ABA Therapy Good or Evil

Potential Trigger Warning- Reader Discretion Advised

Some people do have PTSD and have experienced trauma because of poor implementation of ABA services.  If someone shares these feelings with you please do not tell them “it worked for me.” Listen with an open mind and respect that their experiences were different from your own.

I took a few days off from writing a blog post to really give myself a chance to think about how I wanted to tackle this subject. If someone asked me to answer the question is ABA therapy helpful or harmful my answer would be “Yes.”

Imagine you have a hammer.  You can use a hammer to create beautiful things but you can also use it to destroy property or hurt people.  It is not the tool itself that is evil or good but the person who is wielding the tool.  The person might even try to use a tool properly but due to a lack of proper understanding causes damage.  Imagine a person trying to hammer in a screw.  They understood that a screw can hold things together and that a hammer is used to hit small pieces of metal into the wood to hold them together.  Misunderstanding can do a lot of harm.

If you know my blog then you know by now I love lists! So I am going to list some of the concerns brought up by people around the internet and address those issues.

  • ABA is the same as training a pet and my child is not an animal. If people hate any part of my post it is going to be this part and I am going to get really almost cruel in my bluntness before I resolve so please bear with me.  YES, your child is an animal so are you and me and all people.  We are all classified as animals! In one biology class that was one of the first questions he asked the class was if humans were animals and many people said “no” and were quickly corrected.  Now if you are a religious person I do not want to disqualify your belief that God made us above animals.  Regardless of my belief if that belief influences your judgement then I do not want to be ignored because of a perceived conflict.  We are set apart from other animals in regard to our intelligence.  However, we are similar in most other ways. Behaviorism is used in animal training but humans are, by virtue of our intelligence, infinitely more complex. Our complexity is the reason that I can train a dog in a month and humans take a lot longer to learn.  Behaviorism studies how our environment affects our behavior and as an extension of that our learning.  Is a dog going to learn when he hears the dog food box open he is going to get fed?  Is a child going to learn when you open a box of cereal in the morning that he/she is going to get fed? So why do some kids need ABA and others don’t? Well, why do some kids need to do math problems 100x before they understand it and other kids only need to do it once? We need to stop trying to label this as “training my child like a dog” and start thinking of it as “using the environment to teach.”
  • Compliance Training, you can’t say no! In a corporate world, compliance training focuses on teaching the rules that apply to the job.  Basically, teaching someone what they are or are not allowed to do.  An abusive example: Not allowing a person to go to the bathroom until they have finished 12 hours worth of work. A healthy example: Now allowing a person to hurt small animals. With autism, these things can become harder to determine if the training is abusive or healthy at first glance.  There was a child I worked with who would not act appropriately in the bathroom.  In this scenario, I was not allowed to go into the bathroom with the child. The child would use bathroom breaks to escape from getting school work done, spend excessive periods of time in the bathroom and would play in the toilets and sinks.  With this situation, the bathroom became a restriction.  Telling a kid they can’t go to the bathroom usually is not okay.  However, the student was given multiple chances to go to the bathroom a day and given an extra bathroom pass once a day if needed. Honestly, the child had a ton of bathroom breaks, in reality, the process just restricted bathroom breaks to appropriate times. Once in the bathroom, the child was given a set amount of time to get everything done.  I would stand at the entrance and give a “30-second” warning when the time was almost out and count down the last 10 seconds.  The time was set to give enough time to get in and get out without time to play.  Sometimes compliance training means you can’t say no. If I am driving my son somewhere a seatbelt is not a choice.
  • Removing comfort behaviors, stop stimming. First, some stimming behaviors do have to stop.  These take the form of injurious behavior.  I know a lot of people when they go to the dentist and their mouth feels numb they constantly poke at their mouth with their tongue.  They are trying to get sensory input. Some people on the spectrum do not feel sensation for certain things as easy as a neurotypical person.  Self-injury can be a result of trying to get sensory information just like a person poking a numb spot can. Alternatively, if a person has too much sensory input and they are trying to drown it out they can hurt themselves so that their focus narrows to the one painful thing instead of the sensory onslaught.  If it injures a person then it needs to stop. In regard to nonharmful stimming, I walk a very narrow middle line. In an ideal world, these people could stim all day and it would not be a problem.  In the real world, people are awful and those behaviors can make people a target.  Just today I saw a video from the news of a man out with his mom playing Pokemon GO who had a condiment sprayed on them.  One of the people who did it said, “Yes, I got the retard.” As a mom or a therapist, I try to find healthy opportunities for stimming that do not make the person stand out. For example, my son loves to spin things so I found a keychain that was a flat round disk (ocean themed) with another metal disk on top of it with sharks you could spin.  It gave him the chance to spin something in his pocket or even in the open that did not draw attention like it would have if he was spinning in circles. The subject overlaps with my next topic.
  • Ableism, discrimination. Should an autistic person be allowed to stim if it makes them feel less stressed? Yes. Is it wrong that these people should have to find ways to “look normal” to make other people more comfortable or to avoid abuse? Yes. Does this mean I will take a hard line on this issue? No. Now this is a personal opinion, my job as a therapist and a mother is to teach to the best of my abilities ways to improve the life of my client and child.  Sometimes that means finding alternative stims that fit in and other times those options are not available and it means letting them do what works for them. It is on a case by case basis. I have to keep in mind that what should be and what is are two different things and I need to do everything I can to reduce risk of abuse. I work to help these people fit in as best I can and then turning around and fighting tooth and nail to help normalize autism so that I don’t have to keep trying to force autism into a “socially acceptable format.”  As with anything that can cause discrimination you have to avoid risk situations and fight to remove the risk at the same time. It sucks, it hurts, and it is not fair but I would never be able to live with the guilt if someone I worked with got hurt by others because of a behavior that I could have taught an alternative for.  Sometimes there are not alternatives and it isn’t fair which is why I fight both fronts.
  • Denying escape. Some people feel that extinction means a child cannot escape.  Let me say that any goal in ABA therapy should be one a child can accomplish that slowly pushes the bar forward.  The best example is if I put a child in a room with one door.  Before I closed that door I would build another one and make sure the child knew and could use the new door.  Then and only then would I board up the old door.  When a child uses an inappropriate behavior (like hitting) to escape from something they would be taught an alternative behavior that would let them escape and then the hitting behavior would go on extinction.  If the child cannot do the alternative behavior then ABA is not being used appropriately and that is not okay.  This is the perfect example of applying ABA practices inappropriately.
  • ABA therapy ignores my child’s feelings. Now this statement is kinda true.  As a practice ABA therapy does not concern itself with feelings but only with behaviors.  At least, it ignores feelings in as far as paperwork is concerned. There can be a balance that is sometimes overlooked in education. Let’s say a student is punching a wall.  I could infer that the child was frustrated from multiple things. I could then put my hand between the wall and the child’s fist, say that I can see that they are frustrated and ask them to tell me what is wrong. On paperwork, I would only write the behavior and the consequence, not the inferences.  ABA focuses on facts and I cannot say for a fact that the child was frustrated. I know what happened before, during, and after the behavior as facts that I can use for the purpose of data collection.  However, part of intervention can include teaching and using more emotional based language.  In that case, I might record behavior started after losing a level on Mario.  The behavior was hitting the wall and the consequence was the therapist put their hand in between the wall and the child’s fist and discussed emotions. All of these were observable events.

Is ABA therapy evil, it depends who uses it and how they use it. Parents have to be vigilant. There is a lot more I could have covered and I could have gotten into a lot more detail on some of these subjects (which I probably will later) but this is getting long as it is.  Restraint was one topic that I did want to get into more detail on but want to handle in another post.

What are your thoughts, feelings or questions on these topics? Is there anything you would like me to cover? If I get enough response I might eventually do a Q&A section!