Disclaimers: I cannot diagnose your child, nor provide referrals. I am not affiliated with any ABA company and I am not being paid for sharing this information. The purpose of this article is to help parents by providing a supportive point of view, with as little bias as possible. Ultimately, every single parent should do what they feel right in their heart is the very best thing for their child.
What is ABA therapy, really?
Applied Behavior Analysis (ABA) is a form of therapy that focuses on decreasing maladaptive behaviors (e.g., tantrums, aggression) while teaching replacement skills (e.g., communication). Some other goals also worked on during therapy, depending on the client’s age include: Community skills (e.g., going outside in the community, going shopping, using money), Social skills (e.g., making friends, playing with others), and Daily living skills (brushing teeth, washing hands, getting dressed).
ABA therapy is not “only for Autistic people” but due to restrictions in insurance funding, therapy services are typically only covered when an Autism diagnosis has been provided. However, ABA techniques can be used with any population, and even in business management. In fact, many professions use the principles of behavior to reach specific goals (e.g., education, fitness, and even marketing).
Wait, that sounds great. So, what is the controversy?
In recent years, many Autistic people have, very rightly so, expressed their concerns and negative experiences with some of the methods used during ABA therapy.
The field of ABA is relatively new, and, mostly in the past (but unfortunately, sometimes, still in the present), therapists have used less-than-ideal methods to achieve therapy “goals.”
Some of these “goals” can also be perceived as harmful by Autistics.
These harmful goals consist of (but is not limited to):
Forced eye contact (which can actually be painful for some individuals with Autism).
Forced compliance (forcing someone to follow an instruction, just because). This is dangerous because i teaches
children to do as they are told, all the time. You can imagine why this is problematic.
Decreasing harmless self-stimulatory behaviors often used to cope (e.g., arm flapping pacing, leg shaking).
Restrictive methods (over-prompting, especially physical prompts when they are not fully needed). Physical prompts
don’t necessarily have to be harmful, like when you help your child brush their teeth by helping them with the motions.
However, when used as a way to physically force someone into an act, this could be perceived as problematic.
Robotic teaching (for example, teaching a learner to name all the different kinds of dogs, but not teaching them to use
language in more meaningful ways).
Escape extinction with no replacement skills (e.g., not allowing the learner to exit an activity no matter what, but not
providing them with the skill to successfully leave situations they don’t want to be in).
It’s important to be aware that these problematic aspects of working with Autistic people are not exclusive to ABA therapy. These same issues can be found across professions, including education, speech therapy, and occupational therapy. Parents should be aware of these problematic approaches whenever their child is working with other professionals, regardless of specialty.
Okay, now I am more confused.
It’s okay to be confused. Any big decision that has the potential to impact our children should feel confusing and nerve wrecking. After all, we only want what is best for our child.
So, here are my suggestions:
Love the child you have, as he is.
Accept them fully, and understand that different does not have to mean “bad.”
Stop worrying about what other people think or say. This is much harder than it sounds, but you are going to have to try. People might not understand that your child is different, and even though as a society we are moving towards a direction of more acceptance and understanding, we are many years away from fully grasping this.
Become your child’s advocate. Learn about Autism. Educate others when they are mindlessly judging. But, do remember that you cannot control what other people think or say. Read #3 again.
Embrace that your child is different. If she doesn’t play with cars the way other kids play with cars, and likes to line them up instead, who cares? If he doesn’t really like to play with other kids, and enjoys his alone time, find a balance. If they’re not a fan of saying “hi” when first approaching others, others need to get over it, it’s not that deep.
Focus on what you CAN control and let go of the rest. Focus on supporting your child throughout their journey. Focus on prioritizing their happiness, but also their health. Again, if they don’t play with cars the way they’re “meant” to be played with, who cares? But you should probably care about whether they can brush their teeth. If they can use the toilet. If they can wash their hands. If they can make themselves a meal. If they can go to the grocery store and pay for their own items. If they have some sort of communication (whether that is spoken words, picture cards, sign language, a communication board). But if they flap their arms when they are overwhelmed or excited, and that is not hurting them or anyone else, that could become a trivial issue when looking at the bigger picture. The point is: There are skills in life we absolutely should teach our children. Those are skills that will help them quite literally survive, stay safe, increase their dignity and independence, and potentially help them live happier lives.
However, I am not saying your child won’t be able to do any of the things aforementioned (i.e., playing with toys, being social, spontaneously greeting others). They might do these, and more! But if they don’t meet certain societal-made “milestones,” my advice is to focus on the things that will impact their lives the most.
With that in mind, be flexible. Understand that your child (like every child, really) will have unique needs, and a unique learning system. Keep an open mind: Maybe they won’t learn to write, but they will learn to type. Maybe they won’t learn to play with puzzles, but they’ll learn to build lego designs. Maybe they won’t be the best readers, but they’ll excel with their organization skills.
Don't underestimate them just because they have a diagnosis. Yes - they might learn differently. But this does not mean they cannot learn things, especially the important things (read #6 again!).
Embrace their passions. They are not obsessions or fixations, they are passions. We all have them, or at least, we should.
Pick your battles. Not every battle is worth fighting. And most importantly, not every battle will be won.
Know that you are doing your best. No matter what other moms on Facebook groups are yelling at your for. Only you and your family get to decide what really matters.
Okay. So what should I look for in ABA therapy?
No matter the therapy (ABA, speech, OT), there are certain things to look out for:
What is the education level of the professionals working with your child? Ask! They have to tell you. Don’t be ashamed of being selective. Inquire about their relevant experience.
Who is conducting the therapy? What is their certification level and experience? Who will be supervising them and providing them with oversight? How often is the therapist receiving oversight from a BCBA?
What is their communication like? Do they tell you about the goals that are being worked on? Why those goals were selected? Do they include you in the decision making? Are they available in a timely manner to answer your questions and concerns?
Do they care about your child? Do they speak about your child respectfully, the way we would speak to and about any other child?
Are these individuals people who you see yourself trusting your child with?
Do they try to force goals and therapy hours that you are not comfortable with without offering an explanation? Is that explanation in the best interest of your child?
Are the techniques and interventions tailored to the individual needs of your child and their unique learning systems?
Do they have knowledge about the diagnosis/diagnoses of your child?
Is the BCBA on the case providing you with opportunities for parent training sessions, where you go over your child’s plans, progress, current goals, and discuss any questions or concerns?
Parenting is hard, diagnosis or not. It is normal to be confused, and even frustrated. This does not mean you love your child any less. In fact, these feelings are probably brought on by the fact that you love your child so much, and want to do what is the very best for them. Whatever therapy route or support system you wish to seek, that is a decision that will ultimately be yours (as a family unit) to make. Not me – not other BCBAs, not even the Autistic community who is pro or anti-ABA.