ABA and Why I can’t Support it

I’ve spent most of my career up until this point working with Board Certified Behavior Analysts and spent time learning the framework on which they operate. In my initial training, I was told extensively of the past horrors of the field of support for people with Intellectual and Developmental Disabilities alongside the past horrors of Applied Behavior Analysis. Beyond that, I specifically sought out accounts of survivors of such abuses. Most ABA clinics nowadays with any marketing sense will be quite up front in telling families that they will not modify self-regulating stimulatory behaviors such as hand-flapping or training eye contact, which has been shown to incur great costs for minimal benefit. However, there still remain some major concerns that caused me to turn away from what could have been a lucrative career path. At many points throughout my career I was told that I would make a great Behavior Analyst by BCBAs with whom I’ve worked and greatly respect to this day. In many ways I still think like one, but I’m far more inclined to boost the voices of those who have been harmed by the practices. Of course, becoming a BCBA does not and should not keep me from listening to self-advocates, but I encountered a different problem. A problem that I could not hope to resolve in my position. How could I possibly trust the accrediting agency or the people teaching me with such a wide breadth of ethical allowance, much of which conflicts with my own sense of morality and understanding of ethics? Could I find myself in a position where my grades or salary are dependent on becoming a monster?

In my work trying to address crisis level behavior, I came across several moral and ethical complexities that left me at risk of potentially running afoul of the BACB’s rules, as I imagine most have in this line of work. Things tend to get more complex when more extreme challenging behaviors occur and professionals need to take a hard line to promote consistent responses. Now I may be critical of the field writ large but I do know several BCBAs whom I fully believe are committing the best of their understanding and effort to care for their clients, but we’re all human in a field that, in some circumstances, demands perfection. In trying to understand more, I sought out places where ABA folks would gather to see how they handled ethical challenges. I would often see references to the BACB’s ethics hotline, but it was almost invariably followed by a response saying that it wasn’t worth the effort. This has been a common complaint on multiple forums, but I suspect the lack of clarity may be due to the standards that allow for what many in the field view as human rights atrocities.

This might not make sense if you’re only semi-familiar with the world of ABA, as the BACB touts its ethical standards to the very highest degree. Many of the Behavior Specialists (those who have received a Masters’ education in ABA but not yet met the qualifications for credentialing) I had worked with failed the BCBA exam because of that ethics section. That means it’s good, right? I disagree. I think the ethical code is certainly rigid, but fundamentally flawed. How else could it allow for a treatment that is increasingly shown to increase likelihood of suicide among its recipients, or the use of shock devices. The most infamous example that comes to mind is the Judge Rotenberg Center, but other personal experiences have only bolstered my opinion. There are plenty of accounts from the Judge Rotenberg Center who can give you a better idea of what it’s like to be there, but a few quick points:

Judge Rotenberg Center uses a device referred to as a Graduated Electronic Decelerator—a shock vest, to reduce likelihood of behavior. JRC have claimed that such devices are only used in the interest of safety.
The Judge Rotenberg Center has had several attempts made to close it due to the inhumane treatment, but have been protected from closure through the courts. The center changed its name to honor the man who allowed this to happen.
“Resident Andre McCollins received thirty-one shocks over seven hours in 2002, initially for failing to obey a command to remove his jacket, and then for screaming in pain from the shocks.”- Direct quote from Boston Review article, The Shocking School
In 2013, a Special Rapporteur declared that the rights of the students at the Judge Rotenberg Center had been violated under the United Nations Convention Against Torture.

You might think that the legal issues might have incentivized the BACB to refuse to give the school its credentials and therefore legitimization. While the law says that the school can’t be forced to close that doesn’t oblige the BACB to lend their credibility, right? That is true, but that hasn’t stopped the BACB from continuing to give a platform for this place. In the sources below you can find a listing for ABA International’s conference from 2021 with JRC still trying to justify what they’re infamous for. I specifically went into the line of work to better understand what leads to violent behavior and with my decade of experience I say their claim that there is “no better alternative” is bullshit. What I hear when they say that is that there is no easily practical alternative, or an alternative that they trust their staff to follow through on, or perhaps they genuinely do not understand what plays into these behaviors and have instead committed themselves to the most superficial understanding of it that one can get. On that, I can agree.

During my brief time in ABA clinics, I had a few experiences that turned me away from the business entirely. One of which was when I was forced to directly report under a methodological behaviorist. Methodological Behaviorism is the subset of Behaviorist philosophy claiming that the only relevant factors to behavior are what are visible and measurable. There is some controversy around the use of this term and the term “Radical Behaviorist”, which lends to further confusion. Methodological Behaviorism is the brainchild of John Broadus Watson, creator of the “Little Albert” experiment. Inspired by Pavlov’s experiments with classical conditioning and frustrated by psychology being viewed as a “soft science” he sought to make it a more objective process. He was convinced that human behavior was the sum total of chains of reinforcement or punishment as an organism relates to its environment. He unfortunately got quite a hold on the world before it learned of the McNamara fallacy as a parenting columnist. He touted the ideals of Behaviorism in claiming that he could take any infant and make them a success in whichever career he chose for them, including criminal. He was certainly no hypocrite; he raised his 4 children according to his ideals. What I imagine many of the readers of his columns would be interested to know, however, is that 3 of his 4 children attempted suicide, one of whom succeeded later in life. I was not aware of the entirety of this history when I was put in that position, but I knew from having seen the person’s work that I could not trust their judgment as to what we were actually seeing. I knew this having learned from other Behavior Analysts who offered an understanding of behavior far more sophisticated, and understood the risk of engendering learned helplessness were that understanding not applied. Yet, my job depended on listening to someone that in my view was asking me to behave unethically. Yet, I would have been the one acting out of line for refusal to follow through on this alleged professional’s malformed understanding of their profession. So I left. Naively, I thought I might find a clinic where I could do what I understood to be good work, but the second clinic was even worse. All 3 of the following pictures were taken in 2019 from the same standing position.

In that room it was expected that 3 adults would work with 3 children with varying needs and deliver adequate teaching. If one kid was having a rough time and distracting the other kids, oh well. The business and labor issues in the field are another massive factor in all this but for now I want to focus on how these realities impact children with disabilities and their families. I don’t know of many families that would be comfortable with having their child shocked for wanting to wear a jacket, or who would be keen on following the philosophy of a man in light of the fate of his children. Yet that is still allowed to happen by the BACB. This is to say nothing of how, in order to become a BCBA and work with Autistic children, there are no requirements to learn anything about the condition itself, nor any for that matter. All of that information is from the Behavior Analysts themselves, and thus subject to the many misconceptions I’ve previously discussed. Nor do I think they would be happy to hear of my experience of learning a BCBA, who was responsible for teaching grammatical structures to children, did not know the difference between an adjective and an adverb. I have no idea how many children had drilled into their head that, “The X is very Y,” is a sentence containing an adverb.

Which brings me to my gravest concerns about ABA and what it “is”. Different people use different terms but most often I’ve found the split comes down to those who view ABA as an application of a body of science and those who view ABA as a business. I’ve noticed self-advocates tend to use the latter definition, which I believe many BCBAs would even agree is in need of big changes. However, those who see ABA as an application of a body of science find the discussion easy to dismiss because of it. It’s not much of a secret that consistency is immensely important in teaching new skills, but I’ll admit that even understanding behavior as a reflection of neurological phenomena across time, I learned quite a bit studying this body of science and working with those in it. This is why I have a difficult time joining the voices of self-advocates with the fullness of my own voice until I feel I’ve explained myself. I do still believe that there are wonderfully enlightened people with a sophisticated understanding of behavior and highly concern themselves with ethical considerations, but I’ve found they are exceptions to the rule. Even so, I do still believe that the methods I learned in this process play an immensely important role in discerning effective treatment measures for people who may not have the tools to communicate their experience. To that end it can serve as a way to block inappropriate medication regimens and even undercut the alleged “need” for restraint or seclusion. However, the active applications of this understanding leaves a lot to be desired. Discrete Trial Training is the most popular framework for working on goals determined by parents and practitioners. My understanding of how this works is through the same principle of “practice makes permanent.” Repetition works, and repetition with higher than normal consistency makes it easier to distill all of the environmental information one may attend to down to what’s most consistent and therefore relevant. That’s the driver of DTT. It’s the same principle by which we teach “stop, drop, and roll,” and works to the same effect. Through behavioral repetition comes rote memory in response to stimuli, to the point where a person can even lose conscious awareness of the behavior or the fact that there’s a choice to be made. It’s the process by which we habituate new skills, but it can also be overly rigid, lacking in depth, and potentially leading to engagement in behavior when a situation does not warrant it. This is the concern as told by Autistic self-advocates who fear that an Autistic child, who may not necessarily understand the why behind what they’re doing, may be rendered more vulnerable to bad actors. If an Autistic child is trained to deliver their personal information on request, as currently happens in clinics and schools around the world, this potentially leaves them open for further exploitation by anyone who knows the prompts– deliberately chosen to be intuitive to most. Yet, what DTT trains does not allow for that level of specificity unless specifically targeted for generalization, another process of procedures that, in my experience, does not happen terribly often in clinics. Generalization is a specific process, but what ends up happening is practitioners end up training children to deliver responses to anyone, as it is perceived that the kids need to be able to listen to just about any adult in the clinic or school for practical purposes. This is the case for many skills trained by ABA. This may seem okay in an immediate sense, such as for safety behaviors, but the harms only become truly apparent over time when utilized without the highest levels of care.

Autistic self-advocates are entirely correct in their condemnation of the root of ABA treatment—conversion therapy. The methods Ole Ivar Lovaas used to enforce gender norms on those whose identity differed from them, his Feminine Boy Project, started the path toward the practice now made illegal across the US. It is for the exact same reasons we as a society have decided it is too barbaric for use on transgender children that we should we reject the notion that we can fundamentally alter the human brain beyond some very real and biologically rooted limitations. Those naturally occurring behavioral differences are linked to differences in brain structure and operation, and while others may be able to force them to act in a certain way, it will never be natural to them. If we’re trying to make Autistic people unnoticeable, it’s largely destined to fail with few notable exceptions. The BBC article below recounts an important story along such lines. While the research is sparse at the present time, there is a growing body of evidence that ABA therapy, when improperly applied, leads to similar outcomes in Autistic children. In having these people need to focus on trying to be someone they’re not, we make the outcomes we fear all the more likely. To act in such a way demands levels of executive function that autistic people are more likely to struggle with, and we are seeing an increasing amount of evidence that those same executive functioning skills are essential in both suppressing behavior and regulating emotions. In forcing Autistic people to mask (to act in a manner traditionally considered “normal”), we make more likely the exact things people fear– meltdowns and seemingly erratic behavior. Giving them room to be and regulate themselves, on the other hand, is a clear path to peace. This is much, much, much easier said than done, but the path here is clear if we decide to make it so.

So, with all this being said, what’s a parent to do for their Autistic kid now? The practical realities here are that ABA clinics are one of the few resources families have available to give some comfort that their and their kids’ needs are being understood and helped. However, it’s largely a minefield filled with people who sincerely want to do right, but are early on in their understanding of both behavior and Autism (saying this as both a former paraprofessional, Personal Support Worker, and RBT). Those with more education are learning about behavior almost as some phenomenon in and of itself, rather than the outcomes of functions in a sufficiently different brain, and it is entirely upon them to put it into a broader context. Unfortunately many do not. There is a large draw in ABA clinics to sell out to private equity firms, who absolutely adore the complex, nebulous, and ethically gray nature of this field. The WFAE article I linked below is far more positive about this trend than I am, but the trend is certainly there. They are able to do this with the understanding that those who receive these clinics’ services are not their customers; their parents are. Those clinics often have the money to pay BCBAs enough to not just be a secondary income in a caretaking field, so incentives drive toward being uncritical of giving parents whatever they want. Parents, often afraid or burnt out from providing care alone, may not want to think too hard about establishing a more convenient trend. If we want to counter this, parents need to take it upon themselves to listen to self-advocates’ voices and ensure that anyone they entrust to help their child is on the same page as them and their child. If your child is afraid to go, listen. It very well may be that they’re just feeling a bit tired (which should also be noted), but it could be indicative of something more. To dismiss either possibility is irresponsible. Even if it is “just” persistently being ignored or dismissed. If they’re being ignored for sincere needs or fears, the extinction of hope for help can and will generalize. Of course, this does also make the hard life of a parent much harder, so we run into the problem of practicality here.

Practically speaking, many hands make light work.

Sources and additional reading: