How can something be both "torture" and "best practice" in autism intervention?
Key points
- Applied behavior analysis, or ABA, describes an umbrella of interventions based on the principles of operant conditioning.
- These principles shape the learning and behavior of all of us, disabled or not.
- Attacks on ABA as "torture" reflect a deep misunderstanding of what is actually considered best practice by many researchers and clinicians.
Celebrity engineer and YouTube star Mark Rober recently found himself in the crosshairs of neurodiversity advocates for hosting a fundraiser on April 30 to benefit the organization NEXT for AUTISM (NFA). Twitter exploded with boycott demands from autistic adults opposed to, among other things, NFA’s endorsement of applied behavior analysis (ABA), which they called “abusive.”
This position didn’t start and certainly won’t end with Rober, but has become something of a purity test among neurodiversity advocates, who post on Twitter under the hashtag “banABA.” There’s even a website called “Autistic Self-Advocates Against ABA.” But sorely missing from characterizations of ABA as “dehumanizing” and “state-funded torture” is any real engagement with the framework’s core principles—which actually describe how all behavior, autistic or not, is shaped.
Definition
Applied behavior analysis represents a number of evidence-based interventions informed by the belief, as board-certified behavior analyst (BCBA) Sarah Trautman sums it up, “that our environment totally and utterly informs everything we do—our collective successes, our collective failures. When we can alter the environment, we can help increase those successes.” In other words, ABA “looks at life through the lens of operant conditioning. We’re all products of systems of reinforcement.”
If you’ve ever told your kids they could play X-Box after they cleaned their rooms or did their homework; used an alarm clock as a prompt to get up in the morning; or broken a complicated task into steps to teach to a co-worker, then you have shaped your own behavior or the behavior of others using the principles of ABA.
Criticisms
So what’s the controversy? Gloria Satriale, also a BCBA, told me that ABA “is often confused with the exclusive use of discrete trial training”—repetitive drills used to teach rapid skill acquisition in young autistic children, such as color and number identification. Historically, DTT has been done at a table, but, Trautman added, “the field [of behavioral analysis] has become a lot more naturalistic. We no longer believe it’s required to sit at a table and do drills for five hours.” And DTT represents a small fraction of ABA interventions—which include pivotal response training, verbal behavior, task analysis, visual prompts, intermittent reinforcement, and others. My severely autistic son Jonah, now 22, has been going to Satriale’s ABA-based program for the past eight years and has never done one drill at a table.
Another claim made by neurodiversity advocates is that ABA practitioners forced them to make eye contact or stop classically autistic behaviors, such as toe-walking. “I would never assume that adult autistics who are against ABA haven’t had terrible experiences,” Trautman told me. But that is not typical. Satriale emphasizes that goals should be “socially significant” for individuals and their families.
As I’ve written before , at least in the world of severe autism, nobody cares about harmless stims. We’re too busy working on the skills that will allow our kids to participate as fully as possible in the world: toileting, communicating, street safety, eating in a restaurant. And no intervention has reported better results than ABA, which is why it has been endorsed by the U.S. Surgeon General, the American Medical Association, the American Academy of Pediatrics, the National Academy of Science, and other organizations.
ABA can be, and has been, used for a range of ends
The important point is that ABA is a toolbox that can be used to achieve many kinds of goals: those we consider essential and ethical (like finding a replacement behavior for a child who hits himself repeatedly in the head) as well as those we might not (like acting “normal”). And these are the conversations we should be having, not carving ideological fault lines in the autism community and attacking anyone who crosses.
I actually believe there isn’t one skill that Jonah has learned through ABA that a single neurodiversity advocate would object to: brushing his teeth, showering (semi)-independently, following a recipe, plugging his iPad in when it dies instead of chucking it out the window of a moving vehicle. “ABA is not about teaching kids with autism to be robots. It’s not about teaching kids to stop flapping their hands,” Trautman said. “Fundamentally, the goal of ABA is for people to have as many choices in life as possible”—which is, and always has been, exactly my goal for Jonah.