Applied Behavioral Analysis

Applied Behavior Analysis (ABA) is a psychological science of reinforcing behavior, which used to be called "Behavior Modification', and is sometimes synonymous with the ABA sub-type, "Positive Behavior Support" (PBS). Many people believe that ABA refers specifically to treating Autistic children. ABA sub-types used for Autistic children include "Early Intensive Behavioral Intervention" (EIBI) and, for older children, the "Lovaas Model', which is named after its inventor, Dr. Ivar Lovaas. Pivotal Response Treatment (PRT), formerly called the Natural Language Paradigm, is a play-based teaching methodology that utilizes the science of PBS to modify behavior.

EIBI begins with an intervention that focuses on, what is known as, "Discrete Trial Teaching' (DTT), which is a one-to-one interaction between the child and a trained therapist, who creates a highly structured, individualized and systematic learning environment. The process requires a significant investment in time to be effective; Lovaas recommends 40 hours a week of intensive therapy for two years.

In the intervention, skills are broken down into small, achievable tasks. Every task then consists of three parts: The therapist asks the child to perform a specific action; the child responds; and the therapist reacts to the child's response.

When the child successfully completes a task, the therapist gives the child praise and reinforcement. The rewards for successful completion may be small bites of food, playing with the child's favorite toy, hugs, and tickles. Gradually, external rewards like food and hugs are replaced with verbal praise and social reinforcements. Aggressive and self-stimulating behaviors are redirected into more socially acceptable responses.

Eventually, it is recommended to further "generalize" what the child has learned with EIBI-based methods using child instructed, play-type methods in more natural settings such as "Natural Enviroment Teaching" (NET, a generic term for "Incidental Teaching") and "Fluency-Based Instruction'.

Research shows that utilizing both structured and play-based EIBI methods yield the most effective results. Moreover, 42% fully recover in that they no longer have deficits in social interaction, stereotyped behaviors or interests, or in verbal and non-verbal communication. They also no longer show signs in the core deficit of autism spectrum disorders (ASD): mind-blindedness (or Theory of Mind). However this research has not been verified as accurate.

2007 study
A study completed in April 2007 by the UK foundation Research Autism found that 25 hours a week of therapy could significantly raise IQ scores. According to news service NewsWales, "IQ increased for two thirds of the children receiving the early intervention and very substantially for more than a quarter of them. For example, one child moved from an IQ of 30 up to 70; another from an IQ of 72 to 115. Most of the population of the UK has an IQ of between 85 and 115." This study however has not been replicated.

Criticism
''The following section contains elements that may be disturbing. Sensitive readers may not wish to read it.''"'If someone beat a child to prevent him from doing something they didn’t like, he would probably stop doing it, and you could then say beating is an “effective” method. They could even take data as part of a scientific study to show you that their child’s behaviors decreased after they started beating him. But obviously, that doesn’t mean anyone should beat a child.'"ABA therapy is undergoing serious and increasing criticism, both from Autism experts, ex-therapists, and Autistic people.

ABA therapy has been roundly criticized by the people who have experienced it. They are concerned that ethical issues in ABA may undermine independence and cause emotional damage. "Since ABA affects Autistic people’s lives first and foremost, their voices are the most important part of this discussion, and it’s essential that you listen to what they’re saying," urges ex-therapist Steph.

Normalization Focus
"The behavioral approach that is most popular—Applied Behavior Analysis—rewards compliance with “normal” behavior, rather than seeking to understand what drives autistic actions and attacking the disabilities at their inception."Most cases of ABA focus on making the Autistic person obey the therapist and suppress their Autistic traits. The goal is often to "make the child indistinguishable from his or her peers." Dr. Laurent Mottron noted that “Most educational programmes for autistic toddlers aim to suppress autistic behaviors, and to make children follow a typical developmental trajectory. None is grounded in the unique way autistics learn.”

Researcher Karla McLaren is concerned that enforcing neurotypical behavior " may actually interfere with autistic children’s development, their acquisition of language, their social skills, and their sense of belonging in the world. "

Sue Fletcher-Watson argues that instead of pushing Autistic children to suppress their Autism, therapies should focus on helping them learn how to become "optimally autistic.""'Pushing every child on to the same, neurotypical pathway, ending up in the same neurotypical city, is boring at best, abusive at worst. Early intervention research needs to have a firm foundation in engagement with the autism community, and an appreciation of the skills and learning of the autistic child. If early autism researchers can keep this in mind, we might be able to create something truly valuable – a way to help autistic children become optimally autistic.'"

The Foundation of ABA
ABA holds that if you make a child behave in the way you want, their brain will eventually change until it works the way you want. The theory takes a "black box" approach to the brain, examining input and output while considering the Autistic person's thoughts irrelevant.

Reinforcements, positive and negative, may be used to modify behavior. A positive reinforcement would be something the Autistic person likes, such as being able to play with their teddy bear or being able to read about their special interest. A negative reinforcement or "aversive," used in some forms of ABA, might mean spraying vinegar in the mouth, slapping them, or shocking them with electricity. The focus on obedience may not teach children how to think for themselves. They do not understand why something must be done, simply that the therapist wants them to do it. This may leave them unequipped for more nuanced situations, such as when their girlfriend wants to touch them in a way that their therapist trained them to recognize as inappropriate.

Tactics such as Quiet Hands, a practice that involves physical restraint of stimming and can result in Post-Traumatic Stress Disorder, are often part of ABA. There is nothing wrong with stimming unless it crosses the line into self harm.

Children as the Enemy, and Lack of Consent
i’m holding a spray bottle of vinegar he spits it out after the third time sobbing, he tells me that he hates his life and wants to die six years old the kid sitting next to him cannot speak, and instead starts wailing Many ABA therapists have fought against their patients, rather than working with them. Critics argue that the intense 40-hour weekly schedule, just as demanding as a day job for adults, is designed to break the children's will. Videos of ABA show therapists waving candy in front of sobbing and confused children, while the therapist tells the parents that they will not let the child "win." "'The rule is, once you give a command as an ABA Therapist, you must follow through with it no matter what. If a child tries to cry or escape or engage in any other “behaviors,” you can’t give in, because then you are only reinforcing their bad behaviors and making it more likely that they’ll use them in the future.'"ABA therapists will continue fighting even when the child is clearly distressed. Crying, attempting to leave the room, screaming for help, and lashing out are labeled "tantrums" and do not result in the therapist stopping. In some cases, the therapist may become violent. The child is given no way to communicate a withdrawal of consent, and may begin resorting to violence because a verbal "no" never meant no.

"I repeatedly found that I had to make a choice between doing the ABA and respecting the child," one therapist reflected.

This is particularly dangerous when considering the fact that autistic people are more vulnerable to trauma.

Compliance and Coercion
ABA therapy relies on a child obeying everything that an adult asks.

Children's agency may be completely ignored. Alternative communication devices may be taken away, protests may be written off as "tantrums" or manipulation, and children may be physically grabbed and moved (regardless of whether they want this or not). "'The first step in a program based on positive reinforcement is to find out what someone most enjoys or cares about.... And then making sure they have no access (or limited access) to those things outside of sessions or other situations in which someone is actively reinforcing them to do something.'"Therapists may make access to a child's favorite things contingent upon complete obedience. This could mean only being able to go to English class if the therapist determines the child has been good, or not being able to have a teddy bear unless the child has earned enough tokens, and losing tokens for not complying quickly enough, stimming, asking for the bear, or looking upset.

Goals may include modifying the child's behavior so that they act happy.

Critics are concerned that the emphasis on complete obedience may make a child unable to say no when needed, making them vulnerable to sexual abuse in the future.

Goals
Parents and Autistic people have expressed concern about the goals that many ABA therapists define. They call into question whether forcing a child to do something for the sake of others' comfort is worth it, especially when these goals come before skills such as expressing basic needs.
 * Making eye contact (which may be highly distracting or painful to Autistic people)
 * Hugging or kissing on cue
 * Smiling on cue
 * Toilet training (for the sake of the child's peers, not because the child seems ready)
 * Touching the nose, and other tasks that feel pointless to the child
 * Speaking (rather than communication)
 * Saying phrases that please the parents before teaching how to express basic needs (e.g. "That hurts" or "I need a break")

Other Ethical Violations
ABA has been roundly criticized for violations in ethics. It dismisses the parents' right to know by claiming that "Autistic regression" is a regular phenomenon, and that all Autistic children are or will become anxious and violent, when these changes may in fact be caused by trauma. Parents may be barred from witnessing ABA, on the grounds that they would intervene.

Researcher Michelle Dawson has written an in-depth criticism of ABA and its ethics.

Can ABA ever be helpful?
"'I absolutely, positively acknowledge that ABA is particularly dangerous. I would never allow it to be applied as it was originally intended. But, back to where I started, I do see some benefit in PARTS of its methodology.'"Autistic advocates are split on whether there are any helpful forms of ABA. It is important to note that some consensual therapies are labeled ABA for insurance purposes, and thus the "ABA" that one child receives might be radically different from the form of ABA that concerns critics.

Some advocates believe that ABA is irredeemable, because behavior modification is inherently demeaning, and its intense schedule requires total control over the child's life. A minority of activists believe that in some more drastic cases, carefully-monitored ABA can be consensual and constructive. One Autistic mother has ABA for her daughter, which teaches her to redirect destructive stimming, and allows her to ask for a break whenever she needs it. The mother monitors the sessions to keep up with what her daughter is learning, and make sure that everything runs smoothly.

Safety Tips for Parents
Parents can help keep their child safe by evaluating the following for a specific kind of therapy:
 * Are you allowed to witness what is going on?
 * Does the child enjoy therapy? (A good therapist can make therapy be enjoyable, and let the child feel a sense of agency. However, this is not meaningful if the child's behavior is modified so that they act happy, if the only way to access things they love is through therapy, or if they are trying to appease the behaviorist. )
 * Can the child express the need for a break?
 * Are basic needs held hostage? Will the therapist ignore a "no" because it isn't stated in the "correct" way?
 * Does the therapist want to end stimming?
 * Is the therapist trying to help the child feel happy and be competent, or trying to make them appear normal to others?
 * Is the child's competence being presumed?
 * If your child is typically nonviolent, do you hear about them becoming aggressive in therapy?
 * Would you be comfortable with a non-autistic child being treated this way?
 * Is gaining speech being prioritized over communication?
 * Is the child afraid of their therapist?

Know that it is possible to have a happy life with an autistic child. If you feel that a therapy is hurting a child, it isn't too late to stop it: parents have stopped controlling therapies and reported that their children are doing much better.

Potential alternatives include occupational therapy, RDI, floortime, exercise, AAC, and more. Every autistic person is different, and different therapies work for different people.