2: ABA Reality Check

Feedback from Blog 1 (Eng.)

Well, that didn’t take long. It appears that I may be on to something here with my decision to start this blog. The number of shares, likes, and comments I’ve received in only a few days has surprised me. Don’t get me wrong. I am very happy that the information is getting out there. This was my goal. The following is just a few of the comments I have received from critics of ABA and I will now give my official “blog Feedback” to those comments. Most of the comments below came from “ABA Controversy Autism Discussion UK” on Facebook. https://www.facebook.com/ABAUKAutismDiscussion/ Although I made quick replies to them directly on their page, I have edited and added to those responses for this blog.

Comment: “Is this really the best response BCBA’s can give!?”

Response: Nope, not by a long shot. I am not all BCBA’s. I am one human being working with my heart and soul to help children and their families. Many of these families have had to suffer without the skills they need to help their chldren live happy and independent lives. I have been involved in Autism intervention in Germany for over 13 years and I have spent all of that time trying to be a professional — quietly going about my business answering questions with logic, research, and data. I’ve demonstrated how we can help children overcome issues that have been causing them hardships using their motivation and positive reinforcement. Some of these hardships are the use of aggressive and self-aggressive behavior. These behaviors tend to lead them to being shuffled out of their regular classrooms, regular schools, and eventually their homes (only to be forced to live sedated with medication and/or in institutions). I’ve started to wonder what has being polite and always fighting the good fight gotten me? It has gotten me scratched, bruised, misrepresented and lied about by people who, for the most part, could care less about politeness, professionalism, or truth.

This question is a perfect example of the often irrational standards we are held to in ABA. “Is this really the best response BCBA’s can give?” The question implies that my blog post IS the best response ABA can give and that it is not good enough and therefore ABA is bad. It completely ignores the facts of the post. It ignores that I have worked for over a decade, politely trying to explain the truth about our programming in workshops, books and answers to forums etc. in complex and complete ways. It ignores the fact that in 13 years, I have only had one person who was against ABA ever contact us to try and understand what it really is that we do with our approach. This person was a member of the Anti-ABA crowd in Germany and I’m happy to say is now working independently to help change perceptions among that crowd. I give him a lot of credit for seriously considering the facts and not letting emotional preconceived ideas rule his opinion making process. The rest never contact us for information at all. They never come to a workshop (even though we have offered free chairs) or even read anything more than a short forum post. If they do, it is usually just to find a potential buzz word to latch onto and misrepresent hoping to support their anti-ABA thesis.

So, the simple answer to this question is, No. My blog is not the best. It doesn’t claim to be the best. It doesn’t even claim to be any BCBA’s opinion other than my own (at this particular point in my working life). And similar to how ABA is applied differently by different providers, based on their best understanding and personal approach to good teaching, my opinions should not be lumped in as the opinion of all BCBA’s. It makes your argument look unsophisticated and only serves to try to take an important topic with a thousand shades of grey and paint it as either black or white.

Comment: There is repeated reference (in the Blog post) to “new” ABA, saying that it is different to old “ABA”. However, the principles of behaviour analysis have not changed: they have been the same for decades. ABA continues to focus on changing observable behaviour and differences using environment reinforcements and aversive situations, with internal experience outside its scope because it can’t be seen or measured.

Response: I’m glad this came up as this is just one of the 3 or 4 main “against” arguments that is made about ABA. Often the arguments I hear tend to go back and forth between several different arguments all at once. Regardless of how well I answer one critique, there is always another argument lined up in the cue that can be switched to as a reason why ABA is still not appropriate to the questioner. As soon as I offer a reasonable response for this next argument, I find that they just change their outrage to another area and expect me to answer that as well, all while completely ignoring my previous explanations. I call it the “Yes, that makes sense, BUT!” debate style.

The two most common arguments against ABA refer to a dislike of specific procedural recommendations and a distrust of the behavioral principles themselves.

The first thing to remember about procedural recommendations is that just because you have read or heard about an ABA procedure, does not mean that this procedure is in common use. It is quite possible that the procedural recommendation was only used or discussed in early literature as part of the development of ABA and is no longer considered best practice or even acceptable by the field. In some cases, a procedure might still be viable as an option but, is to be used only under special circumstances. Some procedures might only be called for in situations that are dangerous or potentially life threatening to the child. Even then, they should only be used when all other less restrictive approaches that could be successful have been attempted and failed.

Most ABA procedures are in quite common use in the regular daily environment. Prompting methods, antecedent manipulations, correction procedures and the like, are not rocket science. Schools and other therapy institutions use them quite often. Sometimes correctly to good result. Sometimes incorrectly to miserable result. Sometimes they are used without the knowledge necessary to be successful and therefore you could argue unethically. But, a procedure should always be used based on its likelihood and timeframe of success vs. any difficulty that procedure might cause the child. Additionally, the least restrictive procedures should always be considered before more restrictive ones are used. This is clearly stated in the Behavior Analyst Certification Board Guidelines.

I think any sane person would answer, “No” to the following question; “Would you let someone take a knife and cut into your son’s body and remove pieces of his insides?” Of course this question should be received with a “That is crazy, of course not!” But, what if that child was suffering from a ruptured appendix? Now, answer this question. “Would you let a trained surgeon operate on your child to remove his enflamed appendix to save his life?” Suddenly the answer changes to “Of course I would, what are you crazy?”

So the question isn’t, “is the procedure of cutting into a person ethical or not.” The question is, “under what circumstances would it be appropriate/necessary for a surgeon to take a knife and cut open a body?” Similarly, is a parent unethical for physically stopping their 5 years old son from leaving the house on his own, or not allowing them to have ice cream for dinner, or for saying, “if you hit your sister you need to say you are sorry or go to your room?” These are all procedural recommendations that are common in everyday life and teaching. They might also be recommendations in an ABA program. So, to be critical of ABA one would have to explain exactly what procedural recommendations they are really against and under what circumstances they would be against them. Are they against spraying a child with a water bottle or slapping a child on the thigh? Well, these are not procedural recommendations I would ever make as part of an ABA program and I do not know any other behavior analysts who use these either. So, that concern should be immediately alleviated when working with me or my team. Is it the procedure of removing access to a toy from a child after they have hit their sister? If so, I can explain to you why this might likely be successful as a reduction technique for hitting and approximately how long it should take to work. I can then teach you how to do it safely for both you and your child. How to keep track of the success or failure of the procedure so that it can be changed if necessary. I can teach you how to also focus on reinforcing other behaviors that could replace hitting all while building yourself up as a positive in your child’s life by pairing yourself with reinforcement. As an ABA professional, I can explain all of this to you and then ask you, as the parent, to decide if the process explained is worth the likely outcome for your child. Then I let the family make the decision on if we go forward.

If the procedures aren’t the problem and you are arguing against the principles of ABA themselves, I would suggest that you don’t truly understand what a principle is. The principles of ABA are not made up or invented. They are not something only ABA professionals use. They exist. They are part of life and they are only identified as principles because they are things that are always true. That is what makes something a principle. Reinforcement, Punishment, Extinction, Stimulus control exist and happen whether or not you are aware of it, study it, or consider it in any way. I don’t know anything about you but, I assume you probably have a job and that your boss pays you for your work…. How dare that person use positive reinforcement to get you to do his/her work while you in turn are choosing to use his job to help you feed your family?!?! I’m guessing if you got a speeding ticket you would be expected to pay a fine… What?!?! The Police are using the ABA principle of negative punishment to get you to follow societal rules? How dare those ABA scoundrels! If you try to buy a snack and the machine eats your money, you might put more money in and try again. You might also shake the machine, stomp your feet, and complain. But, you will eventually learn the important lesson of not putting any more of your money in that machine… What cretin invented this blasted ABA Machine that is using Extinction!? The point is, the principles of behavior affect you and your life, all the time, in every possible way. For instance, if you have an itch on your shoulder and you scratch it, you have just been exposed to the principles affecting your behavior. You experienced an aversive stimulus and made a behavior choice that was likely to lead you to the removal of that aversive stimulus resulting in “Negative Reinforcement.” You see, you can’t really argue against the principles. They exist and you and I and our children are all being pushed and moved and guided by these principles every day. That is just a fact of being alive. When teachers teach successfully, it is because they are using the principles of behavior to their advantage (whether they realize it or not). The opposite is true when they teach ineffectively. Without a full understanding of the principles of behavior it is less likely that they will find an alternative approach that works better when they are unsuccessful.

Since the principles exist and affect your kids all the time anyway, doesn’t it just makes sense for you to understand them so that you can use them to support your decision making in your efforts to best raise them?

Bottom line: Arguing against the principles makes no sense and procedural recommendations are an ever changing list of activities that make sense based on the principles. Just as in medicine and other sciences, procedural recommendations are constantly developing as the science grows and develops. And it should go without saying that they are always only used in relation to their cost/benefit ratio as decided by parent consent. So, realistically, the only argument anyone could make against ABA could be that an individual provider was unethical in their approach to using ABA. But, this obviously shouldn’t be applied to the science as a whole and is not an argument for ABA being unethical.

Comment: What do you offer to those who are suffering from the effects of ABA in a way that can be termed traumatization?

Response: If a person has truly been subjected to something that was traumatizing without concern for the mildness of their needs, they should have every right to go after the individuals responsible by any legal means available. Those individual cases of inappropriate ABA abuse should be treated the same way that medical malpractice would be. You wouldn’t argue that medicine should be outlawed because a parent gave a doctor permission to cut into their son to help take out an enflamed appendix. But, you can argue that a doctor was negligent if he cut into a patient to remove an appendix that wasn’t enflamed. This would be good reason to legally address the individual doctor but, not a reason to suggest that medicine or surgery itself should be outlawed or defunded. The same is true for Psychology, Cognitive Behavior Therapy, Psychotherapy etc. And the same is also true for ABA.

“Trying to teach a child with autism to better communicate and interact in the social world without a firm grasp of the principles of behavior is like trying to build an airplane that can fly without understanding Newton’s laws and the concept of ‘lift.’ You might get lucky and stumble upon something that works, but then again, you might not.” — Robert Schramm

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