American Medical Association Refuses To Disavow Applied Behavioral Analysis
First things first: yes, I did spend a day and a half this week on Bluesky methodically and with ever-increasing intensity and outright mania detailing and explaining that the American Medical Association did not change its policy language regarding Applied Behavioral Analysis, culminating in a lengthy post here, since deleted.
All of that, I now know, was based upon my increasingly-dysfunctional cognitive capacities refusing to register what my eyes were actually seeing, which was a single line in a document I’d read at least a dozen times. That line specifically declared that the House of Delegates of the AMA in fact did adopt new language.
I regret the error, and the negative impacts of the obsessiveness. My brain, as I’ve noted, appears to be in a worse state than I thought.
As for the AMA, however, its new policy language does not disavow ABA, which was the original intent of the proposal.
Let’s go through the changes.
Here is the pre-existing policy language, which for whatever reason still exists in their policy finder:
Standardizing Coverage of Applied Behavioral Analysis Therapy for Persons with Autism Spectrum Disorder H-185.921
Our AMA supports coverage and reimbursement for evidence-based treatment of Autism Spectrum Disorder including, but not limited to, Applied Behavior Analysis Therapy.
Here is the policy language that had been proposed (pdf) by the Medical Student Section at last month’s annual meeting of the HOD:
Standardizing Coverage for Persons with Autism Spectrum Disorder H-185.921
Our AMA supports coverage and reimbursement for evidence-based treatments and services for Autism Spectrum Disorder.
This original resolution included a lengthy series of WHEREAS clauses directly and bluntly critiquing ABA.
At the meeting, Reference Committee G amended (pdf) the resolution, changing its policy language to the following:
Standardizing Coverage of Evidence-Based Treatments for Neurodivergent Individuals H-185.921
Our AMA support coverage and reimbursement for evidence-based treatments and services for neurodivergent individuals, including Autism Spectrum Disorder.
The committee also specifically went out of its way to suggest changing the title of the resolution from:
REMOVAL OF AMA SUPPORT FOR APPLIED BEHAVIOR ANALYSIS
to:
CARING FOR NEURODIVERGENT PATIENTS
The specific RESOLVED clauses were as follows:
RESOLVED, That our American Medical Association support research toward the evaluation and the development of interventions and programs for autistic individuals.
RESOLVED, That our AMA work with relevant stakeholders to advocate for a comprehensive spectrum of primary and specialty care that recognizes the diversity and personhood of individuals who are neurodivergent, including people with autism.
It then recommended to the House of Delegates that this amended version be adopted. Despite my absolutely certainty that this did not happen, this did, in fact happen.
It’s important here to note that despite the original proposal’s intention to disavow Applied Behavioral Analysis, the resolution as amended by committee and adopted by the HOD, in the end does not disavow ABA at all.
Instead, it changed the title that expressly disavowed ABA to something more benign. It also chose to refer to “treatments and services” rather than simply “services” as in the original draft. Like the original, it used the phrase “evidence-based”. Between the title change and the maintenance of support for “evidence-based treatments”, the amended resolution would continue to support use of ABA.
Its branding by its proponents, after all, literally is “the only evidence-based treatment for autism”.
What’s more: the HOD is explicit that votes on resolutions are votes solely on the RESOLVED clauses, and not statements of approval for any WHEREAS clauses. All of the many arguments against ABA provided by the Medical Student Section on the original draft would not have reflected AMA policy.
Finally, it remains utterly inexplicable to me that such a change was made an entire month ago and apparently went completely unnoticed by any autism-focused media outlets.
At any rate, while it’s good that the American Medical Association policy no longer simply references Applied Behavioral Analysis, and broadens its support to include services in addition to treatments, the original intent of the proposal from the Medical Student Section was defeated.
The American Medical Association continues to support the use of Applied Behavioral Analysis, conversion therapy for autistic people. They’ve simply masked it behind a euphemism rather than continue to state it expressly.
If you haven’t, read D.L. Mayfield’s piece, “Conversion Therapy, Actually, Is All Around”.