What’s Wrong With “Better” ABA?

This is a preliminary post. There are a bunch of references I need to add, and plenty of examples and stories I could share. But I want to get the basics down now, while they’re on my mind.

There are a gazillion critiques of ABA out there, largely from adult autistic people, and some from the disability rights community in general.

There are also a lot of arguments (including some I’ve made in the past) that many things called ABA today are extremely different from what Ivar Lovaas described. There are ABA programs that are more play-based and naturalistic (eg, PRT rather than DTT — if you’re unfamiliar with these terms, don’t worry about it, they aren’t central to my argument). There are ABA programs that don’t use aversives/punishments or withhold food and other necessities. There are ABA programs that have dropped the absurd goal of trying to make autistic children “indistinguishable from their peers” (I actually had an ABA practitioner laugh in shock when I told her that’s what most ABA aims for. She had never even heard that phrase in her training). There are ABA programs that don’t focus on eye contact and reducing stimming, but are more about teaching independent living skills and communication tools. They give choices, and sometimes allow clients to say “no” to activities or express their autonomy in other ways.

These things are, undoubtedly, a huge improvement. And I am not categorically opposed to offering rewards to help with stepwise learning of certain skills. But there are still problems here, subtler but no less concerning. Here’s a quick look at some of them:

1. Infantilization:

Not all ABA practitioners do this, but most do. It’s not limited to ABA either. Most special education settings (and care programs for disabled adults) are full of well-meaning, nice people who talk to their students and clients like they are talking to a baby or a puppy. High squeaky voices, sing-song tone, baby-talk language and incorrect grammar, full of “no-no’s” and “boo-boo’s” and “time to go beddy-bye!” It’s insulting and inappropriate. There’s no reason that a person would be able to understand a sing-song “no-no!” better than a simple “no” or “stop” spoken in a normal tone of voice. Talking to anyone over the age of 4 this way is just wrong. Ironically, people often argue that they do it because people with developmental disabilities act like little kids, when in my experience, it’s this very approach that keeps many of these people acting childlike. Giving a client more respect, responsibility, and autonomy allows them to grow emotionally even if they still need one-on-one care throughout the day. Infantilization also makes people forget that teens and adults with developmental delays and intellectual disabilities still experience adult feelings and need education about puberty and sex for their own safety if nothing else.

2. Unfamiliarity with other fields of child development:

BCBAs aren’t required to study child psychology, nutrition, or any of the physical and neurological disabilities that commonly accompany autism, such as dyspraxia, hypermobility, auditory processing disorder, sleep disorders, and so on. Because of this, they may choose to focus on skills that aren’t a good match for the autistic child’s physical abilities, such as prioritizing speech over AAC. They might not realize when an unwanted behavior is the result of poor muscle tone, a sign of anxiety that might need a psychiatrist’s care, a symptom of poor proprioception, or an involuntary action caused by temporal lobe seizure activity. The result can be years of trying to get an autistic child to learn or stop a behavior when it isn’t physically possible for them to do so.

3. Unfamiliarity with Autistic styles of learning, socializing, and communicating:

There are some great studies about how autistic people communicate and socialize better with other autistic people than they do with neurotypicals. However, autistic people’s skills in these areas are always measured according to neurotypical standards, and the discrepancies are always seen as a failure on the part of autism rather than an argument for a different approach. Approaches like the Double Empathy Problem and the Intense World Theory are finally starting to chip away at this viewpoint. It isn’t wrong for an autistic person to try and learn some neurotypical interaction skills (once they are old enough to know that this is an option, not a requirement), but it’s deeply unfair that neurotypical people are never required to learn how to be friendly in a way that makes autistic people feel comfortable. No wonder so many autistic children end up feeling that friendships are more work than they are worth!

4. Assuming that performance reflects comprehension:

Dyspraxia, apraxia, test anxiety… there are so many reasons an autistic person might not be able to demonstrate that they understand something, and so they get the same boring basic lessons over and over, while in reality they desperately want to move on to intellectually stimulating material. And then the kid is viewed as having an elopement problem when they try to escape the boredom. I’m all for measurable results, but there are too many things that we don’t yet have the tools to measure accurately, like intelligence and thought. This ties back into my first point about infantilization, as well. A related issue, and a major objection of mine, is that ABA doesn’t explain things to the kids they work with. If you’re going to ask a kid to do some boring thing over and over, at least tell them what you are hoping they’ll get out of it. It can be a simple explanation: “I want you to practice saying this word so you can use it when you need it” could make all the difference in the world to a child’s engagement in speech practice. But ABA doesn’t give the child the benefit of the doubt, even when they claim to believe the child is intelligent. I hate that.

5. “When you have a hammer, everything looks like a nail.”

This is one of my biggest objections to ABA programs. Not that behaviorist techniques have no utility — I think they can, in the right circumstances– but that they are so easy to unintentionally abuse. Physical exercise is a great opportunity to use rewards to encourage incremental progress, and so are some tedious daily tasks. The problem is that once you start using this approach, you start using it in situations where it is inappropriate or even dangerous. You might think it is helpful to reward healthy eating, for example, but this can lead to emotional problems, eating disorders, and paying less attention to internal body signals (which might mean missing the symptoms of an illness, for example).

6. Decrease in intrinsic motivation:

To be less technical: you actually enjoy things less when you get rewarded for them than when you don’t! This issue has been studied a lot in non-autistic people, and much of that research is described in the book “Punished by Rewards” by Alfie Kohn. At a minimum, rewards should be reserved for stuff we hate doing, and only after we’ve established that we can’t find another way to make the activity fun. If a kid hates learning, there’s a problem with the teaching style, not the child. Human beings are born curious. We like cheering our babies on when they pick up new skills and new knowledge, but it isn’t necessary. They instinctively want to figure out how to crawl and walk and climb trees and learn the names of everything. They ask “why” long after we get tired of answering questions. Learning is a natural human activity. Schooling isn’t. Don’t confuse them, and don’t forget which one is more important.

7. Mixing up ABA and the tools it borrows

It is true that ABA can improve a child’s life by bringing in structure and visual supports and schedules ad prompts…. but you don’t need ABA in order to use those accommodations. People learn about these things from their ABA therapist and so they assume that these tools are ABA tools. But so many of the helpful ideas ABA brings in can be found in other places and other types of therapies, ones that don’t rely so heavily on compliance and rewards.

*****

I’m out of time, but this is a good starting point, so I’ll publish it now and hopefully expand on it later.

3 thoughts on “What’s Wrong With “Better” ABA?”

  1. Speaking of teaching skills through ABA, there are things that technically fall under this umbrella, right down to the “no aversives” part, that anyone might agree is abusive. I experienced one such technique (granted in the 90s) from one of my favorite teachers, ironically. I was at a field trip to a pool, and this teacher ducked me underwater and then lavished infantile praise on me in an attempt to teach me how to be comfortable with going underwater.

    I only later learned (from reading the Little House books by Laura Ingalls Wilder) that ducking of that nature has been used as a punishment by the same sorts of people who think spanking and whipping is okay to do to kids. But again, that teacher of mine didn’t intend that as a punishment. And she certainly wasn’t expecting it to trigger a fear of the water (which was later cured by a YMCA teacher who was not trained in special needs teaching).

    This teacher was doing that technique, that most people would recognize as abusive, because she genuinely believed it would be a step to help me learn how to swim. And I wouldn’t put it past a person administering “modern ABA” to do the same thing, for much the same reason. Especially when you consider that there doesn’t seem to be much effort to teach ABA practitioners not to put their hands on a child’s body unnecessarily, especially in the context of learning.

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    1. Yes, as with your teacher, I think there are many cases where the wrong thing is done with good intentions. That experience sounds terrifying to me, and I’m sorry you had to go through it. Ignorance isn’t an excuse, of course, but in trying to get therapists etc. to reform their practices, I have to remember that many of their faults are the result of misunderstanding rather than malice.

      It is all the more confusing because different people do, in fact, respond very differently to different approaches, and what’s traumatic to one person might not be to another. Many neurotypical people respond well to the aggressive challenge approach used by sports coaches and drill sergeants, where being put down makes them try harder because they want to “prove themselves.” To me, that approach is bullying, and I will just withdraw rather than being incentivized.

      Some children have too much caution (I was one of them) and need to be coaxed into trying new things, and sometimes pushed a little past their comfort zones in order to find out that something isn’t actually scary once they try it. I suspect that’s what your teacher was hoping to do for you, but her approach was far too aggressive and insensitive. I wouldn’t be surprised if something like works for some people, though.

      Other children lack caution and have to be kept from doing dangerous things. One toddler I babysat was initially timid about getting into the water, but once she started to enjoy it she lost all sense of caution and had to be watched carefully. One time she jumped in and sank, and of course I pulled her out immediately, and she told me proudly “I dived!” She had no clue that she couldn’t have come back up without my help.

      By the way, I still have trouble putting my face under water, even in the shower, but that is more for sensory reasons. I remember, around age 5, having to learn to take a shower instead of a bath because we had moved to a rental that didn’t have a bathtub. It took a lot of encouragement from my mother, and what helped most was learning to stand so that the water didn’t hit me in the face. Swimming was a struggle for me, too, for the same reason. I’m a pretty strong swimmer now, but not a fast once, because I still prefer the strokes where I don’t put my face in the water!

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