The Threatment Of ABA

Jamie C. Pagliaro, writing for Autism Spectrum News, is concerned about the future of autism and Applied Behavioral Analysis. Mostly he’s concerned about “the limited number of providers and the quality of services”, and not so much about ABA itself.

Running a quick search here for the phrase “evidence-based” will show that I have a passing interest in the fact that ABA is the moral equivalent of efforts to “pray the gay away” and conversion therapy (the latter and ABA both having been conceived by Ivar Lovaas), in that they are more concerned with normative behavior than autistic health.

Some proponents of ABA will make some attempt to obscure the nature of what it does, often focusing on the idea that there’s been a move away from “adversives” or punishments. (Recently I ran into this on r/AutisticAdults) Beneath this, though, always sits the goal of ABA.

ABA is a data-driven treatment approach. Therapists can deliver up to 40 hours of individual treatment per week to reinforce developmentally appropriate behaviors and reduce inappropriate ones that interfere with learning. Throughout, they also collect detailed data to help refine teaching techniques and optimize patient progress. Multiple studies show that early intensive behavioral intervention (EIBI) can effectively improve developmental outcomes in young children with autism. Children who received EIBI saw significant improvements in IQ, language and adaptive behavior compared to those who received standard community care or alternative interventions. ABA also has proven effective in teaching a variety of life skills and reducing challenging behaviors in older children and adults with autism.

As always, take note of the fact that ABA often involves subjecting an autistic kid to the temporal equivalent of a full-time job. Even an ABA that purports to avoid adversives nonetheless inherently is itself an adversive, because 40 hours a week of ABA preclude that child from spending time just being, you know, a child.

When proponents talk about “significant improvements in […] adaptive behavior”, remember again that what they mean by this is normative behavior. What they are driving into autistic kids by the adversive of a 40-hour treatment week is the normative need for them to “adapt” to being “normal”.

ABA perhaps might be a “data-driven” approach, but remember what data proponents are gathering: the degree to which the treatments (initial Freudian typo: threatments) “reinforce developmentally appropriate behaviors and reduce inappropriate ones”. The word appropriate here should be read as normative, and often the inappropriate behaviors are things such as stimming and hyperfocus on special interests.

This is why I took issue with the framing of a recent paper on autism early-intervention research for neglecting “any consideration of the moral or ethical value of the interventions themselves”.

Psychotherapy engages either in social work or social control: whereas the former involves building solidarity and capacity, the latter involves building obedience and conformity. Remember, as I learned three years ago: B.F. Skinner was a failed novelist who basically didn’t have enough empathy to figure out how to write people.

Behaviorism, including Applied Behavioral Analysis, is about nothing so much as social control.