ABA Therapy. Does it work?

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In early 2008, I recall reading a lot of information on ABA, including some written by people who had experienced it. Well beyond "an opinion piece or two" or "a vid of Ivar Lovaas". I have had the opportunity to babysit for a nonverbal autistic child who actually got along with me in ways he didn't get along with anyone else.

It sounds like you've got a program for your child that focuses on particular needs (such as reciprocal communication) instead of simply marking typically autistic behaviors as unacceptable. There's a bit too much of the latter going on still (at least per my understanding).

Anyway, what I read and learned about ABA four years ago was gathered and recorded by autistic adults, and as I said, went well beyond the minimal research you describe here. I wouldn't assume that everyone here is playing Chinese whispers if they don't have a conclusion that is not identical to yours.

Like I stated elsewhere, ABA therapy is probably good for the parents/caretakers. The best judges of how good it is for the caretakers are, obviously, other caretakers.

However, ABA therapy is very much not good for the *child*. And the best judges of how good it is for autistic people are, equally obviously, other autistic people.

So, if you want what's best for yourself, go with ABA. If you want what's best for your child, stay well away from it.

Yes. But--Don't confuse that advice with "do nothing". An autistic child is born into a world that's not made for autistic people, and there are so many things to learn, so many things that must be understood and experienced. That's what therapy is for; it's teaching. Education. For a little child, education is play and interaction and fun, not repetitive drilling. Education, the best sort of education, is the sort where you can experiment and try things and not be afraid to fail, not be afraid to be told "No, that's wrong; no reward." Experimenting, interacting with one's teachers, learning to make oneself heard, and learning about the world is the best sort of education an autistic child can have, and that's what therapy ought to focus on.

I posted in the RDI thread but you have not responded. I will quote you directly and see.

Firstly it seems to me that you do not seem to understand or acknowledge the challenges faced by some people. I'm referring to people that will not be found posting on here. People who can't - yet - speak or type.

To rehash some of what I said there and to illustrate, we're talking for example a child who breaks his arm at school so badly it is visibly bent and who sits silent in the corner so that no-one notices until the parent comes to pick him up. He doesn't seem to know - intuitively - that he can cry out loud as a communication. My son was similar.

This is the level of deficit I am referring to, people with significant apparent cognitive deficits and communication challenges in their ability or understanding of what most others take for granted.

The way to teach a person with that level of communication difficulty is different from you or I or a young Aspie, because they don't have the requisite basic skills to get there. Simple things like joint attention. ABA is a useful way to give them those foundation skills to be able to have further learning. E.g. It would be difficult for you to appreciate how much work and the small steps that were involved in teaching my son PECS, and believe me that is a fantastic tool for him.

PECS was taught through ABA. Most non-verbal children do not go 'ooh PECS, look now I can get what I want'. After all look at whats really involved for starters - theory of mind, planning, understanding visual metaphors etc.
We had some people from our govt come and try and teach him for 15 minutes. These are supposed to be specialists. They thought he would 'get it'. 'Getting it' actually took about 9 months.

Now consider he will also waver in the way he uses PECS. For example he might go to the PEC board and not look at what picture he grabs, he might bring me a PEC of the trampoline when he wants some apple. He knows what he wants, but he does not know that I do not know that. So we have to take him back and make him look so he knows he needs to look so he can communicate. 'Reinforcement'.

Following the interaction above, I then might make a request that he bring me a plate or bowl. I will do this verbally with simple language "James, bring me bowl" and I will then point to the drawer.
The ability to follow a point 'following the distal point' was taught through ABA.
I reinforce it by asking him to pick up stuff he's dropped and pointing to them, in addition to reinforcement this is 'generalisation'. The purpose of this is foundation skills that everyone else takes for granted, things that will be built upon to give him skills that will be useful to him.

The assigning of names to objects, bowl, plate etc was done through 'receptive labelling' its called IIRC. You cannot simply hold up an object in front of my son and say it and have him learn it. It might take a hundred attempts..or a smarter approach.

This is why we use ABA, because its working to give him skills he needs. Skills that he can use so he doesn't get frustrated to the point he smacks himself in the face. And its critical to understand that a modern ABA practitioner would look at that and say "why is that happening, where is the source of frustration or difficulty and what can we do about it?"
Old school would try and extinguish the behaviour.

When our sons therapist came back after Christmas break he was really happy to get back into it. I assume he likes the challenge now, he likes what he does.

I don't know what else to say, other than in the case of my son at least your blanket assertion "If you want what's best for your child, stay well away from it" seems by any measure that I can apply ignorant and demonstrably false.

I have seen it work well. I remember seeing a young girl with Autism sign (in sign language) her first word ever, and it was incredible. Actually, I have never heard anything negative about ABA. It can be very effective for a variety of people.

nostromo, Thank you for that elucidating description.

I can understand that some therapists and some experiences have been negative. I found this video that shows almost exactly what nostromo was describing and I really can't see anything negative about it. Robb is required to focus, but I don't know a single child in grade school that isn't forced to focus against their will versus running around outside and playing.

Even NT children require good teachers and good school systems. It sounds like the most important thing for ABA is also finding good therapists that actually know what they are doing and are putting the welfare of the child first and foremost.

Your welcome.

Thats exactly right. As you say, Imagine a teacher that has no interest in children, drones in a monotone, and won't answer questions. Kids wouldn't learn much. Same with therapists, they need to have their wits about them, be flexible, and care about what they do, and the child IMO. Then to boot you need a good well trained programme manager with brains and experience. Basically you need the same type of people as good regular teachers, they just teach in a bit of a different way.

ABA sounds scary to me honestly to have someone force me to do things a certain way for 8 hours a day thats a work week i mean that would be torture. I have never had ABA therapy and I am pretty sure i never want it.

I don't really buy the "ABA is okay but only for really severe cases" argument. There are better ways of teaching--more efficient, more effective, less stressful for the kid and the parents and the teacher. ABA is an inflexible method that should have only a narrow application, but they're trying to stretch it to cover things it doesn't effectively teach, and that's bad.

People who think ABA is a bad idea aren't saying, "We think ABA is bad, and autistic children don't need therapy," we're saying, "We think ABA is bad, and there are better ways to teach."

There's this fallacy that if a therapy is more intensive or more strict, it must work better; the idea that if a drug has more side effects, it must be a stronger drug, or that if you use a treatment that's got lots of drawbacks, it must be something that's pretty much guaranteed to work. But that's not so. ABA is worse, not better, for profoundly autistic children. It has its applications--it can be used to teach specific skills that do not need to be generalized. But it should not be used to teach a skill that requires innate flexibility, such as communication. There are much better, more effective, faster ways to teach that.

Am I the only one who is now wondering what is the root cause for that? You seem to be assuming that it must be "a lack of communication skills", and that's enough explanation for you. Furthermore, you seem to be assuming that that child *wants* help, but just cannot ask for it. To me, it indicates that there's some kind of underlying issue which would cause him to act that way.

In this specific case, crying out in pain is an instinctive reaction and is not a direct attempt at communication. Yes, some people lack that instinctive reaction. That does not mean they have communication issues, it means that he has a different pain response. So don't lump it into a general 'communications issue'. Yes, the child could have somehow indicated to the teacher that something's wrong. But suppose that the child's instincts are such that they would only indicate something wrong to a trusted person. Now, it's very easy to see how an autistic child grows up not trusting anybody around them, after all, all these people do strange things to him, act in weird ways, and try to force their foreign ways upon him.

Now, I'm not saying that that example is the underlying reason for that behaviour. What I'm saying is that if you really want what's best for your child, you would go to all the trouble of trying to figure out how he 'works', what makes him tick. Now, that is a very daunting task and I don't expect many people to be able to do that.



So ABA is now something completely different from what it was before? Then they should not call it ABA, because most practitioners will be using the old-school methods and as a parent you wouldn't know what to expect.

Also, you don't seem to be looking at "why is that happening" yourself, as I pointed out above. You boldly asserted "lack of communication skills" as the reason why a child with a broken arm would not cry for help, when there are a number of other possible explanations. Perhaps a good therapist can be trained to see beyond the NT-centric explanations for behaviour, and perhaps a great therapist can even train parents to see beyond that as well. But most people don't. When they see AS behaviour, they try to find an explanation that fits within their own worldview, which is necessarily NT-centric.

Here's a question for you: In the example above, with the child with the broken arm, what plausible reasons can you think of for them to remain silent? Could you even accept the possibility that they don't *want* to be helped in that situation? Could you believe that a child with a broken arm will instinctively try to be as unnoticeable as possible?



Pot, meet kettle. If you go around disqualifying people's opinions because they "haven't cared for a low functioning disabled child", you should expect responses like that. Furthermore, you have only demonstrated that ABA 'works', not that it really is the best for the child. I'm willing to concede that there are no better practical alternatives at this moment, but to me that only means that more research should be put into *finding* those alternatives. I have come across several studies, looking at alternative approaches, that seem very promising. (Google for 'autism emotional reciprocity' for example).

I disagree with the level of flexibility that you are saying is in communication. Wanting an apple and asking for an apple is very simple, very basic, and very inflexible within the bounds of our society. Society does not tolerate someone grabbing an apple out of our hands or stealing an apple out of a grocery store as form of communicating "I want an apple." Society simply does not tolerate communication that doesn't follow society's rules. That's why even higher-functioning people are complaining so much that they cannot understand or be understood by using their own means of communication. Communication in society is highly inflexible and follows highly convoluted rules.

Now, flexibility in thinking, yes, I agree with that. Thinking flexibly in order to add creativity to communication is something different from following the inflexible rules surrounding communication within a society.



Such as?

Given the way it's being described by some, yes, it sounds horribly scary. If therapists are using old ways of implementing ABA as some people have described here, they need to either lose their practicing license or be required more training in humane ethics.

Society forces us to do things a certain way 24/7. When was the last time you decided you wanted to do something that went against society's rules and you were allowed to get away with it? (Besides speeding, because that's easy to get away with.) If you go too much against society's rules, they either lock you up in jail or in a loony bin.

We need to change our society to accept differences, rather than trying to twist and break our children to fit into a defective society.

Ask a speech/language therapist. There are plenty. Look into Floortime for an example. The best methods are tailored to the specific child's learning style.

I have a feeling that you would really hate this woman.

Well yeah but not for 40 hours a week on top of school......that is excessive, maybe the issue with this sort of therapy is it being excessive....that's of course besides what I've heard of this therapy causing problems for people when mis-used by mental health professionals that don't have the best interest of the child in mind.

Just something about the child with the broken arm, what if the teacher had a bad attitude towards the child so they did not want to draw any attention to their injury for fear of being ridiculed.......just throwing that out there. I know when I was a kid at school I tried not to bring attention when I got hurt because I did not want to get made fun of for it. So maybe something like that plays a role in the senerio as well.