What is ABA Therapy?
Applied Behavioral Analysis, or ABA as it is commonly known, is considered by most as the “gold standard” for treating autism. It is a system based on behaviorist theories. Simply put, the presumption is that desired behaviors can be imparted to the child by way of a system of rewards and consequences.
The idea of utilizing rewards and consequences is not new. However, carefully applying rewards and consequences to foster particular and quantifiable objectives is new. ABA enthusiasts point to its success in achieving specific outcomes. Alternatively, opponents argue that at best it’s disrespectful and, at worst, can harm the child.
A Brief History of ABA
In 1987 a behavioral psychologist named Dr. Ivar Lovaas first applied ABA to autism. He believed that even profoundly autistic children could change their behavior through the ABA method. The idea was (and is) to extinguish or at least modify behaviors that children with autism exhibit. The assumption being that the absence of autistic behaviors is equivalent to cure.
Initially, Lovaas didn’t hesitate to employ punishments for the non-compliant child. At times these punishments could be rather harsh. Over time these punishments have been eliminated in most ABA therapy. Punishment is often replaced by “withholding of rewards”.
Regardless of one’s opinion of ABA therapy, the axiom that Lovass set out to demonstrate turned out to be quite accurate. A considerable percentage of the children who receive intensive ABA training learn to behave at least some of the time appropriately, and some even lose their autism diagnosis entirely after years of intensive therapy.
However, the question remains as to whether exhibiting appropriate behavior is the same thing as “being cured.”
What Children Can and Can’t Learn Through ABA?
Generally speaking, the intended consequence of ABA is to “extinguish” the particular undesirable behavior and replace it with more desirable behaviors and new skills. To illustrate the point, the therapist may use ABA to teach the child to reduce tantrums and outbursts and its stead to be taught to either sit quietly or make a request verbally while playing with other children on the playground.
However while classic ABA if successful will modify the behavior, there is no intention that it will build social or emotional skills. So, while the autistic child will be taught to greet someone with a handshake, that act won’t be connected with an emotional response toward the other person. The act is divorced from any internal experience.
Why some autism parents and advocates find fault with the therapy
Over the past twenty years or so, ABA, has morphed into a much broader set of techniques and approaches designed to treat autistic children. As ABA has expanded and become more common, there has grown along with it a long list of both advocates and critics. There are three main areas of criticism.
1. Too Tough on Kids?
Initially, Dr. Lovaas treated people with severe impairments seeking to reduce self-injurious behaviors by using both positive reinforcement and punishment. Over the years ABA practitioners have eliminated the aversive reinforcement. Nonetheless, critics of ABA complain that ABA’s significant repetition is too severe for children.
2. Too Focused on Eliminating Behaviors?
Other critics point to the failure of some ABA therapy practitioners to concentrate on skill development as problem behaviors are being eliminated. They ask, “What are the kids learning to do?” “Is there an alternative to throwing that tantrum besides just being controlled or trying to escape?”
The objection of Ari Ne’eman, a leading autistic self-advocate, is its focus on transforming autistic people to appear to be “indistinguishable from their peers” — an expression he draws from Lovaas. Because of this, ABA promotes the disengagement of behavior from its emotional content. The child is being removed from his uniqueness.
3. Too Narrow?
Ne’eman is not opposed to structured interventions as a matter of principle. He believes that other forms of interventions that involve structure such as speech and language may be of more long-term value for the child. This would especially be the case for nonverbal children as it would meld behavior and communication into one intervention.
Ne’man argues that such kids could gain significantly from an SLP who could help them to gain access to alternative forms of communication to give them a new dimension of human interaction. The problem with ABA therapy is that while some children are indeed more controllable, they are worse off than before!