An Honest Reflection on Applied Behavior Analysis

When gathering information on Applied Behavior Analysis (ABA) as a therapeutic method for working with individuals with Autism, it is easy to find rave reviews about the years of research backing the science and the transformation of children receiving this service. It is also easy to find terrifying stories from adults left scarred after years of torture-like participation in ABA. All of this may leave you wondering whether or not this is an option you want to pursue for your child. As a parent, it is important that you get as much information as possible to make the best decision you can to help your child.

There is absolutely no denying that autistics have been traumatized by ABA sessions.  I would love to state this is all in the past, but that unfortunately is not always the case.  Personally, my heart aches at this reality, as to the best of my knowledge this has never been the intention of ABA therapists.  In order to understand how this has happened though, and how to ensure it does not happen to your child when receiving ABA, it is important to start with an overview of what ABA really is.

ABA is the application of the science of behavior analysis.  While often utilized as therapy for children with autism, ABA itself is not simply therapy and not just for autism.  It is a complex science.  In its very simplest form, it analyzes various contingencies in order to determine what causes behavior to change over time.  When we dissect the science, it is easy to see that the foundations of behavior analysis are all around us.  For example, say you wave to a neighbor and they wave back to you.  If you are more likely to wave to the neighbor in the future then their wave serves as a reinforcer of your wave.  On the other hand, say you wave to a neighbor and they scowl at you.  If their scowl served as a punisher, you are less likely to wave to the neighbor in the future. While a simple example, It is important to recognize that behavior analysis is a science that aims to understand behavior. It is not in any way meant to be bad or harmful.

Now, when we talk about ABA as a therapy for autism, it is the application of these scientific principles to individuals on the spectrum.  Herein is where the controversy lies.  Many have, rightfully so, stated trauma over participation in ABA programming. Oftentimes, this trauma is based on programs forcing conformity, such as removing self stimulatory behavior or forcing eye contact.  Additionally, strict adherence to rules without consent, the use of punishment based behaviors, and a loss of unstructured play time as a child are cited as having led to trauma as well.  This application of ABA is often based in the original Lovaas model whose aim was to have an autistic individual look “normal” (Lovaas, 1987).  This paper and its significant results were an impetus for starting ABA with individuals with ASD at a time when there were not many other therapy options. As a result, the methods used caught on like wildfire.  It unfortunately provided a model that was not truly individually focused and subjected many to the application of the science in a way that did not consider the person.  While the intent of these programs were positive, the applications focus on changing the person and not the behavior proved to be traumatic in some cases and thankfully became a strong voice for recognizing the need for change in ABA.

Since then, research on the application of ABA has grown significantly. We have learned the importance and effectiveness of individualizing treatment, increasing focus on positive reinforcement, and using a variety of models and applications of the science that are more natural and fun for clients.  We also have learned the goal is not to force conformity in individuals but to assist them in reaching their own goals. Additionally, the Behavior Analysis Certification Board (BACB) has continued to update its ethical codes to ensure, to the best of their ability, that the science is being applied in a way that focuses on the individual and not on set standards others believe they should achieve.  ABA should not be a traumatic experience, but a positive one. Below are some key components that are important to look for when deciding whether or not to start ABA therapy with your child.

Social Significance

The goal of ABA should never be to change the person but to assist them in achieving their goals.  The science is in behavior and goals should be based in socially significant behavior.  This essentially means that the goals should not be to “remove” the autism, but to teach the individual beneficial skills in order to assist them in their growth, achievements, and independence. 

To go further on this, the focus of these goals should always have social validity, meaning the goals should be socially significant, appropriate, and important to the individual.   The focus should not be on changing the person, but on the behaviors, so that he or she is:

• Assisting one in reaching their goals

• Increasing one's ability to self advocate for themselves

• Providing one opportunity to engage in the world around them in the way that they want to  

With this, there should not be a focus on making someone “look less autistic” by forcing eye contact or removing self stimulatory behavior.  Instead, as an example, the focus should be on increasing communication in order to self advocate; or increasing task completion in order to participate in a desired class where this skill is a prerequisite; or increasing turn taking in order to play a preferred game with a desired peer.  The list of examples could be endless, but the purpose is to focus on skills that assist the individual in reaching their short and long term goals.

Individualized

All treatment plans and programming procedures should be individualized.  This ties in with the intended change being focused on the behavior and not the person.  It is important that the individualization of care extends beyond just the behavior.  This means the goals, programs, the implementation, etc. should incorporate the client’s input.  When looking at the science of human behavior, it is important to note  that what changes behavior for one person will not for another.  While the principles of ABA help us to understand and analyze the complexities of behavior as a whole, the implementation teaches us that the application of these principles varies from one person to the next.  What one person finds reinforcing, another may find punishing.  What lays the foundation for one person to be upset sets the stage for another to be happy.  This individualization is critical for appropriate and effective treatment. 

Relationship Based

There needs to be a relationship between the therapists and the client.  Just like any other treatment, it is imperative that the person receiving therapy likes and trusts the person delivering it.  With this, ABA should always start with relationship building.  No one should come in and try to force a client to do something. Ever. They should build a relationship, and in that time learn about each other.  They should learn what the client likes and dislikes.  How they act on their good days and their bad days.  In what ways they are reinforced, what they consent to, and what is worthwhile to them and what is not.  Additionally, they should build mutual trust and respect.  The therapist should work to get to truly know the client, not to get them to act in the manner the therapist sees fit.  

Enjoyable

ABA therapy should be predominately fun and interactive.  It should be something your child mostly enjoys.  I say mostly because there are times or days that they may not want to participate.  There are also times that they may be working on an important and socially significant goal that is a greater struggle for them.  There are times that they may be frustrated with being held to expectations they are capable of, as we all are at times.  Keeping this in mind, the overall experience should be positive.  While there are many times ABA is delivered in a discrete format while sitting working at a table there is a multitude of research displaying effectiveness outside the table. Additionally, while 40 hours a week is often the recommendation, there is also significant research showing that it can be effective at a lower intensity.  This means that applying the principles of behavior analysis can be done in a variety of empirically validated ways that can be fun, engaging, and beneficial.

As previously mentioned, the decision is ultimately up to you as a parent. From a professional perspective, one becomes a behavioral therapist to improve the lives of others.  While ABA may be misapplied by a minority, like any other type of therapy or treatment, the overwhelming majority of ABA programs for kids with autism uphold the standards of the BACB and create a foundation to unlock learning and independence for the client.  While the initial application of the science may not have always focused on relationships and individualization, the field has developed significantly over the years.  With this, ABA has been proven to have an overwhelmingly positive impact on the lives of countless individuals when applied appropriately.  The important thing is that you gather information, review providers, and make an informed decision that is best for your child.  

For information on Galliant’s clinical philosophy and client centric values visit https://www.galliantcare.com

References

Clarifications Regarding Applied Behavior Analysis Treatment of Autism Spectrum Disorder. Behavior Analyst Certification Board

First Hand Perspectives on Behavioral Interventions for Autistic People and People with Other Developmental Disabilities.  Autistic Self Advocacy Network

Lovaas, O. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children. Journal of Consulting and Clinical Psychology, 55(1), 3–9. https://doi.org/10.1037/0022-006X.55.1.3