This essay is a factual rebuttal of the blog entry “The Shocking Controversy of ABA Therapy” writing by A. Stout and published on The Autism Site.

 

While A. Stout, is certainly entitled to her opinion, one which I respect as someone diagnosed with autism spectrum disorder, it is irresponsible to publish negative comments about ABA therapy, based on very inaccurate information.  There is a seemingly misunderstanding of ABA therapy that has helped many on the autism spectrum in their daily lives.

Applied behavior analysis (ABA) is an evidence based practice (EBP), which means it is a model of professional decision making in which professionals integrate the best available evidence, keeping in mind client values, context and clinical expertise to provide the best services (first link).

ABA is the scientific study of behavior, based on the science of learning and behavior.  The therapeutic practices focus on increasing functional behaviors and decrease maladaptive (negative) behaviors.  This is done through reinforcement principles and focuses on the positives.

ABA focuses on the social impact of the client.  Social impact refers to one’s ability to essentially functioning within society, including communication, social skills, activities of daily living (hygiene routines, cooking, cleaning, etc.) reading and academics.  These are all very important skills clients must learn to their maximum potential for daily functioning.

Behavior analysis was first studied by B.F. Skinner in 1938. Within in the field of ABA there are many subcategories of therapies, which all use ABA principals to focus on the social structure of the client.  Some of these therapies are: discrete trial training (DTT), verbal behavior (VB or AVB), pivotal response training (PRT), Early Intensive Behavior Intervention (EIBI) and Treatment and Education of Autistic and Related Communication- handicapped Children (TEACCH). Many of Skinner’ techniques are still relevant today, including verbal behavior.

The main question A. Stout asks throughout her opinion piece, is “Would I feel good, okay or comfortable doing this with a neurotypical (NT) child?”.  This insinuates again that ABA is just for clients on the autism spectrum or with other disabilities.  However, everyone’s daily life, including NT’s incorporate ABA principles. To prove this point, throughout this factually based rebuttal, NT examples will be highlighted to demonstrate everyday ABA practicality for all people, not just people diagnosed on the autism spectrum.

Ms. Stout states a falsehood when she states in ABA, “you reward a wanted behavior and punish an unwanted behavior”. Punishment in the everyday sense does not happen in ABA therapy.  To understand this, it is best to learn the definitions of reinforcement and punishment in the field of ABA.

In ABA reinforcement refers to increasing a desired behavior.  It has possible to have positive reinforcement, where something is added to increase a desired behavior or negative reinforcement where something is removed to increase a desired behavior.

NT example: (positive reinforcement) You go to work for two weeks, you get a pay check.  The pay check is there to ensure you keep coming to work, as most of us would not continually show up to work without getting paid.

NT example: (negative reinforcement) A child is given a spelling worksheet.  The child believes there are too many problems, for every 3 problems completed a problem is crossed out. Therefore, the child is going to complete more problems to get some removed. (This is also a common accommodation in the school domain.)

Punishment in ABA world is vastly different from what most people refer to as punishment.  Punishment in ABA is where you are decreasing behaviors. Indeed, that is all punishment means in ABA. It is the opposite of reinforcement and has nothing to do with “punishment” in everyday language. As with reinforcement, there is positive punishment, where something is added to decrease negative behavior and negative punishment, where something is removed to decrease a negative behavior.

NT example: (positive punishment) You are running late for work and speeding.  You get pulled over and get a speeding ticket.  After this incident, you now do the speed limit.

NT example: (negative punishment) A child comes home late for curfew from playing with friends. As a result parents take the child’s bike for a week.  The child is not late for curfew again.

With that brief background knowledge (and I do mean brief!) I will address the numbered points in the remaining of the blog, which has many inaccuracies.

  1. ABA therapy does work on compliance as it is a needed skill for daily functioning, in everyone’s life.  The way we gain compliance in ABA will look different in each program depending on the board-certified behavior analyst (BCBA) who develops the treatment plan. However, we NEVER “force” clients to comply with a smile.

 

There are times when we use systematic techniques to decrease sensitivity to foods, clothing, other textures (soap, toothpaste, etc.), but it is done slowly over time.  At no time is a child ever forced to immediately be exposed to aversive conditions or forced to do anything.  Specific procedures are put into place to reinforce certain behaviors to make the aversive stimuli less aversive and more reinforcing.  In ABA the child is NEVER, EVER hurt or harmed through EBP therapeutic techniques.

 

NT example:  Children need to comply with parents, teachers, etc.  Some of these are of course non-*preferred demands.  A child cleans their room, they get a dollar.  This is compliance gained through the ABA principle of positive reinforcement for desired behaviors.

 

  1. Everyone exhibits self-stimulatory behaviors, including children on the autism.  While there are times when self-stimulatory behaviors will be replaced with more socially accepted behaviors or limited depending on the environment.  However, the overall belief of those practicing ABA is that stimming provides some needed sensory input and is a form of self-calming when overstimulated in the environment.

 

Will we “allow” a child to stim for hours because it has a need that is being met? No, as this is not functional for anyone.  If this occurs replacement behaviors are introduced based on ABA techniques and have the same function of the non-functional behavior.  However, some hand flapping, verbal and visual stims on occasion for sensory input/ calming is acceptable.

 

While we always encourage children to explore topics of interest, as therapist we encourage them to do it in a socially acceptable manner and learn social cues to not socially isolate themselves in the natural environment.

NT example:  Biting of nails when not actively engaged is a self-stimulatory behavior.  Many people do this and do not realize it is a stim.

  1. Reinforcers are used daily in everyone’s lives.  Our functioning is based on reinforcement principles derived from ABA.  While reinforcers are sometimes withheld when a high reinforcer is needed for something such as toilet training, they can also be held so reinforcer satiation does not happen (when the item is given so much it is no longer preferred) and so other reinforcers from the natural environment can be introduced.  

NT example:  When a child comes home from school, they must do their homework and complete chores before going outside to play or use electronics, whichever is more reinforcing.

It is evident that ABA is useful in everyday practice for all.  ABA is even more useful as a therapy for children and adults with autism and other disabilities to increase functional communication, desired behaviors, social skills and activities of daily living, while decreasing negative behaviors through systematic programming based on data collection.  Many children and adults alike on the autism spectrum have had immense improvement in the quality of daily life due to successful ABA therapy.

 

About:

Dr. Kristin M. Kosmerl, BCBA-D, LBS is a Board Certified Behavior Analyst- Doctorate and PA Licensed Behavior Specialist.  She is the president and owner of Autism & Behavioral Consulting, LLC in Palm Beach, Florida and Reading, Pennsylvania.  She has worked with children on the autism spectrum for over 16 years.  Dr. Kosmerl is a founding board member and current member of the ABA in PA Initiative.

About the ABA in PA Initiative.  The ABA in PA Initiative is a 501 (c)(3) nonprofit advocacy organization made up of parents, industry professionals, and lawmakers dedicated to change the future for all children in Pennsylvania with Autism Spectrum Disorder (ASD) by ensuring access to Applied Behavior Analysis (ABA) therapy.

 

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