WHEN YOU HAVE NO CHOICE BUT ABA THERAPY

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You may be aware that applied behavioral analysis (ABA, or ABA therapy) is a questionable approach to supporting autistic kids, and that many autism advocates think ABA should be abandoned. But not every parent has to choice to avoid putting their child in ABA. What can those parents do to protect their autistic child’s mental health and self-worth?

Parents do have options, but in order to understand how to support a child for whom ABA has been mandated, we first need to talk about the reasons why ABA is inappropriate for autistic kids—and also the reasons parents and educators might be both misguided about, and adamantly in favor of, ABA.

Why Is ABA Not The Answer?
At its core, ABA therapy conditions autistic children to behave like non-autistic children. Contemporary ABA advocates argue that they have moved past originator Ivar Lovaas’s abusive, cattle-prod era of “screams, slaps, and love.” And yet, per the Autistic Self Advocacy Network’s report on the Need for Improved Behavior Support Services, “Removing aversives from ABA has not resulted in changes to the underlying theories and aims of ABA; that is, to make people with [intellectual and developmental disabilities] ‘indistinguishable from peers.'”

“Many autistic persons who have participated in ABA anecdotally reported feelings of belittlement, expressed the loss of behavioural autonomy, recalled external pressure to “not be themselves”, and viewed reward or consequence systems as a form of control.” –Lung et al

While ABA was framed by Lovaas as a way to keep autistic children out of institutions, it effectively confined them to mistreatment in their classrooms and homes instead. Even supposedly “nicer, kinder” ABA shares its history with gay conversion therapy, and remains focused on molding behaviors rather than on understanding autistic experiences. It ignores the existence of autistic traits and coping methods, focusing on non-autistic priorities like stopping autistic kids from self-soothing stimming.

“Survivor of ABA here. ABA ruined my ability to cope, instead causing severe anxiety around my behavior, actions, & social difficulties It also enabled my parents, who don’t believe autism is real, to medically neglect & “undiagnose” me once I was able to mask “perfectly” out of fear of punishment.” -Timothy

While professionals continue to insist that ABA is the gold standard for supporting autistic kids, “Those studies that report children making long-term gains in functioning are of middling scientific quality, casting doubt on the therapy’s status as an authoritative treatment,” and are riddled with professional conflicts of interest. Autistic people themselves are clear in their objections to the practice, with “most autistic participants who had experienced or observed ABA viewing it negatively, with only a small minority mentioning neutral or positive effects.”

ABA does have legitimate areas of progress, for instance acknowledging systemic racial barriers to autism supports with calls for culturally responsive approaches—but overall the ABA industry remains impervious to and defiant about criticism, and in some cases tries to rebrand itself by co-opting autistic advocate-originated terms like neurodiversity or autism acceptance. Plus, many contemporary incentives behind implementing ABA have nothing to do with helping autistic clients, and instead are about profits, private equity, and milking an emerging market.

Since people outside neurodiversity or autism circles rarely know about ABA’s pitfalls or the reasons to question ABA-recommending professionals, ABA continues to dominate autism services. Very young autistic kids are still placed in ABA therapy for up to 40 hours per week, even though research indicates that more or more intense therapies are not better, and that “practitioners recommending interventions should consider what amounts would be developmentally appropriate.” Not to mention that autistic kids often need more downtime than their peers, not less, and that a case can be made for not putting many autistic kids in therapies at all:

We can support autistic kids in joyous, obsessive, atypical play. We can support them in play that NTs might not recognize as “play” at all. We can look at the sensorimotor, language, cognitive, emotional, and social experiences and skill building that play can provide, and we can find ways to make sure that autistic kids are getting that practice in ways that work for them. And we can back off and let autistic kids be autistic kids. -Julia Bascom

Ideally, therapies and other approaches to supporting autistic kids will be neuroaffirming, meaning working with their neurology and the ways in which that influences their sensory and social perceptions, rather than ABA’s traditional model of “normalization” through conditioned compliance. Although, again, ABA practitioners are starting to adopt the language of neuroaffirmation, so be wary.

And of course there are good alternatives to ABA that parents can fight for, including speech therapy, occupational therapy, and a solid IEP.

Why Might Parents Think Autistic Kids Thrive in ABA?
Parents who come from outside the autism and neurodiversity communities are usually unprepared for and uninformed about the world their child belongs to, and tend to take the word of non-autistic professionals about what autistic kids need to thrive—including the normalization goals of ABA therapy. A satirical take by the autism humor site The Daily ‘Tism has parents claiming,

“Before you judge us, this isn’t the bad ABA, where they train them with electric shocks. This is the good ABA, where they just have to stop stimming, eating when they’re hungry, and will come with us to Thorpe Park so we can use their autism to get out of queueing.”

Too-close-for-comfort satire aside, many parents are convinced that ABA is helping their child. Why might this be?

1. ABA therapy provides a routine that the kids or family don’t have elsewhere in their lives. Autistic kids are often stressed out by not being able to make sense of the world around them. ABA might be the only reliable thing in their schedule. That doesn’t mean it’s what they need.

2. No one besides ABA therapists will work with their child, or believe in that child’s potential. This happens because our society and systems fail autistic kids with significant “behaviors,” intellectual disability, and/or communication disabilities. That doesn’t make ABA more appropriate for those children than for any other autistic child.

3. The therapists are nicer to the autistic child than other people are. Some ABA therapists are truly, kind, well-meaning people. That doesn’t meant that ABA therapy is good for their autistic clients, that the therapists understand or respect the autistic kids’ experiences, or that they aren’t simultaneously traumatizing or misleading those kids about social dynamics in ways that will make those kids’ lives harder rather than easier as they age. Nice people can be misguided, too.

3. Their kids seem happy when they’re doing ABA. See 1 and 2 above. HappIER does not mean happy. Being reinforced to act happy is not the same as being happy. The least bad inappropriate education is not the same an appropriate education that will help someone thrive and learn. And seeming happy might even be a trauma bonding response, which happens when a child or other person bonds with someone who mistreats them because that mistreatment is followed by cycles of positive reinforcement.

4. They see their kids make strides in ABA. We shouldn’t assume autistic kids make progress because achieving skills or milestones might be natural though delayed development, or might be because autistic kids can benefit from 1:1, personalized instruction in general (which should be taken care of by IEPs).

5. They see their kids become willing to do ABA tasks even after initially resisting. And while it is true that autistic people are humans and may need to get past a mental block before doing something they enjoy, being conditioned into compliance is not the same thing as needing a nudge to participate voluntarily. Our autistic kids need to learn that not only are they allowed to set boundaries, but that those boundaries should be respected—especially because people are less likely to respect autistic people’s boundaries.

6.Their kids stop doing SIBs (self injurious behaviors) or behaving aggressively after ABA therapy. This one can be dangerously misleading, as often the reason kids are doing SIBs or being aggressive is due to environmental factors like noises or other sensory issues their parents or ABA therapists may not perceive, or medical factors like illness or injury. Training an autistic child to ignore pain or dysregulation is, frankly, inhumane.

What About When You Have No Choice But ABA?
Sometimes parents have no choice except to put their autistic kids in ABA, and this has nothing to do with being a good or a bad parent. Sometimes ABA is the family’s only supports option for their disabled child, especially when other forms of therapy are not available—not to those who can’t afford to pay out-of-pocket, or in regions that don’t have public-sponsored respite programs. Sometimes the parent’s job and the family’s financial security is at stake, as ABA is their only childcare option. Sometimes judges will mandate ABA during custody battles, or CPS (child protective services) will accuse parents of neglect if they refuse ABA. Sometimes ABA is the only therapy insurance will pay for. What can these parents do?

Do make sure the ABA therapists are following your child’s lead in what play looks like,[b] even if it’s not what the therapists are trained to expect. As Julia Bascom writes, “Wouldn’t it be worth asking [b]how autistic children are playing, and how that play might already meet those core developmental needs, rather than assuming that if we [autistics] aren’t doing the same things as other children, we aren’t doing anything worthwhile at all?”

Don’t let them put your child in ABA for more hours than seems reasonable for a child their age. Children need down time. Autistic children need lots of processing and downtime in order to synthesize, integrate, and learn. Constantly being in “therapy” is exhausting and can be counterproductive for them. Do not feel like you need to use all the hours the agency may insist on, that is often agency pursuing their bottom line and possibly that sweet, sweet insurance-mandated funding—not your child’s welfare.

Do make sure they are doing things your child is interested in. If your child is already in a full day of school, the sessions should be as much like play and entertainment—not work—as possible. Research backs this up: “Our results suggest that efforts to make autistic children’s environment more interesting—rather than efforts to reduce their repetitive behaviors—may lead to greater exploration, including of complex materials.”

Don’t let them use “planned ignoring,” which is core to many ABA approaches—as “being ignored is devastating to people of all ages and neurotypes, which is one reason why neurodiversity-affirming therapists, teachers, and parents refrain from this practice.” As @acidlich.bsky.social writes on BlueSky: “I cannot overstate the horrendous psychological effect going through planned ignoring as a kid had on me. The fact that it continues to be deployed today is absolutely unacceptable.”

Do make sure your child’s “No” (however they indicate it) is respected. ABA (and other forms of behaviorism like Positive Behavioral Interventions and Supports or PBIS) is particularly infamous for eroding autistic children’s self-reliance and making them compliant. Do not let this happen. As Ande Quercus writes, “I wish I’d received more guidance on interpersonal safety earlier in life instead of only being trained in compliance. I hope that by encouraging discussions about this issue, I can help others like me have opportunities to learn the skills they need to stay safe.”

Don’t let them suppress your child’s natural language style like echolalia or scripting.Some ABA practitioners consider these “habits that can be broken,” but there is plenty of research demonstrating that they are functional ways autistic children learn language, and that trying to force them to use more standard language styles is “depriving a child of authentic interaction, impeding their natural language development, and undermining their confidence as a spontaneous communicator.”

Do make sure they understand the concept of processing/initiation difficulties and how these can affect autistic kids. “As much as someone with autism might want to, it may seem impossible to turn a thought in his head into speech from his lips, or to convince her hand to pick up a pencil—in other words, to break free from the gap between intention and action.” So if the therapists are ignoring your kid’s need for processing time, or any motor or initiation difficulties they may be having, make sure those therapists slow down or provide physical support if needed (note this is not the same thing as hand-over-hand).

Do not let them use normalization techniques. Don’t let them insist on eye contact, suppress stimming, make your child tolerate noises, or sit in one place at a desk if they learn better while perched on a beanbag. Whatever inborn autistic tendencies or traits your child has, their ABA team should be trying to work with them, not against them. Find out how much your team knows about autism from autistic-created or informed resources, and provide them if necessary.

Do direct their data collection so it makes sense. (There is no ABA therapy without data collection, because data is how ABA agencies justify their existence to the insurance companies or other agencies paying for the therapies.) Make sure the ABA team records when your child is ill, what kinds of foods they may eat during sessions, their reactions to their clothes or different environments or music, etc.. Data collection is a side-product of ABA and you can use it to your advantage, like finding patterns in how being ill or being with specific therapists affects your child.

Don’t let them isolate your kid. Your child should know that they can always reach out to another person (including you or another family member if the sessions are at home). You should be able to observe the sessions at any time.

Do tell your child what is going on, that they will be in ABA, and that’s why things will be different in therapy sessions. Your child deserves to know why they are doing what they are doing, otherwise they will end up like Tea, who recalls, “Holy s**t it was ACTUAL ABA. I remember. I had a therapist. My parents were talking to the THERAPIST. That’s why they started treating me completely different and taking away all my stuff. It WAS ABA.”

Do not let them patronize you with claims that ABA is what is best for your child, and that you should not question them or their approach. This is about your autistic child. Your priority should be that child’s happiness and helping them thrive, not making them conform to inappropriate neurotypical standards. The ABA team is invested in results that, however “neuroaffirming,” are based on an outdated conditioning process that “violates the principles of justice and nonmaleficence”.

Do not let them talk you into using a robot as an ABA technician! No no nope no.

Understanding the issues with ABA therapy, and having guidance for how to advocate for children placed in ABA, doesn’t mean any of this will be easy, because it’s isn’t and it won’t be. Truthfully, it can be really hard, especially if the ABA team does not welcome feedback or direction.

But if your child knows you are on their side, and you are clear with them about what the ABA therapists are and aren’t allowed to do, that can help make therapy environment less fraught for your child. Plus discussing your concerns about ABA and the reasons behind them may win the hearts and minds of their therapists, and you may even end up with a program that is legitimately neuroaffirming, even though still labeled “ABA.” Good luck to you and your family. I have faith in you.