Sunday, March 17, 2019

Reflections on ABA

If you've been following this blog for a while, you know that I'm deeply skeptical of ABA therapy, attempts at curing Autism, and anything else that shames autistic people for being who we are and/or tries to change us. Far too often, autism therapies try to curb autistic behaviour, with functioning labels being used to describe the degree to which any given individual is able to pass as neurotypical. Granted, all of these things are typically done and used with the best of intentions - we all want what is best for kids on the spectrum after all - but the fact remains that they don't work the way many believe they do; they don't 'minimize' autism per se, they simply teach the child in question to build a mask they can use to interact with neurotypical society more easily.

But is ABA inherently bad?

The answer is... complicated. On the one hand, it absolutely is! Building a conditioned behavioural mask has the unintended side effect of instilling in an autistic individual that how they naturally are is wrong and broken. All of us on the spectrum have experienced this to some degree - even spectrum dwellers such as myself, who have been historically able to pass more easily as neurotypical. Growing up, I always felt that failure was not an option - I had to succeed like everyone else, because I didn't want anyone to know about my neurodivergence. I wanted to be looked at for my abilities, not because of a label I'd been assigned at age 9. It's led to my greatest source of anxiety - being judged through a preconception instead of for who I am. I never considered this before getting involved in the neurodiversity struggle, but this is most definitely masking. Other spectrum dwellers experience this far more intensely, to the point where masking (and its associated mental health issues) is THE most devastating side effect of Applied Behavioural Analysis. It's why most of us on the spectrum are fiercely opposed to ABA therapy and how it has negatively impacted Autistic individuals throughout history.

On the other hand, the core science ABA is based on - behaviourism - is a sound, proven way to condition behavioural changes in humans of any kind. It's been used for some time to curb deleterious habits such as smoking and drinking, and can be potentially very beneficial in effectively teaching life skills to any person, not just autistic individuals - provided it is properly applied. This last part is key - one of the biggest problems with ABA is the dark history of how it was discovered. Dr. Ole Ivar Lovaas, creator of ABA, is well known to have utilized electroshock torture and other painful methods to curb autistic behaviour, seeing himself as 'building a normal person' out of what he saw as the raw human material that was the autistic child. Ethics are therefore key, as is thoughtful consideration of the application of the core science behind ABA. Utilizing conditioning to teach a child how to brush their teeth step by step is perfectly acceptable, for example, provided only positive reinforcement is ever used (because negativity can be cruel). Utilizing conditioning to shame and teach an autistic person not to stim, or to make eye contact uncomfortably, on the other hand, is problematic. It attempts to fundamentally change who the autistic person is on a base level. By all means, teach your child not to stim in a dangerous or self-injurious way...but stimming in itself is natural for the Autistic brain. It’s an outlet for excess energy and helps us concentrate better. Instead of curbing the behaviour (which only has the effect of making us burn with an uncomfortable amount of internal energy), the focus should instead be on finding a safe outlet for the urge. I for one flap my foot or my toes rapidly!

The acceptability of ABA is, therefore, up for intense debate. As an adult on the spectrum, I will always oppose the dangers inherent in it, and seek to promote better, more humane treatments for autistic individuals. After all, making someone feel like they are broken and need to conform with neurotypical society in order to function is deeply problematic and I won't back down from that stance. In reality, however, ABA is often the only type of therapy being offered to those on the spectrum. Typically, it's either that, or nothing, which is in itself a problem. For those kids who do desperately need guidance and assistance in mastering critical life skills, it can be a game changer. Don't get me wrong - in an ideal world, I would prefer any kind of treatment instead of ABA. Given that it is often the only option available, however, the advice I would give parents is this - while it's true that not all ABA therapists are bad, it is IMPERATIVE that you do your homework, critically evaluate how your child's therapy is progressing, and ensure that every step of the way, your child is not being shamed for being autistic, nor is their autistic behaviour being conditioned away. Stay involved, build a rapport with your child's assigned therapist, and make sure everyone involved is acting in accordance with the principles of Neurodiversity: teach us life skills and how to be our best selves, but accept that our brains work differently...and that our normal may not necessarily be yours.

If we all just do that, and accept people for who they are rather than trying to make people who we want them to be, the world will be a far better place.

As always, yours in diversity,

Adam Michael

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