Applied behavior analysis and autism controversy

Applied Behavior Analysis (ABA) is a popular therapy for autistic people. It uses reward and/or punishment to change behavior. ABA therapy may be used for 5-40 hours per week.
Organizations such as Autism Speaks encourage parents to sign their children up for ABA.
ABA has become increasingly controversial in recent years, both for the quality of its evidence base and concerns about lasting psychological harm to autistic people.
==Efficacy concerns==
ABA has long been considered the "gold standard" for treating autistic people.The Need For Outcome Standards In Treating Autism However, research quality has been limited, lacking in random assignment and sample size.Reichow B, Hume K, Barton EE, Boyd BA. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2018 May 9;5(5):CD009260. doi: 10.1002/14651858.CD009260.pub3. PMID: 29742275; PMCID: PMC6494600.Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Dunham K, Feldman JI, Crank J, Albarran SA, Raj S, Mahbub P, Woynaroski TG. Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull. 2020 Jan;146(1):1-29. doi: 10.1037/bul0000215. Epub 2019 Nov 25. PMID: 31763860; PMCID: PMC8783568. A 2018 Cochrane review found only weak evidence that ABA may help some autistic children, noting a high risk of bias.Reichow B, Hume K, Barton EE, Boyd BA (May 2018). "Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)". The Cochrane Database of Systematic Reviews. 5 (5): CD009260. doi:10.1002/14651858.CD009260.pub3. PMC 6494600. PMID 29742275.
One literature review found that 84% of studies published in top journals one year had conflicts of interest, with only 2% disclosing this.US Government Reports that ABA Doesn’t Work.Bottema-Beutel K, Crowley S. Pervasive Undisclosed Conflicts of Interest in Applied Behavior Analysis Autism Literature. Front Psychol. 2021 May 5;12:676303. doi: 10.3389/fpsyg.2021.676303. PMID: 34025538; PMCID: PMC8131529.
==Ethics and potential abuse==
Some researchers have criticized the ethics of ABA. The ethical code has been described as lenient, with no restrictions on use of aversives.Wilkenfeld DA, McCarthy AM. Ethical Concerns with Applied Behavior Analysis for Autism Spectrum "Disorder". Kennedy Inst Ethics J. 2020;30(1):31-69. doi: 10.1353/ken.2020.0000. PMID: 32336692.Long-term ABA Therapy Is Abusive: A Response to Gorycki, Ruppel, and Zane
Autistic people, researchers, and family membersAmerica’s Most Popular Autism Therapy May Not Work — and May Seriously Harm Patients’ Mental Health of autistic people have raised concerns about ABA harming autistic people. They discuss potential abuse in ABA.Aileen Herlinda Sandoval-Norton, Gary Shkedy & Dalia Shkedy | Jacqueline Ann Rushby (Reviewing editor) (2019) How much compliance is too much compliance: Is long-term ABA therapy abuse?, Cogent Psychology, 6:1, DOI: 10.1080/23311908.2019.1641258Why caregivers discontinue applied behavior analysis (ABA) and choose communication-based autism interventions Early research shows some evidence of increased PTSD symptoms in people who have gone through ABA.“Recalling hidden harms”: autistic experiences of childhood applied behavioural analysis (ABA)Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis
A few criticisms include:
*Training autistic children to mask their autistic traits can be harmful. Masking in autism has been linked to anxiety, depression, suicidality, and other harms.Conceptualising Autistic Masking, Camouflaging, and Neurotypical Privilege: Towards a Minority Group Model of NeurodiversityCassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism. 2018 Jul 31;9:42. doi: 10.1186/s13229-018-0226-4. PMID: 30083306; PMCID: PMC6069847.Cassidy, S.A., Gould, K., Townsend, E. et al. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord 50, 3638–3648 (2020). https://doi.org/10.1007/s10803-019-04323-3
*Spending dozens of hours per week in therapy may be exhausting for young children and may prevent them from experiencing other therapies or a "regular childhood."Invisible Abuse: ABA and the things only autistic people can see (Opinion piece by an autistic parent)
*Training children to unquestioningly obey adults may harm the development of assertiveness skills and leave them especially vulnerable to sexual abuse. Previous research has shown autistic people to be at high risk for sexual abuse victimization.Brown-Lavoie SM, Viecili MA, Weiss JA. Sexual knowledge and victimization in adults with autism spectrum disorders. J Autism Dev Disord. 2014 Sep;44(9):2185-96. doi: 10.1007/s10803-014-2093-y. PMID: 24664634; PMCID: PMC4131130.Weiss JA, Fardella MA. Victimization and Perpetration Experiences of Adults With Autism. Front Psychiatry. 2018 May 25;9:203. doi: 10.3389/fpsyt.2018.00203. PMID: 29887806; PMCID: PMC5980973.
Quality of ABA therapy can vary.Low standards corrode quality of popular autism therapy BCBA certification requires no training on autism.
Research on potential long-term harms is minimal. Two surveys of autistic adults who went through ABA as children found that most of them viewed it as harmful.Davis R, den Houting J, Nordahl-Hansen A, Fletcher-Watson S (March 2022). "Helping autistic children". The Wiley-Blackwell Handbook of Childhood Social Development: 729–746. doi:10.1002/9781119679028.ch39. ISBN 9781119678984. Evidence is limited at this point in time.
==Proponents==
Defenders of ABA for autism often use a few types of reasoning:
*Autistic people will not get by in society unless they are taught to "mask" their unusual behavior
*No other therapy has as strong of an evidence base as ABA
*Following ethical best practices is fine for lower-support autistic people, but ethical restrictions should not apply to "severe autism" because it is the only way to help them
Some also believe that ABA can be changed enough to no longer have the same issues.
== See also ==
* Autism
* Neurodivergent masking
* Judge Rotenberg Center
* Self-Injurious Behavior Inhibiting System
* Spanking children
==References==
Category:Autism
Category:2010s
Category:2020s
Category:Ethics
Category:Controversies