Autistics Against ABA

Kat Williams has given us consent to re-post her article Autistics Against ABA. The original dated 2nd May 2020 can be found on her website, CerebrationofKat.

Today (2nd May 2020), I was asked to write about ABA, providing evidence as to why it should not be promoted. While I’m willing to do this, particularly because I haven’t actually written a post specifically on ABA before (I mean, let’s be honest, I’d be adding to the hundreds already out there), this does not negate the time, mental energy, and sheer frustration that comes with (yet again) a person from a marginalised group being asked to do the leg work when a simple Google search would provide all of the information.

That said, I did offer to educate and this is a more permanent form than just replying to a Facebook post. From here you can expect references to ABA, abusive practices, and suicide. Therefore, if you will find any of these topics triggering I suggest you stop reading. I do hope, however, if you’re a non-Autistic (or non-disabled in general) person, you do read this in its entirety. It’s taken a lot of hard work, and I don’t really want it to be wasted.

There’s already so much literature out there so I’ve added a list of articles where you can read about this in more depth at the end of this article. I’ve marked those which are (in my opinion) the best ones to get a full overview of why ABA is – in all its forms – abhorrent. It doesn’t matter if it’s original Lovaas ABA ‘bad ABA’, or if it’s ‘good’ ABA which doesn’t use punishment such as electric shocks, or if it’s something used on Autistic people, or (as I’ve learned today) with children who have Cerebral Palsy. It’s all bad. Period. It would not be acceptable practice with non-disabled children, and gay conversion therapy (which is based on ABA) has been declared unethical, so I cannot fathom why it’s still considered appropriate to use ABA to try to ‘normalise’ disabled children.

Very often people who don’t know much about ABA outside it being ‘controversial’ will say things like “I can’t judge another parent’s choice,” or “People can choose how they want to parent their children.” My counter argument is simple: if I were to suggest that you could smack the disability out of a child you would judge. Rightly so.

“Your character is based on the way you treat the people you’re ‘allowed’ to mistreat” – David Sedaris

So, why is ABA bad anyway?

There are a number of reasons, but I will confine my answer to the top 10. I’m going to refer to Autistic people in this article, but please know that it doesn’t mean that these issues are solely Autistic related. If you’re using ABA with a person who has Cerebral Palsy or any other disability my points still stand:

1. It teaches the person they’re ‘wrong’ They need to be fixed

Repeat after me: Autistic people are not broken non-Autistics.

We have just come out of the other side of Autism Awareness (Acceptance) Month, yet we still have to tell people this. Disability does not diminish a person’s worth. The whole premise of ABA is to make Autistic children indistinguishable from their peers. This in itself should be a ‘red flag’ as therapeutic practices are supposed to help the person being treated. Therefore, ABA’s “goal of specific beneficence is to help individual people, […] is undermined by making people into someone they’re not” (Wilkenfeld & McCarthy 2020).

Well-meaning parents and professionals typically look at this (and the other arguments) and respond with “but you didn’t have ABA, so how do you know it’s abusive?” To paraphrase Chris Bonnello (Autistic Not Weird) if people can educate themselves to know that smoking is bad for you without trying it for themselves, they can educate themselves about ABA.

Another frequent argument is “you’re not Autistic like my child.” I’m not going to delve into this fallacy here, I’m going to take it at face value. Yes, I have a slightly above average IQ. Yes, I’m mainly verbal (sometimes I’m not, but I write about that in other articles). However, intellectual/learning disability and apraxia of speech are not valid arguments for ABA. Parents and professionals often claim that their Autistic child/patient ‘can’t communicate’ so needs ABA to learn how to do so. However, “it commonly turns out that “non-communicative” autists frequently communicate perfectly well—they merely communicate in ways to which people might not typically be sensitive” (Wilkenfeld & McCarthy, 2020).

Parents often want to know why their child behaves in different ways to their non-Autistic peers. I’ve been there, I do understand to a certain degree. However, “researchers do not tend to study why neurotypicals don’t behave in certain ways” (Wilkenfeld & McCarthy, 2020), and this approach just feeds into the premise that the Autistic way of being is wrong; it’s something to be studied, unpicked, and rebuilt. Regardless of how distressing the process of ABA is for those subjected to it, “perhaps a greater injustice is in simply treating ASD as something that merits elimination in the first place” (Wilkenfeld & McCarthy, 2020). Despite the difficulties faced by Autistic people in a world not designed for them,

“we would do well to focus our energies on eliminating the basis of that burden rather than in eliminating the underlying trait.” – Wilkenfeld & McCarthy, 2020

2. ABA addresses ‘symptoms’ not underlying causes

Behaviourism focuses on just that: behaviour. Meltdown? Behaviour. Stimming? Behaviour. Aversion to sound? Behaviour. Co-occurring conditions such as pica or ARFID? Behaviour.

The function of ABA is to eliminate these behaviours to make the Autistic person appear more ‘normal’. However, the underlying reason for said behaviours is not addressed.

Let’s take eye contact as an example. I’ve chosen this because it shows how Westernised ABA is too – eye contact is considered part of polite social interaction here, in parts of the East, it’s considered rude. Eye contact can be at best distracting, at worst physically painful for an Autistic person. Auditory processing disorder could mean it’s essential for one Autistic person to look at someone’s mouth to understand what they’re saying, and for another, looking in the opposite direction could mean they’re taking in what’s being said rather than getting lost in the multiple shades of green which fleck the hazel eyes of the person speaking to them.

This is one area in which the ABA practitioner doesn’t try to find the whys. They insist on eye contact, and the child can only have their reward when they do. This leads me onto…

3. It removes and destroys autonomy  

In a world in which people are being told to ‘be themselves’ and children are being praised for not ‘following the crowd’ it seems nonsensical that Autistic children are being taught the exact opposite. Conformity above all else. No is not an option.

As ABA tightens its noose around the Autistic’s individuality by using operant conditioning and behaviourism, it begins to “alter children’s identities by preventing them from forming and pursuing their own passions;” it’s “teaching them how to blend in rather than exercise their own unique capacities” (Wilkenfeld & McCarthy, 2020). A lack of sense of self is often reported by Autistic adults, and it’s easy to see why. If they’ve been subjected to ABA it’s been trained out of them, if they haven’t they’ve often forced themselves to mask to try to fit in. Very rarely do I meet an Autistic adult who can state unequivocally that they’ve been their authentic self for their entire life.

“An ABA intervention will be considered a success if and only if it results in a desired behavior, regardless of what is going on in the mental life of the child. [… T]his is done in a way that overrides the child’s natural inclinations and does so via at least moderately coercive methods. To paraphrase one person with whom we spoke, if “ABA” just involved giving praise when the child does something good, you would be able to forgo years of training in favor of a lesson that could fit on a greeting card. There might be someone somewhere who practices ABA using only positive words of encouragement, but this is simply not what past recipients of ABA have reported (Kupferstein 2018).” – Wilkenfeld & McCarthy, 2020

4. ABA leaves people open to abuse

Once you teach a child that no means they will be punished until they say yes – either in the traditional sense in which something negative happens to them, or solely through the withholding of a wanted item – you are leaving them open to abuse.  

Parents will share memes like this:

Meme teaching a child about bodily autonomy: "Don't force me to kiss or hug. I am learning about consent and support on this will help me keep safe for the rest of my life"

while defending (or at least not criticising) ABA.  This isn’t just ironic, it’s ludicrous.

ABA is teaching an Autistic child that their body isn’t their body. They’re being taught that they must have physical contact with someone, even if they don’t want to. They’re being taught that they are not allowed to give or deny consent. The proponents are preventing that Autistic child from being able to keep themselves safe for the rest of their lives. At best they’ll be unable to spot toxic friendships until it’s too late, at worst they will be abused.

5. Many people who were subjected to ABA meet the PTSD diagnostic criteria

Scientific evidence to support this is still in its infancy. This isn’t because it’s not out there, it’s because it’s taken this long for a) the first wave of Autistic children subjected to ABA to become adults, and b) for those people to be listened to. That said, research is being conducted, and an early study “noted PTSS in nearly half of ABA-exposed participants, while non-exposed controls had a 72 percent chance of being asymptomatic” (Kupferstein, 2018). This supports anecdotal evidence from the Autistic community in which Autistic adults, both those who are speaking and those who are non-speaking, have written extensively about how they have been traumatised by ABA. I have included many of these articles in the further reading list at the end.

“Respondents of all ages who were exposed to ABA were 86 percent more likely to meet the PTSD criteria than respondents who were not exposed to ABA,” and that “Exposure to ABA predicted a higher rate and more severe PTSS in participants, but the duration of exposure did not affect satisfaction with the intervention in caregivers.” – Kupferstein, 2018

This alone should demonstrate the potential harm, yet ABA practitioners and parents vehemently try to deny the claim. This in itself is abusive as it’s (again) telling the Autistic person that their experiences are wrong and/or not real. Just like ABA in practice, in which Autistic children are taught that they don’t really detest the feel of jelly, they just need to touch it every day for several hours to get over it. Both the ABA practitioners at the time and the people denying the resulting PTSD are gaslighting the Autistic person.

6. ABA teaches masking, which is a proven suicide risk

Let’s be clear: ABA does not make an Autistic person non-Autistic. Its ‘success’ is in its ability to make an Autistic person mask their Autistic way of being (or traits). Masking is not only exhausting and a completely unauthentic way of living, it is one of the “risk markers for suicidality unique to ASC” (Cassidy et al, 2018).

Suicidal ideation and completion of suicide is already overrepresented in the Autistic community:

“In a large sample of 374 adults newly diagnosed with Asperger syndrome (AS; autism without language delay or intellectual disability), 66% had contemplated suicide, significantly higher than the general population (17%) and patients with psychosis (59%); 35% had planned or attempted suicide [2], higher than previous estimates of attempted suicide in general and university populations (2.5–10%).” – Cassidy et al, 2018

and as this study shows, Autistics who mask are at higher risk again. ABA is designed to force the mask on when we should be encouraging our Autistic young people (as well as the adults they become) to take the mask off and love and embrace themselves for who they are.

7. Length of time a child is in therapy

Autistic children who are in ABA are often subjected to 25-40 hours per week of intensive practice. Children start ABA as young as 2 years old. That’s 25-40 hours in which they cannot make a free choice. They’re not playing as they want to. They are having to conform to hours of operant conditioning while their non-Autistic peers are playing in sandboxes, having naps, and scribbling with crayons. They’re being robbed of their childhood, working hours which would floor most non-Autistic adults.

8. It’s not ethical

Behaviourists have to equate autism to cancer to get ABA studies past ethics boards:

“When a judge, or Dr Maurice, or any behaviourist yells cancer, any ethical consideration for autistic people obediently hurries to the nearest exit.” – Dawson, 2004

This is because they know it’ll eliminate the ethical questions of consent – “a project presuming to transform the nature of unconsenting clients through behaviour interventions must be challenged as to its ethics” (Dawson, 2004) – and ABA gone wrong, such as those Autistics “injured and killed in restraints” (Dawson, 2004). If autism is presented as equal to a disease which kills without radical, objectively harmful to the body, treatment, then the suggestion of intensive hours and removal of autonomy doesn’t seem that bad. If it ‘cures’ the Autistic child of this ‘thing’ that’s stolen their life, then ‘the ends justify the means’.

This is, of course, a strawman. Autism doesn’t kill. Autistic people often get killed too young, but it’s not being Autistic that’s done it. It’s how they’ve been treated (when they die by suicide) or the lack of support (why they die by the hands of their caregivers).

Therefore, the ethical questions need to be placed back on the table. However, when questioned about obtaining consent from Autistic people regarding being subjected to ABA, Dr Gresham, a pro-ABA doctor, “found the idea of autistics being involved or consulted in legal, research, or treatment decisions absurd–like consulting with the mentally-retarded” (Dawson, 2004). If this is the public opinion of ABA proponents, I shudder to think about what their actions are when alone with vulnerable Autistic children.

“Challenging the autism-ABA industry’s ethics requires that autistics are seen as human beings with human rights. We do not live in a society that acknowledges this. We are in a society in which autistics have rights only if and when we resemble non-autistics.” – Dawson, 2004

A black and white cartoon saying 'wrong direction' with a child running towards a wall. His shadow has angel wings.

9. It’s not about the needs of the disabled person, but the needs of society

Something I invite the pro-ABA (or undecided) parents reading this article to ponder is this: are the things you’re trying to ‘fix’ problems for the Autistic child, or problems for you? Are they truly issues which need remedying, or are they being seen as issues because of societal norms? To the Autistics subjected to it, ABA “at least appears to have inherited its foundations’ interest in societal benefit at the expense of individual rights” (Wilkenfeld & McCarthy, 2020).

A huge amount of behaviours seen as being without purpose, such as intense interests and stimming, are immensely helpful for Autistic people. Therefore, having interests withheld until the Autistic child performs a task they are either finding physically difficult or just really mentally don’t want to do is cruel. Preventing an Autistic person from stimming only serves to dysregulate them. The ABA practitioner isn’t doing anything to help the Autistic person, they’re making them more palatable to society. (Yes, I know that not all ABA practitioners stop children from stimming. Please don’t #NotAllABA me, the rest of what they/you do is awful anyway.)

Other things ABA practitioners work on are Autistic children eating appropriate foods. Performing self-care tasks in a manner society would approve of. Getting them ready for the outside world, rather than getting the outside world to at least meet the Autistic in the middle. At no point are the views of the Autistic person considered. Nobody is using their wellbeing as a unit of measurement for success. “Making decisions for patients for the sake of bettering society seems immediately suspicious from a modern perspective … as doing so places comparatively little emphasis on good of the patients themselves” (Wilkenfeld & McCarthy, 2020).

“ABA places an undue burden on autistic children is by defining therapeutic success primarily in terms of autists’ ability to fit into normal societal structures.” – Wilkenfeld & McCarthy, 2020

10. It doesn’t really work

Even with the unhelpful measures of success, ABA doesn’t work in the way it claims. Yes, it forces some Autistic people to act less Autistic, but it doesn’t ‘cure’ them of autism, how could it? You cannot change who someone inherently is, but you can force it into a dark cavern of their mind, a place they’ve learned to hide it and be ashamed of it.

A literature review of ABA effectivity studies was conducted in 2013. “Most of the literature review papers conclude[d] that the intervention programs are controversial, expensive and dependent of external variables” (Fernandes & Amato). They found that control groups were often not used – something which is essential to determine whether or not what is being tested is effective, or whether there is a placebo effect.

A more recent study shows that “conflicts of interest are prevalent but under‐reported in autism early intervention research” (Bottema‐Beutel et al, 2020). This means that there is a lack of transparency and the claim that ABA is evidence-based needs to be challenged.

“There is not enough evidence of ABA’s preponderance over other alternatives.” – Fernandes & Amato, 2013

To sum up

ABA has been described as “an extremely negative experience” (Wilkenfeld & McCarthy, 2020) by a huge number of Autistic adults who have been subjected to it. Chris Bonnello (Autistic Not Weird) did a huge survey in 2018 which showed that the Autistic community is against ABA, with 34.16% of all respondents and 53.48% of Autistics saying they would not recommend its use. Please note that the vast majority of the remaining percentages weren’t pro-ABA. A large percentage of the respondents abstained from answering. Only 13.92% agreed with ABA overall, and 5.19% of Autistics.

As “the standard measures for autists’ success make very little mention of the subjective well-being of [Autistics]” (Wilkenfeld & McCarthy, 2020) it is hard to claim that any outcome is an objective success. Sure, the Autistic child may now give eye contact, eat a few more things without vomiting, and communicate by speaking, but is a lifetime of thinking that they’re inherently ‘wrong’ worth it? Is a lifetime of PTSD the price you’re willing to pay for conformity?

Reference List

Bonnello, C (2018), Autistic Not Weird (online) https://autisticnotweird.com/2018survey/

Bottema-Beutel, K, Crowley, S, Sandbank, M & Woynaroski, TG (2020) The Journal of Child Psychology and Psychiatry (online)  https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.13249

Cassidy, S, Bradley, L, Shaw, R & Baron-Cohen, S (2018), Molecular Autism (online) https://molecularautism.biomedcentral.com/articles/10.1186/s13229-018-0226-4

Dawson, M (2004), No Autistics Allowed (online) https://www.sentex.ca/~nexus23/naa_aba.html

Fernandes, FDM, & Amaton, CAH (2013) Scientific Electronic Library Online (online) https://www.scielo.br/pdf/codas/v25n3/en_16.pdf

Kupferstein, H (2018), Advances in Autism (online) https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2017-0016/full/html

Wilkenfeld, DA & McCarthy AM (2020) Kennedy Institute of Ethics Journal (online)

https://muse.jhu.edu/article/753840

Further reading

https://neuroclastic.com/2019/03/27/is-aba-really-dog-training-for-children-a-professional-dog-trainer-weighs-in/amp/ If you read nothing else, read this!

https://neuroclastic.com/2019/03/28/invisible-abuse-aba-and-the-things-only-autistic-people-can-see/ – includes videos which are important to watch, but are disturbing and upsetting

https://tania.co.za/non-speaking-autistics-thoughts-on-aba/ – views of non-speaking Autistics

http://www.astraeasweb.net/politics/aba.html

http://www.thinkingautismguide.com/2017/04/if-not-aba-then-what.html

https://web.archive.org/web/20160313110407/https://www.realsocialskills.org/post/120453082402/aba-therapy-is-not-like-typical-parenting

http://strangeringodzone.blogspot.com/2017/05/analysing-responses-to-aba-critiques.html

https://www.psychologytoday.com/us/blog/the-homework-myth/202001/autism-and-behaviorism-0

 

A critique of the use of Applied Behavioural Analysis (ABA)

Posted with permission from Dr. Damian Milton, originally written as the Appendix for the Labour Party Autism / Neurodiversity Manifesto Steering Group, 2018

Content Warning: this article discusses depictions of torture and abuse.

“…right from the start, from the time someone came up with the word
‘autism’, the condition has been judged from the outside, by its appearances,
and not from the inside according to how it is experienced.” (Williams, 1996:
14).

This report looks into the commonplace implementation of Applied
Behaviour Analysis (ABA) and Positive Behavioural Support (PBS), criticisms of
these approaches, and why they are not usually supported by neurodivergent
communities, before concluding with some recommendations for future practices.

ABA can be defined as the application of techniques based upon the
philosophy of radical behaviourism (pioneered by B.F. Skinner and others). ABA
seeks to utilise these theories of learning in order to alter behaviour.
Contemporary theory and practice, despite moving beyond the ‘methodological
behaviourism’ that prioritised behaviour modification, to the use of
‘functional assessments’ of the ‘antecedents, behaviour, and consequences’ of
behaviour within a context (or ABC method), still primarily focuses on reducing
behaviour deemed ‘aberrant’ or ‘inappropriate’ and increasing behaviour deemed
socially ‘valid’ and ‘acceptable’. By following the principles of radical
behaviourism, thoughts and emotions are treated as behaviours operating in the
same ways as observable actions (Research Autism, 2018). Such a philosophy is
criticised by other schools of Psychology or Philosophy of Mind (Stanford
Encyclopedia of Philosophy, 2015). Proponents of ABA suggest that it is a
‘natural science’ of behaviour, rather than a ‘social science’ dependent on
hypothetical constructs.

“Behaviour Analysts are not distracted by the many different theories of
the causes of autism.” (childautism.org.uk, 2018).

Critics would suggest that rather than being an objective natural
science however, it rather uses a flawed set of conceptual concepts at the
expense of excluded concepts that have developed through other disciplines and
perspectives. Despite being a general theory and practice, it is often
incorrectly assumed to be a specific intervention used with autistic people (by
both some proponents and critics). The history of ABA is not without
significant controversy outside of working with autistic people though. One of
the pioneers of using ABA to make autistic people ‘indistinguishable from their
peers’ was Ivar Lovaas who also utilised the method as a form of ‘conversion
therapy’ for transgender children:

“Rekers and Lovaas conducted the treatment in response to the parents’
concerns not the child’s. Furthermore, they challenged all four of the reasons
Rekers and Lovaas stated for going forward with the treatment, including the
need to relieve the boy’s suffering, the idea that the “problems” would
continue into adulthood, that an early intervention may be the only treatment
that worked, and that “the parents were becoming alarmed.”” (Wilhite, 2015).

These remarks are eerily familiar with regard to the reasons given as to
why ABA is often administered upon neurodivergent people. In the UK, a somewhat
less extreme version of ABA has taken shape in the form of Positive Behaviour
Support (PBS):
“Another way to decide what to teach a child with autism is to understand
typical child development. We should ask what key developmental skills the
child has already developed, and what they need to learn next. The statutory
curriculum in the countries of the UK also tells us what children should learn.
Then there are pivotal behaviours that would help further development: teaching
communication, social skills, daily living or academic skills that can support
longer-term independence and choices.” (Hastings, 2013).

Despite contemporary behaviourist theorists such as Hastings (2013) who
favour PBS claiming to use a non-normalising social model approach, it is clear
from the above passage that a normative approach to child development and
education is being utilised. Such a view can be contrasted with autistic and
wider neurodivergent and disabled activist accounts regarding behavioural
intervention. A recent multicentre, cluster randomised controlled trial
conducted by Hassiotis et al. (2018) however found no ‘treatment effects’ in
terms of reductions in ‘challenging behaviour’ between those being cared for by
staff trained in PBS compared to those who were not, and that further research should:
“…endeavour to identify other interventions that can reduce challenging
behaviour.” (Hassiotis et al., 2018:1).

According to the UK Society of Behaviour Analysts, the use of ABA should
be based on a number of values, including a focus on the ‘individual’ and on
‘skill acquisition’. “Behaviour analysts ensure that the goals, methods, and
outcomes of any intervention are important, understandable, and acceptable to
the person whose behaviour is being changed, as well as to those who care about
the person (e.g., parents, carers, teachers).” (UK-SBA, 2018).

Given that ABA is practised upon young children and less verbally
articulate autistic people, coupled with the lack of understanding often found
in non-autistic people’s interpretations of autistic ways of being and actions
(Milton, 2012, Chown, 2014, Heasman and Gillespie, 2017, Sasson and Morrison,
2017), these values cannot be ensured. The ethical decisions as to what
behaviour is to be addressed and why is left to carers and professional
advisors. It is also notable that the behaviour often deemed in need of change
by professionals for ‘social validation’ are not as important, understandable
and acceptable to the autistic person expected to perform and comply.
Similar issues would also be pertinent with all neurodivergent identities.
“Any decisions made about how behaviour will be assessed or changed are
sensitive to the individual circumstances of the person and are aimed at
improving quality of life.”
(UK-SBA, 2018).

Yet, when quality of life is defined in normative terms and without the
input of neurodivergent people, or even deliberately not addressing critique,
it can only too quickly become ableist oppression. Behaviour analysts suggest
that ‘skill acquisition’ should be seen as primary goal of intervention. This
places the pressure on the neurodivergent person to conform to society, whilst
not making the same effort in return (Milton, 2014, 2017) “…to address quality
of life issues by improving skills that can remove barriers to learning and facilitate
independence and best practice utilises methods based on ABA…” (Keenan et al.
2014: 167).

The narrative presented by some leading advocates of ABA see autism and
other neurodevelopmental ‘conditions’ as barriers to learning, and ABA as a way
of facilitating independence and improving skills, and that this will all lead
to a better quality of life. This statement is however highly normative, and
unsympathetic to a social model of disability. Criticisms of ABA are often
misrepresented by ABA proponents as a caricature, without attempting to engage
fully with those criticisms. This is particularly relevant when such practices
are implemented on potentially vulnerable people.
“One expects lobby groups to give vent to fixed and emotionally charged views,
but one expects more from scientists. Tolerance of scrutiny, acceptance of
criticism, and objectivity in experimental approach and the interpretation of
outcomes are expected. A discipline that makes extravagant claims of its
methods, overstates its scientific status and has difficulty agreeing on
definition of its terms will struggle to achieve scientific credibility.”
(Hughes, 2008).

For many neurodivergent activists, the normalisation agenda inherent in
such approaches is not a caricature, but a felt experience of living in what is
perceived to be an inherently ableist society. Who gets to define what is
‘appropriate’, ‘challenging’, ‘disordered’, and ‘socially important’, is always
imbued with unequal power relations (Mason, 2005). A denial of the directly
felt harm of those that have had such methods implemented on them is often met
with increased anger and frustration from members of the neurodivergent
communities, as well as some parents (for examples see: realsocialskills, 2018,
Omum2, 2018, Dalmayne, 2018), yet despite this, activists have attempted to
explain what their contentions are, even making distinctions between differing
experiences of ABA (Unstrangemind, 2018). The impasse between these
perspectives is not just over the ideological purpose that a method is set to,
but also the processes of ABA-based practices.

Although Milton (2016) found that interventions akin to PBS were popular
amongst parents, this was contrasted with the views of autistic people.
Tensions between these views are likely to persist, but a greater understanding
of the reasoning behind why differing stakeholders are attracted to differing
ideologies and practices can help all to build a common language in which to
debate the issues. Such a way forward is being held back by those with a
dogmatic adherence to ABA however, and a focus purely on the reduction of
so-called ‘challenging behaviours’.

“…the whole ABA movement appears increasingly more like a cult than a
science: there is a charismatic leader, a doctrine, a failure to engage with
criticisms, inquisition and denunciation of any who criticise (however mildly),
misrepresentation of critics, and proselytising exercises to gain more converts
and spread the word.” (Jordan, 2001, cited Fitzpatrick, 2009: 141).

A study by Remington et al. (2007, cited Fitzpatrick, 2009) compared
those who had home-based ABA to those who did not, over a two-year period.
Using measures of intelligence, language use, daily living skills, and a
statistical measure of ‘best outcomes’, the majority made no significant
advances. Magiati, Charman and Howlin (2007) found no significant differences
in a range of outcome measures either, although large differences were found
regarding outcomes within both control and experimental groups. Hogsbro (2011,
cited in Milton, 2016) found that on average, ABA provision had a negative
impact on a number of standardised measures. Yet, the parents of children on
such programmes were found to hold the highest expectations for their
children’s educational progression, and professionals and parents using this
model subjectively rated improvements higher than all other groups. Similar
findings were also found by Kupferstein (2018).

“I had virtually no socially-shared nor consciously, intentionally
expressed, personhood beyond this performance of a non-autistic ‘normality’
with which I had neither comprehension, connection, nor identification. This
disconnected constructed facade was accepted by the world around me when my
true and connected self was not. Each spoonful of its acceptance was a shovel
full of dirt on the coffin in which my real self was being buried alive…”
(Williams, 1996: 243).

In this quote, the late Donna Williams (1996) suggests that by learning
by rote how to act as a nonautistic person can produce a ‘masking’ effect and
be detrimental to long-term well-being and mental health. Williams (1996)
directly criticised the use of behavioural techniques such as ABA for only
working on function and appearance, and for their lack of fit with autistic
perceptions. For Williams, such techniques:
“…may feel like a senseless ritual of abuse, regardless of its ‘good’
intentions.” (Williams, 1996: 51).

Kupferstein’s (2018) recent study regarding the potential links between
ABA, post-traumatic stress disorder (PTSD) and autistic people found that
respondents across all ages who were exposed to ABA were 86% more likely to
meet the PTSD criteria than respondents who had not been exposed to ABA
practices.

Major issues with the ABA theory and practice:

– What behaviours are reinforced and deemed as functional and of social
importance and relevance is chosen by an outsider
– ‘Reinforcements’ may be inappropriately given (e.g. the bombardment of
emotionally laden praise, and hugging, and punishments being potentially
internalised as rewards such as timeouts)
– Rote learning can lead to training people to behave as if their problems do
not exist, or lead to ‘autopilot’ responses
– The claim that ABA will suit everybody as an applied method – it clearly does
not
– The focus on behaviour at the detriment of subjective understanding and
cognition
– Often focuses on compliance and founded on normative assumptions
– Reduces opportunity for natural curiosity and exploration
– Utilises ‘reinforcements’ that are often extrinsic rather than intrinsic
motivations for activities
– The lack of generalising of newly learnt ‘skills’
– Sometimes punishment is endorsed as a ‘last resort’
– The intensity of programs (often suggested that one works on ABA programs for
forty hours a week).

Instead, it is recommended here that practices should:

– Take a holistic and person-centred approach which therefore takes into
account neurodivergent sensibilities, sensory perceptual differences,
subjective accounts, cognitive theory, and a social model of disability
– Building understanding and communication between all involved
– Enabling environments to be more accessible
– Reducing direct confrontation
– Ethical considerations must be built in to every step of the process of
acquiring professional competencies
– Use of dangerous restraint methods and forced seclusion should be seen as
disciplinary offences
– Rather than focusing on perceived weaknesses and absent skills, utilise
strengths and interests
– Neurodivergent perspectives must be built in to every step of the process of
acquiring professional competencies
– Building local expertise and communities of practice, drawing upon
multi-disciplinary expertise, but places the neurodivergent person at the
centre of considerations.

Although similar criticisms can be made of other normative interventions
that are administered upon neurodivergent people, few have as poor a track
record in terms of participation as ABA and PBS. Although individual practice
by parents and indeed professionals may not seek normalisation in the use of
ABA, the flaws in its theory and implementation mean that we should be looking
beyond its scope. Therefore the endorsement of PBS by the Care Quality
Commission, alongside the widespread use in schools and mental health services
needs urgent review. As a way forward, it is suggested here that the
person-centred and socially sensitive approaches being developed by groups such
as Studio3 and AT-Autism are promising and that these need to be tested with
high quality research.

References
Child Autism UK (2018). ABA and autism. Accessed online at: https://www.childautism.org.uk/aboutautism/applied-behaviour-analysis-aba-and-autism/
Chown, N. (2014). More on the ontological status of autism and the double empathy problem. Disability and Society. Vol. 29(10): 1672-1676.
Dalmayne, E. (2018). Applied Behavioural Analysis: First-Hand Accounts, Accessed online at: http://www.autismdailynewscast.com/applied-behavioural-analysis-first-handaccounts/27715/emmadalmayne/3/
Fitzpatrick, M. (2009). Defeating Autism: A Damaging Delusion. London: Routledge.
Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I. S., Crabtree, J., and Cooper, V. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial. The British Journal of Psychiatry, 1-8.
Hastings, R. (2013). Behavioural method is not an attempt to ‘cure’ autism, Accessed online at: https://theconversation.com/behavioural-method-is-not-an-attempt-to-cure-autism-19782
Heasman, B., & Gillespie, A. (2017). Perspective-taking is two-sided: Misunderstandings between people with Asperger’s syndrome and their family members. Autism, published online July 2017: http://journals.sagepub.com/doi/abs/10.1177/1362361317708287#articleCitationDownloadContainer
Hughes, M-L. (2008). ABA – Giving Science a Bad Name? Accessed online at: https://thepsychologist.bps.org.uk/volume-21/edition-5/letters
Keenan, M., Dillenberger, K., Rottgers, H., Dounavi, K., Jonsdottir, L., Moderato, P., Schenk, J., VireusOrtega, J., Roll-Pettersson, L. and Martin, N. (2014). Autism and ABA: The Gulf Between North America and Europe, Review Journal of Autism and Developmental Disorders. Vol. 2(2): 167-183.
Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis, Advances in Autism, Vol. 4(1): 19-29.
Magiati, I., Charman, T. and Howlin, P. (2007). ‘A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders’, Journal of Child Psychology and Psychiatry. Vol. 48 (8): 803-812.
Mason, M. (2005). Incurably Human. Nottingham: Inclusive Solutions.
Milton, D. (2012). On the Ontological Status of Autism: the ‘Double Empathy Problem’. Disability and Society. Vol. 27(6): 883-887.
Milton, D. (2014). So what exactly are autism interventions intervening with? Good Autism Practice, Vol. 15(2): 6-14.
Milton, D. (2016). Educational discourse and the autistic student: a study using Q-sort methodology [doctoral thesis]. Birmingham: University of Birmingham.
Milton, D. (2017). Challenging the ideology of idealised normalcy. in: Milton, D. and Martin, N. eds. Autism and Intellectual Disabilities in Adults, Vol. 2. Hove, UK: Pavilion Press.
Omum2 (2018). ABA and Autism – the thorny problem of control and consent, Accessed online at: http://smallbutkindamighty.com/2015/06/16/aba-and-autism-the-thorny-problem-of-control-andconsent/?utm_content=buffer71bf8&utm_medium=social&utm_source=twitter.com&utm_campaign
Realsocialskills (2018). ABA therapy is not like typical parenting, Accessed online at: http://realsocialskills.org/post/120453082402/aba-therapy-is-not-like-typical-parenting
Research Autism (2018). Applied Behavioural Analysis, Accessed online at: http://www.researchautism.net/autism-interventions/types/behavioural-anddevelopmental/behavioural/applied-behaviour-analysis-and-autism
Sasson, N. J., and Morrison, K. E. (2017). First impressions of adults with autism improve with diagnostic disclosure and increased autism knowledge of peers. Autism, published online November 17th, 2017: http://journals.sagepub.com/doi/abs/10.1177/1362361317729526
Stanford Encyclopedia of Philosophy (2015). Behaviorism. Accessed online at: https://plato.stanford.edu/entries/behaviorism/
Unstrange Mind (2018). ABA, Accessed online at: https://unstrangemind.wordpress.com/2014/10/07/aba/
UK Society of Behaviour Analysts (2018). Behaviour Analysis. Accessed online at: http://uksba.org/behaviour-analysis/
Wilhite, C. (2015). Trangender people and behavior analysis’ dark past. Accessed online at: http://www.bsci21.org/transgender-people-and-behavior-analysis-dark-past/
Williams, D. (1996). Autism: An Inside-Out Approach. London: Jessica Kingsley.

Original publication can be found on https://neurodiversitymanifesto.com/

Does ABA harm Autistic People?

By Shona Davison;

Shona is an Autistic mum to two autistic children. She is Studying for an MA in autism at Sheffield Hallam University. Interested in educating others about autism.

Content Warning: this article discusses depictions of torture and abuse.

Applied behaviour analysis (ABA) is a behavioural therapy which has the goal of changing observable measurable behaviour, usually by manipulating antecedents or using reinforcement (usually positive reinforcement as negative is less commonly used now). Data is used to see how the rate of behaviour changes from these manipulations.

Manipulating environments and consequences in order to influence behaviour perhaps sounds harmless and similar to how many people parent? I do not believe it is harmless though – ABA has a murky history, which I discuss below.

There is not one universal definition of ABA, some therapists use the term more loosely than others and in the US some therapies are given the name ABA in order to access insurance funding. This article may therefore not be referring to your ABA. Some ABA providers have the problematic goal of making autistic people ‘indistinguishable’ from their non-autistic peers. If the provider you are considering using has that goal then this article most likely is referring to your ABA.

Many autistic people speak up against ABA but our smaller numbers and pathologized identities mean our voices often go unheard or ignored. Advocating against ABA can elicit a barrage of criticism – even against those who have first-hand experience and are describing their own personal trauma.

I see the popularity of ABA as a symptom of various factors: society does not accept difference; does not understand autistic behaviour or how to support autistic people; and does not trust the autistic person to be able learn without ABA. How has ABA come to exist? The more powerful party (non-autistic people – they have numbers on their side) make judgements about the behaviour of members of the marginalised group (autistic people). They do not like or understand what they see, and decide they need to change it, rather than accommodate it. This does not usually come from a bad place. Often the kindest, most caring people believe the way to help us, is to help us become more ‘normal’. This is what happens when one takes a medical model approach to autism – when one considers autistic people to be broken, disordered or ill. Many of us do have medical problems, but that is not the same as autism being medical.

It is possible to change behaviour using ABA, there is no question of this – though not as effectively as some would have you believe (see Dawson, 2004; Hassiotis et al., 2018, Hughes, 2008). But this is beside the point. We ought to be considering whether we should change the behaviour – which is often harmless and often useful. Quite often the main beneficiary is not the autistic person, it is the people around them.

Dr. Ivar Lovaas considered the goal of ABA to make autistic people ‘indistinguishable from their peers’. This aim puts all the responsibility for change on autistic people. Autistic people try so hard to get by in this world and often that means we compromise ourselves to ‘fit in’ with non-autistics. We force ourselves to do things that hurt us or make us uncomfortable, which partially explains the high rates of mental health problems and suicide in our community. Despite all this effort, we often still stand out as different and so still get judged and criticised. This aim of ‘indistinguishable’ still gets cited by ABA providers. While society strives for this goal – the goal of making us ‘normal’ – our human rights will be violated. Aiming for ‘normal’ is unethical, often unachievable and many first-hand accounts suggest it comes at too high a cost to the autistic person.

Critical thinking

Critical thinking is essential when evaluating any potential therapy for autistic individuals and sadly this is not a skill most people possess. When considering the pros and cons of ABA please ask yourself the following questions:

1. Does the individual who is advocating for or against ABA have any financial or professional incentive to do so?
– Have they been paid to do it?
– Is their career or professional status dependent on them convincing people of the benefits or problems associated with a particular therapy?
– Are they are selling ABA or an alternative to it?

2. Does the author have an emotional reason for advocating for or against ABA?
– Parents who love their children and may have spent a small fortune and given up many hours of their time to support their child using ABA are not going to want to hear that they are inadvertently causing harm. There is a strong emotional motivation to ignore or to discredit anyone who says that they are.
– Practitioners who have chosen careers in good faith because they want to help autistic children, will not want to accept that they are doing the opposite.

3. Be aware of cognitive bias.
– It is much easier to convince somebody of a lie, than to convince them that they have been lied to.
– We tend to believe what we come across first. This is often support for ABA, unsurprisingly, given the size of the marketing budgets behind it’s promotion and the power imbalance between those who advocate for it (often non-autistic people, perhaps parents or practitioners) and those who advocate against it (often autistic people, some of whom have been recipients of ABA).

Bear these factors in mind when considering how much weight to give to an individual’s views. I’m not suggesting people who work in the autism industry (and I do consider it an industry) are automatically untrustworthy – after all building a career out of your passion is something most of us would love to do. I am simply stating that scepticism is your friend when reading anything related to autism.

For the purposes of full disclosure and to aid your critical thinking, I will tell you a bit about me: I am an autistic parent to autistic children. I am in the final module of an MA in autism. I do not get paid for any autism work – I currently give up my limited time for free because I am passionate about helping other autistic people. My view is that ABA hurts autistic people. It is only because autistic people are a marginalised minority group who struggle to be heard, that most people do not seem to grasp this. It strips autistic people of dignity, violates our human rights and is evidence of how so many of the non-autistic population believe that autistic people want to be like them. Most of us just want to be happy. It is hard to be happy when the relentless narrative is that you are broken and need fixing. If I had the option of not being autistic, I would not take it – nor would I take it for my children. That does not mean life is easy for me, it means I like myself and my children the way we are.

History of ABA

ABA has always been controversial. In the 70s it was used to ‘cure’ children who were at risk of developing ‘adult sexual abnormalities’ (i.e. gay or transgender). One study had as its goal to extinguish female ‘sex-typed’ behaviours from a young boy called Kraig (Rekers and Lovaas, 1974). He was subjected to three times weekly treatments of ABA, where his mother was trained to ignore ‘feminine behaviour’ and give him attention for ‘masculine behaviour’. Signs of his distress were described as ‘tantrums’ and the boy ‘putting pressure’ on his mother for her attention. Doll play was relatively easy to extinguish but ‘feminine gestures’ (e.g. limp wrist, hip swaying) remained until ‘spankings’ were introduced. The whole paper is littered with language that shows contempt for the boy: ‘flirtations’, ‘screechy’, ‘brat behaviour’. The language used says so much more about the adults observing and judging the behaviour than it does about Kraig, who was only four years old when treatment started. Reading it 40 years after it was written, I am filled with disgust. I hope and believe that society will look at ABA for autistic people with the same abhorrence in 40 years time.

What about more recent evidence for the use of ABA with autistic children? If I do a search for ‘ABA evidence autism’ and pick a random journal article (Smith and Iadarola, 2015) I find the behaviour of autistic people described as ‘tantrums’ and ‘aggression’. The likelihood of being autistic is termed ‘risk’. Many behaviours that I would consider logical and adaptive given individual sensory experiences are described as ‘symptoms’ e.g. extreme food selectivity. The paper refers to parental and caregiver stress multiple times but not once does it mention the autistic child’s stress. A child who is ‘aggressive’ or has ‘tantrums’ is likely a stressed child. Why do so many people fail to see that? Why do autistic people always get the blame for challenging interactions? Why are we trying to change autistic people and their behaviour rather than changing their environment to reduce their stress? Very often behaviour of parents, teachers and caregivers are a major source of stress for the child and are therefore one of the causes of the ‘challenging behaviour’. We should call all behaviour that challenges someone else ‘challenging behaviour’ rather than just reserving that term for the least powerful party (the autistic person). I am writing this from experience – I know what it is like to parent and teach autistic people as well as to be autistic.

Whilst ABA has changed and evolved over the years it does not hurt to remember where it came from. Here are a couple of quotes from Ivar Lovaas, the ’father of ABA’.

“You see you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense – they have hair, a nose and a mouth – but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build a person. (Lovaas cited by Chance, 1974, p76)”

When you consider that Lovaas appeared to believe autistic people are not fully human, it is easier to understand his unethical approach to ‘treating’ us. Electric shocks were one of a number of ‘aversives’ used on autistic children. Electric shocks are still used on autistic people in one well known facility, the Judge Rotenberg Centre and are condoned by the Behaviour Analysis Certification Board (BACB) and the Association for Behaviour Analysis International (ABAI). Here is a description of ABA being used on an autistic child called Pamela. It is an extract from the article ‘Screams, Slaps and Love’ in Life magazine (1965):

The most drastic innovation in Lovaas’ technique is punishment — instantly, immutably dished out to break down the habits of madness. His rarely used last resort is the shock room. At one point Pamela had been making progress, learning to read a little, speak a few words sensibly. But then she came to a blank wall, drifting off during lessons into her wild expressions and gesticulations. Scoldings and stern shakings did nothing. Like many autistic children, Pamela simply did not have enough anxiety to be frightened.
To give her something to be anxious about, she was taken to the shock room, where the floor is laced with metallic strips. Two electrodes were put on her bare back, and her shoes removed.

When she resumed her habit of staring at her hand, Lovaas sent a mild jolt of current through the floor into her bare feet. It was harmless but uncomfortable. With instinctive cunning, Pamela sought to mollify Lovaas with hugs. But he insisted she go on with her reading lesson. She read for a while, then lapsed into a screaming fit. Lovaas; yelling “No!”, turned on the current. Pamela jumped — learned a new respect for “No.”

Lots of things come to mind when I read that extract. It is quite clear that the author has difficulty empathising with the autistic child. There is no attempt to understand the reason for the behaviours and motivations are assumed which are almost certainly inaccurate. Why are ‘wild expressions and gesticulations’ a problem? Who are they hurting? I do not believe that Pamela did not have enough anxiety to be frightened. As an extremely anxious autistic person, I know that I express anxiety in ways that many non-autistic people would fail to recognise. Few people can tell when I am anxious, unless it becomes a full-blown panic attack. From my autistic perspective, I would guess that Pamela stares at her hand because she enjoys it. It is most likely a positive sensory experience – no one should have the right to stop her if she is not hurting anybody. And to stop her by electrocuting her, then describing her as ‘cunning’ for wanting a hug when she is upset? Despite, or perhaps, because of this repugnant treatment and disregard for ethics, the therapist gets proclaimed as innovative and pioneering.

Changing behaviour using behavioural techniques is not particularly difficult. Perhaps we should be asking: ‘should we change the behaviour?’; ‘who will benefit from changing this behaviour?’; and ‘are we changing behaviour without addressing an underlying root cause?’.

Evidence based?

There are critiques of the evidence for ABA available online so I will not go into detail here (see Dawson, 2004) but I will comment that when I read research the most obvious thing that researchers so frequently fail to get right are the outcome measures. Interventions get judged by non-autistic standards of ‘success’. If you can speak, have a job, have lots of friends and variety of interests but you are not happy, how is that a successful outcome? Not everybody wants friends or a lot of hobbies! My passions are few but they are very strong, make me happy and help counter-balance stressful elements of my life. If a non-autistic person assessed my life, they may well disapprove or worry about plenty, but that is because humans find it difficult to empathise with people who are different to them. As non-autistic people are the majority, I am fairly well versed in non-autistic ways and I find many elements bizarre. I do not judge non-autistic people for incessant small talk, asking questions when they are not interested in the answer and hugging to say ‘hello’. I accept non-autistic people as they are and would not dream of suggesting they need therapy to be more like me. So why do we have academic papers written by respected researchers where they are judging an intervention by whether it makes the person behave more like a non-autistic person? I find it so difficult to read these papers – to me it is so apparent that they are missing the point. We should be aiming for happy autistic people not autistic people who can pass for ‘normal’. Whilst this basic concept is not understood, time and money will continue to be wasted on research that does not help autistic people but further stigmatises and hurts us.

Another problem with most research is that it does not look at long term outcomes. What is the point in proving that an intervention meets a short term (flawed) goal when we have no idea of the long-term consequences? There is certainly plenty of anecdotal evidence that ABA has long term negative consequences (see further information) and we are even starting to see academic research (Kupferstein, 2018) though we need much more. As we are disadvantaged in education and employment and there is still stigma and risk of discrimination, there are still not as many openly autistic researchers as I would like to see. Autistic people do not usually have budgets for research, or staff devoted to marketing and PR, unlike ABA providers, so our stories may not be as well promoted. Also, there are still people who believe that being autistic means we are unable to advocate for ourselves or others.

Autistic voice

Historically, the voice of autistic people has been stifled. Simon Baron-Cohen wrote in his book Mindblindness (1999) that theory of mind (the ability to put oneself metaphorically in another person’s shoes – an ability he theorised that autistic people lack) is ‘one of the quintessential abilities that makes us human’. The implication, of course, that autistic people are not fully human. Frith and Happé (1999) claimed that our lack of theory of mind weakens our awareness of self. If autistic people are perceived to be lacking self-awareness or not to be fully human then our accounts will be undervalued. Here are some examples that demonstrate how still today some see us as less than human:

1. The person first or identity first debate – why do so many non-autistic people advocate for person first language saying we need to remind everybody we are people first and foremost?

2. Here is an article in Psychology Today where we are described as ‘undomesticated humans’ – the author Christopher Badcock believes this is preferable to being described as aliens (another dehumanising term). We are even compared to Siberian foxes.

3. Ian McClure a psychiatrist who is influential in the treatment of autistic people (he chaired the SIGN 145 guidance and was an external reviewer for the NICE guidance), spoke at a national conference where he described autistic people as ‘not quite right’, ‘causing havoc’ and ‘emotionally stuck at the level of a 2 year old’. He suggested that ‘two human species came together’ and we ended up with ‘a genetic mess’. Click here for the transcript of a 10 minute edited version.

There is still a long way to go before autistic people are afforded equal rights and respect. It is hard being autistic and constantly having to defend yourself against these views which often come from autism professionals – the very people who are supposed to be serving us.
Recent research suggests that autistic adults should be considered experts on matters relating to autism (Gillespie-Lynch, Kapp, Brooks, Pickens and Schwartzman, 2017) so I recommend that parents seek to connect with them in order to understand their child and how to support them.

Conclusion

If you are considering ABA for your child please research widely on the topic, including views from autistic people. Remember to be critical of everything you learn on the topic. You can only come to a balanced view if you take the time to do this.

There is too much anecdotal evidence saying that ABA harms autistic people to just brush it under the carpet. There is also some academic evidence that ABA causes harm. Hopefully the growing number of autistic academics will mean that more research will be done in this area – improving quality of life is a common theme in the research that autistic people tend to prefer, contrary to where the funding goes (research on genes and finding causes).

Most people can see how unethical it is to use ABA to teach gay people to behave like straight people. Why then is it still deemed acceptable for autistic people? I have never heard a good answer to the question.
Anxiety, depression, post traumatic stress disorder and other mental health problems are not an inevitable part of being autistic. They can be avoided and I believe the best way is with love and acceptance. A stressful childhood is not conducive to good mental health and wellbeing.

Trust that understanding and accepting developmental difference does not mean that your child will not progress.
As Beardon (2017) states:

“Autism + Environment = Outcome”

One can’t change the autism, so in order to improve the outcome, one needs to focus on changing the environment.
Every autistic person deserves to be loved and respected for being their authentic autistic self.

Further information

Relationship between trauma and ABA – anecdotal evidence
An open letter to families considering intensive behavioural therapy for their child with autism by Virgynia King and Bob King.

Part 1:
http://www.astraeasweb.net/politics/aba.html
Part 2:
http://www.astraeasweb.net/politics/aba2.html

The truth about ABA:
http://autismmythbusters.com/parents/therapy/the-truth-about-aba/

Relationship between trauma and ABA – research evidence

Evidence of increased PTSD symptoms in autistics exposed to applied behaviour analysis. Kupferstein, (2018)

https://www.researchgate.net/publication/322239353_Evidence_of_increased_PTSD_symptoms_in_autistics_exposed_to_applied_behavior_analysis

First-hand accounts of ABA

My thoughts on ABA – Amy Sequenzia:
https://autismwomensnetwork.org/my-thoughts-on-aba/

Are there any adult autistics who are willing to share their personal experience of ABA therapy?
https://www.reddit.com/r/autism/comments/50bhcd/are_there_any_adult_autistics_who_are_willing_to/?st=isida1k8&sh=4b2e6577

Quiet hands by Julia Bascombe:
https://juststimming.wordpress.com/2011/10/05/quiet-hands/

References

Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, Mass: MIT Press.

Beardon, L. (2017). How can unhappy autistic children be supported? Retrieved from https://blogs.shu.ac.uk/autism/2017/07/03/presentation-by-luke-beardon/

Chance, P. (1974). “After you hit a child, you can’t just get up and leave him;
you are hooked to that kid”. O. Ivar Lovaas Interview With Paul Chance. Retrieved from: http://neurodiversity.com/library_chance_1974.html

Dawson, M. (2004). The misbehaviour of behaviourists. Retrieved from http://www.sentex.net/~nexus23/naa_aba.html

FRITH, U. and HAPPÉ, F. (1999). Theory of Mind and Self‐Consciousness: What Is It Like to Be Autistic? Mind & language, 14 (1), 82-89.

Gillespie-Lynch, K., Kapp, S. K., Brooks, P. J., Pickens, J., & Schwartzman, B. (2017). Whose expertise is it? evidence for autistic adults as critical autism experts. Frontiers in Psychology, 810.3389/fpsyg.2017.00438

Hassiotis, A., Poppe, M., Strydom, A., Vickerstaff, V., Hall, I. S., Crabtree, J., and Cooper, V. (2018). Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial. The British Journal of Psychiatry, 1-8.

Hughes, M-L. (2008). ABA – Giving Science a Bad Name? Retrieved from: https://thepsychologist.bps.org.uk/volume-21/edition-5/letters

Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behaviour analysis. Advances in autism, 4(1), 19-29.

Rekers, G. A., & Lovaas, O. I. Behavioral treatment of deviant sex-role behaviors in a male child. Journal of Applied Behavior Analysis, 1974, 7, 173-190.

Smith, T., & Iadarola, S. (2015). Evidence Base Update for Autism Spectrum Disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897-922.