How Today’s ABA Degree Programs are Bridging the Divide Between ABA Therapy and the Neurodiversity Movement
You don’t need to be very far in your journey to becoming a Board-certified ABA to have noticed that applied behavior analysis is not beloved in some circles of the autism community.
Detractors claim that it violates fundamental tenets of bioethics and justice and infringes on the autonomy of children and even parents. Critics say that ABA therapy in Autism Spectrum Disorder (ASD) cases can be more harmful than the disorder itself. In part, ABA is still shedding impressions of the field made in its early years, when punishments were still part of the Consequences in the ABC model.
But an outdated reputation isn’t the only point of contention. There are more fundamental conflicts between the use of ABA and the personal dignity and freedom of those on the autism spectrum.
Just as ASD treatment came to elevate and professionalize the field of applied behavior analysis in the first place, it may now redefine ABA as it’s taught and practiced.
Applied Behavior Analysis Was Originally Seen as the Miracle Cure for Autism Spectrum Disorder
Parents of children diagnosed with autism prior to the mid-1990s had few choices for therapies. While behavioral interventions were common, the studies and trials that eventually built evidence of their effectiveness were still being processed. Moreover, the only people conducting them were licensed psychologists, and relatively few of them.
But the promise of those results were starting to circulate through the grapevine. A number of states began licensing or certification programs for behavior analysts, including high-population states like California, Texas, New York, and Florida. The Behavior Analyst Certification Board® was incorporated in 1998.
This push was the fuel that ABA needed to become an established and accepted profession. Parents drove government and insurance companies to cover ASD treatment using ABA, and even to mandate it in some cases.
The surge of ABA credentialing across the country coincided with the rapidly increasing number of diagnoses of ASD in children as diagnostic criteria were broadened and the disorder became less stigmatized. It was only natural that those waves came together, putting millions of kids into Discrete Trial Training (DTT) and other proven ABA interventions.
A Generation of Patients Bring Mixed Opinions to ABA Outcomes
Many parents were thrilled with the outcomes of that therapy. There’s no question that ABA delivers some big wins for quality of life and communication skills for many patients. But not all the kids who had gone through those programs came out grateful.
As some of the earliest participants in structured ABA therapies came to adulthood, though, their reviews of the process weren’t as glowing.
For some individuals who have reacted poorly to ABA, it leaves a lasting mark. Being conditioned to act counter to deeply held internal feelings has resulted in something like PTSD for some. Others, with a memory of constantly being reminded they were different and always being watched for out-of-band behaviors, experience depression and low self-esteem. Ironically, some even feel that it is the legacy of their ABA treatment that creates difficulties in communicating and forming relationships in their adult years.
For these people, typical ASD behaviors like stimming, lack of communication, or failing to make eye-contact aren’t problems—they are simply part of who they are. A therapy that actively suppresses those behaviors can feel like it’s trying to extinguish a normal part of themselves.
Of course, this isn’t what any ABA therapist is aiming for. It can be distressing to learn that your patients come away from their treatment with these feelings. But due in part to the unique state of ASD as a disorder primarily diagnosed and treated at young ages, this sort of delayed feedback may be inevitable.
Autism Rights Movements Call Into Question Any Form of Therapy
This perspective is behind a new wave of activism for people with ASD, driven not by parents and therapists, but by those with autism themselves.
The autism rights movement, or autism acceptance movement, is part of a broader disability rights movement in the United States.
This is a group of individuals with ASD who take another tack entirely: that it is less a condition to recover from than valid and acceptable point in a spectrum of neurocognitive differences found among humans in general.
In this view, ASD behaviors should be accepted, not corrected.
If that’s the case, then ABA isn’t alone in rejection. Any kind of treatment would be an attack on acceptance. But it’s clear that applied behavior analysis has drawn most of the fire in the debate so far.
Defining an Accepted Range for Neurodiversity May Be the New Challenge in Applied Behavior Analysis
All of it calls into question what normal really is—and what role parents and healthcare professionals have in establishing it. Behavioral scientists are quick to acknowledge that normal is a range, not a standard. It’s where the edges of that range are set and what society considers acceptable where the arguments appear.
As advocate Emma Dalmayne put it in a 2022 interview with PBS, “We don’t need to be fixed because we’re not broken. There isn’t a cure. There isn’t a treatment that you can get that will cure autism, because we’re not diseased. We’re not injured. We’re not at fault in any way.”
Though the idea that anyone with ASD is ever at fault for the condition hasn’t been part of the treatment landscape for decades, some of the other perspectives can be a surprise to ABA therapists. And they call into question some of the underlying assumptions not just of ABA in ASD, but of any treatment for autism at all.
Yet it’s clear as well that the promises of ABA were oversold in those early years as well. It was called a pathway to full recovery, from a condition that we now know is slippery to diagnose and rightfully seen as a spectrum of behaviors… some of which may fade, others of which are simply aspects of individual personality. Recovery can be as complex to define as autism itself.
Is the Divide Between ABA and Neurodiversity Advocates Too Big To Bridge?
The two sides can’t even agree on the language to use. ABA therapists today are taught to use person-first references, such as a person experiencing ASD; many in the autism rights movement prefer to be called simply an autistic person, just as you might describe someone with red hair as a red-headed person.
The language reveals the divide: is ASD an intrinsic feature of personality, or a condition to be treated?
This is all tough stuff to sort through, both medically and philosophically. The list of question is long, and the answers uncertain:
- What is normal?
- Where does a changeable behavior end and intrinsic personality begin?
- To what extent are parents and therapists justified in forcing changes?
- Will ABA be seen in the future as something like forcing left-handed people to use their right hands?
- Does ABA achieve actual results in behavior change, or simply teach kids with ASD to become better at masking?
Finding Common Ground in the Neurodiversity Debate Requires Answering Questions Rooted in Societal Expectations
At heart is the question of socialization. At one extreme, these are arguments that could be leveled against almost any act of parental discipline. Should children not be acculturated to use indoor voices and interact politely? And if not through behavioral strategies, then how?
Pediatricians have a saying: every toddler is a psychopath with a relatively good prognosis.
Activists like Dalmayne argue that the difference between parenting and ABA techniques is that it’s compliance driven. But that’s a hard sell to behaviorists who have studied reinforcements in every other aspect of life. A human society isn’t a society without a level of compliance, and behavioral incentives have always been a part of building it.
It’s hard to argue with ABA as a more progressive alternative to institutionalization, which was the destination of many profoundly autistic individuals of previous generations.
Neurodiversity Advocates May Not Speak for Everyone With ASD
It’s also true that the advocates have a problem in their own house. “Nothing about us, without us” is one of the rallying cries in the autism rights movement. The idea is that goals, therapies, and even the language used to describe the condition shouldn’t be set without the involvement of those affected.
But that condition necessarily excludes the category of individuals with ASD that are furthest along the spectrum. Those patients, largely non-verbal, unable to communicate, and sometimes self-harming or incapable of independent living, don’t have a voice in the debate.
Just as those with milder symptoms don’t want to be defined by the neurotypical, it’s a problem to assign motivation to the least abled based on what those on the more abled end of the spectrum have to say.
How the World of Applied Behavior Analysis Education Is Dealing With Neurodiversity Challenges
So there’s no clear path to ethically decide whether or not ABA as a whole is appropriate for the treatment of ASD. But that’s not to say that the field isn’t taking the debate seriously. In fact, researchers and educators have been digging deeply into new ways to train therapists and approach ASD treatment.
This shows up most commonly in coursework in cultural humility and neurodiversity affirming practices that are routinely included in ABA ethics instruction today.
It’s also true that instruction in behavior change procedures found in the typical Master of Science in Applied Behavior Analysis program today almost entirely go around once-common aversive techniques and focus on rewards. This is still behavior modification, but without many of the problematic treatments that opponents usually call out.
ABAI ethical standards already call for affirmative practices that respect and support the autonomy and identity of each individual client. Perhaps the most difficult, and maybe unresolvable, bar to clear there is that the most typical patient in ASD therapy is a child. Their autonomy and identity are still being established, a process in which the therapist and parents play an inextricable role.
The Future of Applied Behavior Analysis in Autism Therapy Rests on Exploring Challenges in Neurodiversity and Ethics
These are hard questions for anyone devoted to a career in ABA, and particularly in ASD therapy, to confront. Yet it’s right at the center of behavior analysis to constantly be asking questions, to constantly be performing experiments.
This is particularly true for those pursuing doctoral studies in applied behavior analysis today. As part of that education, coming up with dissertation topics that inform the future of ABA practice is central to the degree. The outcomes of those studies change practices at every level.
And those questions are finding answers. It’s common for ABA studies today to cover the issues of freedom and happiness, of long-term impacts, and the importance of tailoring therapy to individual patients. Therapists graduating from ABA programs today by default consult with parents and their children about goals. They take into account preferences and potential instead of just dropping in a textbook program.
That’s a much harder path, but one that is more appropriate and ethical. And it’s only possible because of the high level of education that modern ABA therapists go through and prove through rigorous licensing processes in almost every state.