The Most Popular Therapy for Autism Might Also Be the Most Harmful

by Kristina Artuković

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I first heard about ABA therapy two years ago in a support group for parents of children with Down syndrome. ABA is predominantly used on autistic children and is commonly offered to their parents, but it is actually promoted in a range of brain-based disability communities.

During the first months after learning about your child’s diagnosis, you want to immerse yourself in every kind of support available; you want to treat every issue, prevent or address all the scary stuff – it’s a particularly vulnerable period. So I started researching many things, including ABA, wide-eyed and hungry for information.

ABA stands for Applied Behavior Analysis. To me, that sounded as if someone would make an analysis of why a child might behave in a certain way and then offer some insightful explanations and tips for parents to better accommodate their child’s needs. But no. It does not work like that. It’s actually the opposite.

ABA’s goal is to modify a child's undesirable behavior by making them behave in a desirable way by means of operant conditioning (punishment and reward system), predominantly through “positive reinforcement.” Have you noticed any red flags yet? I went on to research this further, and here’s what I’ve learned so far.

1. ABA is grounded in unethical research

ABA practice was formed on the basis of the experiments and methods conducted by Ivar Lovaas in the 1970s. Lovaas worked with autistic children and came up with a behaviorism-based method for making autistic children “indistinguishable” from others. This involved positive reinforcement like giving praise, food and toys for neurotypical-compliant behavior, but it also involved physical and emotional abuse by hitting and starving children, scaring them with extremely loud sounds and giving them electric shocks (not electroconvulsive therapy – just plain electric shocks). A couple of years later, Lovaas took part in a new endeavor based on his methodology with autistic children. This time, the goal of therapy was to eliminate “feminine behavior in male children” – in other words, this was conversion therapy. So there were two types of pathologization with the same abusive principle of conversion. Today, one practice is rightfully being banned across the states, but the other is flourishing.

2. ABA is severely outdated

Behaviorism is the basic principle of ABA. Behaviorism is a school of thought in psychology exclusively concerned with observable behavior and the external factors that influence it. As a response to the dominance of psychoanalytic theorizing, behaviorism was unabashedly empiricist and made itself deliberately blind to one’s internal psychological landscape. It was just about observable behavior and behavioral inputs-outputs. However, during the 1960s, there was a dramatic shift in psychology towards neuroscience and cognition, piling new insights and discoveries on top of the knowledge obtained from behavioral science. This turn happened prior to Lovaas’ experiments on children — meaning the principles on which his “treatment” was founded were already outdated when he started applying them. Consequently, both the old and the current ABA practices fail to implement any of the new knowledge in psychology that came after behaviorism; they are firmly bound within the limits of a vintage doctrine. ABA does not take into account some very important things we have learned about child development, trauma, neurology or even biophysical factors of behavior. ABA conceives of autism as a set of inappropriate behaviors, not as a unique way of being. ABA therapy does not incorporate any autism-specific concepts like, for instance, the double empathy problem, diversity in social intelligence, monotropism, autistic masking and camouflage.

3. ABA is discriminatory

The aim of ABA is to make autistic children behave as allistic children, training them to minimize stimming, to make eye contact, to mimic social interest, to verbalize their thought processes, to renounce their authentic play and engage in allistic playing modes, etc. ABA was not designed to address the child’s needs or help parents understand their children and create an environment that nurtures the child's self-determination, intrinsic motivation and positive self-image. Nor does it respect their agency and autonomy – it was designed to make a child comply with the needs of others.

There's evidence that ABA causes PTSD: persons of all ages who were exposed to ABA are found to be 86 percent more likely to meet the PTSD criteria than those who were not. I’m quite positive that the vast majority of ABA therapists are well-meaning people. However, the very principle is discriminatory. And the invisible abuse that occurs happens precisely because this principle is played out over and over again — from 20 up to 40 hours a week!

It’s worth noting that a portion of the therapists that apply ABA do engage children in autism-friendly methods, encouraging them to express themselves, communicate their needs and learn to keep themselves safe. Even though they make a departure from ABA principles and adhere to the “neurodiversity lite” approach, these therapists might still call their practice ABA in order to obtain coverage by health insurance. It’s a proper mess.

4. Many autistic self-advocates speak against ABA

In a 2018 survey on autism conducted with more than 10,000 people – both autistic and allistic, 53.48% of autistic responders were against ABA, and only 5.19% were in favor. There is mounting evidence coming from autistic people that ABA is seriously harmful.

According to my experience as a parent of a child with Down syndrome, it’s a common misconception that parents of children with conditions are immune to ableism. I sometimes catch myself thinking in an ableist manner, and I’ve seen others do it, too. I am also very aware that conditioning is part of parenting, and it sometimes feels like dos and don’ts are all we deal with. But there is a line: if your child’s behavior has to do with who they are at the most basic biological level, then it is your obligation to create a suitable environment for this little person, not the other way around — which makes them go against their organic givens in order to render themselves suitable for the environment. I am positive that many fresh parents of autistic children are not very well acquainted with ABA, and the industry preys on them. But when autistic people say ABA is bad, we should listen. Parents may well be the relevant targets of the autism therapy industry, but we have a moral obligation to inform ourselves directly from the source: autistic people.

5. There are better ways than ABA

There are numerous findings that indicate that ABA is not effective in securing positive life outcomes for autistic persons (however and by whomever these outcomes might be defined).

Autism is not a disease anyway: it’s a variation of our neurocognitive functioning. We are still learning about autism, but how much are we learning from autistic people themselves? If the most common therapy for autism equals the negation of observable autism, then what does that say about the state of the matter? It’s no wonder so many autistic people have mental health issues — not just because of ABA, but because of a world so bent on excluding their way of being that not only is it possible that such therapies still exist, but they actually constitute the most widely accepted and funded autism treatment out there.

Research shows that autistic people can be, quite objectively speaking, experts on autism, since they often build upon knowledge from their lived experience of being autistic by further researching autism in a systematic manner. They themselves might be the best therapists of other autistic people, as they tend to endorse non-stigmatizing conceptions of autism, are not interested in making autistic people comply with allistic behavioral norms, and may often have heightened empathy for the challenges other autistic people may face. There are autism-friendly therapeutic methods and systems of learning led by autistic experts. We should give them so much more than a chance: we should give them primacy.