Consequences of ABA

When I got my drivers license, I had to get a purse so I could carry my license. The one I picked I would wear everywhere but bed. My Dad called me "bag girl" and I would rebuff that I needed what was in it. To be honest, everyone in my family knows that I am different. I appear to be quirky, intelligent and a nice person. I would never use a word like normal to describe myself. However, many approaches to mental health wish to reach out to this normality and bottle it so that people can be happy. Normality can be defined in serval different ways but does a treatment like Applied Behavioral Analysis help someone with autism?

I chose the text, International Review of Research in Developmental Disabilities, Volume 49, Chapter 6 by Elizabeth Will and Susan Hepburn. Reviews like this can be thorough and the technical terms are helpful to determine the facts about the therapy or experiment. The text can be found here.

A good question to start with is what Applied Behavioral Analysis(or ABA) is. It is a treatment course that can be used to approach addiction, as well as neurogenetic disorders that lead to behavioral issues. autism is included of course but the therapy can be used for Down Syndrome,



Smith–Magenis syndrome,



Prader–Willi syndrome



and Williams syndrome.



Each of these conditions has similarities in behavior when compared to one another; a difficulty with one or more parts of social interaction.

Social skills, much like linguistic skills, should be integrated as early as possible to help the individual interact and retain the skills for later in life. The authors admit that there is little research on the long term effects but with this kind of treatment, time is of the essence.

The principles felt silly explained the way they were, I had to remember that the authors were summarizing years of research and clinical research. ABA focusses on linking a stimulus to a behavior, and that behavior to a consequence. This is not naturally negative, just the terms they use. The example was that if a parent gives a child a choice between goldfish and raisins as a snack(stimulus), and the child points to the goldfish(behavior), and the mother gives the child the goldfish(consequence), then the child will learn that being given a choice and then pointing at it results in getting that thing.

The therapy itself, when done by proper practioners, works to teach necessary skills and promote those behaviors over ones that might cause the individual harm. For instance, learning what causes the individual to become aggressive and giving the individual an approach to calm down. This is in line with Skinner's Operant Learning Theory, rewards push an individual towards actions related to the actions just taken and punishments push an individual away from a behavior. (more about Skinner's evidence for this, including his box, here ) Skinner's evidence reinforces the idea that if a child is having a temper tantrum, giving them a cookie or a toy will only increase the likelihood of the action happening again. Simple enough, reward good behavior and dissuade bad behavior. 

Treatments like this come with a dilemma, because children are impressionable. Many experts worry that this might lead to children taking on a call and response to actions, making these individuals robotic at best and tortured at worst. In an article by Spectrum, a site dedicated to news about autism, they talked with parents of children who had gone through ABA and one said that their child knew how to say "Hello what is your name?" but did not understand the meaning behind it. Mimicking and merely passing for normal does not change the ability of the individual.

Additionally they explored the use of physical punishments to reduce stimming by the Young Autism Project in the 1970's. Stimming is the act of physically moving a part or your whole body to relive stress, or any emotion. Rarely are these harmful but the project did not differentiate between harmful or benign. This is the information I was used to hearing about, torture to stop something that was not harming anyone. In these early days they also would hold food to have the child keep eye contact and give the child the food for success. That just sounds degrading in my mind. Today, the focus is on reward through praise and punishments through words alone, rather than treats and electric shocks respectively. 

Though the features have changed, there are still ethical concerns with the approach to therapies for the behavioral benefit of the individual. Ariane Zurcher, a parent of an Autistic child on the family's personal blog mentioned her own personal experience with ABA and how they reacted when it did not work. The child(funny enough also called Emma), was blamed for regressing and not retaining the training that would have her "mainstreamed by Kindergarten." A four year old was misbehaving and resisting a treatment by the schools' standards. She lamented her choice as she reminded herself that she would never have done this to her neurotypical( a term used to describe people who do not portray autistic symptoms or at least not enough to have a difficulty with their daily life) son. If her children are the same, why did one have to do more work to get the same results. The fear comes from the idea that the behaviors of the autistic person are harming them socially and should be corrected. When put into practice, the act is misleading, because it implies that autism is something to be removed.

The ethical concerns of ABA treatments are largely ignored. Michelle Dawson, in her essay about ABA's ethical concerns, gives proof on all sides of the support team. Informed consent on the behalf of the patients has been discouraged, not by autistic individuals, but by a neurotypical parent. Another advocate for ABA compared autism to cancer, implying ABA works just like chemotherapy. This can be dangerous for reasons mentioned above but I will reiterate, autism does not need to be removed. The idea that autism only causes pain for the individual and the family is very prominent in the ABA environment. Martyring the families like Autism Speaks tends to do also does not help understand and promote a healthy lifestyle for the individuals with autism either. This is not even touching on the original experiment being flawed or further testing only having one subject.

To wrap up my own feelings on the issue, I am sort of glad I flew under the radar when it comes to early diagnosis. Between insurance, payments, finding a practioner and the practice itself, ABA feels like it would have had more cons than pros for my own treatment. I do not have a need to be normal or fulfill some quota for happiness.