Dear New York Times: ABA is not a therapy6 min read

 “My thinking is first and last and always for the sake of my doing.”

(James, 1890; Fiske, 1992; Gollwitzer & Bargh, 1996).

In an article “Early Treatment for Autism Is Critical, New Report Says” pub­lished by the New York Times, ABA providers are uncrit­i­cally offered the plat­form to adver­tise their “therapy” without any dis­senting opin­ions or crit­ical insight.

It should be known to the New York Times and noted that ABA is also viewed crit­i­cally from an aca­d­emic per­spec­tive. Among other things, the study and evi­dence base is far from being as clear as it is pre­sented in the article. The studies on ABA often have method­olog­ical short­com­ings (for example, studies often include single case design or oth­er­wise extremely small num­bers of test sub­jects, no studies on long-term effects in rela­tion to the sat­is­fac­tion of the par­tic­i­pants, no con­trol groups…), and they are basi­cally based on a mis­de­f­i­n­i­tion of autism as Elle Loughran has already aptly explained in her article “The Rampant Dehumanization of Autistic People.”

If one starts out from a wrong def­i­n­i­tion, nothing rea­son­able can come out of it (like when the medieval doc­tors used a wrong but coherent theory to explaine dis­eases as the results of winds, nat­ural gases, and the four human humours: blood, phlegm, yellow bile, and black bile).

The min­imum jour­nal­istic stan­dards would have required a more bal­anced article. Instead, ABA is touted as a mir­acle cure, without any side effects. It’s not cred­ible, even if you don’t know any­thing about ABA. A pro­found inter­ven­tion in the nature of a child, without any reported on neg­a­tive side effects? It smells like a snake oil salesman.

In Germany, ABA is still being viewed crit­i­cally and is there­fore not cov­ered by health insur­ance com­pa­nies. As autism is not con­sid­ered cur­able, it log­i­cally cannot be cured ther­a­peu­ti­cally and there­fore the ABA “therapy” cannot work by def­i­n­i­tion.

However, we are also flooded with fantasty-based arti­cles and adver­tise­ments from insti­tutes that offer this dres­sage at high prices. A mir­acle cure! No neg­a­tive side effects what­so­ever! Almost like magic! These are pied piper methods, and it’s com­pletely non­sen­sical that The New York Times has pub­lished such an article.

I am not against sup­ports, accom­mo­da­tions, or ther­a­pies– as in the field of speech therapy or psy­cho­log­ical sup­port in coping with stress, sleeping prob­lems, etc. I am against ABA as as a “therapy,” because this “therapy” does not deserve the name therapy and uses methods of brain­washing and operant con­di­tioning.

Quote from Dr. Levy from the New York Times article: “The most intense inter­ven­tion is Applied Behavioral Analysis (A.B.A.), a pro­gram that addresses spe­cific behav­iors, iden­ti­fying trig­gers and antecedents, and responding with rewards when a child behaves in the desired way.”

That rings a bell for me…

What is ABA? In a nut­shell: ABA is based on the behav­iourism that sees the human being as a blank page that can be filled with con­tent or deleted at will. This school of thought came into dis­re­pute in the 1970s because of its con­ver­sion ther­a­pies for homo­sex­uals, and is now expe­ri­encing a cyn­ical renais­sance with ABA.

The use of ABA for the treat­ment of autism is crit­i­cally eval­u­ated in many parts of the world, because it is based on one of the darkest chap­ters of behav­iourism: the exper­i­ments of Olé Ivar Lovaas, who tried to “cure” autistic chil­dren.

For Lovaas, autistic chil­dren were “only per­sons in the phys­ical sense, but not a per­son­ality in the psy­cho­log­ical sense.” He saw his task in con­structing a person from their raw mate­rial. To achieve this goal, he used slaps and scare tac­tics. Although these are not always part of ABA treat­ment today (though elec­tric skin shocks are still used at the Judge Rotenberg Center), ABA aims to change the behav­iour of autistic chil­dren without learning the rea­sons for their behav­iour. 

To achieve this, so-called “early ther­a­pies” are car­ried out on young chil­dren for at least 40 hours a week, an inten­sive working week. Typical char­ac­ter­is­tics of autism such as stim­ming or spe­cial inter­ests that help autistic chil­dren cope and reg­u­late their ner­vous system are pre­vented. Even when they claim it’s not, the aim is often that the child behaves as little like an autistic as pos­sible to the out­side world.

The training causes great harm on the psy­cho­log­i­cally, even if this is not imme­di­ately apparent. Basically, the use of ABA is a sign that the child is not accepted in its per­son­ality and iden­tity, which is inex­tri­cable from autism. In order to expe­ri­ence this, one only has to ask autistic people who have expe­ri­enced this treat­ment.

Some studies, such as those men­tioned in the New York Times article, do con­firm the effec­tive­ness of ABA. Besides the method­olog­ical short­com­ings men­tioned above and also con­trary studies that found no effects, “suc­cesses” are not sur­prising because ABA is clas­sical con­di­tioning: the effect of psy­cho­log­ical manip­u­la­tion that is empir­i­cally mea­sur­able.

Now, when studies find that autistic people can be suc­cess­fully con­di­tioned to behave incon­spic­u­ously and sup­press their actual per­son­ality, suc­cessful con­di­tioning is suc­cessful dres­sage, but not suc­cess in terms of the sat­is­fac­tion of the indi­vidual, as is the case with other psy­cho­log­ical ther­a­pies.

To put it suc­cinctly: one can also force behav­iour by means of tor­ture, but I would not call therapy such a thing. ABA is about adapting the out­wardly vis­ible behav­iour of a person to a defined system. The needs of the indi­vidual are put aside in favour of the sen­si­tiv­i­ties of the envi­ron­ment.

And this 40-hour weekly con­di­tioning is best done with tod­dlers, according to the New York Times article which func­tions more like a com­mer­cial than cred­ible jour­nalism– just as Olé Ivar Lovaas trained homo­sexual boys in the 70s to say that they sud­denly found only women attrac­tive. Today, this thought makes our hair stand on end in horror. In the past, deaf chil­dren were forced to read lips, today they are (hope­fully) taught sign lan­guage. Left-handed chil­dren had to write with their right hand. Today, left-handed chil­dren are no longer forced to deny their neu­rology and are of course allowed to write with their left hands.

In the past, the rule was: no matter what the child feels, the main thing is that it looks normal. Nothing else counted. The black box didn’t matter. The arro­gance of the majority, the status quo, deter­mined suc­cess. Fortunately, that has changed in many areas. But the voices of autistic people are still not being heard. Now, there is an aggres­sive push to bend even the youngest chil­dren into expen­sive ABA “ther­a­pies.”

In 20 years, the sci­en­tific com­mu­nity will be ashamed of this.

I am sure that ABA sup­porters will claim that I am exag­ger­ating when I men­tion behav­iorism and tor­ture in one sen­tence– but it’s not very far off. Behaviorist methods were also used by psy­chol­o­gists and other pro­fes­sionals to develop tor­ture methods for the C.I.A. (the psy­chol­o­gists involved called this “The Behaviour Management Plan”), which were used, for example, in Guantanamo Bay.

Radical behav­iorist methods of clas­sical con­di­tioning should finally be put where they belong: on the garbage heap of his­tory, and not be uncrit­i­cally pro­moted by the New York Times.

Additional sources:

Fiske, S.T. (1992). Thinking is for doing: por­traits of social cog­ni­tion from daguerreo­type to laser­photo. Journal of Personality and Social Psychology, 63(6), 877–889.

Gollwitzer, P.M. (1996). The Psychology of Action: Linking Cognition and Motivation to Behavior. New York

James, W. (1890). The prin­ci­ples of psy­chology. New York : Holt.

 

 

 

 

 

 

 

 

 

 

 

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5 Comments

  1. Not to men­tion a few studies done on ABA point to a high PTSD rate among autis­tics after said ther­arpy.

  2. I agree that ABA is harmful, and that New York Times shouldn’t be a plat­form for mar­keting it — espe­cially without any men­tion of the con­tro­ver­sies asso­ci­ated with it. However, I’d like to cor­rect this:

    “ABA is clas­sical con­di­tioning: the effect of psy­cho­log­ical manip­u­la­tion that is empir­i­cally mea­sur­able.”

    Classical con­di­tioning is spe­cific behav­iourist term that means to link a stimuli with a par­tic­ular emotional-physiological auto­matic ner­vous system response. An example is if you’ve come to asso­ciate the McDonald’s logo with sat­is­fying hunger, and as you drive on the motorway late at night and you’re hungry, you see the McDonald’s logo. Your hunger sud­denly feels intense, your saliva pro­duc­tion increases, and the McDonald’s drive-in feels mag­netic. Whatever you decide to do in this sit­u­a­tion, the emotional-physiological reac­tion just described is a result of clas­sical con­di­tioning. Emotional-physiological responses to a trigger or sit­u­a­tion AKA a stim­ulus (or col­lec­tion of stimuli) are mod­i­fied by linking the stim­ulus emotional-physiological response by con­sis­tently linking it to a dif­ferent out­come. The new out­come hap­pens regard­less of the indi­vid­uals’ behav­iour, it is not “con­di­tional”.

    ABA is based on Operant con­di­tioning, and the for­mula is stim­ulus — behav­iour — con­se­quence. Behaviour is mod­i­fied by con­trol­ling the stim­ulus and the con­se­quence, so that’s where we have rewards and pun­ish­ment. The con­se­quence is con­di­tional; it depends on the indi­vid­uals’ behav­iour what the con­se­quence is, so in a sense the indi­vidual is given con­trol over the out­come (“if you do *this*, then *that* hap­pens”), so they learn to con­trol their behav­iours, and con­sciously behave in par­tic­ular ways.

    Both types of con­di­tioning influ­ence behav­iours, and both types of con­di­tioning are taking place relent­lessly and simul­ta­ne­ously, whether anyone is aware and delib­er­ately “using them” or not.

    In ABA and traditional/balanced dog training, the whole or main focus is on using operant con­di­tioning to alter behav­iours, whereas the clas­sical con­di­tioning aspect does typ­i­cally not get much atten­tion. Generally the emo­tional wel­fare of the indi­vidual is valued and con­sid­ered impor­tant, the more atten­tion turns to clas­sical con­di­tioning, along­side the operant con­di­tioning models used to train behav­iours (not just for autistic people).

    1. My apology for the typos in my com­ment above, I wish I could edit it. This:

      “Emotional-physiological responses to a trigger or sit­u­a­tion AKA a stim­ulus (or col­lec­tion of stimuli) are mod­i­fied by linking the stim­ulus emotional-physiological response by con­sis­tently linking it to a dif­ferent out­come.”

      should say:

      “Emotional-physiological responses to a trigger or sit­u­a­tion, AKA a stim­ulus (or col­lec­tion of stimuli), are mod­i­fied by con­sis­tently linking the stim­ulus to a dif­ferent out­come.”

      (Sorry the sen­tence got scram­bled)

    2. Author

      Hi Anna, thanks for your mes­sage — it’s true, ABA uses both classic and most operant con­di­tioning (I had over­looked that), I should add that to the text. But it doesn’t change the core state­ment — the manip­u­la­tion is mea­sur­able. And the problem is that well-being is not impor­tant in ABA, only the behav­ioral out­come. There are no studies even that mea­sure whether par­tic­i­pants are happy or unhappy. That doesn’t seem to matter.
      To be honest, I find per­son­ally operant con­di­tioning even more eth­i­cally sen­si­tive — as you know, operant con­di­tioning is also used by game devel­opers to create games with an addic­tive factor.

      We cer­tainly agree on this:
      Classical con­di­tioning: already existing reac­tions are con­di­tioned to new stim­ulus con­di­tions (Pavlovian dog)
      Operant con­di­tioning:
      Learning of stimulus-response pat­terns from orig­i­nally spon­ta­neous behav­iour +
      The fre­quency of a behav­iour is per­ma­nently changed by its pleasant (appet­i­tive) or unpleasant (aver­sive) con­se­quences.

      Thank you for your addi­tion, because it is true that ABA very often uses operant con­di­tioning.

  3. This con­tains a lot of mis­con­cep­tions and common mis­char­ac­ter­i­za­tions of Applied Behavior Analysis, which is essen­tially just a series of tools devel­oped from the study of human behavior.

    Like all tools, ABA can be and cer­tainly has been mis­used, but to dis­miss ia field so com­pletely is to ignore the many chil­dren who have been helped and the many people who can advo­cate for them­selves due to evi­dence based prac­tices devel­oped by behavior analysis including PECS and other methods for teaching verbal behavior, chaining pro­ce­dures to teach com­plex tasks, dif­fer­en­tial rein­force­ment, and Natural Environment Teaching.

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