Applied Behavior Analysis or ABA is commonly used to treat people with autism spectrum disorder (ASD). It was developed in the 1970s by Drs. Ivar Lovaas and Robert Koegel although their work was greatly influenced by behaviorists such as John B. Watson, Ivan Pavlov, and B. F. Skinner. ABA is founded on the principle of giving and taking away reinforcers; when an ABA professional wants to increase a skill, they use a reinforcer, and when they want to decrease a behavior, they take a reinforcer away. In the simplest of terms, reinforcers are simply things that are enjoyable, such as having a few moments to play with a desired toy. In many countries, ABA is the only treatment option for autism that is reimbursed by insurance agencies. After all, ABA has been proven to be effective in treating ASD by numerous studies. Even so, ABA faces its fair share of criticism.
The Bad
Use of Cruel Punishment Methods in the Past
During the early years of ABA, cruel punishment methods such as electric shocks were commonly used to reduce behaviors that were considered negative. Although such methods are no longer applied and the ABA of today focuses on rewarding positive behaviors, this doesn’t change the fact that many people suffered from unethical practices in the 1970s.
Trying to Force People into A Neurotypical Mold
Even today, many ABA therapists are criticized for trying to reduce behaviors like hand flapping or spinning because these behaviors may look odd in the eyes of neurotypical people. It’s important to note, however, that these self-stimulating behaviors are rarely harmful and may even help a person with autism to reduce feelings of anxiety they experience in stressful situations.
Unqualified Practitioners
ABA has also been criticized for using inexperienced, unskilled people as its main service providers. Although the assessments and behavioral intervention plans employed in ABA are typically conducted by Board Certified Behavior Analysts (BCBAs) with at least a Masters, most actual treatment hours are carried out by Registered Behavior Technicians (RBTs) who have usually only taken a 40-hour-long course on ABA. Although RBTs have to be formally supervised by a BCBA, these two types of professionals frequently don’t spend much time together as most health insurance agencies only pay for one professional to work with a client at the same time. As a result, a client may spend tens of hours a week with a person that knows very little about how to implement ABA therapy.
Not Focusing on Skill Development
Some people also criticize ABA for focusing too much on reducing negative behaviors like physical aggression instead of emphasizing developing new skills. Although ABA has been shown in many studies to be an excellent method of teaching, for example, social and language skills, many ABA practitioners still see reducing negative behaviors as what counts when it comes to evaluating the success of ABA therapy.
Not Involving Parents Enough
Although countless studies have shown that ABA is far more successful if parents are involved in implementing a plan, parental training is not often emphasized enough in ABA. This isn’t always even the fault of the therapist, however. Lots of parents think that it’s the job of the therapist alone to take care of therapy, or they may shy away from providing intervention because they doubt their abilities and fear causing more harm than good.
Abilities Don’t Generalize
Some people also say that the skills learned in ABA don’t generalize to new settings or items. A person may have learned to request apples, for example, and doesn’t know how to request other items. These types of instances are frequently caused by unskilled ABA therapists, however. A qualified ABA therapist builds generalizations into their program by, for instance, teaching the person in different environments (including natural settings).
Forgets Emotions
ABA therapy focuses only on behaviors. Unfortunately, as much as 40% of children with ASD struggle with anxiety. Many people with autism are also depressed or have other mental problems that can’t be helped by ABA therapy. Ideally, ABA should be combined with a form of therapy that aims to reduce psychological problems such as mindfulness or cognitive-behavioral therapy (CBT) techniques.
Too Much Compliance Training
It has also been stated that in ABA therapy people are taught to obey meaningless commands in the name of “compliance training.” Every child, whether on the spectrum or not, needs to learn to follow instructions given to them by their parents or teachers, but these instructions should be meaningful and given respectfully. There is no need for ABA therapy to resemble a dog training session.
The Good
Despite the criticism ABA therapy is faced with, it still has plenty of benefits. ABA is considered the best evidence-based treatment method for ASD by the US Surgeon General and by the American Psychological Association. This means that ABA has passed scientific tests regarding its usefulness, quality, and effectiveness. There are probably more studies on ABA than any other therapy used to treat ASD and most of them demonstrate that ABA therapy improves, for example, intellectual functioning, language development, daily living skills, and social functioning in most people on the spectrum.
In Conclusion
In the hands of a skilled parent or therapist, ABA can be a powerful tool. Yet, parents should be careful when choosing their providers since ABA can also be used in an ineffective or even harmful way if the person providing the therapy doesn’t have the skills or the experience necessary for proper treatment. Also, recent studies clearly show that ABA therapy given by professionals isn’t enough; parents must be involved to see progress. Still, if the ABA program is individualized, includes parental training, focuses on skill development in addition to reducing harmful behaviors, and generalized learned skills, ABA can offer great results.
ABA should not be used alone if a person has emotional problems. ABA also shouldn’t aim to turn a person with ASD into a “neurotypical” individual but should respect their unique qualities. After all, stimming doesn’t hurt anyone, so why try to change that behavior? A good ABA program can help a person with ASD become more independent and a better version of themselves without trying to change who they are.
Also, ABA shouldn’t be seen as the only acceptable form of therapy for ASD. There are also many other great methods such as floortime or play therapy that could be used instead of or in addition to ABA.
References
Allen, K.D., & Warzak, W.J. (2000). The Problem of Parental Nonadherence in Clinical Behavior Analysis: Effective Treatment is Not Enough. Journal of Applied Behavior Analysis, 33, 373– 91 https://doi.org/10.1901/jaba.2000.33-373
Cachia, R.L. & Anderson, A., & Moore, D.W. (2016). Mindfulness in Individuals with Autism Spectrum Disorder: a Systematic Review and Narrative Analysis, Rev J Autism Dev Disord DOI 10.1007/s40489-016-0074-0.
Dawson G, Burner K. (2011). Behavioral interventions in children and adolescents with autism spectrum disorder: A review of recent findings. Current Opinion in Pediatrics, 23(6), 616-620.
Feinberg, E., & Vacca, J. (2000). The drama and trauma of creating policies on autism: Critical issues to consider in the new millennium. Focus on Autism and Other Developmental Disabilities, 15, 130-137
Hagopian LP, Rooker GW, Jessel J, DeLeon IG. (2013). Initial functional analysis outcomes and modifications in pursuit of differentiation: A summary of 176 inpatient cases. Journal of Applied Behavior Analysis, 46(1), 88-100.
Lang R, Mahoney R, El Zein F, Delaune E, Amidon M. (2011). Evidence to practice: Treatment of anxiety in individuals with autism spectrum disorders. Neuropsychiatric Disease and Treatment, 7, 27-30.
Reichow B, Volkmar FR. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(2), 149-166.
Walsh M. B. (2011). The top 10 reasons children with autism deserve ABA. Behavior analysis in practice, 4(1), 72–79. doi:10.1007/BF03391777
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