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On ABA: Evidence-based Doesn’t Mean Good Therapy3 min read

Many times “evidence-based therapy” can be little more than a mar­keting strategy.

Evidence-based:

- It is a term that in psy­chology is often used to des­ig­nate a therapy as being of a dif­ferent ori­en­ta­tion than tra­di­tional psy­chotherapy, without nec­es­sarily having sci­en­tific studies that show its long-term ben­e­fits or the per­cep­tion of well-being on the part of the client and the recip­ient of the therapy.

- Studies that the­o­ret­i­cally show “evi­dence” often base their evi­dence of effi­cacy over “doing nothing” or over pseudother­a­pies designed for the study in ques­tion, not over estab­lished ther­a­pies.

- There is a “pub­li­ca­tion bias” where studies that do not show if the therapy under study is sig­nif­i­cantly better than others, the study is not pub­lished, affecting meta-analyses.

This infor­ma­tion is from Dr. Johnathan Shedler, who notes that these highly stan­dard­ized forms of therapy are more mar­keting strategy than tangibly-helpful inter­ven­tions. They’re data-driven, unnat­ural behav­ioral approaches that depend on exploiting bad sci­ence to create a myth of being effec­tive.

This phe­nom­enon most often occurs in “autism” inter­ven­tions, wherein the evi­dence of greater effec­tive­ness of therapy that pre­sumes to be “evidence-based” is not supe­rior when com­pared to other inter­ven­tions.

Evidence of What?

It’s impor­tant for con­sumers, espe­cially those making deci­sions for chil­dren, to be skep­tical of state­ments that adver­tise a therapy as “sci­en­tif­i­cally proven” or “evidence-based.” What exactly is the evi­dence proving?

Sometimes, those who most aggres­sively repeat the words “sci­ence” and “evi­dence” are remiss when it comes to saying what that means. When asked what specif­i­cally is evi­denced, they remain silent, toss out jargon-heavy aca­d­emic arti­cles behind Research Gate pay­walls listing every­thing and any­thing related to ABA, or quote the Ivar Lovaas’s 1987 study showing the ques­tion­able achieve­ment of “indis­tin­guisha­bility from peers.” At the same time, they go to great lengths to sep­a­rate them­selves from Lovaas’s methods, or even worse, to jus­tify them by citing cul­tural con­text.

Mom And in respect to ABA the answer is very clear: The majority of the cases, many times with insignif­i­cant num­bers (yes, often single case design with only one learner) and per­formed by those who sell ABA, show that with the “ade­quate” rein­forcers, a person changes spe­cific behav­iors.

I am not ques­tioning that it’s true that ABA influ­ences behavior; but for me, that fact is not evi­dence of much. If a person is given a token of affec­tion (or a sign of interest, or a con­nec­tion on their terms) when they let someone prick their finger with a needle and only when they let someone prick they finger, they will most likely learn over time to let people prick them without ques­tioning. Most of the time, it is up to the family to con­sider what the autistic person should learn or unlearn, and not the autistic person.

If the family and ther­a­peutic team are not under­standing the autistic per­spec­tive, they can train the autistic person to ignore their own needs and wants for affec­tion or other rewards like access to their secu­rity blanket or favorite toy– because only when they comply are they are allowed to do what they enjoy.

Until then, they are restricted from what they want until they achieve what they set out to do in therapy. This therapy can be as inten­sive as 40 hours per week for chil­dren under the age of three.

Evidence Is Not Ethics

I, and many others, seek to go fur­ther when it comes to any study about autism:

  • Why are we studying this?
  • What are we trying to achieve, and why?
  • Are there eth­ical prob­lems in respect to these results or the means by which someone tries to achieve them?

Evidence Based on What?

For me, studies of effec­tive­ness in achieving behav­ioral change are not suf­fi­cient proof of appro­pri­ate­ness, long-term well-being, or that the ben­e­fits out­weigh the risks, espe­cially since so many times unques­tion­able obe­di­ence is what is being taught.

In addi­tion, for a therapy to be “evidence-based,” the fol­lowing is required:

  • Clinical expe­ri­ence
  • Best cur­rent research
  • Client/patient per­spec­tives

Assuming that ABA com­plies with the first two points, (it doesn’t), the last point requires careful review and con­sid­er­a­tion. In autism studies– his­tor­i­cally and often even cur­rently– only the per­spec­tive of fam­i­lies, excluding the autistic person, are con­sid­ered.

This hap­pens not only with ABA but with count­less studies on treat­ment and med­ica­tions “for autism” in gen­eral. And hence the enor­mous biases of inter­pre­ta­tion towards autistic people and the very fre­quent unin­ten­tional damage that is caused to us.

The so-called “sci­en­tific evi­dence” is not exempt from these biases. Let us not naively believe that every­thing that claims to be “sci­ence” is unques­tion­ably pos­i­tive.

Editor’s note: This article was orig­i­nally pub­lished in Spanish on Aprender a Quereme and has been repub­lished by the author, a member of The Aspergian team.

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5 Comments

  1. There is a LOT of ‘Bad Science’ out there, espe­cially in the ‘soft’ sci­ences.
    Basically ‘sci­ence’ does not prove any­thing, It fails to dis­prove or sup­ports the hypoth­esis. Enough inde­pen­dent studies that fol­lowed good sci­en­tific methods and that sup­port a hypoth­esis, then it becomes a ‘theory’. Never a proof.
    Then of course the really BIG problem is that we do not know how to deter­mine the cause of ‘Autism”, except is iso­lated cased of brain injury.
    Thee will never be a uni­versal ‘cure’ or help for ‘autism’.
    Some kids MIGHT ben­efit from ABA, but I serious sus­pect that it is unlikely to ben­efit all, or even the majority.
    In fact I totally believe that there will NEVER be a ‘uni­versal remedy’ for what is cur­rently diag­nosed as ‘autism’.

  2. Thanks for this. I’m having a hard time explaining to people why I don’t like the “sci­en­tif­i­cally based” ABA.

  3. “Evidence based” doesn’t mean eth­ical and it doesn’t mean the goals are good ones. Nor does it mean there aren’t any side effects.

    By the way, I caught a typo. Check the first sen­tence in the 3rd para­graph of “Evidence of what?” It looks like you forgot to delete a word from an ear­lier draft.



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