and concerned with appearances in public lay down on the bedroom floor with her son to cuddle. They were both smiling blissfully.
Yesterday, a parent apologized for interrupting a disabled child’s conversation.
Today, I watched an autistic child tolerate, with good humor, the fumbling attempts of an ABA tech to engage in play-based interaction. The parents are being patient, hoping that they can teach the neurotypical tech how to better interact with autistic children. The kid is being a good sport about it– probably better than I would have been. I think this also answers my question about whether ABA can be totally benign: yes, so long as the family knows what boundaries to set and teaches the kid not to take it too seriously.
Today, a mother felt renewed hope for her child’s future.
Today, the most profoundly autistic child on my roster did so many things I’ve never seen before that I stopped counting. Among them: voluntarily paid attention to something an adult was showing him, used the toilet without prompting, calmly tolerated multiple adults conversing in his presence, shared a trampoline and eye contact with another child, and held a vocal (though not verbal) conversation with the same child.
Should I call these small miracles? Small miracles can be huge. In fact, they are everything.
I haven’t written much here lately. In part because my general brain energy has been at a low ebb, and partly because it’s gotten harder. Looking back at my older posts, sometimes I feel sad at how they now feel naive and optimistic in some ways.
My job has gotten harder. Not because of the clients, but because of the rest of the world. Parents, therapists, siblings, barriers and obstacles, institutions of thought and culture and society… And it’s much harder to write about my work when I have things to say that aren’t as positive. Sharing the good times is easy. Sharing my mistakes feels useful to myself and others. Sharing my good ideas is gratifying. Talking about the hard parts is… hard.
I know the parents of my clients love them greatly. I know these situations aren’t easy for anyone involved. But I need to write the following letter. I’ve been needing to write it for a while now.
A quote comes to mind: “The names have been changed, but the stories are real.” The following was inspired by many situations, with many different children.
Once, while jumping, you accidentally head-butted me so hard that my jaw throbbed for a week. Hearing an adult call you “stupid” in a moment of anger hurt worse….
…You bit me, hard enough to bruise, and while the other adults clustered around asking if I was ok, I was worried about you, and what could have made you miserable enough to injure me…
…You frustrate me at times. You throw tantrums, throw objects, break things, hit and kick. I’ve lost my temper and yelled at you on more than one occasion. But nothing you’ve ever done has made me as angry as when your sibling wished– out loud, in front of you– to be an only child…
…You’re rougher than you mean to be, and your clumsy attempts at friendly interaction have made me wince all too often. What feels worse, though, is the fact that I wince or flinch against my will– I don’t want you to know that you hurt me, because I know you never mean to. I’d happily suffer more pain to see you smile…
…Once, after a therapy session, you punched me in the stomach for taking away the cookies. Your small fist didn’t hurt me. The pain and frustration in your eyes, however, left a wound that still hasn’t healed. I would rather be punched again than see you cry.
All of you: you have my sympathy, you have my unconditional love, and you have my complete forgiveness for any injury you have ever caused me. And you always will.