I felt a need to write a response to The New York Times article, “Early Treatment For Autism Is Critical, New Report Says,” in part due to my great respect for this paper. The NYT is the American paper of record, and I have always taken its journalism seriously. This is why I was especially troubled to find this piece published within.
The article promotes the use of ABA (Applied Behavior Analysis) therapy on children as young as 18 months to two years, pre-formal autism diagnosis. Dr. Susan E. Levy, a co-author of the study, is quoted saying that ABA therapy is, “very very important.” All I could think upon reading this was, “Et tu, New York Times?” It seems that even the best and brightest minds have bought into the Great Behavior Fallacy around autism, and my heart cries for the children who are bound to get hurt.
Many of my brilliant autistic colleagues at The Aspergian have published amazing and wrenching pieces about how ABA actually tortures autistic children. It puts tremendous psychological, social, and at times physical pressure on children to get their behavior to appear more neurotypical. This bombardment can last for 20 to 40 hours a week in children under five years old, and can lead to depression, anxiety, and PTSD— which can last into adulthood.
But even the pain caused to autistic children isn’t my largest problem with ABA “therapy.” The worst part is that after inducing all of this suffering, it doesn’t even work. ABA may make parents more comfortable with their autistic children, but it will never treat autism itself or make life less painful for those born autistic.
“But ABA is evidenced based,” you may argue. “They have all of these charts and graphs and extensive research that show that ABA changes behavior.” Yes, in some cases, ABA will change a child’s rote behaviors. I say some because ABA apologists do not even want to talk about all of the children who “fail” out of ABA because they aren’t good candidates for behavioral conditioning, but I digress.
What ABA won’t do is treat or cure autism because autism is not a behavioral condition. And this is The Great Behavior Fallacy underlying behavioral autism treatments. Autism is a neurological disorder and/or way of being, not a behavioral one. And to treat a neurological condition effectively, neurological differences cannot be overlooked and ignored.
This is a common premise in medical theory, not one of my own creation. For example, the common cold is a virus– well, many viruses. When a virus infects you, you feel fatigue and your nose runs and your throat burns and tickles. Sometimes you get a low grade fever to try to combat the virus. When you feel these awful feelings, you may choose to take a pain reliever/fever reducer, such as ibuprofen or NyQuil, and these medicines will make you feel better until the virus is gone.
Claiming that you can treat a cold with a pain killer or decongestant is the equivalent of what ABA is claiming to do. By their logic, if you are no longer aching and coughing, you don’t have a cold anymore, nevermind that the virus is still large and in charge. It is like saying that a bandaid can “treat” a cut. All it does is make you a bit more comfortable while it heals.
But NO ONE in modern medicine will claim that a pain reliever or a fever reducer can treat a virus. They may lessen the impact of viral symptoms but can do nothing to eradicate the virus itself. This is why modern science promotes vaccines for severe viral infections. We have no effective treatment for viruses. All we can do is prepare our bodies for them if they attack us. A suppressant may stop our bodies from coughing, but scientists and doctors are smart enough to know that coughing is a mere symptom of a cold, not the cold itself.
To extend this analogy, coughing is an observable behavior. It might mean someone has inhaled a harmful or irritating substance. It might mean they need to get rid of fluid in the lungs, clear an object lodged in the airway, or because of a medical condition like asthma, acid reflux, or a heart condition. Coughing serves a purpose in each of these scenarios, and though it might look the same from the outside, the internal triggers vary. Suppressing a cough could prolong an illness or lead to complications. It would be treatment of an underlying circumstance without regard for what caused the cough.
But at least band aids, suppressants, and pain killers make sick people feel better. ABA does the opposite, applying “treatment” by making life harder for autistic people. And autism is not like a cut or a virus. It’s not a disease or an injury. It’s a way of existing.
If you look closely at ABA research, it never claims to treat autism in any sort of existential or neurological sense. What it does is break down the behaviors that the DSM (Diagnostic and Statistical Manual for Mental Disorders) uses to diagnose autism and attacks those behaviors. In large part, I actually blame the DSM for this fallacy because, due to their lack of conceptualizing and defining what makes autistic people tick internally, many of their diagnostic criteria are behavioral in nature. This is what makes the ABA deception possible.
For example, the DSM lists differences in eye contact as to make eye contact as an example of a deficit in nonverbal social communication in its diagnostic criteria for autism. It does nothing to explain that autistic people CAN make eye contact but often avoid it pathologically, due to neurology that makes it extremely painful or uncomfortable.
ABA then relentlessly drills the child until they finally give in and start making eye contact just to make the ABA stop. After awhile, the ABA trainer sees an increase in eye contact statistically and tells you that the child is less autistic or behavior has improved.
The problem is that this intervention hasn’t cured the underlying autism at all. The child still has the same neurology and finds making eye contact as painful as ever. They are still autistic. All the ABA “therapist” has successfully done is make non-compliance even more painful for the child than compliance. This is why in order to function, ABA has to create considerable discomfort for children, even if it isn’t discomfort that NT parents can see or understand.
This is how ABA can produce study after study showing that it treats autism– and why it will always fail to do so. ABA can force a child through endless rote repetition to increase eye contact, to give up the flappy-handed stims that bring them comfort and peace, to touch their noses and smile at strangers, but it cannot make these behaviors comfortable and safe for these children internally. They cannot cure autism.
This is where ABA will routinely pull out its second great lie. “ABA is not painful for your child,” they tell parents, “because after repeated repetitions, autistic children habituate to a given behavior. It becomes less painful for them. Autistic activists just don’t understand basic neurology. The children wouldn’t perform the behavior if it wasn’t becoming less painful for them.” That is one theory, but as an autistic person, I disagree and have an alternate theory. I will explain.
I learned about behavior theory and habituation in my psychology and development classes while training for my Master’s degree in Social Work. Apparently, (I say apparently because I am not neurotypical and do not know firsthand.) a Neurotypical person when exposed to the same stimulus repeatedly will eventually begin to adjust to this stimulus. This theory is often used to treat phobias, since a Neurotypical person who fears– say, clowns— can become less scared of them over time when exposed to clowns repeatedly in a safe setting with safe people.
I do not refute this, not being Neurotypical myself; it may very well be effective. What I can tell you as an autistic person, however, is that our minds are not wired to quickly habituate based on personal experience. Yes, I am more habituated to noises and smells than I was as a child, but I habituated over many YEARS of grit and work, on my own terms and developmental curve, and not a forceful regiment of therapy sessions.
And there are some things that I can’t or don’t tolerate, but I’ve worked out accommodations for myself that allow me to participate in life on my own terms. I truly believe that the challenge of habituating is a part of the neurology that separates autistic people from the rest of humanity.
And ABA has done no studies to prove otherwise neurologically. They merely claim that their success in creating behavior change is proof of autistic habituation. But there is another ironic behavior theory besides habituation that can explain the “success” of ABA just as accurately, and if this theory is correct, the implications are truly heartbreaking. I understand why ABA prefers their theory of habituation.
Psychologist Martin Seligman established the concept of learned helplessness through a rather cruel experiment on dogs in 1965. He put dogs in small, confining containers, the kind that no normal dog would habituate to, and left an opening in one side of the container. The dogs would all immediately try to leave through the opening and be attacked with powerful electric shocks until they retreated back into the container. The dogs tried to escape many times and received extremely painful shocks. The dogs began to cower in their crates and stopped even trying to escape.
But that isn’t all. Eventually, Seligman removed the gadgets producing the electric shocks from the holes in the containers. He expected that since he did this in full view of the canines, that they would all immediately escape their confinement. But they didn’t. The dogs had given up and did not even try to get out of the boxes. But it gets worse. Seligman thought that maybe that box wasn’t a bad enough stimulus to get the dogs to take one last shot at escape, so he tried again. He electrified the enclosures for a bit leaving no way to escape while the dogs received shock after shock.
Then Seligman made a door in each container. All a dog had to do to escape those containers was to walk forward a few feet to freedom. But the dogs stayed in those containers and continued to get shocked the vast majority of the time even with a gaping hole in front of them. Stunned, Seligman coined the term “learned helplessness” to explain this behavior.
Learned helplessness posits that once an animal or person suffers enough inescapable pain, they may be psychologically broken to the point where they no longer try to escape the pain, even if handed the perfect opportunity.
This is an equally plausible explanation of what happens through repeated ABA exposure. When children begin ABA, most resist. They try to run away, they dissociate or shut their eyes, they have meltdowns, they turn their bodies away. After hundreds of hours, they do the behavior and stop trying to escape in some cases, though in many cases the stress actually causes distress, depression, anxiety, and/or PTSD. Why? I think that likely these children are the dogs in Seligman’s non-electrified enclosures from the first experiment. The children suffered so greatly when they attempted to run away from or resist ABA that they just quit trying and settled for the lesser pain of eye contact or quiet hands.
“Well smarty,” the ABA therapist might say, “if that were true, then why would the kid be making increased eye contact at home with no threat of ABA bombardment?” Because if the child has learned helplessness as the dogs did, they will give up on resisting these behaviors, even when the “shock” of ABA is removed. They will continue to make eye contact and have quiet hands, even though it causes them pain, because they have learned helplessness. They have given up.
Does ABA therapy still look therapeutic to you given the very real possibility that training Neurotypical-looking behaviors into children does not spare them the very real neurological pain that these behaviors cause? This is why autistic people behave differently in the first place. Is it worth torturing autistic kids to force “normal” behaviors knowing that it does nothing to cure autistic neurology? Would we be so eager to achieve quiet hands if we actually accepted that we were literally breaking autistic children to get them?
I issue this challenge to parents, the New York Times, and to practitioners of ABA itself. Prove me wrong. Step out from behind the circular conclusions you draw from behavior and run a real neurological study. Prove to me that you are neurologically treating autistic wiring through habituation, rather than breaking autistic children using learned helplessness by creating autistic pain and forcing compliance.
And if you cannot prove me wrong, ask yourselves if we are the very monsters that I am sure you were thinking Seligman was as you were reading this article, by forcing ABA therapy onto toddlers when we truly have no idea what it does to them. I hope that you are having an easier time living with this reality than I am.
15 Responses
Excellent.
“They merely claim that their success in creating behavior change is proof of autistic habituation. But there is another ironic behavior theory besides habituation that can explain the “success” of ABA just as accurately, and if this theory is correct, the implications are truly heartbreaking. I understand why ABA prefers their theory of habituation.
Psychologist Martin Seligman established the concept of learned helplessness through a rather cruel experiment on dogs in 1965.”
About that, here’s the thing – if ABA altered behavior through habituation, why do ABAers deem it so crucially important for parents to continue the ABA at home when the professional therapy sessions are over? And why is it equally important that all these ABA demands be repeated in various “naturalistic” settings? Could it be because habituation isn’t enough to account for these behavior changes (given that if it were the therapists wouldn’t need to be pushing 24/7 therapy and in “naturalistic” settings)? Could it be because by making the ABA spill over into all sorts of settings, they are shutting multiple exits in the child’s mind and making it more likely that the child will exhibit learned helplessness that generalizes to more settings?
I think it could be. If a kid only experiences ABA lite in one setting and the parents don’t repeat it (as I did) they may experience mental damage, even a lot of it, but they won’t exhibit the level of learned helplessness needed for them to exhibit an “optimal outcome”. Whereas kids who find that the ABA follows them wherever they go will expect that the ABA could follow them at any minute and thus are less likely to try and escape the masking in other situations. Thus, making the ABA follow kids wherever they go makes learned helplessness more likely to develop. Though of course ABAers will sell you a very nice pitch about “consistency” when they describe that plan.
Lucy:
sat down to read the 1965 Seligman experience/experiment in its full horror as AspieGurl shared with us.
I do not know that he was a monster. The situation monstered him. Like Milgram and Bandura and their respective colleagues and theories.
And I am less sure he has changed his ways – Positive Psychology is everywhere in the schools.
I thought it was “set and setting” issues myself. [this comes from the biological/drug world – music festivals a great exemplar].
Learned helplessness has a way of generalising and spreading.
Yes, if it is in just one or two settings [like mathematics and physical education] one has more of a chance to access feelings of safety; acceptance and competence. [Yours truly is quoting Bill Nason here]. And in a sense one needs to pull on them more.
The whole “pervasive and permanent”. [and there is another P-word] Could exhibit just enough to tip over their personal edge/comfort zone.
And things that follow where you go? In the Benelux world and in France – surveillance is so much a thing. It has been so from the 1790s to the 1980s … Even during the strikes which are across the fields and workers.
And when the child forgets or does not know that Masking is a Thing you CAN Escape [the four “reasons” ].
That consistency pitch – much enhanced by these neoliberal and neoconservative memes.
Talia Welch is a very good ally whose “Meta Helicopter Parenting” I read and discussed yesterday [13 January 2019 – it continues until the 31st].
Did you see ABA rise in 2003 [late Bush]? I did.
There are more decent; stronger; safer ways to become comfortable with the autist in your house. That is what I would wish to tell families and parents. Things which may actually be congruent with your values than judgement and convenience.
If we take this out of the autism context it’s perfectly obvious why the habituation “explanation” is false. I learned in the field of trauma recovery that in order for habituation to work, the exposed person has to feel safe. Not just “be” safe, by some outside arbitrary standard – actually *feel* safe. (Sometimes you can fake this, as in a study where people with spider phobias listened to a steady, strong heartbeat while looking at spiders, and gradually became less frightened of them, but that hardly compares to an ABA environment!)
I tried for years to habituate myself to using the telephone, as technology improved such that my hard-of-hearing self theoretically would have been able to use it – but I never felt safe doing it, or even using relay or TTY services. The threat of not understanding, or being dismissed and humiliated, was always there. It wasn’t until I gave up trying to be okay with it that the sheer terror that came with a telephone ring began, slowly, to abate. (Not learned helplessness – I gave up trying to use the phone altogether.)
These kids getting ABA’d nonstop never even get to learn what feeling safe feels like.
“Is it worth torturing autistic kids to force “normal” behaviors knowing that it does nothing to cure autistic neurology? Would we be so eager to achieve quiet hands if we actually accepted that we were literally breaking autistic children to get them?”
I think for some parents and other people involved in “treating” autistic kids, it’s exactly that: they’re perfectly willing to break the kid as long as the kid will afterward “pass for normal” and “not look so autistic.” It’s not about helping the child — it was never about helping the child — but intead about helping everyone else not have to be around a kid who “acts autistic.”
“Would we be so eager to achieve quiet hands if we actually accepted that we were literally breaking autistic children to get them?”
I have reason to believe the answer would be “yes”. ABA was never meant to help anyone (not even the parents, who for the most part are simply deceived) other than the neurotypicals who want to maintain the status quo.
It wouldn’t be the first time that psychiatry/psychology was repurposed as a tool to control people either. The Soviets were quite fond of diagnosing anyone who opposed their regime with “sluggish schizophrenia”, locking them up in mental institutions for torture and calling it treatment. Is it any surprise that people us, who question why the current social norms exist, are put through a similar experience?
Hmm.. I’m a little speechless and don’t know what to say. I’ve been working as an ABA therapist since 2014. I do agree with many of the points in your article. For example, don’t believe ABA cures autism and that’s been our motto. The BCBA’s I’ve worked with never promised parents a cure was possible or their children were completely going to change, etc. In fact we never made such promises and that we’re there to help the child become more independent and help manage maladaptive behaviors such as severe tantrums and how to appropriately intervene based on the functions of the behavior. We taught many self-help skills which is only going to help the child in their day to day lives. ABA actually has great teaching methodologies such as task analysis for instance to help teach brushing teeth, tying shoe laces, etc. There’s many skills acquisitions being taught using DTT, task analysis, natural environmental teaching, etc. So it’s not all about teaching eye contact or etc. Again, I do agree with a lot of your points especially, teaching through excessive repetitions, trying to stop hand flapping, drumming which is part of the four functions of behavior sensory stimulation or SSB. In those cases I was taught to help the child replace it with more socially appropriate behaviors such as clapping. So we didn’t completely try to extinct the behaviors. There’s children who would bite their wrists as a sensory stimulation to the point of hurting the skin around it it. We had her bite into a sensory diet necklace. And it didn’t work, so went back to having her wear wrist protectors because her hands would get bloody due to all that biting.
I read this very carefully before trying to respond. I get why the literal application of learned helplessness theory does not feel relevant to you. You don’t use a zillion trials and try to soothe and change behaviors that are bad habits with good habits. But this can be equally insidious and I will try to explain why.
I didn’t go through formal behavior training as a child, but I did have my behaviors “adapted” by behavior professionals. The primary lesson I learned as a child from this experience was that adults honestly didn’t care about my thoughts, feelings, or suffering as long as they liked my behavior. This was a depressing revelation for a six year old.
You see even if a child doesn’t learn helplessness from systematic torture, they learn helplessness because professionals like you just don’t seem to hear them. Wrist biting and all other behavior are our form of communication. We don’t need “good habits” and “wrist guards”. WE NEED YOU TO CARE THAT WE ARE IN SO MUCH PAIN WE BITE OUR ARMS. And speak for us. And adapt our environments accordingly.
We need you to learn from us rather than the other way around. We need our therapists to be our voices and advocates, not ignore our needs while trying to alter our behavior.
Thank you!
There is a lot wrong here. Almost too much to even comment on. From the misuse of a single behavioral principal habituation to effect treatment outcomes that are unfounded. This actual is not about ABA. This is actually about something that has been going on for years. People who are neuro-diverse and able to communicate that, just want to be accepted by people who are neuro-typical. And that is noble and true. The logic used here to be change a behavior that may be better described as quark is not the same a child who bashes his head into to the ground to the point of bleeding and concussion. Similarly to alcoholism as a coping strategy, smashing your head into the ground is not a quark. It is a serious problem, like alcoholism, if untreated. It is however, a form communication that needs to changed to something that won’t hurt that person. Good treatment is not torcher. Torcher is living in a world were the only way to communicate is to hurt yourself. How dare you and any other anti-aba groups masking yourself as advocates try to take away effective treatment. The only thing that made a difference in my child’s life from bashing his skull in to learning how to talk and communicate, and say, “I love you.” was ABA. Your advocacy to say that we all need to accept neuro-diversity and reinforce their rights is in a good place. Your advocacy to condemn an effective treatment is cruel.
You’re literally disregarding everything a neurodiverse person is telling you in order to let them know what neurodiverse people want. Do you not see the problem here Thomas??!!
Soooo– a lot to think about here. First, as a parent of a child on the spectrum, my desire is not to make him conform to my expectations. I’d like him to achieve as much as he can in his short lifespan–ABA holds out the promise of enabling him to communicate better, decrease maladaptive behavior –behaviors like running into traffic, eating poisonous items, and on.
I’ve learned a different aspect to the fallacy that Wendy mentions here, and I wonder if she could comment. I see many interventions attempted and then when behavior is altered, the ABA practitioners look to the behavior change as evidence that their interventions worked. But this is plainly a post hoc ergo propter hoc fallacy. It MAY be the case that intervention x, y, or z got my child to stop behavior Q, but it’s impossible to illustrate a causal link between the intervention and the behavioral change.
At any rate I’m ambivalent about ABA therapy. I appreciate the normalization that the neurodiversity group has brought us; I also see how some behaviors are harmful and must be addressed. Further, as a parent, I have an obligation to hep my child survive and thrive once I’m dead and gone. Leaving a profoundly autistic child to face the world on their own seems more abusive than attempting to help that child achieve his potential.