ABA and Stimming

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So, I have a friend who's an ABA therapist. I quizzed her in depth and it seems like she's actually good at her job and certified (which not all ABA people are). The only thing we disagree on is, she doesn't think that children should stim. Basically her logic was this.

1. Emotions don't exist in ABA.
I told her stimming is emotional self regulation and she said it doesn't matter, what matters is the environment and what is achieved.

2. Children can and do stim for attention. It also seems like she thought that was the main function of stimming.
She changed her phrasing on this kind of after I argued with her. But I don't remember how.

3. Stimming keeps a child from being able to attend to tasks at hand.
If a child is stimming, they're not able to learn from their environment, do whatever a therapist is trying to get them to do, etc.

Could you guys help me go through these points? What do you all think?

Thanks!

Last edited by BigSister on 13 Mar 2014, 9:04 am, edited 1 time in total.

She's dead wrong, but it's not her fault. She's the latest (and hopefully last) of several generations of behaviorists, and despite the cognitive revolution, autism is one of the few fields where behaviorist psychology is still hanging on. She was taught that ABA is the best and only proven way to teach autistic children, and she believes what her professors taught her. People usually do, when they're talking to someone with multiple PhDs. But behaviorism is actually on its way out, and has been for some time.

Let me explain... Psychologists, in general, have a pretty big chip on their shoulders about being scientific. We're a new field of science, comparatively--a little over a hundred years of history, that's all. For a lot of that, we had a lot of theorizing untestable ideas and basing entire theories on nothing but a few case reports. Many psychologists were trying to stick to what they could observe and prove, but even then they were accused of not being real scientists. A lot of early psychology was done through introspection... people would train themselves to report exactly their perceptions and feelings. For people who were in more well-established branches of science, such as biologists and chemists, it was little more than philosophy.

Along came the behaviorists. They made a rather simple decision: They would ignore anything they could not directly observe. That meant that they saw the mind as a "black box"--a thing that could not be observed, and of which one could know only which input produced which output. So they focused on stimulus and response. Ring a bell often enough while feeding a dog, and the dog salivates when it hears the bell. It was anathema to say, "The dog feels happy." Or even, "The dog thinks that the bell means food." You couldn't talk about what the dog thought or felt. You couldn't even say, "The dog is hungry"; you had to stick to a statement like, "It has been six hours since the dog was last fed." Behaviorists stayed away from the mind. Stimulus, response, and that was it.

Since then, we've changed our minds: Feelings are indeed important; thoughts are important. The cognitive revolution taught us that the things that people communicate about their thoughts and attitudes can be used to help them understand themselves. Brain scans let us correlate thoughts with physical changes in the brain itself, allowing us to peer into the black box. Testing methods were developed, and ways were found to make those tests reliable. Now, psychology has many branches, and many ways of studying the same things, whether that's from the perspective of society or the perspective of the family unit, or the process of learning, or the biochemical and electrical changes in the brain. We study how people try to become the people they know they should be, how people recover from damage, and how people see themselves in the world they are in.

Only a few areas of psychology still use behaviorism as their primary basis for understanding the mind. These two major areas of psychology are animal behavior and autism treatment. Stimulus, response; ignore the mind, ignore the emotions, because they cannot be observed.

Behaviorism as an autism treatment was most popularized by Lovaas, whose method of applied behavioral analysis is still used. He started out trying to "cure" homosexual or gender-divergent boys into becoming "indistinguishable from their typical peers", but when this did not work, he turned his attention to autism. He found that he could, by use of constant reward and punishment, force autistic children to behave in the way he wanted them to behave. Aversives--painful punishments--were a key part of his strategy. Thankfully, they are not used particularly often now; those that are, are milder than what Lovaas used (ex., modern therapists might use being ignored as an aversive, rather than pinching, hitting, etc., as Lovaas used).

But even rewards are damaging. It is a well-known fact that when you reward someone for doing something, the task itself becomes less desirable. For example: Reward a preschooler for coloring, and he will stop wanting to color voluntarily. (This was the result of a rather famous study, which has been replicated with various tasks and with various age groups.) So in order to teach an autistic child something via ABA, what you are doing is establishing compliance, rather than actually teaching the purpose and value of the behavior; and even when the behavior could have been fun for the child, you drain the fun from it by making it a chore that's necessary to gain a desirable reward.

Now let's turn to modern ABA. Thankfully, a lot of modern ABA has been moving away from rigid Lovaas-style discrete trials, away from aversives, and toward more exploration and play. Some ABA therapists are ABA in name only, and are probably better described as combination occupation- and speech therapists. But much of modern ABA still relies heavily on molding the child's behavior into a certain desired pattern, rather than (and often at the expense of) increasing independence, competence, and self-determination.

There's a reason I call ABA "dog training for children". That's exactly what it is. It's the exact same psychological theory, now applied only to animals and mental patients. ABA therapy, the less like traditional ABA therapy it is, the more useful it tends to be.

As for your friend's points:
1. Emotions are ignored in ABA, but they certainly exist.
2. It is conceivable that some child, somewhere, has engaged in stimming for attention, but it is not something I have ever seen, or ever personally done. If anything, it is done surreptitiously.
3. Actually, stimming helps me attend to the tasks at hand. I have done some of my best thinking while rocking or waving my hands or tapping my feet. Quite a few studies have shown that, for children with ADHD, movement helps them think better. I believe this is the same effect I experience, and I would not be surprised if this is also the experience of many autistic children.

Last edited by Callista on 12 Mar 2014, 11:51 pm, edited 1 time in total.

I think I can rocking and jotting notes at the same time.

I believe self could have benefited from a good behavioral analyst.

I must disagree with the therapist the OP talked about; I think there's nothing wrong with stimming at all. Stimming with stones and my small plushies actually helps me avoid one of my more harmful stims/compulsions of biting and picking at my nails. Perhaps what these ABA therapists should consider is that if they forbid a harmless stim, a more problematic one that's actually harmful might take its place due to the stress and anxiety caused by the removal of the harmless, innocent stim.

Here's a link about stimming someone posted in another topic: http://juststimming.wordpress.com/2011/ ... iet-hands/

I said that getting rid of stims could lead rise to harmful stims. But she said she doesn't forbid stimming. She just tries to get rid of whatever situation led rise to it. The example she cited was that she had a child who would stim for attention. He would stim whenever he was alone in a room and then someone would come and pay attention to him (whether the child liked the attention or not wasn't mentioned), hence she determined he was stimming for atttention. They taught him that whenever he felt like stimming he should go get a person and the person would play with him. They did not use aversives or directly stop him from stimming, but they did reward him whenever he didn't stim.

So...not as bad? But bad because I'm sure your natural reaction, as mine is, would be to say...ummmm...maybe he was stimming when he was alone in the room because he was embarrassed about his stims? The whole just focusing on behavior thing doesn't take emotions into account.

I also asked her about what she'd do if a child was stimming because of a happy situation. What do you do then, try to get rid of the happy situation? I don't remember her response...

Last edited by BigSister on 13 Mar 2014, 9:02 am, edited 1 time in total.

Also, do you guys know if there's any pro-stimming perspective by an ABA? Or studies or anything with data? She's not going to listen to just perspectives...

I can only think of one example, you tell a kid not to suck his thumb and he does it just to annoy you. Otherwise, I question this therapist's credentials.

While the initial research done by Lovaas in the 1970s in UCLA demonstrated great impact of ABA intervention on austistic kids in reducing unfavourable behavior such as stimming, subsequent studies have not been able to replicate the same level of impact or demonstrate significant change of from early intervention. Despite early intervention being described as recommended to improve outcomes and reduce behavior such as stimming, the data they rely on is badly out of date. Overall modern research into ABA actually demonstrates a general decline in effectiveness.

I might not argue with her as this issue might interfere with the friendship, so probably would steer clear of this topic. And I apologize for a long post, skim it, I hope it makes some sense.

For (1) I don't think someone who is saying emotions don't matter will listen to arguments they do, but your friend might agree that whether the feelings matter or not, the expression of emotion through behavior often does matter. Therefore even if emotions don't matter under her understanding of ABA, understanding and responding may sometimes be useful in addressing the resulting behavior. If she doesn't feel this matters, than a person receiving ABA would need additional service providers to address this, and that kind of ABA being therefore limited and limiting.

(2) I can't think of any good argument for how stimming is attention seeking, so I wouldn't argue it, that's rubbing her face in it like she's stupid, and she's your friend. I suppose that once in awhile someone might stim for attention so perhaps she is right once in awhile, but someone stimming alone might fear punishment or humiliation in front of her, might feel bored or lonely or anxious and her walking into the room providing attention is primarily serving to direct and focus the person's attention on her. There is no more reason to assume stimming is attention seeking because it stops when she enters the room than there is to say that a group of high school students hassling and bullying an autistic child stop this behavior (if they do) when the principal walks over because bullying is attention seeking behavior. I suppose y could ask her whether that means bullying is attention seeking. Or people stop speeding on the highway when they see a police car because they are seeking attention? No, they stop speeding because they are afraid of being ticketed for speeding.

(3) this is the most interesting to me. There is evidence that when a child is stimming, he or she does not learn as well. That's an association, and does not demonstrate causality, nor does it indicate which factor would be the cause and which the result if there is a causal relationship. I'm not a statistician but psychologists being scientific are supposed to be into statistics. Your friend may not change her mind but for those of us who believe stimming is self regulating, the assumption would be that the cause of better learning when stimming stops would most likely be that the stimming stopped in relation to increased regulation and decreased arousal. That stimming stopped because the person felt better and upon feeling more regulated, they were more able to learn. Logical because excessive arousal has been shown to interfere with learning.

People sometimes stick to beliefs like they are a religion, I don't often feel I've been persuasive when I use what seems like logic to me. If your friend sticks to her beliefs that doesn't mean she is wrong. And if she is effective it's possible that she does more that is helpful than unhelpful, and for the children she works with maybe that big picture is more important than the things she might be getting wrong.

One more thing to consider is that sometimes people are seemingly very rigid in their theoretical beliefs but their actions can still be humane and flexible and compassionate as they are based in who they are. If this is a good friend, then regardless of some beliefs you would challenge as wrong, it's possible the positive things about her that have made her a friend are what she is acting from most of the time when she is working with a child. And really, when I am stimming, I'm upset, a warm hug or kind words, a calm tone, will often help me. I'm not sure how much I should or need to care if the person providing this comfort believes I am stimming for attention which, in an existential sense, might be the case that stimming is an act of self calming in a universe in which I don't know how and can't self regulate adequately and wish for something, someone, to come in and regulate me. Which in that existential sense if you go deep enough is a valid perspective. Not thinking that's what your friend means, but you could always ask.

She does. I really do believe she's more helpful than unhelpful, because she's so positive reinforcement based and has a high level of ethics and compassion. She told me that she's been looking for a job closer to home and she refused to work at several ABA places because she felt it would be ethically wrong to do so (presumably they were doing the type of ABA therapy that we think of here at WP when we think of ABAs). And she believes in spreading her message of positive reinforcement and training and ethics to other ABAs, which we all know, her included, that many need to hear.

So overall I think she's a wonderful presence and I'm really pleased with her. When we sat down and I quizzed her (and I quizzed her in depth, guys, although in a nice way if you're worried about our friendship), she really did pass with flying colors and when we parted ways all we really disagreed on was stimming. And, again, she doesn't actually physically stop the stimming, just rewards the child for not stimming, which I'm less uncomfortable with.

So hands down you got it right, she does far more good and is far more helpful than she is not. And thanks for taking our friendship into consideration, Waterfalls.

My daughter's shrink solidly believed this and convinced me of it for a while. Her special ed teacher also believed (a special ed program within a regular school). So I tried to stop her stimming at home. This resulted in her mood worsening significantly at home so I stopped and just let her be but didn't tell her shrink or school.

When she switched to a school for autistic kids, everything changed. They strongly believed stimming was functional and needed to be "managed" only to the extent that the stims were self-harming or socially inappropriate (hands on crotch, for a crass example). To that end they would teach kids ways to stim that were non-self harming and socially appropriate. This involved things to squeeze, shake, touch etc. They had boxes of these stim items in every classroom. Some kids used them to take breaks when it all got too much. Some kids, my daughter included, learned how to stim while doing a task simultaneously. She can now stim while holding a conversation and it helped greatly with academics. She could answer academic questions as long as she was stimming simultaneously. After a while, the need to stim dropped significantly and now she does it now and then and it never interferes with anything.

The teachers gave me a catalogue so I could buy Christmas presents for her that were her favorite school stim accessories. They circled the ones she used the most. There is a market for stim accessories and the catalogue was aimed at therapists so there must be a subset of therapists who are well aware of the usefulness of stimming.

I told all this to her shrink. He grudgingly accepted it saying that he wanted to be consistent with what was happening at school. That was a few years ago and now it is a non-issue. She does it according to him when she is talking about things that upset her (he is a shrink, after all, so trying to get her to talk about those) but it never interferes with what she's saying.

tl:dr
Some professionals are aware that it stimming is functional.

http://www.sensoryuniversity.com/

above website is the one they directed me to so I could buy stim accessories. Many of the items are sold cheaper elsewhere, but it gives ideas and product names. Notice the large number of items that children can safely chew on to replace the more harmful stim of chewing on fingers or grinding teeth.

Last edited by Janissy on 13 Mar 2014, 9:48 am, edited 1 time in total.

I kind of think that categorizing stimming as unfavorable is part of the problem, too.

When I stim, happy becomes happier. When I stim, creatively, entire worlds in vivid detail pop into my mind. When I stim, scary goes away [or at least gets smaller] as does confussion. When I stim, I'm fairly sure that my IQ rises significantly. Just thinking about how so many want to inhibit our autisticness I get so angry, Thankfuly, I am able to stim when this happens. And that helps.

I love the way you phrased that. That was beautiful.