I Was Part of the “Good ABA”

I became an RBT because I saw a real opportunity to help people.

A coworker mentioned that she had been looking into the voices of the autistic community. She said that there was a big push away from ABA. In training, they presented all the research that supports how much better autistic lives are because of ABA; reduced self-harm, aggression, greater adaptive functioning, and less family stress. With that kind of evidence, who could possibly be against ABA?

Our clinic was a part of the new “good ABA.” It checked off all the boxes of what to look for in ABA clinics; “child-led,” “natural environment teaching,” “reinforcement, not punishment focused,” “communication driven,” and “not discrete trial training (DTT).” I was part of a force for good, part of the cutting edge of the field where ABA was seeing true reform.

Editor’s note: this article contains descriptions of abusive therapy. Reader discretion advised.

It still haunts me hearing that electronic voice say “granola bar.”

The longer I worked there, the more I started seeing the red flags that weren’t visible when I initially wore those rose-colored glasses. It started with one of my favorite students, a nonspeaking child who was incredibly intelligent and very funny.

I could tell that he was bored with his programming. 90% of it was maintenance. He already knew how to perform the desired behaviors. The reason they were still there was that the BCBA and others couldn’t reliably get him to produce the behaviors.

We were encouraged to run DTT-style trials with him, where he would get frustrated very easily to the point of self-harming. He was doing this with every tech three times a day, 40 hrs a week.

I started seeing other coworkers gossip about him, discussing how he was “manipulative” because he would seek reinforcement without performing “desired behaviors he knew how to do.” I couldn’t help but laugh at the idea of a 7-yr-old being “manipulative” of adults around them.

That kind of thinking was what led to my first instance of seeing something so morally abhorrent that it was impossible not to speak up. I was shadowing another RBT and watched the student request food on his AAC device. Previously, the supervisor had set up an eating schedule for the kids so they would eat their lunches during the school day, and he was out because of training.

The RBT gently told him no, that he would have to wait for lunch, and he went and played. He continued coming back to his AAC asking for food, and the RBT continued to deny him. I watched this slowly escalate over a period of 30 minutes until I saw the student start breaking down crying. He brought her to his snacks and pointed at them, and the RBT continued to say no.

I urged her to let him, but and she brushed me off saying that it would be “reinforcing maladaptive behaviors.” He went to other staff and brought them to his snacks, and everyone ignored him because he was exhibiting “attention-seeking” behavior. He manded over and over again, and it still haunts me hearing that electronic voice from his AAC device say “granola bar.”

I had enough and sat him at the table and gave him food. He continued to cry softly as he ate his snacks, so emotionally overwhelmed he couldn’t stop. I told my supervisor about the incident, and she wrote up a “training protocol” that was posted on the door of how lunchtimes were flexible.

I asked if she was planning on telling his parents and she said, “What is there to tell? A kid having a problem behavior for food? That’s nothing new. We don’t report that kind of thing in our clinic, and if we did, there’d be way too many things to write reports on!”

 “It’s like he had PTSD or something!”

That’s not where it stopped. Shortly after, another supervisor bragged in a staff meeting about the research they were doing on the IISCA and a functional analysis they ran on a nonspeaking child.

The child had a history of self-harm and aggression, so they were trying to target the behavior so they could “turn it on and off at will.” They first gave the child homework and a bunch of puzzles all mixed together so there was no solution.

In response to this, he didn’t have a “maladaptive behavior,” so they were forced to escalate. They started yelling at each other from across the room (knowing this kid had extreme hypersensitivity to noise) and banging items around the room. They brought in a speaker to blast music that the kid hated. The music was so loud it could be heard in other rooms.

He continued to self-regulate and didn’t have a maladaptive behavior. They started forcing him to watch clips of TV shows he hated and did all of these aversives combined trying desperately to produce a behavior.

Finally, what broke him after 20 mins of what I can only describe as torture, they let him get up as if to let him leave and then forced him to sit down when he had reached the door. The kid started crying, and they considered the functional analysis a success.

I was horrified as my supervisor enthusiastically told me about how much better he was making this child’s life. All I could feel is the deepest pit in my stomach, knowing how horrible my own sensory problems were and imagining that on a child who has no ability to stop it.

In a staff meeting, the BCBA joked that “it’s like he has PTSD or something” when discussing him avoiding the room they were in. Both supervisors and the RBT who were present at the time laughed. She discussed how frantically he would act when she would even start to blast music to “turn on the behavior” and how quickly he would scream “my way, my way, my way!”

She said all of this laughing and boasting about it, and I looked around and saw my coworkers laughing with her. They didn’t understand how cruel it was. They had no training on how to deal with sensory regulation in autistic children.

Every clinic considers itself to be the “good ABA.”

This clinic considered itself as part of the “good ABA” and still does. I had no idea how to report it and was traumatized by my experience. I had heard about how stringent the BACB was with documenting events for them to take a case seriously.

At the end of this, I didn’t have enough documentation to feel like they would truly do much, especially hearing their inaction at even larger ethical violations like JRC’s use of GED shock devices. I could already envision the slap on the wrist or worse, complete dismissal “proving” my supervisor in the right.

I went public with the information, knowing I would be terminated.

Statistically and anecdotally, not every clinic can be the “good ABA.” It’s so easy to lose sight of what’s happening when you’re hearing things described in more appealing language. When valid criticisms are raised, ABA therapy has historically morally disengaged.

I urge practitioners to watch the reaction of refusing to acknowledge harm when presented by autistic people, by coworkers, by supervisees, and by that feeling in the gut that something isn’t quite right.

It’s time the field listened to autistic people, especially when it’s difficult.

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29 Responses

  1. RBT – Registered Behavior Technician
    ABA – Applied Behavior Analysis
    BCBA – Board Certified Behavior Analyst
    AAC – augmentative and alternative communication
    PTSD – post traumatic stress disorder
    IISCA – interview-informed, synthesized contingency analysis
    JRC – Judge Rotenberg Center
    GED – graduated electronic decelerator

  2. I don’t actually have words for how sick this makes me especially torturing the kid to make them exhibit a behavior, and feeling like they could just “turn it on and off.” Also, a lot of super conservative people frequently view children as manipulative so while super disappointing I’m not surprised by this take.

    1. Also, here’s the thing – the ability to turn negative emotions on and off like a spigot is a KEY feature of manipulative people. Plenty of them will cry, let loose, get all rage-y, and then, the MINUTE the police show up, the person is DEAD calm, as if nothing happened, and they would be all of a sudden if the police showed up in the middle of one of these rages. So basically, they are trying to teach this kid to develop a manipulative behavior. And if the kid succeeds, they will either be all *shocked pikachu face* when the kid uses it to manipulate, or they will punish the kid for the manipulation when it happens, even or perhaps specially if it shows up in the innocent form of using the crying as a synonym for “please” – or if the miraculous happened and the kid started to have such control that they could use the crying itself as a stim (which wouldn’t happen since that’s not really how these behaviors work, control over them isn’t THAT good and if it was then the kid would have to be a master meditator of the woo-ish variety).

    2. I agree with your analysis of how sickening that torture is. However, I would like to say that viewing children as manipulative has nothing to do with being conservative or any political ideology. The only thing that is is just being plain bad.

      1. Please pay attention to the lack of capitalisation of ‘conservative’ in Fiver Connolly’s comment. They weren’t saying that Conservatives (political) view children as manipulative. They were saying that conservative (not usually liking or trusting change) people view children as manipulative.

  3. In addition to the horror of what you saw, a couple things came to my mind. One is how Dr. Ross Greene tells of the absurdity of adults labeling kids, especially kids who experience difficulty in their lives, as manipulative. The other thing is in your description of your interests, you listed “mental health acceptance.” You many be interested in a couple resources that I believe are cutting edge in the world of mental health/mental illness. One is a blog from the NAMI (National Alliance on Mental Illness) website about The Transdiagnostic Dimensional Approach: a new way of understanding mental illness: https://www.nami.org/Blogs/NAMI-Blog/August-2021/The-Transdiagnostic-Dimensional-Approach-Another-Way-of-Understanding-Mental-Illness. The other is Dr. Stephen Porges interview about mental health: “How Safe Do You Feel? Revolutionising Mental Health with the Polyvagal Theory”: https://youtu.be/f2ZJ0NJ4d0g

  4. This is literally the definition of child abuse. How is this “research” allowed to be carried out? How did anyone get this past ethics approval? How did the child or their parents consent? This abuse needs to be reported to children’s services to be investigated as BACB is not interested in protecting vulnerable children.

    1. the sad thing is it doesnt get caught cause something like this happens in ABA centers every single day. if they were shut down for practices like these the field wouldnt exist.

  5. I had a very similar experience in my time at private ABA clinics. However, my frustration and despondence over how I was expected to act in order to “teach” these kids was informed by my understanding of ABA developed at my previous and current place of work, where I do strongly feel that the heuristics and understanding that the science of behavior analysis brings have been helpful in addressing some unambiguously harmful behavior.
    There can be no doubt about the harms of ABA practice at many, if not most ABA clinics, given the perverse incentives of the business, but is there any room for refining our understanding of behavior in order to use it in a truly ethical fashion? A neurologically and psychiatrically informed means of ethical practice?

  6. I am currently a Registered Behavior Technician. I am also currently completing a masters degree in ABA. This case is absolutely unacceptable. The protocols carried out violate multiple ethics codes that behavior analysts take an oath to abide by. The treatment plan for these children can, and should be reported. I do think that this article insinuates that all ABA is bad ABA even when received at quote “good ABA” clinics. While any clinic you take your child to should be fully researched, I do think the “all ABA is bad” line of thinking is not beneficial or accurate. I have seen multiple patients become empowered through ABA and be able to live with a higher life quality and more independence than before treatment. ABA does not have to include a single punishment procedure if implemented correctly and clients should NEVER be deprived of food. I think this article highlights the caution that should be taken with ABA, but does not encompass what ABA is about. I am truly sorry the children were treated like this, and I wish they had access to better treatment.

    1. if that’s your takeaway i think you’re missing the point.

      those kids you know, are they happier or do they *look* happier from your outside perspective? are they better equipped to make decisions for themselves and self-regulate, or are they easier for their parents to handle? what defines “independence”? is it appearing neurotypical enough to go out to eat in public? or is it accepting oneself for who you are and having the autonomy to pursue the things that matter to you? is the goal of ABA to help an individual reach their full potential or to modify their behaviors to ones you think are better?

      give these questions real and serious consideration, and then reread this article again and think about it some more.

      1. ABA isn’t for everyone, it is just a therapy option like occupational, physical or speech. I think Autistic people should have the right to any resource they want and choose. You are bringing up very important points that I think anyone involved in any therapy should ask themselves everyday.

        For me, the only goal we have is to empower the kids and teens we work with. We do this by teaching them to advocate for themselves. The first communication we teach is to say “no” and ask for what they want. Autistic individuals need to be able to ask for what they want to advocate for self regulation (asking for headphones, sensory tools, quiet spaces or breaks etc.) and for safety (we are required to teach safety and adaptive skills). Assent (consent for minors) is essential to the ethics code. If the individual withdrawals consent, treatment is stopped. The kids at our clinic are allowed to go home when they ask.

        We could care less how they “look” in public or if they “seem” neurotypical. Stimming etc. is never reduced or shaped unless it directly endangers the individual (ex. Severe concussion causing headbanging, hand biting leaving scars/tendon damage, Coprophagia, public masturbation etc. (all which I have worked with)). Individuality and neurodiversity is celebrated (we have multiple staff members with ASD and other diagnoses).

        To implement ABA, minimum 2 hours a month of parent training is required, where we teach parents how to understand what their child wants through communication training. Sadly Autistic kids have a higher risk of abuse; Behavior therapy (for parents) can reduce this risk and rebuild relationships. Additionally many kids with intense maladaptive behavior (severe aggression) that aren’t able to communicate their needs end up in isolated classrooms, group homes or other psychiatric facilities which also creates a higher susceptibility to mistreatment and abuse, not to mention limited access to education which is a human right.

        It is an intensive therapy and again should be researched just like any therapy. However, given the neurotypical world we live in, why take away the few resources Autistic people have as an option. It is hard enough already.

        With consent (of both the individual and families), ABA targets communication, adaptive skills and social skills while collaborating with OT, PT, SLPs. Due to our difficult healthcare system, other therapies alone cannot provide the hours for individuals to see significant change.

        Sorry that was long, I just feel it is not fair to judge an entire field and deny those of resources who choose/want it, especially when ABA prioritizes independence above everything else. ASD individuals should always have the right to whatever resource they want for themselves.

    2. I was part of the “good” ABA, no abuse, I had a lot of fun. I lived a pretty normal life, got married, had a child…. And then suffered Autistic Burnout at age 34. I now have a loss of skills, fatigue daily, and am extremely sensitive to stimuli like lights or sounds. It doesn’t stop Burnout from happening, it only delays it. Now it going to take me three to five years to get back to how I was functioning before, only this time I’m actually working with my body and doing things like wearing headphones, allowing myself to stim freely, and doing and eating things that my body asks for.
      I am healing the years of abuse on my own now.
      Because even though I thought I was having fun and fainintnew skills, my body was in pain, I just got really good at ignoring it in order to get praised as a child.

  7. @ GSKT: Your assertion that autistic people aren’t afforded the same rights as non-human animals is depressingly funny because it’s so, so true.

  8. @Louis Stay
    So ABA is good or bad thing? should we provide ABA therapy to Autistic kid?

  9. @Louis Stay
    So ABA is good or bad thing? should we provide ABA therapy to Autistic kid?

  10. This article is making me sick. In a couple of years this will not be allowed anymore and we will be ashamed of what we have done to children that are so unable to make their own decisions.
    It is the same kind of therapy used to supposedly “cure” homosexuality. It is sickening. And in my opinion if you are not willing to have a challenge in life as parents, do not have any children! The world will be better off without your egocentric behaviour and decisions.

    1. ABA therapy teaches the skills they need to be able to make their own decisions (communication skills etc.), instead of just assuming that they are automatically not capable (ableism). Autonomy is a human right that every child deserves. Why would we not want them to learn to advocate for themselves?

      Additionally easy to say that if parents are not willing to have challenges they should not have children. The children are here already and did not ask to be born. Should we punish the kids and limit access to resources and a healthy environment because the parents are bad?

      Also ABA is a science. Like any technology it can be used for good or evil. Current ABA is absolutely not what is used in conversion therapy (that would break almost every ethical violation in the code). Should people stop seeing psychologists and getting therapy because they used to give people hundreds of labotomies and torture them in mental institutions? Definitely not. Should we abhor people who still use the science for evil? Absolutely.

      Link to ethical code: https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-230119-a.pdf

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