r/ABA • u/anxiousbonsai • Jun 17 '21
Journal Article Discussion Concerns About ABA-Based Intervention: An Evaluation and Recommendations
I know there is a lot of discussion about the ethics of ABA on here, so after reading a fantastic article today, I had to share. I have no personal relationship to this article or the authors but it's a great read. Authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD. It is open access, so no barriers to reading it! Essentially, Justin Leaf et. al decided to look at all the major complaints against ABA-- Lovaas, 40hrs for kids, use of electrical shock, use of punishment, that reduction/elimination of stereotypic behaviors (stimming) is abusive, a study that said ABA caused PTSD-- and see whether they were backed by the evidence.
Concerns About ABA-Based Intervention: An Evaluation and Recommendations by Justin B. Leaf et. al
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u/Sweeper1985 Jun 17 '21
I've been following Leaf's work for a while now and recommending his articles in online discussions where the "all ABA is abuse" line is touted and misinformation prevails. Unfortunately it rarely makes a difference, and the research is dismissed on all sorts of grounds. I just get called ableist, told I'm dismissing lived experience (just by citing research), accused of being a child abuser or quite literally torturing kids, or trying to make a profit (even though I don't even deliver ABA and haven't for years now). And then there's the argument that no researcher or clinician can even comment on the approach unless they are themselves autistic... which I guess is a handy way to dismiss any view someone doesn't like. It's so frustrating and upsetting 😪
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Jun 17 '21
And then there's the argument that no researcher or clinician can even comment on the approach unless they are themselves autistic...
Which is interesting because there have been several posts by practicioners on here who are themselves autistic.
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Nov 17 '21
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Jun 20 '21
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u/Sweeper1985 Jun 20 '21
I have no idea who or what you refer to.
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Jun 20 '21
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u/Sweeper1985 Jun 20 '21
Are you alleging that Leaf did this? If so, what is your source?
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Jun 20 '21
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u/Sweeper1985 Jun 20 '21
Seriously what are you saying here? For someone who says they "couldn't be any clearer" you are being very vague.
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Jun 20 '21
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u/Sweeper1985 Jun 20 '21
I'm sorry you can't converse to any normal standard or be honest about whatever it is you're trying to say.
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u/imareceptionist Jun 17 '21
I really enjoyed this article! I've been struggling about if I should pursue certification or not, and this really helped open my eyes to understand both sides of the conversation
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u/AaBaBaMa Jun 17 '21
No mention of collaborating with OT/PT/SLP on goals, yet BACB reports being all about collaboration. And the use of the term “consumers” for the people being treated aligns with ABA being a business-model versus a medical model.
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u/anxiousbonsai Jun 17 '21
You could reach out to the lead author and see if they may look at that in the future! I’m not sure why they would have mentioned OT/PT/SLPs there though as that’s not really a complaint of ABA being unethical? We do need more collaboration but not every child has other therapists.
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u/nocal02 Jun 17 '21
I guess in the medical model people prefer "patient," maybe that's something worth studying.
As for collaboration, it seems like an important issue to you. Do other fields, such as OT, regard that as a professional requirement?
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u/AaBaBaMa Jun 19 '21
Yes. It is considered unethical to recognize a concern and not refer to the appropriate professional field that diagnose/treat that area (e.g. ENT for resonance, OT fine motor/sensory, SLP for communication, etc.). It puts professional certification at risk, but far more importantly it is not in the best interest of those we serve.
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u/nagb150 Jun 17 '21
I think this article is a great starting point but still fails to dive into some fundamental aspects of anti-ABA arguments. For instance, when discussing personality and goals, it seems as though they dismiss arguments of "ABA altering personalities" but citing that the behaviorist perspective of personality is different. But I think the core of the argument here is that because ABA therapists are only interested in the behavior of clients, you cannot address the socio-emotional learning or self-advocacy/consent skills also needed to thrive. Practices like hand-over-hand prompting, compliance, and reinforcement training at its core fails to intrinsically motivate clients to practice the functional skills we are teaching for themselves but instead trains them to respond in accordance to our demands.
I know this criticism will likely be unpopular, but as a former ABA therapist at a well-respected residential center for 3 years and now turned SLP, I have spent a long time being uncomfortable with a lot of ABA practices but lacked the arguments to articulate why. This article gives some constructive language to both sides but still pads the harm of past and present ABA. The statement on how the intensity of intervention is far too much at 40 hours a week being excused by 40 hours only being an average as if that makes it better? ABA still has a long way to go, and it's not about distancing itself from its past. We need to work alongside Autistic individuals and have trauma-informed care practices and listen and accept criticism rather than defending ABA with the research done at the expense of Autistic individuals.
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u/nocal02 Jun 17 '21
fails to intrinsically motivate clients
Statements like these just aren't supported by the evidence, though.
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u/nagb150 Jun 17 '21
I'm curious how intrinsic motivation is measured in the existing research
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u/nocal02 Jun 17 '21
well, from the article I posted:
The term intrinsic motivation is generally understood in contrast to extrinsic motivation. Intrinsically motivated behaviors are those in which there is no apparent reward except with the activity itself (Deci, 1975). Extrinsic motivation, on the other hand, is said to occur when an activity is rewarded by incentives not inherent in the task. Although these terms have been criticized and debated (e.g., Bandura, 1986; Dickinson, 1989; Flora, 1990), they are accepted by many researchers.
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u/nagb150 Jun 17 '21
Ah sorry, I didn't realize you linked an article when I saw your comment on mobile. I can understand criticisms of these definitions of motivation as they do not account for the larger context of the activity or behavior. Granted, I did not yet take the time to read the article you provided in its entirety yet.
In my experience, the lack of intervention and understanding for socio-emotional and trauma-informed care is still lacking in ABA and future interdisciplinary collaboration will hopefully help with this. As other people have brought up, our clients are frequently multidimensional and receive many services including psychiatric, PT/OT/SLP, etc and ABA should continue to adapt practices to be better understood and accepted widely in these health professions.
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u/AaBaBaMa Jun 20 '21
What evidence are you reading and what outcomes are they measuring?
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u/nocal02 Jun 20 '21
The evidence is linked in my post, but there's more where that came from anyway. I guess when I link things they don't show up on mobile, so perhaps you don't see the link.
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u/waggs32 BCBA Jun 17 '21 edited Jun 17 '21
It seems like your comments did a good job of giving an example on how different a behaviorist viewpoint is than others in a similar field.
You state that we are only interested in behavior and then list other categories (social-emotional learning and self-advocacy skills) that a behaviorist would fit within behavior as things outside of behavior.
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Nov 17 '21
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u/nocal02 Jun 17 '21 edited Jun 17 '21
Great article, thank you for sharing! I suspect it won't convince anyone who has made sweeping unsupported claims, but I doubt anything could.
I'm reminded of a film/case study by
Todd RisleyRichard Foxx called "Harry." A man with developmental disabilities who had lived his entire life in an institution and who engaged in severe SIB -- his nose was permanently damaged. After a few sessions with Todd Risley, he went on outings into the community, trips with his family, and engaged in some activities in the facility. Some of the treatment and goals are antiquated, but what was medicine like 50 years ago?