Spend a few minutes entering “Applied Behavior Analysis Controversy” into a Google search bar, and you might be alarmed by the results. Of all the hot-button topics in autism today, the applied behavior analysis autism controversy is among the most polarizing with both advocates and critics, believing firmly one way or the other about ABA. It’s our belief that many of the ABA therapy controversies come about because of misunderstandings and misinformation about how ABA works and how we study it.
What is Applied Behavior Analysis (ABA)?
Consider the textbook definition of ABA from Cooper, Heron, and Heward (2007):
Applied behavior analysis is the science in which the principles of the analysis of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change.
Arguably, this definition leaves room for interpretation of what is and is not considered ABA. Combined with a rocky history of practitioner misbehavior in the early days of ABA, and the door is left wide open for ABA criticism and debate.
How does ABA therapy work?
Before ABA, some children with autism were treated with traditional talk therapy. For obvious reasons, this was not a very effective therapy for this disorder. Families with autistic children often had to make a difficult decision. Keep their children at home and provide constant life-long care or place them in an institution?
When Dr. Lovaas came up with the idea of ABA in the 1960s, it changed the future of autism treatment and therapies. In the 1970s, Dr. Lovaas launched the Young Autism Project at UCLA. The goal of the Project was to apply his ABA methods to children with autism. His program grew into what we now call ABA. His goal was to make children with autism appear as normal as possible. Parents were cautiously optimistic that there was finally an effective therapy for their loved ones. Early ABA wasn’t without its flaws though. Thankfully, ABA evolved and improved over the years.
Modern ABA practitioners subscribe to the philosophy that there are observable relationships between the environment and how one behaves. ABA works by studying the ‘what, why, and how’ of these relationships to make meaningful changes for others. ABA is not only therapy, but it’s also a science.
ABA therapists use positive reinforcement to encourage desirable behavior and discourage certain negative behaviors which could be harmful. When certain behaviors are rewarded with something of value, the individual is more likely to repeat that behavior. The idea is that children’s inappropriate behaviors will then decrease. Sometimes rewards are tangible items, like a favorite food or a small toy. Other times the reward might be a high five or a compliment. Positive reinforcement is unique to each individual and is part of the appeal of ABA.
ABA involves several different phases that allow therapists to tailor the therapy to the needs of the individual. Applied Behavioral Analysis therapists collect and examine data, including what happens before and after a behavior occurs in the environment. By understanding these variables and manipulating the environment, ABA therapists can change the likelihood of a response happening in the future. ABA focuses on increasing pro-social behaviors like communication and play and focuses on decreasing maladaptive and harmful like aggression and self injurious behavior.
ABA Therapy Controversies
Why is ABA therapy controversial? Even though ABA exists to improve the lives of others, the field has faced controversy throughout its relatively short history. In the 1960’s, behavior therapy was not focused on positive reinforcement. The work of Dr. Lovaas, for example, emphasized both positive reinforcement and punishment through Discrete Trial Training. Most ABA therapy criticism comes from parents and adults who received ABA therapy as children. Occasionally, some researchers in other disciplines also raise concerns about the outcomes of ABA compared to other treatments. Among those concerns are:
Controversy #1 – It’s overly formulaic.
Some critics believe that ABA relies too heavily on a set of systematic principles. These concepts are sometimes described as unbending and dogmatic. Others say that ABA largely ignores cognitive processes like:
While it’s true that ABA focuses heavily only on behaviors that can be observed and measured, an ABA therapist also relies on data analysis. This means it can be challenging to understand for anyone not specially trained in the techniques and terminology.
Controversy #2 – It does not support neurodiversity.
The published goals of Dr. O Ivar Lovaas, one of the pioneers of ABA autism therapy and many other early ABA programs, were to help individuals with autism spectrum disorders become “indistinguishable from their peers.” That included labeling some behaviors like hand-flapping and toe-walking as problems and actively working to reduce them. This is one of the biggest criticisms of ABA. Many advocates in the autism community disagree on whether those behaviors should or should not be targeted in traditional ABA therapy.
Ari Ne’eman, a disability rights activity and co-founder of the Autistic Self Advocacy Network, believes that autism is both a disability and a neurological difference. He does not see it as a disease that should be cured. He likens autism to homosexuality or being left-handed. It is merely a difference, but something that should be considered pathological. Contrary to traditional ABA beliefs, ABA shouldn’t focus on trying to make autistic people indistinguishable from their peers. Behavior therapies and treatments for autistic people should focus on developing cognitive skills as well as those related to:
- independent living
The controversary goes beyond autism spectrum disorder and ABA. Parents of children with attention deficit hyperactivity disorder are also split on the use of ABA. Some argue that kids with ADHD should be allowed to be themselves and be appreciated for their differences. Advocates believe children should not be viewed as needing to be fixed.
Truthfully, there’s no right or wrong answer here. Many parents with an autistic child do desire that their children develop the tools and skills to lead a healthy, fulfilling life as their same aged-peers. Other parents and advocates for children with autism disagree and believe that the world should move towards acceptance of all individuals, regardless of their differences. Given the sensitive nature of this issue to individual families with autistic kids, it’s likely that this area of ABA controversy will continue in the future.
Controversy #3 – It’s too demanding.
Another ABA therapy criticism is that it is too demanding. Many early intervention ABA therapy programs and research studies suggest that children should receive up to 40 hours per week of therapy. While this level of intensity has been shown to produce benefits in children with autism, other child development advocates suggest the treatment is too demanding.
Most actual ABA treatment plans schedule children with autism 10 to 20 hours per week. Children may work with a variety of therapists, each one hosting their own session. Very rarely is there a recommendation for a 40 hour intensive ABA program. Even so, those who advocate against ABA still feel the time parameters are too much.
Controversy #4 – It’s focused more on ‘bad behavior’ rather than on skills like play.
As mentioned above, some ASD advocates believe that ABA therapy heavily focuses on addressing challenging behaviors like aggression and self-injury instead of addressing skill acquisition targets like language and play. Given that high-quality ABA is individualized to each learner, an ABA therapist might argue that for a particular individual, challenging behaviors interrupt learning other skills and have to be addressed first. Other advocates suggest that enhancing language and play skills first would reduce an individual’s reliance on challenging behaviors.
Controversy #5 – It’s difficult to compare to other therapies.
One of the primary reasons applied behavior analysis criticism continues to exist is that it’s challenging to compare ABA to other treatments, especially for autism. Unlike pharmaceutical studies where large group comparisons can be made between treatment and non-treatment groups, ABA is often studied on a smaller scale, with sometimes fewer than 20 participants in a study.
Finally, given the ethical implications of withholding therapy from children and individuals with developmental disabilities, it’s seldom examined against a placebo or ‘absence of treatment’ model in the same way that drug therapies can be evaluated. This makes it challenging to assess and compare ABA with other treatment modes.
Controversy #6 – If focuses on eliminating behavior instead of skill development.
Another argument of ABA is that while students are learning what not to do, they aren’t learning what they should be doing. There might be a goal to reduce tantrum behavior, but what should the child do instead of tantruming?
Those who argue against ABA say that dollars could be better spent on developmental therapies that provide a young child with functional skills in areas like communication and language development. ABA is often covered by insurance while other treatments are not. Children with newly diagnosed autism may have limited services available outside of ABA. This leaves parents to pay out of pocket for speech and occupational therapy that could end up being more beneficial for their child.
The Spectrum of Benefits of ABA
What we do know about ABA is that–just like autism–there seems to be a spectrum of outcomes and benefits to those who receive treatment. Most behavior analysts acknowledge that ABA techniques do not work for everyone. Several different behavioral therapies and techniques may need to be implemented before a child makes progress.
Despite the spectrum of outcomes, ABA therapy success rates are generally favorable. Systematic reviews of ABA studies performed by both government agencies and university researchers confirm that most children with autism receive some benefits from ABA therapy. The Centers for Disease Control and the American Psychological Association both recognize ABA therapy as an evidence-based treatment for autism and other developmental disorders. In fact, many states cover autism therapy in their state funded insurance programs. Benefits include improvements in:
- intellectual functioning
- social communication
- independence with daily living skills
Some children with ASD no longer meet the diagnostic criteria for ASD after receiving ABA.
Improvements Are Needed to Resolve the Controversy
Is ABA bad? Not at all. Ultimately, improvements need to be made in how we study ABA therapy and how we customize the treatment models to address some of the misconceptions of ABA. We need better tools to identify which children are likely to benefit from ABA and which techniques may be better suited. Behavior analysts need to get better at fine-tuning the therapy for individuals, including person-centered and family-centered treatment planning. Parents need to be coached on how to advocate for their children, recognizing what they value in their own definitions of positive outcomes.
It is always a good idea to speak to individuals on the autism spectrum to get their perspective on ABA therapy. You could also speak to family members or other therapists to get their thoughts and impressions. Before deciding if ABA is the right therapy for your child or family member, you need to learn as much as possible. While ABA isn’t the right fit for everyone, ABA therapies can play a beneficial role if used correctly.
Updated June 2022