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What is the Controversy Surrounding ABA?

What is the Controversy Surrounding ABASpend a few minutes entering “Applied Behavior Analysis (ABA) Therapy and Controversy” into a Google search bar, and you might be alarmed by the results. Of all the hot-button topics in autism today, ABA 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 controversies surrounding Applied Behavior Analysis come about because of misunderstandings and misinformation about how ABA works and how we study it.

What is ABA?

Consider the textbook definition of Applied Behavior Analysis 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 controversy and debate.

How does ABA therapy work?

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 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 therapy focuses on increasing pro-social behaviors like communication and play and focuses on decreasing maladaptive and dangerous behaviors like aggression and self-injury.

The Controversy Surrounding ABA

Even though ABA exists to improve the lives of others, the field has faced controversy throughout its relatively short history.  Many of the concerns come 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 thoughts, feelings, and problem-solving.

While it’s true that ABA focuses heavily only on behaviors that can be observed and measured, the therapy 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 treatment for autism and many other early ABA programs, were to help individuals with autism become “indistinguishable from their peers.”  That included labeling some behaviors like hand-flapping and toe-walking as problems and actively working to reduce them.  Many advocates in the autism community disagree on whether those behaviors should or should not be targeted in ABA therapy.

Truthfully, there’s no right or wrong answer here.  Many parents of children with autism 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 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, it’s likely that this area of controversy will continue in the future.

Controversy #3 – It’s 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.

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 therapy is individualized to each learner, some behavior analysts 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 these controversies continue 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 therapy 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.

The Spectrum of Benefits of ABA

What we do know about ABA therapy 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 therapy does not work for everyone, or that several different ABA 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 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.  Benefits include improvements in intellectual functioning, social communication, and 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

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.

Amy Sippl

Applied Behavior Analysis | Saint Cloud State University

Bachelor of Arts (B.A.), Psychology | University of Minnesota

April 2020

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