ABA: rote? too demanding? useful?
September 26, 2006 by Kristina Chew, PhD
Filed under Health
Applied Behavior Analysis (ABA) is a teaching method that is widely used to teach autistic children. It is based on B.F. Skinner’s principles of behavioral science. It is through ABA that my son Charlie not only learns academic skills in school and with ABA therapists in his home sessions; it is thanks to ABA that my husband taught Charlie to ride a bike, that Charlie learned to swim and boogie-board, and that Charlie goes with us to grocery stores, malls, movies, train rides, Manhattan, and many more places. It is because of ABA that Charlie can talk.
It is not hard to find criticism of ABA and of behavior therapy in teaching autistic children, on the internet and elsewhere. Michelle and Tom DiPiazza, whose daughter Jodi is autistic, note these concerns in the third in a series of articles on autism in the Bergen Record.
“This is the hard way,” Tom said about the ABA approach. “Your child cries and you have to fight through it. It’s very expensive, and it’s going to take a long time.”
They had been worried about ABA, which has been criticized as teaching rote, robotic responses rather than true communication. Detractors say it is too demanding, particularly for children diagnosed when they are toddlers. Some recent research has found more modest success than the original study.
Would it really help if Jodi learned “touch your head” and earned an M&M? Was it worth subjecting her to hours of tears? They had seen a posting on the Web, from a mother who said her child developed post-traumatic stress disorder after ABA therapy. Some therapists even told them to limit the sessions to only a few hours a week, to avoid pushing Jodi too much.
But pushing was just what Jodi needed, they decided.
The article is entitled Bringing Jodi back and provides a detailed account of Jodi’s life and her education. Jodi currently attends the Alpine Learning Group, which is “one of the top ABA schools in the country.”
Some readers will take issue with the ABA teaching methods described in Bringing Jodi back and with other aspects of ABA teaching. Some of the ABA that Charlie has received in certain settings has seemed “rote” and “robotic.” ABA, as ued in Charlie’s current school and home program, has helped him learn and grow in many ways. A number of posts on my Autismland weblog that refer to ABA can be accessed here.
There are a lot of things I like about ABA, and a few things that could stand improvement (largely the attitude of most of the consultants I’ve come across). At one point, I thought I might be the person to deal with that, but not anymore.
What is next then, if I may ask?
I like to think it’s the individuals like yourself who did ABA—sat with Charlie and laughed with him and figured out how to get him to say /f/ with /i/—who have made the deepest influence on him. Not theories, not even research—one caring individual at a time.
I imagine you’re right about the deep influence. And I consider myself lucky to have been able to be that influence for so many children.
I think that dividing up psychology into all these different disciplines (and then divvying up the treatments etc. according to that as well) does a disservice to the clients we purport to serve.
Why does it have to be ‘developmental vs behavioural’ (Greenspan vs Lovaas)? Why can’t we combine the two and create something wonderful? If the only reason is that it’s hard to design a good study to be able to find out if that approach “works”, then that’s a stupid excuse for not doing what’s right for the kids.
Honestly, my dream way back when (as “long ago” as two years) was to eventually be able to run a study that compared the results of a truly “eclectic” program to those of the past (and current) research studies, and to compare quality of life between treatment methods.
By “eclectic” I mean using all of the methods currently in use (from Son-Rise to FloorTime to Lovaas ABA & Carbone AVB to appropriate medical/biomedical intervention to OT to speech therapy – focused on communication, not just speech – to physiotherapy etc.) in individualised combinations, as appropriate for each child.
Well… I think the title of the article is horrible.
I think it’s horrible that “gazing off into the distance” and “touching one’s face” are considered bad things in need of extinguishing, or even necessarily signs of lack of focus.
I think it’s horrible to coerce or force a child to tell their parents “I love you”.
I think it’s horrible that she was clearly learning on her own in ways that are very autistic ways to learn, and ABA is somehow getting the credit for that. She clearly, like me, is hyperlexic and has perfect pitch. And, like me, she undoubtedly learned those things in ways that ABA can actually slow down.
I do not care for title of the article, or language that refers to “bringing back” a child.
On the one hand, ABA and behavior therapy are contrary to my personal beliefs about humanity. On the other hand, ABA has helped Charlie a great deal, not to “come back,” but to learn, and it would be dishonest for me not to say this.
I think it’s important—necessary—for parents to cast a cold critical eye at any teaching method or therapy they have chosen for their child. We have to keep asking questions.
I read the article as well and as the mother of an autistic 4 year old gilr it was difficult, to say the least, to embrace ABA therapy. In fact, it went against everything I believe in. I do know this though, my daughter has learned every single thing she knows through the use of ABA therapy. Gazing into the distance is not a crime. My child would still be gazing into the distance 24-7 without the hard learned skills provided by ABA therapy.
Let’s face it. We can theorize about ideal therapies ad infinitum but one fact remains. ABA is the only therapy that actually is proven to work in helping autistic children learn. And I know that it has. I’ve seen the strides my daughter has made. So, really it’s a little ridiculous at some point to argue over its usefulness. It is right now the only proven therapy that helps autistic children to learn anything. Having said that, it’s the choice I made to give my child a chance to learn as much as she can.
The fact remains that autistic children live in this world. A world where at best, they don’t seem to fit and at it’s worst, a world where they can’t live in their own skin. I don’t suggest that I need my child to be “indistinguishable from her peers” or anywhere close. She’s a lot bettter than most of her “typical” peers. However, I would like to up her comfort level and her ability to function in THIS world, the one she has to live in. I’m happy for her when she learns a new skill and she’s happy too.
I agree it is horrible to force a child, autistic or typical, to tell their parents they love them. But what a tremendous joy it is to teach a child who does love you to say those words….to give them the gift of communication and to receive it. Learning is always a good thing for both typical and autistic children. I know for sure that my daughter could not have learned the tremendous volume of skills she has at 4 had we not implemented a good ABA program.
It’s all about the individual. For my child, it is the only thing that has helped. And the results have been greater than I could ever have imagined. I love the quirky, eccentric part of my daughter, I always have. I love it more now that we can share it.
Jez, thank you so much for writing in here about your daughter and ABA, which is the cornerstone of my own son’s education. It is the reason he can talk, plays the piano and rides his bike, goes everywhere with us, has been able to learn and so much more. Because ABA has been so much a part of my son’s life and learning, I am always interested in hearing criticisms of ABA—of why ABA has not “worked” for a child—of why it does not seem “useful.” For our family, as for yours, it most definitely has been!
Jez;
“I agree it is horrible to force a child, autistic or typical, to tell their parents they love them. But what a tremendous joy it is to teach a child who does love you to say those words….to give them the gift of communication and to receive it. Learning is always a good thing for both typical and autistic children.”
My sentiments exactly.
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What absolute hogwash. The ABA “studies” are entirely flawed, and no one mentions that the statistics the ABA industry uses about “cure rates” are based experiments they did with kids involving electric shock treatment.
ABSOLUTELY HORRIFIC.
I have never let anyone use ABA operant behavioral modification techniques on my son, and he has blossomed, matured and learned to overcome some of autism’s ill-effects. We used a developmental rather than a behavioral approach, autism is a DEVELOPMENTAL disorder, not a behavioral one. And the development is simply delayed, not frozen.
ABA has a difficult to read history. It has evolved and my son has, too, “blossomed, matured and learned” thanks to it. Best wishes—-
Different strokes for different folks.
Our experience has been as Kristina’s and others’.
Having gone through the gambit of approaches and even “left to her own learning” for a stint, a behavioral approach and ABA has enabled our daughter to understand and learn that which was not addressable otherwise. Perhaps if something else had been equally or more helpful to her…well.
There’s a big difference between “training” and actual learning .
There’s a huge difference between teaching and operant conditioning.
The comment that I called HOGWASH was this : “ABA is the only therapy that actually is proven to work in helping autistic children learn.”
The above quote was taken out of my previous post, for some weird reason. I get so sick of hearing that lie, perpetuated by the billion dollar ABA industry. Anyway, this is total ABA territory, so it was silly of me to write anything. I just came across that ridiculous quote while searching for something else and had the urge to respond. I’ll go before someone gives me an M&M and tells me to touch my nose or look them in the eyes.
My son’s never had an M & M (he doesn’t do well with dairy) and he never did a “look at me” program (his ABA is provided by the Lovaas agency). Glad to hear your son is doing so well.
Jez Rourke wrote: “I do know this though, my daughter has learned every single thing she knows through the use of ABA therapy. Gazing into the distance is not a crime. My child would still be gazing into the distance 24-7 without the hard learned skills provided by ABA therapy.”
Elsewhere, Ms Rourke wrote about her wonderful daughter,
“Every single thing she knows, she learned from ABA. This is fact. Except for the things that seem to be her gifts. She spelled words with refrigerator magnets long before ABA therapy. She plays the piano almost in spite of ABA therapy. She taught herself to read without the use of ABA therapy. Adding and subtracting. She was obsessed with numbers and sequences of numbers before ABA.”
Not bad for a kid who is “gazing into the distance 24-7.” I guess literacy, numeracy, etc., aren’t “skills” in autistics who aren’t in ABA programs.
If you follow the link I provided above, you’ll see how behaviour analytic views of autism result in very obvious autistic learning being pathologized and written off.
Behaviour analytic views of autism are public policy in Canada and enshrined in Canadian jurisprudence. As a result, the atypical ways in which autistics learn well are officially regarded as contributing nothing to society, as a blight on society, as uninteresting and useless, as pathological, as destructive and less than human, as urgently requiring eradication, etc.
“I’ll go before someone gives me an M&M and tells me to touch my nose or look them in the eyes.”
I understand that there might have strong feelings, and I agree that there are some claims across the board by behavior analysts that need to be substantiated and analyzed more fully. I also agree that ABA providers need to exercise caution not to use the technology to apply rote procedures to control behavior inappropriately or teach skills that are of no real usefulness to the child. I have used ABA and I exercise a great deal of criticality over instances of sloppy analysis or when I see as instances of unethical practice.
However, I do not quite understand how stating that which has demonstrated to be useful to our daughter is the cause for insults and generalization about our ability to discern so.
As I said, different strokes for different folks. I am also glad that your son has done well under the choice that you made.
Regan, I was not responding to you at all or saying anything about your daughter … I was responding to Jez Rourke’s flagrantly untrue statements, which she repeats twice in the same paragraph:
” We can theorize about ideal therapies ad infinitum but one fact remains. ABA is the only therapy that actually is proven to work in helping autistic children learn.”
(hardly a FACT –it is her OPINION.)
and:
“It is right now the only proven therapy that helps autistic children to learn anything.”
WHAT UTTER NONSENSE.
So, I am sorry, Regan, if you are offended by what I have written, but statements like those ones Jez make offend me too. As a parent who has chosen not to have anything at all to do with treating children that way, absurd claims like that make it seem that unless I drill my kid 40 hours a week, jab him daily with vitamin B-12 injections after having shoved 40 vitamins down his throat and smeared chelating cream all over him and kept him diligently away from anything with the dreaded gluten in it, (including playdoh, even if he doesn’t eat it) — if I am not doing all that — I am not doing the right thing and my child will “suffer a lifetime of autism” because of it.
I think most parents choose ABA because someone else does the work and someone else pays for it. If parents were given a choice between the government paying for Floortime or ABA, and they weren’t swayed by the false “cure-rates”, and deeply flawed studies touted by the ABA industry … they would opt for Floortime. But with Floortime, the parents do most of the work, not therapists, so again, parents who do not want to do the work themselves, parents who want other people to “fix” their kids, would opt for ABA. The ABA industry also does an expert job making parents feel entirely inadequate and incapable of helping their children themselves, and that’s truly repugnant.
And thanks, yeah my kid is doing well, he is happy, has friends, speaks, has conversations, goes to school with ‘typical” kids and says I LOVE YOU to me because he actually wants to, not because anyone trained him to do so. Love is an emotion, not a skill one can be taught. ABA does NOTHING to address the fundamental capacities for relating, communicating and THINKING. ABA does nothing to help a kid build relationships, improve social capacity, or improve higher level thinking skills and cognition.
Happily, ABA (at least in Charlie’s home program) is evolving and has taught him what you mention in the last paragraph. But ABA has indeed become an industry and a business and there is a lot that must be critiqued.
Actually ABA taught in a natural environment helps a great deal in relationships, communications, social capacities and cognitive abilities. Just like parents, there are good and there are bad.
Applied Behavioral Analysis for Childhood Autism: Does the Emperor Have Clothes?
Page 45, Behavior Analyist Today
http://tinyurl.com/2zjdax
I’ve written a few posts on Stanley Greenspan, too; links are at kristinachew.com. Also, I explained more of our experience with ABA in an article in the Lovaas newsletter. Critique is always needed.
http://lovaas.com/meetingpoint-2007-06-feature-02.php
I work as an ABA therapist. I got involved after my nephew was diagnosed at the age of three-his mother noticed how well he and I got along and encouraged me to apply for a job.
Before Spencer entered ABA therapy, he was almost totally mute, could not be potty-trained (at 4), and other basic hygiene rituals such as brushing his teeth led to horrific battles. It was difficult to take him places, as he had such awful tantrums: screaming until blood vessels burst in his face, crying, hitting.
Just under a year later, Spencer is capable of sitting quietly at his desk at school, has only an occasional ‘accident’, and is happy to brush his teeth. He sings and makes eye contact, and likes to come over to sit on my lap.That may not sound like a lot to someone who has never met him, or had an experience with another autistic child, but for Spence and our family, it’s huge.
Working as a therapist, I agree that the therapy itself looks odd, and I can see how some people could look at it as “HOGWASH”. But all I have to do is look at Spencer, or any of the children that I work with, to *know* that this therapy works, but only if everyone involved is ready and willing to commit to it. If you’re not, it won’t work.
To those who disagree with me, and have autistic children who have been able to somehow come to terms with their symptoms, I congratulate you on your success. To those who might be on this site, researching therapies for your own child who has just been diagnosed, I urge you to look into ABA therapy.
Sigh, sorry to see I missed this debate, for the most part, but a year or so later I am here to add my opinion. This is an area I’m very interested in and always like to talk about.
My feeling on ABA is that it is a wonderful program, with some very big ‘holes’. One thing I find very frustrating is that the ‘holes’ in ABA are rarely discussed – people either declare ABA the perfect program or vilify it, often irrationally on both ends. It’s hard to get a good discussion about some middle ground going.
As far as the positive, I think ABA really taps into the learning style of children with autism. Repetition, motivation, breaking into small steps, starting with the concrete, scaffolding, consistency, creating successes for the child to feel good about – these are good teaching tools in general, but even more important to an autistic child.
In terms of the negative – my biggest issue is context. Context, context, context. A really good ABA provider will teach skills in context or teach generalization. I am here to say that at least half of the providers I have observed do not. So the child sits at a desk and can point to nose, eyes, ears, can tell you a dog says woof, and recite what age they are. Um…so what? None of this means anything if it’s not used in a communicative context. Too often I see children flee the therapy table as soon as they have earned ‘reinforcer’ time, only to do something completely solitary and avoid all interaction. If, in ‘real life’ interaction, nothing is carried over, then what’s the point?
Second issue is that I think ABA is much more practical for basic skills than high level skills. You can easily do drills and reinforce a child who is learning colors. How do you do this when you are teaching a child to be a good friend? I think this is where some of the more cringe-worthy ABA moments occur, the ones that spark accusations that ABA promotes ‘robotic’ behaviors. I support ABA, but I groan inside when I see a child prompted to approach another child and recite, in a singsong voice “Hi-my-name-is-John-do-you-want-to-play?”
I still applaud ABA in many areas. I do think; however, that trying to explain the development of human cognition based entirely on behavioral principles (as hard-core behavorists do,) is like trying to explain the physics of the universe based on the Law of Gravity. Sure, you have one very real piece, no one is debating that, but why try to make it the only piece?