Ableist & Pathologizing Therapy Approaches

Applied Behavior Analysis

ABA is a an approach that focuses on behaviors, with a goal of shaping and increasing desired behaviors and decreasing undesired behaviors.  Some of its main concepts are:

•Antecedent-Behavior-Consequence – A way to teach and understand behavior

•Positive Reinforcement - Each time the person uses a target behavior successfully, they get a reward.

•Punishment – Each time the person does an unwanted behavior, something aversive happens to them.

•Task Analysis & Chaining – A way to break down tasks into small steps to train each part individually and then put them back together

•Prompting & Fading – A way to ensure students never have errors, which is then decreased over time as the student is trained in the target skill

•Shaping – Providing positive reinforcement for behaviors that are closer and closer to the target behavior.

As you can see from looking at just a handful of their techniques, ABA is a very structured system.  It claims to teach important skills and increase helpful behaviors, while decreasing harmful behaviors.  And on the surface level, it appears to work, and do just what it claims. If your child receives ABA, you may have seen what appears to be progress with communication, daily living skills, or whatever else the therapist has decided is important to work on. Many research studies have been done that purport to prove its efficacy.  Many professionals believe ABA to be necessary for autistic children, claiming that it is the only research-based treatment for autism.  It is generally seen as the “gold standard.”

Besides being effective, ABA also may appear to be play-based and fun.  Your child may appear to have a great relationship with their ABA provider, and love going to ABA therapy. Your pediatrician may have recommended it, and you may know Autism Moms that sing its praises. Most schools even endorse ABA through its use in their autism support classrooms. But no matter how it appears on the surface, ABA is a method for manipulating your child’s behaviors and controlling them, regarded as “conversion therapy” for autistics.  It is largely condemned by the Autistic Community and those within the Neurodiversity Movement. However, due to fear-mongering and lobbying of ABA organizations, parents of autistic children are often pushed into ABA, while being kept in the dark about the viewpoint of the entire Autistic Community.

ABA is Abuse

ABA is unethical, immoral, and a violation of human rights.  Although ABA providers don’t see ABA as abusive, It is the autistic people who have been submitted to ABA who get to decide whether ABA is abusive or not. An overwhelming majority of autistic individuals are against ABA.  Below are just a few of the reasons why:

•ABA is compliance training, which teaches children that their needs and desires do not matter, and that their bodies do not belong to them. Forcing children to ignore their instincts and boundaries makes them more susceptible to bullying and sexual abuse in the future.

•ABA promotes the idea that autistic people are broken, and that they must change to fit in. It rewards them for hiding their pain and distress, while fitting in with neurotypical norms.

•ABA assumes that autistic kids won’t do what adults are asking, rather than can’t do what they are asking. It doesn’t look at underlying physical or emotional needs or skills, only focusing on compliance. ABA is an outside-in approach, rather than an inside-out approach focused on meeting needs.

•ABA causes increased symptoms of PTSD, poor outcomes for mental health, and increased risk of suicidality.

Given these, it’s easy to see why autistics say that ABA is abusive.  Sadly, there are many more reasons supporting this idea as well.  Unfortunately, this information is often not presented to parents of autistic children.  ABA is often presented as a parent’s only option for their autistic child.  Parents who choose not to use ABA are often seen as neglectful, because there are a lot of professionals who think it is what is needed for autistic children.  They are sadly unaware of or ignore autistic voices that are trying to advocate for a better future for autistic children, in which they are not subjected to abuse masquerading as treatment.  But now that you know better, you are responsible for doing better. There are better approaches than ABA for your child.

Alternatives to ABA

While therapies such as ABA (applied behavior analysis) are quite frowned upon due to their focus on "curing" autism instead of assisting the neurodivergent individual, there are some neurodiversity-affirming therapies and supports that can be beneficial.  These won’t try to “treat” or “cure” autism, but will try to assist with some difficulties that may be decreasing the child’s quality of life.  It is important to remember that autistic children don’t inherently need therapy.  However, below are some supports and therapies that may be beneficial based on your child’s needs:

Supports:

• Environmental modifications

• Collaborating with your child to solve problems

• Co-regulation

• Respecting and listening to your child

• Meeting your child’s needs

• Augmentative and Alternative Communication

• Realizing that children do well if they can

Therapies:

• Speech/Language Therapy*

• Occupational Therapy*

• Physical Therapy*

• Mental Health Counseling or Therapy*

  *With a trauma-informed, neurodiversity-affirming therapist experienced in working with autistic individuals