ABA is not a therapy

 “My thinking is first and last and always for the sake of my doing.”

(James, 1890; Fiske, 1992; Gollwitzer & Bargh, 1996).

In an article “Early Treatment for Autism Is Critical, New Report Says” published by the New York Times, ABA providers are uncritically offered the platform to advertise their “therapy” without any dissenting opinions or critical insight.

It should be known to the New York Times and noted that ABA is also viewed critically from an academic perspective. Among other things, the study and evidence base is far from being as clear as it is presented in the article. The studies on ABA often have methodological shortcomings (for example, studies often include single case design or otherwise extremely small numbers of test subjects, no studies on long-term effects in relation to the satisfaction of the participants, no control groups…), and they are basically based on a misdefinition of autism as Elle Loughran has already aptly explained in her article “The Rampant Dehumanization of Autistic People.”

If one starts out from a wrong definition, nothing reasonable can come out of it (like when the medieval doctors used a wrong but coherent theory to explaine diseases as the results of winds, natural gases, and the four human humours: blood, phlegm, yellow bile, and black bile).

The minimum journalistic standards would have required a more balanced article. Instead, ABA is touted as a miracle cure, without any side effects. It’s not credible, even if you don’t know anything about ABA. A profound intervention in the nature of a child, without any reported on negative side effects? It smells like a snake oil salesman.

In Germany, ABA is still being viewed critically and is therefore not covered by health insurance companies. As autism is not considered curable, it logically cannot be cured therapeutically and therefore the ABA “therapy” cannot work by definition.

However, we are also flooded with fantasty-based articles and advertisements from institutes that offer this dressage at high prices. A miracle cure! No negative side effects whatsoever! Almost like magic! These are pied piper methods, and it’s completely nonsensical that The New York Times has published such an article. This would not be the first time – in 1971 the New York Times published a hymn of praise for the „healing“ of homosexuals: „the therapists report that they have helped between 25 and 50 per cent of all their homosexual patients – regardless of age or original motivation – to make a hetero sexual adjustment.”

I am not against supports, accommodations, or therapies– as in the field of speech therapy or psychological support in coping with stress, sleeping problems, etc. I am against ABA as as a “therapy,” because this “therapy” does not deserve the name therapy and uses methods of brainwashing and operant conditioning.

Quote from Dr. Levy from the New York Times article: “The most intense intervention is Applied Behavioral Analysis (A.B.A.), a program that addresses specific behaviors, identifying triggers and antecedents, and responding with rewards when a child behaves in the desired way.”

That rings a bell for me…

What is ABA? In a nutshell: ABA is based on the behaviourism that sees the human being as a blank page that can be filled with content or deleted at will. This school of thought came into disrepute in the 1970s because of its conversion therapies for homosexuals, and is now experiencing a cynical renaissance with ABA.

The use of ABA for the treatment of autism is critically evaluated in many parts of the world, because it is based on one of the darkest chapters of behaviourism: the experiments of Ole Ivar Lovaas, who tried to “cure” autistic children.

For Lovaas, autistic children were “only persons in the physical sense, but not a personality in the psychological sense.” He saw his task in constructing a person from their raw material. To achieve this goal, he used slaps and scare tactics. Although these are not always part of ABA treatment today (though electric skin shocks are still used at the Judge Rotenberg Center), ABA aims to change the behaviour of autistic children without learning the reasons for their behaviour. 

To achieve this, so-called “early therapies” are carried out on young children for at least 40 hours a week, an intensive working week. Typical characteristics of autism such as stimming or special interests that help autistic children cope and regulate their nervous system are prevented. Even when they claim it’s not, the aim is often that the child behaves as little like an autistic as possible to the outside world.

The training causes great harm on the psychologically, even if this is not immediately apparent. Basically, the use of ABA is a sign that the child is not accepted in its personality and identity, which is inextricable from autism. In order to experience this, one only has to ask autistic people who have experienced this treatment.

Some studies, such as those mentioned in the New York Times article, do confirm the effectiveness of ABA. Besides the methodological shortcomings mentioned above and also contrary studies that found no effects, “successes” are not surprising because ABA is classical conditioning: the effect of psychological manipulation that is empirically measurable.

Now, when studies find that autistic people can be successfully conditioned to behave inconspicuously and suppress their actual personality, successful conditioning is successful dressage, but not success in terms of the satisfaction of the individual, as is the case with other psychological therapies.

To put it succinctly: one can also force behaviour by means of torture, but I would not call therapy such a thing. ABA is about adapting the outwardly visible behaviour of a person to a defined system. The needs of the individual are put aside in favour of the sensitivities of the environment.

And this 40-hour weekly conditioning is best done with toddlers, according to the New York Times article which functions more like a commercial than credible journalism– just as Ole Ivar Lovaas trained homosexual boys in the 70s to say that they suddenly found only women attractive. Today, this thought makes our hair stand on end in horror. In the past, deaf children were forced to read lips, today they are (hopefully) taught sign language. Left-handed children had to write with their right hand. Today, left-handed children are no longer forced to deny their neurology and are of course allowed to write with their left hands.

In the past, the rule was: no matter what the child feels, the main thing is that it looks normal. Nothing else counted. The black box didn’t matter. The arrogance of the majority, the status quo, determined success. Fortunately, that has changed in many areas. But the voices of autistic people are still not being heard. Now, there is an aggressive push to bend even the youngest children into expensive ABA “therapies.”

In 20 years, the scientific community will be ashamed of this.

I am sure that ABA supporters will claim that I am exaggerating when I mention behaviorism and torture in one sentence– but it’s not very far off. Behaviorist methods were also used by psychologists and other professionals to develop torture methods for the C.I.A. (the psychologists involved called this “The Behaviour Management Plan”), which were used, for example, in Guantanamo Bay.

Radical behaviorist methods of classical conditioning should finally be put where they belong: on the garbage heap of history, and not be uncritically promoted by the New York Times.

Additional sources:

Fiske, S.T. (1992). Thinking is for doing: portraits of social cognition from daguerreotype to laserphoto. Journal of Personality and Social Psychology, 63(6), 877–889.

Gollwitzer, P.M. (1996). The Psychology of Action: Linking Cognition and Motivation to Behavior. New York

James, W. (1890). The principles of psychology. New York : Holt.

Picture: Bundesarchiv, B 145 Bild-F010223-0012 / Unterberg, Rolf / CC-BY-SA 3.0

Team spirit

As a child, I particularly liked series with teams. I was fascinated by the idea that each individual has strengths and weaknesses, and that individual weaknesses are accepted and the individual strengths are seen and used in such a way that in the end a goal can only be achieved by working together.

This team character was evident, for example, in the „Teenage Mutant Ninja Turtles“:

Leonardo: a natural leader, sometimes too stubborn and quite egocentric.

Raphael: angry, impulsive, but also the comedian of the team.

Michelangelo: very childish, but fun-loving, loyal and strong.

And my personal favourite as a kid, Donatello: the clumsy scientist.

Yes, they are in some way stereotypical, but I find the main message important: that completely different characters build a functioning team together, without mocking their differences and emphasizing the strengths of the individual. This diverse team works even better than if each Turtle were working alone.

I really liked it. The idea of diverse teams. This pattern was repeated in almost all children’s series of the 80s and 90s like e.g. Ghostbusters or Sailor Moon.

The frightening realization came when checking fiction with reality: the diversity shown in popular children’s series was in no way near to reality. In real life, conformity and homogeneity was propagated as the ideal. Those who are different are excluded, bullied or at best dragged down from above as mascots. An ideal  team in reality seams to consists only of „Leonardos“, people pretending to be Leonardo, people imitating Leonardo and people obeying to Leonardo… There is no room or place for Donatello’s world view, Raphael’s way of being or Michelangelo’s opinion in real life teams.

The power of language and framing

Until recently, psychology concentrated mainly on „weaknesses and deficits“ instead of strengthening and highlighting existing strengths. And even today, both in pedagogy and psychology, one’s own and mutual acceptance is not the goal. Instead there are diagnoses mainly based on deficits, and even possible strengths are redefined so that they only appear as weaknesses.

Some of the so called “deficits / weaknesses” of the Autism Spectrum are a matter of interpretation, of definition, of context.  And the majority, the neurotypical ones, define the status quo: what is normal is good. With us autistic people it is the case that all our „differences“ are interpreted negatively, although some traits could also be seen as positive depending on the point of view.

As a thought experiment I have now reformulated some typical personality traits of autistic and neurotypical people in such a way that the autistic is presented more positively than the neurotypical, in order to once again illustrate the power of language in this context.

The following common characteristics of neurotypicals are scientifically known and have been researched for decades. Their effects can e.g. lead to wars and to bullying. Nevertheless, they are not attributed to be neurotypical „deficits“, although they clearly could be defined as such.

Examples for deficits of the average neurotypical person

This are common negative traits of neurotypical people:

  • Neurotypicals can be easily influenced by authorities – and tend to obey authority even in violent and immoral ways.
  • Neurotypicals are needy for belonging to a group – they are prone to actively exclude others to feel belonging to a group and give up their individuality to do so.
  • Group membership leads to strong exclusionary behaviour which even goes so far as to trigger a tendency to favour one’s own group at the expense of others, even when it means sacrificing in-group gain.

These negative tendencies of neurotypical people were shown in the Milgram experiment (Milgram, 1963), in studies on group conformity and group coercion (Asch, 1951, 1956), and in research on discrimination and exclusion of outgroup members (Tajfel, 1970).

Examples of strengths of autistics

This common autistic traits could compensate for the above-mentioned neurotypical deficits (if these strengths were not pathologized):

  • Autistics own a strong moral system in the sense of Kant’s categorical imperative that is not easily shaken by peer pressure.
  • They have a high sense of justice and high sensitivity for the suffering of others.
  • Another positive trait is their high sensitivity for moods of other people.

(Sources: Garnett, Attwood, Peterson & Kelly, 2013; Markram, & Markram, 2010).

These lists could be continued… The sad fact, however, is that our common strengths, like e.g. a strong moral system which is entirely in Kant’s sense, are stigmatized as „inflexibility“, while the „blind obedience“ characteristic of many neurotypical people is regarded as normal. This is the power of language, the power of framing… This is the power of the majority that defines what is called a deficit and what is not.

What is my point?

Well, to come back to the beginning of this article: I wish for a world in which we are accepted with our strengths and weaknesses. I wish for neurotypicals to reflect that they also have weaknesses that some of us autistic people could well supplement if we were included in teams. I think if people listened more to autistics, we would be able to create a better world together.

I don´t want a world of Leonardos, where the Donatellos, Raphaels and Michelangelos are excluded.

I would like to see diverse, heterogeneous teams full of mutual respect in which individual weaknesses and strengths are reflected and accepted. Because we have all strengths and weaknesses, but unfortunately neurotypical people too often forget their weaknesses and do not pay attention to the strengths of the neurodiverse people. They seem to not understand how teams should work.

Sources:

Asch, S. E. (1951). Effects of group pressure upon the modification and distortion of judgment. In H. Guetzkow (ed.) Groups, leadership and men. Pittsburgh, PA: Carnegie Press.

Asch, S. E. (1956). Studies of independence and conformity: I. A minority of one against a unanimous majority. Psychological Monographs, 70(9), 1–70.

Garnett, M. S., Attwood, T., Peterson, C., & Kelly, A. B. (2013). Autism spectrum conditions among children and adolescents: A new profiling tool. Australian Journal of Psychology, 65(4), 206–213. doi: 10.1111/ajpy.12022

Kant, I. (2004). Grundlegung zur Metaphysik der Sitten. Göttingen: Vandenhoeck & Ruprecht.

Markram, K., & Markram, H. (2010). The Intense World Theory: A unifying theory of the neurobiology of autism. Frontiers in Human Neuroscience, 4. doi: 10.3389/fnhum.2010.00224

Milgram, Stanley (1963). Behavioral Study of Obedience. Journal of Abnormal and Social Psychology. 67(4), 371–8. doi: 10.1037/h0040525

Tajfel, H. (1970). Experiments in intergroup discrimination. Scientific American, 223, 96–102.