ABA Therapies?

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Hey everyone,

I have a neurotypical friend who is studying to work with us ASD folks eventually, and her professors are really pushing her to investigate Behavioral therapy. She wanted to me to find out (since I have no personal opinion/preference) what the ASD population felt about ABA, as opposed to humanistic treatments. Are they successful? Helpful? Do you prefer them?

To help assess your answers for her, could you also tell me when you got your diagnosis (age), and how long you've had it for. If you have any oppinions or experience with either I'd love to hear it!

You will likely get a lot of negative feedback about this. Years ago, behavioral therapies used things called aversives and many people on the spectrum were subjected to some pretty horrific behavior under the guise of trying to "help" them or "cure" them. For a fairly extensive summary of many of the criticisms, see: http://www.sentex.net/~nexus23/naa_aba.html

My daughter had ABA/VB therapy and it was wonderful for her. She had it from 2-5, though from 2-3 it was more intensive and more...um...fluid from 3-5 (IOW, we used some concepts and principles of behaviorism, but stopped using discreet trials). VB helped her gain verbal skills and ABA helped her gain a wide variety of skills necessary for interacting with others. My personal opinion is that when it is used to help an autistic child function at their highest level, it can be very helpful, but when it is used to try to "train" the autism out of the child and make them typical, it is disrespectful. For example, none of my ABA implementers were allowed to do more than request eye contact. No one was allowed to force it under any circumstance. Nor were they allowed to repeatedly ask for it. Nor were they allowed to give any reinforcer other than "thank you" when she complied with their request. If she didn't look at them, they just had to continue with what they were doing. They also had to stop if they were pushing her to the point of meltdown.

I've never received ABA therapy myself but I'm studying ABA and I love it. I can understand why ABA has a bad reputation, actually when I first observed an ABA classroom I was very disappointed in what I saw but after studying it more thoroughly and having more observations in different settings I came to realize that the teacher in the ABA classroom I initially saw was either not properly trained or just not very good. When implemented properly ABA can do amazing things. I actually implemented an ABA based intervention for a student in the class I'm interning in (he's speech/language impaired, not autistic) and he has made SO much progress. Doing his work was a misery for him at first but now that he has his token board he is very enthusiastic about getting it done so he can get his reinforcement afterwards. He is not only more productive and learning better, he is enjoying school much more.

In terms of ABA not being "humanistic," I'd just like to point out that ABA is based on the principles of human behavior that applies to ALL humans, what we do in ABA classrooms is simply a very condensed version . Like it or not, all the behaviors we engage in are reinforced in some way or another; if they are not, we stop or decrease the behavior. You would not go to work if you were not getting paid, you would not put a coin in a vending machine if nothing came out... ABA may appear dehumanizing because we give reinforcements more frequently than what would occur in typical day to day life but the fact is for children who have difficulty with learning that reinforcement may be necessary to motivate them.

Another common misconception about ABA is that it is just discrete trials and it's just used for kids with autism. The principles of applied behavior analysis are used all the time in general education classrooms, in businesses, hell even the justice system uses ABA principles. It is a VERY broad concept. I've actually used self-management and video self-modelling strategies, that are based in ABA, to help improve my own behavior, and it works.

In terms of ABA being successful, YES. There is more research out there on the effectiveness of ABA as an intervention for kids with ASD then any other treatment, and there's so many different methods that fall under the ABA umbrella that it suits a variety of different learning styles.

And as for diagnosis, I was diagnosed when I was 19, that was 4 years ago. Like I said, I never had ABA therapy, but I feel strongly that when implemented properly with a good teacher, ABA can be a great intervention.

My gut-instinct was that ABA therapy was not favorable, but I've no inormation on the differences of behaviorialism and humanistic therapies.

I'm just curious as to what you consider humanistic therapies? Something like floor time? The thing about floor time (aside from the fact that there's very little to no research to support it) is that it's only effective for a certain portion of people in the autism population, it may help children who are emotionally disconnected but does little for kids with extreme behaviors or self-destructive behaviors.

I think a lot of people have very old-fashioned views of ABA and behaviorism. Yes, there are people out there who happen to be ABA therapists/teachers who use punishment or want to force kids with ASD to be typical and force eye contact and such... But there are teachers/therapists in NON ABA therapies who do that too, there is *nothing* within the principles of ABA that describe forcing children to fit a mold and punishing kids for being autistic. Applied behavior analysis is simply the science of behavior, and in therapies we use its principles to help children increase behaviors that will help them function in school and their day to day life and decrease behaviors that cause problems.

I didn't have that treatment. I'm against it, though. I'm against it due to the history behind it. I'm not really for the reward and punishment system that they use. I also don't like the methods that Lovass used on his original subjects. No child should have to be yelled at in the face, or cattle prodded. I also don't like the forced eye-contact that the therapists still use to this day. I'd also like to add that 40 hours a week on top of 25 hours of school seems like a lot. That's 8 hours a day, on top of 5 hours of school. That's time that spectrum kids need to wind down, after a very harrowing day of school.

ABA is abusive.

The "abusive" tendency of ABA isn't really in the aversives that some programs use; or anyway, it doesn't need those things going on to be abusive. To ruin a child's life, it only needs to replace the intrinsic joy of learning with the extrinsic rewards. Once that happens, you cannot help doing exactly what they want because you cannot help desperately wanting their rewards. The actual skill is irrelevant. You lose your free will. Your happiness becomes dependent on whether the people around you are happy with your efforts.

It might be worse, for many kids, to be so often told "No. Wrong. You're doing it wrong. That's wrong. Stop doing that. Sit down. Be quiet." Over and over again. Or, the more insidious option: Simply not getting something you have been looking forward to. The crushing disappointment--the absence of a star on a chart; the lack of a reward, the horrible gap where you should have found the thing that you were looking forward to. For an autistic person, disappointment is not just unpleasant; it shatters the soul. When something unexpected happens to you, it's like being thrown into deep water in the middle of winter, to discover you can't swim. When something you hoped for doesn't happen, it's torture. That's why it doesn't matter whether you are given a punishment, or not given a reward. The lack of reward, to someone who thrives on predictability and order, is a punishment worse than a predictable but unpleasant event.

It's not really failing that's so bad. You have to fail a few times before you get something right; and someone who is naturally fond of learning won't mind that sort of failure, as with every failure you learn a little more; but that sort of learning is self-directed and playful, not regimented and externally imposed... in fact, regimented identification of failure tends to make unavailable the tendency to take failure as a sort of natural experimental step to learning. You have to know when you're not doing something right, and know what you can improve (I have in fact had trouble with a professor who would not tell me what I should improve, and had to get a counselor to intercede for me); but there comes a point at which correction becomes not useful but oppressive.

The main problem is that the failure is pointed out, made obvious, repeatedly--while it is labeled, oh-so-strongly, as bad. Unacceptable. When failure is both unacceptable and inevitable (and it is inevitable in all learning), the child is set up for defeat.

When somebody tells me I am doing something wrong, dismissing my effort when I've done my best at it, it hurts more than just about anything you could say to me. Whether that's breaking a rule, or messing up a problem in class, or being reprimanded for being mistakenly rude, every time I feel very bad about it. Sometimes it's necessary, sure; and I don't hate people for doing it. But when I have tried my best, and when it's still no good, it feels like... well, it feels as though I've disappointed myself, and been disappointed by myself, at the same time. I want very much to do well. When I'm told I haven't, it is almost the same upset as having plans changed suddenly.

With small things, it's easy enough to correct. I only feel that way for a little time. Like at work: "Put the slides in the ethanol for five minutes, not three." Okay. I can do that. It feels bad to be corrected; but once I've set the timer for five minutes, the feeling fades and they eventually see I remember to do it that way. Little unexpected events aren't so bad--but they add up. So does criticism.

If I were told repeatedly that I was doing something wrong, especially in a loud, abrupt way like a "NO!" or even a physical slap or shock... Well, it wouldn't be the physical that hurt me the most. It would be the rejection of my effort that hurt. I tried my best and you still do not think it's any good. I've done it wrong. I've failed. That hurts.

I initially failed at going to college because I wasn't ready to live on my own yet, nor manage college without help. I became depressed because of my failure--so badly depressed that I became suicidal and had to be hospitalized twice (though whether these hospitals had any positive effect is rather doubtful). When I am told that my best effort isn't good enough, and worse, that who I am is not good enough, it hurts more than any physical force ever could.

If only they will tell me how to do it right, I don't have too much trouble with corrections. But there is only so much correction somebody can take, especially someone like me. Repeated, over-and-over, as in ABA, "This is the only right way to do things; your effort is not good enough," would have created that sort of suicidal depression in me that happened when I failed in school. Of course, at the age when one usually goes through ABA, suicidality cannot easily be acted on, especially if one's emotions are also blunted from being dosed with neuroleptics. (Some children, reportedly, have tried.)

I'm quite sure I deserved those failing grades, of course. One doesn't learn physics while staring at the wall and trying to gather one's slowed thoughts into a coherent pattern. What might have helped--the supports that now allow me to legitimately earn good grades and hold a (heavily individualized) internship--simply wasn't available to me at the time. Circumstances basically set me up for failure, and the results, with my personality, were inevitable. Still, no one is to blame, because no one--including me--knew I had more challenges than most.

But people teaching little autistic children don't have that excuse. They know the child learns differently... or, they should know.

One shouldn't blame a dyslexic person for not reading a word correctly, nor a deaf person for failing to recognize a tune, nor an autistic person for not reciting the correct greeting. And yet... this ABA... it is setting the child up for repeated failure. For everything the child learns successfully, he will have been told, "No." "Wrong.", or else have his effort ignored (which amounts to the same thing) repeatedly; and it's even worse when the skill is developmentally unavailable to learn at all, and there isn't even a success at the end of all that failure. I think that happens rather often, as people have an idea of autistic people needing years of practice to manage the simplest things. They will try to teach the child something he is not ready to learn, and teach it for years, until he is finally ready to learn it and does; and then they will assume it was their teaching that got him to learn it.

If a child fails at school, you get him tutoring and show him how to catch up. You don't just sit him down in front of the problem until he chances on the correct answer. Long before he does, frustration and the repetition of "No!" and "Wrong!" will have caught up with him, and he'll get the idea that he oughtn't to try at all, lest he fail. Nor does it do any good to guide his hand through the movements of making the right answer on the paper, as it won't mean he's understood the concept; only how to draw the correct figures. But if that child is autistic, both forcing repetition and forcing imitation without understanding are well-accepted and widely-used techniques.

The problem of prompt-dependence might be directly connected to that, too, for some cases. Having to hear someone tell you to do something in order to be able to do anything at all could be directly connected to the natural hesitance that anyone feels to initiate action, after repeatedly having been told "no!" when he takes any sort of initiative. I realize that for some it's an executive function issue; but for others, I would surmise it is closer to, "If I try anything on my own, I risk being told I'm wrong; so I'd better play it safe and not try at all."

Good ABA has been the best thing ever to happen to our son. It's is fantastic and to be honest, I am a little scathing of those who chose not to seek it.

ABA is not a text book therapy though and so it's success will always depend on the skill and insight of the professionals driving the program. If they are substandard, then so too will the program and the outcomes.

Our family was fortunate to be able to work with the best in our country and the modern, flexible, fun learning environment that they provided has given T not just specific skills, but the ability to learn from his environment. Everyday activities, friends, learning -all these are now intrinsically reinforcing for him.

Our version of ABA has involved no table top drills, few rewards external to the activity and respect for my sons personality, likes and dislikes. We have sought to expand his view of the world in a safe, fun and scientifically validated way. It's been hugely successful and I wish every child on the spectrum had access to such quality early intervention.

ETA I'm 33 and dx'd Aspie last year. My son is 3 & 3/4, was dx'd with PDD-NOS at 23 months. His intensive early intervention is winding up, although we will continue to consult with his team moving forward.

Last edited by item on 20 Oct 2012, 10:51 pm, edited 1 time in total.

Callista, what you are describing is 'ABA' at its worst. Good ABA is about positive reinforcement, fading supports to reduce reliance on external reinforcement and using the appropriate tool for the situation.

Just as you would not try to flip an egg with a whisk, the tools that behaviour analysts use are only beneficial in particular situations.

Also, good practitioners recognise that if the child is not learning, the child is not at fault, the practitioner has chosen the wrong method. ABA is all about motivation and setting up for success, not failure. It is a science which informs clinical decisions, not a one-size fits all factory model therapy.

If the OP's friend wants to help autistic kids, then I recommend going into education to develop materials and techniques to teach autistic kids in ways that work for them based on how their brains work.

If you look at great educators, many of the successful methods are ABA based anyway.

Callista, modern ABA programs are nothing like you describe. Or at least good ones aren't; I have seen behaviorist approaches poorly implemented so I'm sure there are still places out there run that poorly still exist, but I'll say again, whether or not ABA is appropriately implemented is dependent on the teacher, you can have a bad teacher in any educational program, unfortunately if a teacher isn't properly trained in ABA (or teaching) it can have some serious negative affects. But what people are describing about yelling and forced eye contact is NOT an ABA thing. I've been in many special ed settings ,ABA, generic self-contained and inclusion programs and unfortunately that sort of thing can happen in any of those settings. It depends on the teacher and their attitudes/philosophies. I was in general education classrooms my entire childhood and I was frequently yelled at for things I couldn't help. I was forced to write and rewrite my work only to have it torn up by the teacher who said it was too sloppy, made to stay in the class during recess and lunch to keep rewriting until my arm was in pain only to have it torn up again. I was terrified of school and held negative attitudes towards school for most of my life but I don't blame the general education system, I blame the teachers I had.

All school systems have rewards and consequence systems. Yes there are some kids who are naturally fond of learning who don't need them, but for some kids learning is a chore and is unpleasant. For many children tasks such as speaking, pointing and processing language are extremely difficult and the joys are learning are simply not enough for them. As for dependency on prompts and reinforcement; a GOOD ABA program will fade the use of prompts and reinforcement when they are no longer needed. The goal of the programs is to get kids ready for less restrictive classroom environments (or, if that's not possible, ready for life outside of school when they graduate). It's understood that no one is going to be giving out tokens in the real world; when the student can function without it it is supposed to be faded over time.

I have never seen a child in an ABA program be blamed for their mistakes (sadly, I've seen that in other educational settings, probably more so in general ed than special ed). Any decent teacher knows it is HER job to make sure her students aren't learning, and if one approach isn't working another has to be tried. That's why we take so much data in ABA- to see what works, so we can do more of it... And what DOESN'T work, so it can be replaced with something that does. The philosophy that has always been emphasize in my program is that ANYONE can learn, we just have to find out how, and that it's our job as the teachers to figure out what each student needs in order to succeed. There's nothing within the principles of ABA that includes yelling at students repeatedly and telling them "no." I'm sorry if that was your experience but it's nothing to do with ABA, it may have happened in an ABA program but it could have happened in any educational program.

A good ABA program does that. That's why it's used for kids with autism (though many of principles of ABA are used with other populations as well).

ABA classrooms are highly structured and predictable to minimize any stress from unpredictability or deviation from routine that an autistic child might experience. Visual schedules are used so kids can SEE what is going to happen and know what is expected of them-no surprises. Actually, that's part of why I want to work in an ABA program. I like the sense of structure and predictability,other types of classrooms are often very unpredictable, also like working with kids with ASD.

Many of the techniques used in ABA work well specifically with kids with autism because of the way their brains are wired. Some include:

Video modelling- a way to teach children that involves watching the skill to be taught on video. Works well for many kids with ASD who are visual learners and who may find interaction with others uncomfortable so may learn better from watching the skill on video

Social Stories- EXPLAIN social situations to kids to help them understand the situation better, such as why children may act a certain way and how they can respond. Helpful to kids with ASD because they may not understand social situations

Peer modelling- involves the use of trained peers to help a child with ASD in social situations; again, kids with ASD have social difficulties so this works specifically well with this population

Task analysis schedules- break down a skill into many different steps and includes visual pictures and written directions for each step; helps kids with ASD because it breaks things down and includes visuals to help them process the information

Discrete Trial Instruction- the unfortunate misconception is that DTI and ABA are interchangeable terms- they are NOT at all, DTI is simply one teaching method under the ABA umbrella. It is helpful for young children or very severely affected children because it is highly structured and breaks a skill into very simple steps so the child can eventually complete the whole skill/understand the whole concept that they would not have been able to had it not been broken down

And those are just a few techniques, there are tons are different teaching methods so if one method doesn't work so well with one student you can always move on to somethings else that may be better suited to their learning style.

The thing with ABA is that the farther away it is from behaviorist theory, the more beneficial it tends to be.

Behaviorist psychology treats the mind as a black box--something that cannot and should not be a factor in psychology, because it cannot be directly observed. Only behavior is observable; therefore only behavior is scientifically relevant. With the cognitive revolution, pure behaviorism fell out of favor; in fact, ABA is its one remaining foothold in human psychology.

The Lovaas method originally contained--and sometimes still does--a heavy emphasis on aversives, such as hitting, pinching, shouting, or in more modern clinics, electric shocks. Aversives are no longer particularly popular, though they are still used; nowadays, instead, rewards are used. The problem with using rewards for autistic children is that the lack of a reward is strongly aversive. I would go so far as to say that if the reward is at all desirable, it is counterproductive. This has been shown in human psychology experiements repeatedly and consistently: People extrinsically rewarded for behavior tend to stop the behavior as soon as they are no longer rewarded and feel much less positively about the behavior. The more desirable the reward, the less they value the behavior. And when the reward is phased out, the behavior stops.

Yes, therapy which is called "ABA" now includes teaching the reasons behind a behavior. But the theory of ABA itself posits that teaching the reasons behind anything--or, in fact, targeting the child's cognitive state at all--is useless and unscientific. Rather than asking whether someone understands something, it asks whether someone can make the proper response when presented with a stimulus.

Social stories are not part of ABA. They have been adopted by ABA practitioners, but they are not based on the theory of ABA.

What I see with "ABA" is that people have been using therapies that don't actually have anything to do with "applied behavioral analysis" and calling them ABA--mostly because ABA is the kind of therapy that most insurance companies will cover. It's a matter of money, really. If it weren't for that, we'd have thrown ABA away (or perhaps left it for places like the JRC to use) and gotten on with just calling it "occupational therapy" or "speech therapy" or just plain "teaching".

How come that when I said something unrelated to ABA, about education for autistic kids and a recommendation for the OP's friend, some other posters respond to me with advertisements for ABA? I was suggesting going into education as a path towards helping autistic kids, since the OP's friend is interested in that. A solid theory and practice of educating autistic kids is desperately needed, since our brains work differently, and lots of things that work for typical kids don't work for us, and we are going to need different materials and techniques to target our ways of thinking, e.g. eggstreme visual for a subgroup of us, eggstreme verbal for another. I still recommend going into education for the OP's friend.

Callista most behaviorists don't think that way, actually most ABA classrooms are highly individualized to suit the needs as well as interests of the students and ask student's opinions frequently, they certainly don't treat them like blank, thoughtless boxes. Whenever possible, teachers involve the students in their own behavior plans such as by letting them choose reinforcers, having them explain why they engage in behaviors or having them identify what situations they have difficulty with. Obviously that's not always possible, not all students have the ability to communicate that information but when possible it's always ideal to have the student's input.

I know aversives were used in the past; because of the controversial past with behaviorism there is a huge emphasis on ethics in current ABA training programs, when getting certified as a board analysts candidates must agree to an ethical contract, part of which states using punishment only when other options would not be effective and when using punishment to use it alongside a form of reinforcement. And rewards are not simply taken away in ABA programs, they are faded out and gradually replaced with more naturalistic reinforcers that would be more commonly experienced in day to day life.

Education for autistic kids is completely related to ABA. Applied behavior analysis is the most widely used and accepted teaching method for kids with autism. I am a special education major and I can tell you that if you want to be a teacher specifically for with kids with autism, you go into ABA (unless you want to work with kids with AS or HFA, but I'm assuming that's not the case with OP's friend since ABA was suggested to her). Schools and classrooms for kids with autism are generally ABA schools. Yes there are a few alternatives out there, like TEACCH and DIR/floortime, but those are generally combined with principles of ABA because they are not as extensive as ABA nor do they have the research to back them up. They're also much harder to get trained in as a teacher since they are not widely accepted methods. At the present moment the teaching techniques used in ABA are some of the best methods out there to meet the needs of kids with ASD and their unique learning styles.