For definitions of terms, please check out FAQ 1.
Table of Contents
- What is “New ABA”? – A brief history of ABA
- Why is it controversial?
- How does ABA differ from parenting?
- Is there any “Good ABA”?
What is “New ABA”? – A brief history of ABA
CW: This section describes abusive practices in ABA. Reader discretion is advised.
Historically, ABA was known for harsh punishments (aversives) like beatings, spray bottles, verbal harassment, withholding food, public shaming, and shock treatment. The original goals of ABA can be summed up well by the most-attributed “founder of ABA,” Ole Ivar Lovaas.
“[Y]ou start pretty much from scratch when you work with an autistic child … they are not people in the psychological sense.”Ole Ivar Lovaas, attributed ‘founder of ABA’
One of the major criticisms of “original ABA” is that its methods heavily influenced Lovaas’s involvement in The Feminine Boy Project, which was foundational to conversion therapy for gay and trans youth.
The rhetoric of ABA initially promoted itself as the only known “cure of autism.” Since the punishments were seen as preferable to institutionalization, the harm was rationalized and widely supported by the medical field and parents.
When considering the rise of Autism Speaks through cure rhetoric, it explains why the two are often connected. Autism Speaks has also pushed legislation to get ABA mandatory insurance coverage in many states, legitimizing the practice. ABA set the stage rhetorically for Autism Speaks, and the two mutually benefit from pushing parents towards seeing autism as in need of immediate intervention before it’s “too late.”
ABA also positioned itself as the only scientifically supported autism therapy, shunning other therapies as pseudo-scientific and ineffective. This is similar to how behaviorism arose from rhetoric regarding it as the sole objective psychological science. It was later recognized as lacking crucial dimensions (like unobservable, internal states) to treat holistic mental health.
Over time, original ABA methods like Discrete Trial Training (DTT) were missing crucial components like the generalizability of outcomes. New methods like Naturalistic Environment Teaching (NET) along with a wide array of variants like EDSM, PRT, PBS, and PECS were introduced. The aversive punishments received negative attention and were regarded as inhumane.
ABA outwardly shifted to focusing on naturalistic, child-led, rewards-focused interventions in an attempt to ethically practice ABA. The original goals remain the same; improve communication/adaptive skills, and reduce “problem behaviors.”
This coincided with the first wave of people that went through ABA becoming adults; many spoke out about the traumatic experiences where they were forced to stop being autistic at threat of violence.
While there is no set period in time where this change emerged, from my understanding, there was a progressive shift in ABA to distance itself from its historical past.
If you talk to most ABA therapists, they would agree that the “old ABA” was bad. They claim that the “new ABA” is good, pointing to advancements in naturalistic techniques that are not as explicitly punitive. This “old ABA” vs. “new ABA” has served to silence people that experienced ABA, regarding them as having old ABA and therefore not having an informed perspective on current ABA practices.
Autistic ABA survivors and others in the community point to how many of the techniques that caused harm are still present and that because the goals are still the same, they still punish autistic expression and favor making autistic children more like their neurotypical peers.
It is also worth noting that there are still ABA organizations highlighted at major ABA conventions practicing electric shock torture at the Judge Rotenburg Center (JRC). They recently went after an autistic-run non-profit for publishing statements regarding the inhumane treatment. The “old ABA” is not so distant as ABA therapists tend to argue.
Why is it controversial?
Requirements for Practice
Currently, only 31 states in the U.S. require a BCBA to be licensed with the state (with a few states with proposed legislation). This means that, unlike other therapy professionals, many states have no external body of regulation for ABA professionals. They are still required to get certified through the BACB to practice, but the BACB is an independent body that can decide the rules for certification and what qualifies.
Considering other blatant unethical processes in the field, like the JRC, the BACB has some apparent conflicts of interest in judging ethical conduct. This is why an external regulation body is necessary to maintain ethical conduct.
Another concerning aspect is that currently, no states require a license for RBTs. They are essentially practicing therapy without a license, with minimal training, and all under the guise of being supervised by someone with more credentials. I can’t think of the equivalent of an RBT in any other type of therapy because it’s broadly recognized that the level of experience and training necessary to practice is far beyond what an RBT has.
There are also no strict guidelines for learning about autism or child development for any ABA therapist.
Below, I’ve created a table using Washington State, one of the 31 states with licensing requirements for BCBAs, RBTs, and Licensed Mental Health Counselors (LMHC). While there are different pathways for BCBAs and LMHCs, I used the most common technique for obtaining licensure for each.
|Supervised Practice Hours||Direct Supervision||Continuing Education (Every 2 years)|
|BCBA (WA State, USA)||1500 hrs||75-150 hrs||32 hrs|
|RBT (WA State, USA)||40 hr classroom training (not practice hours)||5% of hours post credential, 2.5% individual||0 hrs|
|Mental Health Therapist (WA State, USA)||2500 hrs||100 hrs||36 hrs|
Issues with Consent/Assent
Another concern is that many ABA interventions inherently don’t offer the option to consent or even punish when a client does withdraw consent.
Some ubiquitous issues with consent in ABA are pairing, improper understanding of accessibility needs (including minimal verbal options for non-speakers), punishing “vocal non-compliance,” and using fidgets, breaks, food, or other needs as reinforcers. Many also don’t present a choice to engage with the intervention, use restraint and seclusion, remove loved reinforcers from home to “make them more effective,” and don’t understand meltdowns or how to prevent them.
In theory, the behaviors targeted for reduction and increase should be purely for the client’s benefit. However, many clinics use the parent’s perspective to form goals. Many providers (often unconsciously) set goals to help make the parents’ lives easier, like teaching them to say hello to their parents or stop screaming to help parents focus. Taking parents’ thoughts into consideration isn’t inherently a bad thing. When ABA often uses rigid behaviorism tactics, you force compliance regardless of their interest if it is not for the client’s benefit. It would only take one goal not made for the client’s benefit in the 40 hours per week of ABA for it to become unethical. Not many other therapies give the therapist so much control over their client.
Nothing in the ethical code directly specifies in which contexts the client is the kid vs. the parent. This also leaves murky areas for prioritizing the parent as an ethical choice.
The prompt hierarchy is another example of issues with consent. One of the issues with the prompt hierarchy is that it assumes all behavior is willful or incompetent. It believes that if someone isn’t doing something you’ve asked, they either do it because they don’t want to or don’t know how to. Working with a population with many co-occurring disabilities necessitates determining if the behavior isn’t happening due to motor, physical, or other unseen interworkings. It also requires physical force to complete a task if a child isn’t responding.
For example, when I worked in ABA, a child struggled to put on their shoes. I was supposed to work through the prompt hierarchy, but I paused and considered the environment. I realized that the kid was embarrassed, as he had two adults pressuring him to put on his shoes, a behavior he already knew how to do but was struggling with that day. I waited for him and let him know there wasn’t a rush to the next activity, and immediately he was able to put on his shoes and looked incredibly relieved.
Reducing Humans to Animals
Another concern about ABA is that it completely ignores internal states. It believes that humans can be reduced to behaviors that can be explained and manipulated. There is no room to analyze emotions or other physiological states that can’t be observed. This is also why there is sparse research examining ABA’s psychological and emotional effects in the short and long term.
Take the four functions of behavior, for example. While the four functions of behavior may appear logical, it is reductivist and only sees human behavior as four categories. Since it is phenomenological, you can point to anything as “evidence” for those categories.
I could categorize human emotions into good, bad, and weird. I could categorize my feelings as happy, content, and excitement are good; sad, lonely, and angry are bad; and confused, off-put, and deja vu are weird. Obviously, there are only three human emotions now! The evidence is that every feeling I experience can fit into these three categories.
It’s rational to see how this line of thinking is faulty.
Suspect Evidence Base
Methodologically, behaviorism created single-subject designs to measure baseline and subsequent behaviors, and this has been the foundation of much of ABA’s evidence base.
While single-study designs can help prove a behavior has successfully changed, they are not generalizable to broad populations. They also only prove that the behavior successfully changed. They don’t adequately address any effects of the intervention beyond behavior change.
Beyond this, a proper control group is not typically used in multiple subject designs in ABA research. There are only groups where children receive interventions and no groups that show whether the behavior would have developed without the intervention.
There are many Conflicts of Interest (COIs) not disclosed in ABA research. One study examining ABA literature found that 87% of the 70 studies with no declared Conflict of Interest found at least one author who provided ABA services or consultancy for ABA providers (clinical/training COI). They also found that only 5 studies out of 180 were group designs instead of single-case designs.
It is worth noting that there is a lack of transparency about the widespread methodological issues. That is significant considering that this evidence base has been used to receive government funding, support from the medical field and the public, recognition from the largest autism non-profits, and hundreds of thousands of dollars from insurance and parents. It has also contributed to other therapies for autistic children not being covered by insurance companies and disregarded by the court system, forcing many families into needing care with ABA as the only option.
How does ABA differ from parenting?
While the two may look similar, ABA differs in application, goals, and systemic power.
I do not have children. I will be very clear that my perspective of parenting may be incomplete.
Most parents’ goal is to raise a happy and pro-social child, where they are secure in themselves and actively try to better the community. Obviously, this isn’t the case for all parents, but when comparing the two, it’s easier to establish a baseline.
ABA is not simply reinforcement. We use reinforcement regularly in our daily lives, which is very important in parenting.
To examine the differences, it’s helpful to look to ABA “parent training,” where therapists will often come to the parent’s home and teach the parent how to practice ABA when the child is not with the therapist. The therapist will often instruct parents to make reinforcers sparse so that the child has to communicate for them. The therapist will instruct parents on how to apply reinforcement and punishment, how to gain the child’s attention, the prompt hierarchy, identifying the functions of the behavior, and the motivating operations (circumstances that make reinforcers work better).
In parenting, typically, this level of structure is absent. Suppose we’re discussing “gentle parenting” (authoritative parenting). In that case, it advocates for natural consequences and rewards — which with NET may be similar but is not similar to other types of ABA. Authoritative parenting would place boundaries around access to reinforcement but would recognize giving access to loved items without demands is necessary for warmth and would never withhold food for the sake of compliance.
Gentle parenting would believe in errorless teaching but likely wouldn’t resort to physically restrictive methods like hand-over-hand. Authoritative parenting doesn’t reduce a child’s actions into behaviors with functions but instead notices the emotional motivations and is empathetic to the child’s internal states.
So, ABA is more akin to authoritarian parenting, which requires compliance and lacks warmth. ABA differs from any parenting style in that it has systemic power. It can be used to take kids away from parents if they don’t comply with treatment, regardless of how much it costs. It uses rhetoric discussed earlier to lure parents into believing their child is broken. It has legislative power allowing it to exist instead of therapy without a therapy licensing board.
Parenting is not ABA. Even authoritarian parenting.
Is there any “Good ABA”?
If you converse with an ABA provider about ABA, you will quickly hear the argument, “I practice good ABA.” Every provider believes they do. To be fair, there are many risks to examining your own practice and whether you are practicing “ethical ABA.” Most ABA providers go into the field because they genuinely care about other people and see ABA as a way to help. But, many ABA therapists still practice the problematic interventions I’ve identified here.
This is the heart of the ABA controversy. Is there any such thing as good ABA? I’ve interviewed autistic ABA practitioners and ABA survivors. Many people don’t believe that there is an ethical form of ABA. At its core, ABA does believe in changing behaviors with disregard for internal states, which is manipulation. And while manipulation can be used for the benefit of someone, how can we say that it’s in the client’s benefit when so many are coming forward with hidden harms of ABA (both new and old)?
That’s not to say that individual people have not benefitted from ABA. Some people have. There’s a lot of nuance to the conversation when considering the client’s racial, cultural, socioeconomic, location, clinic, and accessibility needs. As a consequence, it’s hard to say for sure what the appropriate action is.
Many call for an overhaul of ABA and go about it differently. Some believe they can change it within the field. Others believe the field is too corrupt to fix. Some risk their licenses or livelihoods in the pursuit of ethical treatment. And many more are complicit in a demonstrably unhealthy environment.
There are some critical changes that the field needs to make before it can be considered safe. And it needs to be a field where the unethical practices are not so pervasive that trying to pick an ABA provider is a minefield because you can’t tell on the surface which is the “good one” vs. the “bad one.”
Another question is, if the field does change so significantly that it becomes ethical, would it even be able to be called ABA? When some foundational techniques (behavior manipulation on vulnerable populations) have such a high potential for harm, can we ever be confident that we can ethically practice this goal?
Some practice ABA in name alone. Unfortunately, there’s not much one can do with a degree in ABA outside of ABA, and many insurances do not cover any autism therapy outside of ABA. So, some providers will provide other services and still call themselves ABA providers since that is what they’re certified in. This further complicates which ABA providers are “good ABA.”
This is not a new debate. This debate has been around as long as behaviorism, with psychodynamic therapy taking its place. Behaviorism on its own is generally not practiced outside of ABA. Therapists have considered it unethical when practiced alone without a multi-modal approach.
Regardless of the solution, it seems like ABA will have to become multi-modal, have better regulations, methodology, procedures for consent, education, humanistic goals, and consideration for the autistic community to start being an ethical field.