Applied Behavioral Analysis, also known as "ABA," is
the most common therapy for "treating" autism. In the US, it is the only autism therapy that most insurance companies will pay for.
It's also pretty universally hated as abusive by those who have been unfortunate enough to have had it inflicted on them. For those of you who don't know, it was designed by the same guy (Ivor Lovaas) who created gay conversion therapy. He was working with two kids, one an "effeminate" boy, and one an autistic boy, trying to train them to be "normal." The same basic reasoning and methodology are at the heart of both gay conversion therapy and ABA. (Note the sample size he was working with, folks, that's gonna be important.)
Oh, but ABA is kinder and gentler now! its proponents say. They don't use punishments, only rewards! as if that somehow makes it less coercive. (And, oh, by the way, while it is true that most ABA therapists don't use punishments, there are still a ton who do, and the practice is still condoned by their professional organization.)
Most ABA professionals are absolutely unaware of how much adult autistics who have been through ABA hate and loathe it, how much trauma it causes. But even when they
are aware of it, their excuse is that it's "evidence based." We have to do this, because it's the only thing that works! It's the only thing that's been scientifically proven! And I knew that part of that claim was bullshit, because there aren't any longitudinal studies of ABA (i.e. what results can you find a decade or two later); all the studies are of immediate effects. But it's worse than I thought.
Someone just did a meta-analysis of all autism intervention therapies. And guess what they found!
The vast majority of studies of ABA are not scientifically valid enough to be included in the study. Either they're case studies of ONE (1) child, or the results are reported by parents and/or therapists (and such reports are NOTORIOUSLY BIASED, parents will report a child received benefit from a therapy the child never even RECEIVED). Yeah, sure, the results reported are glowing, but the whole "study" is junk! When you take out the junk studies, not only are there not many studies left but the results are a lot more ambiguous than ABA proponents would claim. I knew that Lovaas' initial research had been done on only two kids, one autistic and one "effeminate" (i.e. queer), but I had assumed (silly me) that he'd followed up with larger studies once he had his methodology worked out.
And you know what? It isn't just that the "evidence" for ABA is incredibly flimsy and their whole "but it's EVIDENCE BASED so if you don't like it you're against SCIENCE!" is bullshit. The meta-analysis showed that when you only include studies that are based on actual scientific method and shit like that, there are two "promising" types of therapy, and
ABA IS NOT ONE OF THEM. There are two studies that, when one looks at ACTUAL evidence and not just ABA practitioners writing self-congratulatory odes about their star victi--er, sorry
patient, show actual positive results. And those two therapies are Naturalistic Developmental Behavioral Interventions and DIR/Floortime. Neither of which, after a decade of keeping up with autism news, I had ever even
heard of.
To every ABA "therapist" who's ever justified themselves by claiming to be "evidence based,"
FUCK YOU.
For those who want a less-academic summary of the study, that has some really choice things to say about ABA and those who practice it, Alfie Kohn has an
excellent blog post about it. Here's my favorite bit:
The uncomfortable irony is that we are apparently supposed to accept such appeals to “evidence” on faith. I have written elsewhere about how research cited in the field of education sometimes doesn’t stand up to close examination. This is particularly true of traditional practices rooted in behaviorism — not only ABA and similar interventions for children with special needs but also highly scripted direct instruction of discrete facts and skills in early childhood (and beyond) and explicit phonics-based strategies for teaching reading.9 You might assume that those who use the phrase “evidence-based practice” (EBP) are offering a testable claim, asserting that the practices in question are supported by good data. In reality, the phrase is more of an all-purpose honorific, wielded to silence dissent, intimidate critics, and imply that anyone who criticizes what they’re doing is rejecting science itself.10 It’s reminiscent of the way a religious leader might declare that what we’ve been told to do is “God’s will”: End of discussion.
Moreover — and it took me awhile to catch on to this — behaviorists often use “EBP” just as a shorthand for the practices they like, in contrast to the (progressive or humanistic) approaches they revile. It doesn’t matter if the evidence is actually weak or ambiguous or even if it points in the other direction. They’ll always come up with some reason to dismiss those inconvenient findings because their method is “evidence-based” by definition. (On social media and elsewhere, you can get a glimpse of how modern behaviorism resembles a religious cult, with adherents circling the wagons, trading ad hominem attacks on their critics, and testing out defensive strategies to employ when, for example, people with autism speak out about how ABA has harmed them. Or when scholarship shows just how weak the empirical case for ABA really is.)