Applied behavior analysis (ABA) is a therapy for autism that encourages certain behaviors and discourages others. ABA therapy is controversial, as some argue that it reinforces the idea that autistic behaviors are inherently wrong.
Autistic people do not need treatment to “cure” their autism. Rather, they need different levels of support to help with challenges that may affect their quality of life.
ABA therapy aims to improve skill development in autistic people. It also encourages certain “desirable” behaviors and discourages “undesirable” behaviors.
ABA therapy is controversial, as some autistic self-advocates argue that it frames autistic traits and behaviors as undesirable and tries to force autistic people to act neurotypically. This may actively harm autistic people.
This article examines whether ABA therapy is harmful, how it works, and the potential problems with the therapy. It also examines alternative therapies.
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The question of whether ABA therapy is harmful is divisive, and the answer may depend on a person’s individual opinions, experiences, and needs.
ABA therapy is a widely used behavioral approach that aims to improve skill development in autistic people. It
However, some people argue that ABA therapy may be harmful to autistic people, especially when practitioners implement ABA procedures too harshly or with a focus on eliminating harmless autistic behaviors.
Some autistic self-advocates argue that ABA therapy reinforces the idea that autistic behaviors, such as stimming and avoiding eye contact, are inherently undesirable.
Trying to eliminate these behaviors may force autistic people to mask their autism. Masking involves adapting behavior to appear more neurotypical. Doing so
However, some medical professionals argue that when practitioners implement ABA therapy correctly, it can help autistic people who have more complex needs learn how to be more independent.
For example, autistic people with minimal language abilities, those with delayed cognitive development, and those who might hurt themselves or others may benefit from learning communication and coping skills through ABA therapy.
Is ABA therapy harmful?Hear from a medical professional on the topic of ABA therapy.
“I do not feel that ABA therapy is harmful to autistic individuals as a blanket statement. If implemented appropriately and with adequately trained therapists, ABA therapy is a well-researched method for increasing functional skills in individuals, not just those with autism.
“ABA therapy is not appropriate for all individuals with autism, as not all individuals have deficits that are interfering with their functioning. Historically, some ABA therapies used methodologies that were more punishment-based and rightfully have gotten a bad rap. However, current ABA best practices focus on positive reinforcement and acknowledges the benefits of autistic traits while not attempting to squelch them.
“Good ABA therapists encourage and support other therapies such as [occupational therapy], [speech-language pathology], and psychotherapy. We haven’t written off modern medicine due to historical practices once commonplace, such as bloodletting and using cocaine for headaches. We continue to do research, learn from our mistakes, and aim to make society a better place for all.
“It is not our goal as [board certified behavior analysts] to cure autism or to make someone less autistic. It is our goal to make each person as independent as possible.
“A lot of the anti-ABA movement does not seem [to] acknowledge the tremendous benefit it plays for the severely and profoundly impacted autism community. Approximately 26% of the autism community has a diagnosis of level 3 autism, and these individuals are significantly impacted by autism. Many have minimal to no language abilities, delays in their cognitive abilities and often have severe and harmful behaviors that require 24-hour care and possibly residential medical care.
“Much of the efforts to mainstream and deinstitutionalize all individuals with disabilities has removed much needed care for this population of individuals.”
— Dannell Roberts, PhD, BCBA-D
In ABA therapy, therapists encourage desired behaviors and discourage undesirable behaviors to develop and improve various skills in autistic people.
ABA involves many teaching methods.
In DTT, therapists use step-by-step instructions to teach autistic people to respond or behave in desirable ways. Therapists break lessons down into smaller parts. They reward desired answers and ignore undesired responses or behaviors.
Therapists conduct PRT in a natural setting rather than a clinical setting. PRT aims to improve certain key skills in autistic people, such as communication, to help them learn other skills.
The potential problems with ABA therapy revolve around how practitioners may apply the therapy.
ABA therapy may be helpful for some autistic people when therapists implement it responsibly to improve the autistic person’s quality of life.
However, the therapy
Each person responds differently to therapy, and ABA therapies differ according to the therapist’s practices and the individual’s needs. Some autistic people may benefit from ABA therapy, while others may not.
May punish autistic behaviors
Some autistic self-advocates, such as the Autistic Self Advocacy Network, argue that ABA therapy causes harm by punishing autistic behaviors.
While ABA therapy may benefit autistic people by discouraging certain harmful behaviors, such as self-injury, punishing harmless behaviors by ignoring or blocking them may cause harm.
Some
However, punishing autistic behaviors can reinforce the idea that those behaviors are inherently wrong rather than addressing social stigma about autism.
May ignore the needs of autistic children
In some cases, ABA therapy may reduce certain behaviors in autistic children.
While this may be easier for parents, caregivers, and teachers, it sometimes ignores the children’s needs.
Discouraging behaviors such as stimming (self-stimulating through behaviors such as repetitive movements) may cut autistic children off from soothing or coping mechanisms.
Stimming
Might try to conform behaviors to the norm
Negative reinforcement in ABA therapy may encourage autistic people to mask their autistic traits and behaviors and conform to neurotypical behaviors.
Although masking can help autistic people avoid social stigma, it can lead to several negative health effects,
- mental health difficulties
- exhaustion
- burnout
- suicidality
- identity confusion
- difficulty forming relationships
Can cause emotional distress and PTSD
One 2018 study suggests that ABA intervention during childhood may cause trauma, which can lead to lasting distress in people with autism.
Children who have exposure to ABA may be more likely to experience stress reactions such as the fight, flight, or freeze response, which occurs when a person feels threatened.
Of all the early childhood autism interventions that the researcher surveyed, ABA correlated with the highest likelihood of post-traumatic stress disorder (PTSD) symptoms.
According to the study, negative reinforcement in ABA therapy may activate a fear association in a child and can lead to negative self-perceptions and shame.
Learn more about the overlap between PTSD and autism.
Aside from ABA therapy, other treatments for autism are available to help autistic people address challenges that affect their quality of life. Options
- Developmental approaches: Treatments such as occupational, speech, and physical therapies aim to improve specific developmental skills in autistic people.
- Psychological approaches: Methods such as cognitive behavioral therapy focus on understanding the connections between emotions, thoughts, and behaviors. They can help treat mental health conditions in autistic people and help people develop coping methods to address specific challenges.
- Social-relational approaches: These treatment methods aim to improve social skills and help autistic people build emotional and social bonds.
- Educational approaches: Educational methods such as the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach focus on consistency and visual learning.
Learn more about specific therapies through the Association for Science in Autism Treatment.
What are the negative effects of ABA?
ABA therapy may result in negative effects for some autistic people, such as:
- loss of self-regulatory behaviors
- mental health complications
- low self-esteem
What are the pros and cons of ABA therapy?
Possible benefits of ABA therapy include:
- skill development
- reduction of harmful behaviors such as self-injury
- reduction of social stigma
The cons of ABA therapy may depend on the individual and the professional who is providing the therapy. Potential cons include:
- cost
- time commitment
- punishment for certain autistic behaviors
- emotional distress and mental health complications
- encouragement of masking and conformity to neurotypical behavior
- inadequate addressing of the needs of autistic people
Many therapists use ABA therapy to help autistic people develop skills that can improve their quality of life. This therapy method encourages certain desired behaviors and discourages undesired behaviors.
However, ABA therapy is controversial, as some people argue that it punishes harmless and even beneficial autistic behaviors.
ABA therapy may be helpful to autistic people if therapists implement it sensitively and in a way that meets each autistic person’s needs. The therapy may cause harm if a therapist relies on negative reinforcement and ideas of neurotypical conformity.
