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.