This is Part Two of my series. You can find Part One here. This article dives into the key strategies used in ABA.
In order for parents to make an informed decision about ABA, we need to understand the what’s, why’s, who’s and how’s of the intervention.
This crucial information is often omitted when the doctor recommends ABA, leaving parents to make a completely uninformed decision.
Yes, this article is longer than I’d usually write. ABA is a sensitive topic that has significant impacts.
There’s a lot to cover and I’m targeting the parents who are searching for resources so they can make a decision about enrolling their child in ABA. So I want this article to be comprehensive.
Before beginning, I want to clear up some common misconceptions:
- ABA is not a treatment for autism. As I stated in part one, autism isn’t a behavioral diagnosis. It’s a neurological and developmental diagnosis.
Autistic traits and co-occuring conditions frequently manifest as observable behaviors, but the root causes for those behaviors originate from within an autistic person’s nervous and sensory systems. - The term “ABA therapy” is inaccurate and misleading. We should stop using that phrase altogether. ABA is an intensive intervention created with the sole purpose of conditioning behavior.
- The people working with our children are not “ABA therapists.“ In fact, they aren’t therapists at all. BCBA stands for Board Certified Behavior Analyst. RBT stands for Registered Behavioral Technician. None of those titles include the word “therapist.”
Many RBT’s have little more than a high school diploma. They’re only required to complete 40 hours of training, pass a test, and undergo 15 hours of supervision before they can work independently with our children. (That’s less than two weeks of training.)
While RBT’s technically work under the supervision of a BCBA, they hold a great deal of control over day-to-day programming and interactions – with little more than a high school diploma.
For this article, I’ll use the terms technician and analyst interchangeably in reference to the adults working with our children.
The information in this post comes strictly from resources intended for ABA providers. My own knowledge and opinions will be italicized.
The Basics of ABA
Antecedent, Behavior, Consequence (The ABC’s of ABA) – This is the cornerstone of ABA intervention. The antecedent is what happens before an “undesirable behavior” occurs. The consequence is what happens after.
If it sounds simple enough, that’s because it is. If nothing else, ABA is well-packaged. That’s a big reason for its success. While there’s plenty of data taken for bar graphs and line plots, there’s very little thought involved.
Functional Behavior Assessment (FBA) – When an “undesirable behavior” arises, the technician will complete an FBA to determine the “function” of the behavior. What is the child getting out of it?
There are only four functions of behavior analysts choose from: access, attention, avoidance (escape), or automatic (sensory). In this context, sensory means that the behavior “feels good to the child.”
After choosing one of the four functions, technicians relay their analysis to parents. They also provide extra insights to help parents understand the child’s behavior better. Parent education is essential to the success of ABA.
This is when analysts reinforce words like attention seeking, noncompliant, defiant, aggressive, and manipulative. These terms, no matter how inaccurate, are at the heart of behaviorist practices. They frame the conversation surrounding autistic behavior in our schools and in our communities.
We almost never hear words like emotional regulation, anxiety, fear, confused, unheard, and undervalued. These are the words we should bring to the forefront. The problem is these words go against behaviorist principles, and that’s bad for business.
The human condition doesn’t fit neatly into four categories. People have complex sensory systems, a wide range of emotions, and a need for communication and respectful relationships.
There are multiple ways to judge the circumstances surrounding any given behavior. Therapists and counselors go through years of school in order to make those assessments. RBTs and BCBAs don’t have the training, nor do they have the authority, to suggest anything beyond the measurable, viewable surface.
Interpreting behavior is subjective, and those judgements have significant impacts on our children and the autistic community overall. As parents, we should be mindful of those impacts.
Key Strategies Used in ABA
Preference Assessments – During the first few days of ABA, the technician learns what makes the child happy. What are his favorite activities, foods, games, and toys? Does he like high fives or stickers? Does he like big reactions, or something more subtle? What’s his comfort item?
It seems like this time is used to bond with the child because it’s so fun, but the information is actually used in behavior modification plans as reinforcers.
Pairing – Technicians use their results from the preference assessments to “pair” themselves to the child’s favorite things. I know this seems confusing, because the technician doesn’t pair with the child. (Again, this comes straight from ABA provider resources.)
By pairing with the reinforcers, the technician becomes the gatekeeper of all-things-fun-and-good. If the child wants his favorite activity or item, he will now have to go through the technician to get them. Pairing increases the likelihood that the child will want to stay with the technician and will comply with directions.
Example: If your child’s favorite toy is a ball, the technician will keep the ball close (pairing with it), so the child can only access it when she does something to “deserve” it.
Behavior Improvement Plan (BIP) – This is also known as a behavior modification plan or program. Using results from the child’s FBA and preference assessments, the analyst creates a goal to extinguish certain behaviors using the following methods:
- Discrete Trial Training – The adult provides a prompt (demand) and reinforces the desired behavior with a reward. For instance, each time the child sits at the table, the technician gives the child a half of a gummy bear to reinforce that behavior. These rewards are referred to as tokens.
- Withholding – When the child doesn’t exhibit desired behavior, the adult withholds the reinforcer from the preference assessment. This can be as obvious as withholding a treat, favorite toy, or recess time, or as subtle as withholding a smile.
The next time someone tells you ABA isn’t like it used to be, this is what they’re talking about. Instead of squirting hot sauce into a child’s eye (yes they used to do that), they’re withholding positive reinforcements instead. While only one causes physical pain, they both are heartbreaking and hurtful. - Planned Ignoring – This one is self-explanatory. It’s the method of extinguishing an undesirable behavior by not giving it a response.
For example: If the child is upset and unable to express why (hungry, sick, tired, overwhelmed) the technician will ignore the child until she stops communicating that discomfort.
If this strategy doesn’t bother you, I’m guessing you didn’t read the first part of this series. You might want to do that now.
Food for Thought
Best practices in early childhood aren’t complicated – not even for autistic children. At the foundation you’ll find a safe, supportive, and nurturing environment. At the core of every quality program, you’ll find child-led learning experiences, with an emphasis on play.
There are no rules about how to play or what goals the child should achieve. There are, however, guidelines for protecting children’s emotional health from even the slightest chance of harm.
There’s nothing therapeutic or developmentally appropriate about intensive behavioral conditioning, not for one hour per day and certainly not for 40 hours per week.
The practice is, in fact, compliance training– treating children like machines in order to force them to act the way their neurotypical peers act, even when it goes against their own unique neurological make-up.
(I don’t say ABA treats children like animals. Actually, most people treat their pets with more humanity than ABA strategists treat autistic children.)
Autistic people have unique developmental timelines and sensory profiles. Instead of suppressing their behaviors, we should value them and learn from them.
They aren’t wrong or disordered, they’re simply different. Pressuring our children to do things before they’re ready adds extra levels of anxiety, frustration, and shame.
As parents, we should put our energy into protecting our children from the false narratives of “disordered behavior” and “catching up.” We should create a bubble of support, acceptance, and empowerment.
Only then can we strengthen their confidence and encourage a strong self-identity so they can live their best lives.
Part Three of this series will address how parents can identify behaviorist strategies in settings we don’t expect to find them being used.
More helpful links for now:
On Hurling Myself Out Into Traffic to Get Out of ABA Therapy by Alexanderstreasureblog
I Am a Disillusioned BCBA: Autistics Are Right about ABA by Jo Ram
The Hidden Cost of Planned Ignoring by Dr. Mona Delahooke
ABA for Creating Masking Black Autistics by Cheyenne Thornton
More book recommendations for now:
Ido in Autismland by Ido Kedar
Uniquely Human by Dr. Barry Prizant
Sincerely, Your Autistic Child by AWN et al
The Explosive Child by Dr. Ross Greene
- The Strategies of ABA – What Parents Should Know Before Making a Decision - May 3, 2021
- Does ABA Work? We’re Asking the Wrong Question. - April 8, 2021
24 Responses
absolutely excellent 2 part article. Every parent considering ABA for their child needs to read this. Thank you.
This is such crap. A turd in fancy wrapping. This is NOT how ABA works. YES, you used ABA terms but you manipulated the data for a biased read. For example: If the child is upset and unable to express why (hungry, sick, tired, overwhelmed) the technician will ignore the child until she stops communicating that discomfort. ~~ A technician would not do that. That would violate the whole purpose of learning communication. Something that ABA has helped my nonverbal child with tremendously!!! IF anyone is seeking ABA, please seek out other sources for information. This is bias AA hogwash!!
Sounds like you’ve met every single technician out there, lol.
This is the epitome of what’s wrong with our society.
The writer of this article literally compares squirting hot sauce into a child’s eye and not rewarding them when they don’t complete a goal….
Imagine going into a school and telling a teacher “my child deserves an a on this paper” when their child just wrote their name on the paper. That is what the writer of this article considers abuse. No! Every child in the entire world hast to learn, work, grow and change. Everyone.
If you refuse to teach your child to ‘not use a diaper’, ‘eat with a fork’ or ‘brush their teeth’ (all things taught with ABA) because that would be “changing them“ than you are not only neglecting your child but actually abusing them. Children with autism deserve it the opportunity to learn and grow like everyone else and depriving them of that is harmful to them!
Moreover telling someone that they’re abusing their child for trying to teach them how to use the toilet is mind blowingly disgusting…
I’ve read your reply a few times and want you to know that autistics can learn to use the commode, eat witha fork or brush their teeth…all without ABA. Children learn to do things when they are ready, they work, learn, grow and change…all without aba. It’s a shame that parents continue to be unaware of the harm that this practice does.
kat mcgurk: Making claims that “autistics can learn to … all without ABA” and “children learn to do things when they’re ready” presupposes that you have the authority to speak for the entire community. No one has that authority, especially someone who doesn’t include autistics who are also intellectually disabled; not all autistics can learn those things with or without ABA, and not all of them will ever be ready to do so.
That’s the worst shame within the autism community: autistics who believe they can speak for the entire community while simultaneously dismissing autistics who are far more disabled by their autism and/or intellectual disabilities.
>while simultaneously dismissing autistics who are far more disabled by their autism and/or intellectual disabilities.
Who on this thread has said anything about their own support needs? What qualifies you to diagnose a stranger over the internet?
That’s a good argument against what you say we’re doing.
Here’s what concerns me about one of the not rewards. Planned ignoring reminds me a lot of the silent treatment, which is a form of emotional abuse.
There is a very good channel about learning I’d like to recommend to you: Zoe Bee. She doesn’t talk about ABA in specific, but she does have an excellent video on grades. I would appreciate it if you had a look.
When my son was in ABA and he used his AAC to say “stop , cookies”. You know what the ABA therapist did? They stopped and went and had cookies together. You’re lying about ABA and probably never actually experienced it or didn’t actually experience real ABA from a real therapist.
It’s interesting you used the term “therapist” when the article explains that the techs are not therapists. Were you with your son all the time while the aba tech worked with yours? Did they use food rewards or planned ignoring ever?
And oh the irony of there being absolutely ZERO grace in that reply, “You’re lying about ABA and probably never actually experienced it ” –> “The name Hannah stems from the Hebrew name Channah, which means “favor” or “grace.””
My son’s RBT most definitely will with hold rewards and does planned ignoring. I hate it which is why I’m reading this article. Because I want to take my son out of it immediately. My son is more provoked than helped in my opinion. Every day that the RBT is at our home is a nightmare pretty much. Some days are good and productive. I think at this time, we don’t need ABA.
Whenever someone writes about ABA, many parents immediately come to its defense. It’s happened here. There are better ways to support autistics than with behavioral conditioning and stressful 1:1 behavioral modification. I can’t imagine 1 hour a day of this let alone 8 that many children experience now. It’s a good article with food for thought for those who are ready to hear it.
Whenever someone writes an obviously-biased article about ABA-based therapies and targets parents who are considering the therapies, they almost never include information about children whose self-injurious or aggressive behaviors have been ameliorated by this intensive 1:1 support.
I can’t imagine that most of the autistics who write these articles and comment on them have ever experienced ABA-based therapies themselves.
And yet somehow those who pull the self-injury card never ask any of the folks who STARTED self-injuring as a result of having been previously subjected to ABA. Because that happens.
Load of crap. Wish I could include a screenshot of the notes from yesterday’s session in which the therapist noted my son was “disregulated” not “defiant”. I just don’t understand the purpose of spreading misinformation & trying to scare parents from getting their child support to help improve their lives. ABA has done wonders for so many kids. Let people try what they want & do what is best for their child without the scare tactics & guilt trips.
Re: “You’re lying about ABA and probably …” Yes, yes, everyone whose experience is not in line with your experience is by definition a liar because your experience is the only right and possible experience. Man, talk about a poster child for rank arrogance, “I AM PARENT OF AUTISTIC THEREFORE I AM A FRIGGIN GOD SO BOW TO MY INFINITE KNOWLEDGE OF ALL THINGS AUTISTIC! And by the way, I am one hell of an awesome martyr too!”
(I’ve long heard that us autistics cannot comprehend snark and sarcasm, so God {the actual God, not the parent of an autistic who thinks that being that makes them God} only knows if I did that right.)
Please tell us all about your personal experience with ABA-based therapy, but only if you can do it without being sardonic and making yourself out to be a martyr.
Can you?
scottfw: Please tell us all about your personal experience with ABA-based therapy, without being sardonic and making yourself out to be a martyr.
Can you?
As someone who worked in a sloppy ABA environment and as a parent whose child has been so misunderstood and unfairly labeled, I greatly appreciate the concerns raised in this article. If ABA cannot respond sensitively and respectfully to these concerns, it deserves to be discredited so empathetic, supportive therapies can have a chance to help autistic children and teens.
what you are describing is an unethical ABA program with gross oversimplification. I encourage you to look into relational frame theory and acceptance and commitment therapy, both which stem from ABA and shocker, address verbal behavior AND emotions and thoughts and especially internal states of being. I’ve been hounding an OT for one of my clients for support due to dysregulation. I can’t get them to answer me. So who is the issue there?
I am afraid articles like this will do so many children a disservice… Maybe instead of veering parents away from ABA, we can start teaching how to tell a good therapist/company from a “bad” one?
We could dissect any terminology and make it look “bad” or “good”, this article is just that and can be misleading…
In articles such as this, negative personal accounts of past ABA therapy are brought up (never positive ones)…
And, although ABA has changed/advanced (as has psychiatry and medicine in general) that fact is just brushed off…
In my opinion, articles such as this should start off with “this is the opinion of…”
Help for autistic people varies as much as the spectrum varies. We need to learn more about autism and we need to be better with diagnosing to better serve the autistic community.
In all my experience of ABA, I haven’t seen any good ABA. There’s meh ABA and bad ABA. Meh ABA does stuff that other therapies do better, and avoids some of the worst pitfalls of ABA, but it’s still not worth doing instead of stuff like occupational therapy, speech therapy and sensory integration therapy.
I wish articles such as these did not conflate everything under a tiny umbrella, because it requires a lot of effort to parse things out. I am a neurodivergent BCBA (finishing their doctorate), so I’m going to do my best to separate my responses into two main points:
Above everything, I think the most important part of this article (perhaps I’m wrong) is to call attention to abusive, traumatic, or otherwise problematic practices that have been and are currently present in ABA therapy (yes, I will use the term “therapy” because I am able to appreciate the arbitrary nature of words, to which we give meaning, and can treat “behavioral therapist” and “psychotherapist” as two very different concepts). The history is real and the harm ABA can cause is also real. While this article’s description of ABA is wrong and grossly simplified on many counts, that does not diminish the larger point, which is that many, MANY individuals have described experiences with ABA that should horrify any practitioner in the field. Rather than dismiss those experiences, they should be brought to the center and inform our practice. The responses above that focus on what this article got wrong are, I believe, missing the much larger issue. I left the field for a time, because these practices did not align with my values, resulting in an overwhelming burnout. And while I have seen and worked with “good BCBAs” who utilize trauma-informed care and assent-based practices, this is sadly not the norm and too many practitioners continue to use strategies that are abusive, distressing, and even result in Trauma. On top of that, not enough of “the good ones” are speaking out, so these practices continue to go unchecked.
I do want to clarify a few things about ABA, however, as both the article and many of the comments are missing some key information. First, ABA is the application of behavior analysis to change behavior in meaningful ways. While ABA is often synonymous with “treatment of autism” (I’m not going to unpack the problems of that label/concept, but that is how it’s most commonly phrased), ABA is significantly more broad. The principles of behavior are not limited to those who practice behavior analysis. All behavior is governed by these principles – behavior analysis simply utilizes our understanding of those principles in a more systematic way. Consider one of the article’s examples: “withholding reinforcement” to “extinguish behavior” (this is called extinction). If you walk into a dark room and flip the light switch, and the light DOESN’T turn on, your behavior is now on extinction (the reinforcement, the light turning on, is withheld) and your attempts to turn on the light via the switch will quickly drop to 0 (usually). Everyone employs these principles to shape the behaviors of those around them, albeit in unsystematic ways (this isn’t an exaggeration, but rather an evolutionary feature of our species). Under this paradigm, learning is synonymous with behavior change and teaching is synonymous with behavior modification. Many people have commented that there is no good ABA (one described it as either “meh ABA” or “bad ABA” – I got a chuckle out of that description). Sadly, I know a lot of practitioners who use interventions that fall under one of those two categories, so this assessment is understandable. ABA includes quite a bit more, including things like: behavior skills training (used in companies), self-management strategies, Prosocial (for groups), mindfulness, goal setting, modeling, and role play. I personally use an intervention called Acceptance and Commitment Therapy (ACT), which promote psychological flexibility and values-directed living (i.e., living the life you want to live).
Maybe it’s too late for ABA as a field; I’m not sure. The thought of shaping the field to what it SHOULD be seems insurmountable and reading the comments above (both pro- and anti-ABA) underscores this, for me. I for one feel more at home in Contextual Behavioral Science, which more closely aligns with my own values (and, I would imagine, many people here). One thing I would ask of the people reading this article who are pro-ABA: Please listen to the voices and experiences of people as they talk about their pain and trauma caused by ABA; don’t dismiss those experiences just because there is also some misinformation.