Spectrum's ABA excuse piece

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When Terra Vance took a course to become a registered behavior technician (RBT) in 2015, she was trying to transition from a career as a teacher to one as a psychologist. To get the supervised hours she needed for her psychology license, she had taken a job working with mentally ill adults for a company in Lynchburg, Virginia.

Instead, her employer told her the company had a backlog of autistic children and wanted her to help with that caseload. The employer paid for her to get the RBT certification, which would qualify her to deliver what many researchers consider the gold-standard autism therapy, applied behavior analysis (ABA), under supervision to these children.

Vance completed the online course — a series of videos followed by quizzes from a company called Relias — over a weekend. She was intent on learning the material, she says, but found out later that other students cut corners, letting the videos play while they did other things and looking up quiz answers on their phones. It was easy to pass: If you failed a quiz, you could just re-watch the video and take it again.

Vance had spent 14 years teaching English to middle- and high-school students, and she had developed a reputation for helping autistic students. (She was diagnosed with autism herself in 2017.) But when she started accompanying another RBT on home visits, she felt unprepared, she says. Extra training she received from her employer — on privacy, patient rights and restraint training — did not add to her confidence. No one taught her how to change diapers or adequately manage aggression, she says, which she would have found more useful.

Vance also quickly became skeptical of the kind of therapy she was being trained to deliver.

The sprawling industry that has coalesced around ABA is causing frustration for many — technicians, clients and experts alike. Plenty of therapists in a wide range of settings, including schools, homes and clinics, do ABA well, and plenty of studies support its value, says Zachary Warren, a clinical psychologist at Vanderbilt University in Nashville, Tennessee. But ABA’s worth depends greatly on who is delivering it. And as autism diagnoses and demand for ABA have risen over the past decade, how to ensure people are qualified to deliver the therapy effectively has become a point of contention.

And it’s not just the credentials that have come under scrutiny. On-the-job coaching and supervision are supposed to make up for gaps in the training, but some RBTs find that the agencies they work for do not provide much of either.

Yet, critics say, the agencies that hire RBTs often rely on a vast pool of undertrained labor. These businesses collectively train and employ tens of thousands of RBTs to work with children. “It’s being treated as a money grab in many places,” Bailey says. He estimates that there are hundreds, if not thousands, of these companies in the United States. Some are profitable enough that they have become popular buys for private equity firms.

ABA can take various forms, including the Early Start Denver Model and pivotal response treatment. Its general aim is to teach language, social and other skills by breaking them down into small parts, often with rewards and a sense of fun worked in to boost motivation. Although scientific support for the method is not rock solid, studies stretching back for decades indicate that, when done well, ABA can facilitate learning and improve social communication, minimize challenging and self-injurious behaviors and improve daily functioning in people with autism, intellectual disability and attention deficit hyperactivity disorder, among other conditions.

Anecdotal reports of success abound, too.

The majority of therapists are not abusive. Many are just not taught to adjust ABA to an individual child, which is critical to the method’s success. Part of the problem is that most RBT training courses teach formulaic, child-unfriendly techniques, as if delivering ABA were like following a recipe, Leaf says.

Autistic adults who had ABA as children have criticized the therapy for forcing them to act in ways that made them uncomfortable, for pathologizing their neurodiversity and for being too scripted, inflexible and robotic.

Questions about qualifications have long been an issue for the field.

Alongside the credentialing efforts, the field has quickly grown in popularity, buoyed by a rise in autism prevalence. In the U.S., the ranks of BCBAs grew from fewer than 400 in 2000 to 16,000 in 2014, three-quarters of them working with autistic people, according to certification board data. By 2017, the board had anointed more than 34,000 RBTs worldwide. By October 2020, almost 83,000 people had received an RBT certification (and more than 42,000 had become BCBAs).

At the same time, state mandates for insurance coverage of ABA (all states now have them) have reshaped the industry, experts say, opening up the potential for greater profit for agencies that shift more hours and responsibility to RBTs.

Industry changes may have come with growing pains, as many RBTs have expressed concerns about their lack of supervision from BCBAs: Every year, 1,200 to 3,600 messages — from RBTs, BCBAs and families — pour into the ABA Ethics Hotline, which Bailey has run in one form or another for more than a decade.

Realistically, BCBAs could oversee a maximum of 5 to 10 RBTs at once (depending on who the clients are), given the time it takes to observe, provide feedback and complete paperwork, Bailey says. But many are assigned to manage 15 to 20 RBTs, he says, in part because there are too few BCBAs to go around: More than half of U.S. counties have no BCBAs at all.

When Shannon Des Roches Rosa’s high-support autistic son was 12, the family turned to an agency near their Silicon Valley, California, home. For the first couple of years, no technician the company sent lasted more than a few months. The family cycled through at least 10 technicians, says Rosa, who is senior editor of Thinking Person’s Guide to Autism.

“A lot of them didn’t have what it takes to work with a person who has a lot of autistic behaviors,” Rosa says. And the turnover and poor care took its toll. Rosa’s son was often miserable, which was stressful for Rosa. “Whenever there was a new therapist who arrived in the house, it was worse for me than having nobody there,” she says.

In the early days of ABA, researchers in the field never dreamed that outside companies would take it over and overhaul it in ways that would harm its reputation, Bailey says. “Right now, [ABA] is known as the gold standard for treatment of autism, and that’s because we have so much research on this,” he says. “But if you don’t translate the research into practice, and if you don’t monitor the practice, it’s not the gold standard anymore.”

There are scant data to support any benefits from ABA delivered by RBTs, Warren adds.

During her brief stint as an RBT, Vance found out she was pregnant with her daughter, who is now 4. When her daughter was almost 2, she was assessed for language delays and diagnosed with autism. Vance never considered seeking ABA for her. She sees too much potential for harm as a tool to control how children behave. “I think I’m raising a phenomenal, thoughtful, caring, emotionally supported, happy child,” she says. “That’s what matters.”

I was interviewed by Spectrum Magazine about my experience with ABA. The journalist, Emily Sohn, was great. All our interactions were positive.

Somewhere between my interview with her and what was published, what I thought was going to be published was lost.

It seems ABA is a N American thing there’s not much ABA in the UK besides a handful of special schools that have started importing ABA as their unique selling point.

It’s been positively reported in our media but I suspect the endless therapy is too expensive for the NHS which isn’t a factor in the US insurance system.

Parents of kids with autism may be better off trying floortime and sonrise maybe giving Bumetanide, it’s safe been around for decades and in stage 3 trials for autism at the moment and significant numbers of kids seem to be positive responders.

Son-Rise is the opposite of ABA in that it requires the parents to act autistic by mimicking the child in order to communicate. On the surface it seems like a ND advocates wet dream after so many therapies similar to gay conversion therapies designed to “extinguish” autistic behaviors. Yet they brag about recovering people from autism which is quackery and bait and switch.

:lol: The only worry I have here would be a parents' petty reason to ever take any treatments; because it's 'expensive', reputated abroad, etc.

Nevermind if there's poor quality control in abroad, let alone the mass ignorance here.



If a parent chooses to gamble their child's life, out of love or ignorance, who am I to object?
And if that gamble pays off and tells everyone off...

Whether or not to make another parent makes the same gamble because someone else's gamble paid off, is still a gamble.
Even if that gamble meant 'better than nothing' vs 'better done nothing'.


It's not my duty to save every person's life from their own and someone's mistakes.
But all accounts had to be known.

What irks me still are the lack of accountability.

But what does that actually mean in a world full of people blaming each other within incalculable factors?
And countering said incalculable factors with an equally incalculable yet unequal factors?

I think its just parents feeling they have to do something. There`s no real treatment options for autism and if you include destructive / violent behaviour doing nothing is not an option.

Not every autistic kid behaves like an angel unfortunately.

Where there`s nothing else people return to the same thing, im reminded of Einstein`s theory of madness doing the same thing again & again expecting a different result.

Until better therapies come along Parents will still be compelled to go down the ABA path because its the only one.

If Neurodiversity hates ABA so much why don`t they devote their time lobbying for research into better therapies that can replace ABA rather than the do nothing & let your kid end up disabled as its part of a natural difference of the human genome. If your kid destroys your home in the meantime don`t dare complain about it as well you martyr mom.

Not likely to win many supporters there & just leaves ABA as the only thing left.

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