Is ABA Therapy Harmful?
- January 11, 2022
It is vitally important that anyone seeking support services for themselves or loved ones do their due diligence in investigating not only whether those services are truly effective, but also whether or not that apparent effectiveness is also associated with potential harm.
It’s highly likely that anyone conducting a Google search on topics related to ABA therapy will turn up results showing the role it has played in the abuse of disabled persons. In this blog post, I will openly acknowledge and condemn the ways in which procedures based on ABA can and have caused harm.
That said, I will also explain how the science of behavior analysis can (and should always) be used safely and ethically, and affirm Waypoints’ commitment to empowering and supporting autistic children in a way that’s safe, respectful, empathetic, and fully celebrates neurodiversity.
One Shameful Example: The Graduated Electronic Decelerator
As noted on our Frequently Asked Questions page, practitioners associating themselves with ABA have caused undeniable harm to the clients they’ve claimed to serve, and at Waypoints we know it would be dismissive of that harm to simply hide behind the claim that “not all ABA is like that.” Indeed, when I was in graduate school studying behavior analysis, we as students were actually taught that in some extreme cases apparent harm was justified.
As a bit of a digital hoarder, I have a PowerPoint slideshow from one of my courses pulled up while I write this blog post. In it, a series of slides explains that one agency developed a Graduated Electronic Decelerator (GED) device to be used with clients who engaged in extremely dangerous and harmful behaviors, and for whom other less-intrusive interventions such as differential reinforcement had not been effective. This device provided an electric shock meant to punish and discourage ostensibly dangerous behaviors.
We were reassured that, despite repeated attempts to take the agency to court and end the use of these practices, actually the use of the GED by ABA therapists was fully safe and ethical:
“After an extended and appropriate baseline, an official recommendation to use the GED would be made. A parent or legal guardian had to first agree. Then a physician (MD) would have to sign-off that the procedure would be safe. Then the proposal went through several layers of Human Rights committees, internal and external. If all of these entities approved usage, then it went to a Probate Judge for final approval. Staff persons have to test the device on themselves before each use, and it can be used only for the target behavior. The JRC also has video monitoring in all classrooms and all group homes to monitor all behavior at these sites, including any applications of the GED.”
We were shown graphs of data highlighting the efficacy of the GED, as well as positive testimonials from caregivers who had approved its use. These were held up joyously as the gold standard of social validity—people willing to testify in court on behalf of the interventions being used!
In the time since earning my degree, I’ve learned much more about the danger of misuse of procedures like these, both in theory and in actuality. Even if such procedures could be justified in extreme circumstances, those circumstances are simply not the only cases in which they’ve been used. The GED has not been used exclusively for intervention upon dangerous behavior, but also contingent upon simple noncompliance and stereotyped movements and vocalizations. Shocks have been applied more than prescribed, and at higher magnitudes.
The risk of abuse of punishment procedures is well-documented, both in our empirical peer-reviewed literature as well as in real-life cases in which real, lasting harm was done. Scrutiny of agencies using such procedures continues to this day, but the procedures remain in use. In July of 2021, an FDA ban of the use of shock-based intervention was overturned.
Most importantly, I’ve learned to prioritize the voices of the disabled community with whom procedures like these are being used. The Autistic Self Advocacy Network has written extensively in denouncement of procedures based upon aversive control, as has ADAPT.
The Importance of Affirming Neurodiversity
The GED is an extreme example of the potential for ABA to be harmful. It’s probably fairly obvious that procedures like shock, restraint, and seclusion are high-risk. But it’s also important to keep in mind that any focus on changing behavior to fit societal norms—rather than changing the environment to accommodate individuals’ needs—can be harmful.
While the Ethics Code for Behavior Analysts emphasizes “respecting and actively promoting clients’ self-determination,” some ABA providers set goals and design interventions without the client’s direct input or consent. Specifically, they may prioritize abject compliance with authority and reduction of atypical social or motor behaviors (like stimming). Even procedures based upon differential reinforcement (rather than punishment) can be highly restrictive, if the goal is for an autistic individual’s self-expression and natural diversity to be dampened.
No one’s brain functions in the exact same way as another person’s brain, and this is referred to as neurodiversity. Like other facets of diversity, neurodiversity includes a broad, natural spectrum of human experience. Autism spectrum disorder (ASD), ADHD, and learning disabilities are examples of neurodivergence.
The neurodiversity movement is deeply tied to the cause of disability rights in general, as well as to autistic self-advocacy. The neurodiversity movement believes that autism should be accepted, not merely acknowledged or understood. In the context of behavior analysis, our goal at Waypoints is not to eliminate autism, but rather to celebrate individuality while ensuring that day-to-day life accommodations are provided and advocated for.
RELATED POST: Autism Spectrum Disorder Cannot Be “Cured.” That’s Not a Bad Thing.
In a presentation titled “Make Yourself Uncomfortable: Navigating Autistic and Allistic Social Communication Differences and Encouraging Authenticity,” autistic advocate Madi Holcomb shared potential outcomes of the enforcement of social norms in neurodiverse communities:
- Compensation—studying neurotypical social cues in order to incorporate them.
- Masking—daily practice of pretending to be neurotypical and hiding autistic traits.
- Hypervigilance—anxiety about facial expressions, gestures, etc. because of the impression that one’s own social instincts can’t be trusted.
- Assimilation—buy-in to social norms with the perspective that you HAVE to hide.
In the self-assessment of these outcomes, high scores are correlated with depression and poor well-being.
In addition to asserting that our practices at Waypoints will never include procedures like seclusion or restraint, nor behavior reduction unless there is a clear risk of danger to oneself or others, we will do our part to “advocate by platforming the disabled and demanding their human rights, dismantle systemic ableism within the field, and rebuild trust and truly helpful services.”
Progressive ABA: A Better Way Forward
This blog post by C. L. Lynch of NeuroClastic posits that “the problem with ABA is that it addresses the child’s behaviors, not the child’s needs.”
As someone who has studied and practiced the science of behavior analysis for more than 15 years, it breaks my heart that the application of “behavioral therapy” based on that science has come to that.
Indeed, from the scientific perspective, it should be exactly the opposite—all behavior is a function of environmental needs. Any behaviors taught or changed in the course of ABA services should, above all, fulfill the client’s needs. While I again will assert that I cannot and will not deny that ABA has often been practiced in the ways described by Lynch, it doesn’t have to be.
A push for progressive and trauma-informed ABA services has been strengthening in recent years. As just one example, Gregory Hanley emphasizes the importance of assent and prioritization of clients being happy, relaxed, and engaged (what he calls HRE) during sessions. If they are not, or if they withdraw assent, we aren’t doing our jobs correctly. Signals that ABA services are compassionate could include:
- Starting by asking questions (e.g., interviewing caregivers and clients, as opposed to standing apart and simply observing and taking notes).
- Creating a context in which the probability of dangerous behavior is near-zero (as opposed to trying to observe a direct baseline level of “problem” behavior by deliberately evoking/occasioning it).
- Never justifying the means by the ends and emphasizing values over procedures; doing what is safest in the moment.
- Empowering the learner. While we do introduce more challenging situations and unpredictability as part of services, we immediately and empathetically acknowledge resistance. It’s more important to allow clients to momentarily escape, self-soothe, etc. in order to teach them that they never need to escalate to self-injury, tantrums, or aggression.
- Shaping skills including communication, toleration, and cooperation. The main drivers of behavior changes should be motivation, prompts, and contextually relevant and individualized reinforcement, not aversive control.
It is our hope at Waypoints that we can embody these values. While I quibble a bit with some terminology like “televisibility”—we push to provide ethical services because it’s the right thing to do, not so that it looks better in the public eye—this pledge is largely representative of our goals.
Evaluations and Recommendations, Across the Field of ABA
In closing, I want to highlight a recent publication by Justin Leaf and colleagues reviewing concerns about ABA programs, evaluating the validity of those concerns, and proposing methods of addressing those concerns.
Kristen Bottema-Beutel and Georgia Pavlopoulou have since responded to Leaf and colleagues’ recommendations by arguing that they “only superficially engage with these important issues, and fall short of supporting neurodiversity, despite their intention to do so.”
As a field, we have a long way to go when it comes to clearly denouncing harmful practices, taking action to stop their use, and strongly advocating for ethical application of the science of behavior analysis. It is my hope that we can continue to have these conversations in good faith, and in full transparency with those that we make careers out of supporting.
To that end, if you have questions or concerns about ABA or any of the materials linked to in this post, we’d love to chat with you at info@waypoints.life.
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