Russell Lehmann, RussL.co and Board Member of The Arc of the United States and
Casey Clay PhD, BCBA-D
Children’s Hospital of Orange County
“Disagreement is the first step toward progress” -Mahatma Gandhi
First, we must say upon reading the article, The Mismeasure of Misha, in the Boston Globe in late November our hearts were broken. The opinion piece is a scathing critique of ABA service providers written by a father of a son with autism–who still faced struggles after receiving ABA. It also explores scientific roots of ABA, which are also cast in cold, uncaring, and manipulative terms. After reaching out to colleagues in the ABA community who had read the article, their first response was similarly one of heartbreak. This may be counterintuitive to what you might expect from practitioners and consumers of the field who had just read an article degrading their science and life’s work. Anger seems to be the go-to reaction these days when one feels under attack; however, professionals in human services tend to have more compassion than most. Importantly, just as a surgeon who has lost a patient on the operating table, or a first responder who cannot save a victim of a recent accident, ABA practitioners also experience this heartache when those they serve do not end up in a better or happier state. We’d be willing to bet that if you informally surveyed 100 experts in ABA, the individuals they weren’t able to help are the ones that keep them up at night, motivate them to learn better or new skills, and are they ones from which they carry figurative and literal scars on their body.
The article was also discouraging to the autistic individual or family who have poured hours of work in effective ABA practices, only to read about hope being lost and effective services prevented for those who have not shared their experience. While healthy skepticism should be a part of all consumers of healthcare (and indeed many professionals encourage this) overt attacks on an evidence-based practice might turn a parent or individual seeking help away from science and toward pseudoscience. For example, see a dedicated ASAT page about becoming a more savvy consumer featuring numerous articles such as It takes a Village to Stand for Science: Showcasing Some Allies (where Kathryn Daly and Dr. David Celiberti offer resources for the autism community seeking evidence and remaining skeptical). Also, if parents and individuals turn away from science and evidence it can lead to damaging effects and there are many examples in the field of autism (see Dr. Paul Offit’s writings for examples of unscientific treatments for individuals with autism).
Evidence-based interventions are critical to serve the entire spectrum of individuals affected by autism. A recent documentary on PBS titled In a Different Key highlights the range of effective services available for autistic individuals as well as the large differences in behavior and needs across the autism spectrum. Interestingly, many of the experts interviewed in this documentary hold the Board Certified Behavior Analyst (BCBA) credential; however, this was not indicated in the movie. This may be an issue as parents and individuals with autism who see the documentary may be looking for help and curious about the services available and who might provide them. The documentary depicts that for many parents of children with autism and challenging behavior, ABA, and the science supporting it, has been lifesaving. The key ideas that are reflected in this documentary are that neurodiverse individuals have different needs, and that disparities related to services exist. The documentary does an excellent job showcasing these neurodiverse needs and the empathy ABA practitioners can demonstrate in the care they provide. This is in contrast to other media outlets that are attacking similar providers and methods being spotlighted in this documentary. An attack on effective, science-backed requires a carefully considered and vigorous response.
Our impression is the anti-ABA movement intends to “fight back” against society at large, which is seen as imposing autistic individuals to conform and threatening to diminish the unique traits of those on the spectrum. This process might lead to outcomes of taking away their individuality and ultimately, their dignity. Intertwined with this is the mission to stop “abuse” and “torture” among a population seen so differently from a societal view. The reaction is to provide pushback on the idea that those with autism are perceived as a sort of threat to the rigid social structures that have developed within our society over the decades and centuries.
We believe that this is a viewpoint held by a small, but vocal portion of autistic adults who have had negative, unpleasant, and even traumatic experiences with ABA treatment themselves or who have heard stories from others about treatment. It is not our intent to discount this viewpoint for it is a valid one to have, especially if shaped by the lived experience. However, this movement has taken over a sacred space that should be used for open and collective dialogue within the autism community. The fervent “ABA is torture” stance leaves no room for differing perspectives, and more importantly, differing experiences and outcomes.
It’s possible that the field of ABA has gone away from its foundation and the recent interest from business entities has introduced new challenges and barriers in maintaining the quality of care we feel ethically compelled to provide. However, the field of ABA is a young one, and just like the science it’s based on, is continually refining, and improving. For example, recent publications by Dr. Greg Hanley and his colleagues in the flagship journals of ABA are focused on compassionate care, trauma informed care, and inclusion of choice procedures to involve the individual with autism (Gover et al., 2023; Hanley, 2010; Rajaraman et al., 2022). Interestingly, some of these articles are revisiting previously discussed topics from decades ago. For example, the article “Soft skills: The case for compassionate approaches or how behavior analysis keeps finding its heart” by Roher, Marshall, Suzio, and Weiss in 2021 is building off the seminal article by Wolf in 1978 “Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart.” Other examples of providing compassionate care and careful ethical decision making can be seen in recent statements by the Association of Behavior Analysis International and Association for Professional Behavior Analysts.
The vocal backlash by many critics of ABA might be described by most behavior analysts as a form of counter control– counter control is understood by behavior analysts and has been discussed for many years. For example, the behavior analyst and scientist, Dr. Murray Sidman, discussed this at length in his 1989 book Coercion and Its Fallout. Yes, a behavior analyst wrote an entire book, over thirty years ago, examining coercive practices in society and rebuking the use of coercion. Behavior analysis has shown that coercive practices do not work. Coercion is, in the long run, self-defeating, and punishment eventually proves counterproductive. The issue with counter control is that it should be informed, productive, and bridge-building. It’s clear to us that compassionate care has been at the forefront of the behavior analyst approach for decades and has been recently highlighted as particularly relevant in the past and the current time.
Addressing some possible misunderstandings
The article “The Mismeasure of Misha” interestingly references Krutch’s (1953) The Measure of Man, which the author describes as espousing the idea that behaviorism’s spread is due to individuals becoming like automata, “conditioned to like being conditioned.” This robotic description of behaviorism that also classifies and “puts people into boxes” is a common misunderstanding. A more relevant reference would be Stephen Jay Gould’s (1981) book The Mismeasure of Man in which Gould refutes the argument of ranking people according to their genetic gifts and limits. Of note, this book is recommended by many professors of applied behavior analysis and is required reading in some courses. It’s possible the parent and author of the recent opinion article is familiar with this book and chose the title of the piece wryly to imply behavior analysts have gone the same way as past controversial scientists (see Herrnstein and Murray’s The Bell Curve). However, much to the contrary, behavior analysts specifically emphasize the precise, objective measure of the behavior of the individual to accentuate individual differences, which in our opinion strengthens self-worth instead of washing it out with pooled differences.
Although the bulk of the article is a mischaracterization of Skinner and Behaviorism (which the author may be mistaking with “Methodological Behaviorism”), our purpose is not to summarize a whole college course’s worth of correct understanding into a written accord. We would like to point out, however, that Skinner preferred to refer the science as “Radical Behaviorism.” Radical not in the sense that it denied everything that was unobservable (thoughts, feelings, emotions), but because it included them. For example, Skinner wrote: “No entity or process which has any useful explanatory force is to be rejected on the ground that it is subjective or mental. The data which have made it important must, however, be studied and formulated in effective ways (Skinner, 1964, p. 96). So, the idea is that thoughts, feelings (private behavior) can also be measured, and if wanted changed, if made visible or “public” (e.g., thought journals). Skinner also elaborated on ways we can see or “access” private events in his book Verbal Behavior.
Including all voices for individualized care
A hallmark of ABA is the focus on individualized assessment of the person at the individual level. This can be contrasted to other healthcare fields that focus on assessment at the group level and then tailor to the level of the individual. This leads us to pose the question: Does not individualized care consist of an individual and their care provider? It is not a collective where one size fits all. Yet, we hear nothing but anti-this and pro-that. From our experience in understanding autism, it sometimes can lead to thinking in black-and-white terms. Thus, we are at a juncture where we need to encourage more balanced views that work to ensure the concerns of advocates who were not treated well are considered and addressed while also continuing to improve our efforts to provide increasingly trauma-informed and compassionate care to those seeking treatment for their autism.
And we get it. Hindsight is indeed 20/20, and upon looking back at our stances that can become quite rigid due to the emotional investment of our lived experience, we realize how limited our perspective on any given issue or circumstance can be at times. Not just for advocates, but for all people. The key here is to be aware of how limiting our subjective experiences are. So, although there are times when all individuals become narrow-sighted and lose the context of the bigger picture, it’s important that we are also AWARE that this occurs, habitually. Breaking unhelpful thought patterns is only possible if you first self-reflect and mindfully identify how you think. When both “sides” consider the bigger picture, it may allow a safe space for all voices to be heard and emphasized in individual care.
Finally, we are reminded of the ancient Jain parable of nine blind men encountering an elephant for the first time. Each man touched a different part of the elephant. One man touches the tail and thinks it’s a rope. Another touches a leg thinking it’s a tree, so on and so forth. In the debate over ABA treatment in the autism community, the vast majority of perspectives are siloed, often unnuanced, and clash with various other perspectives. Dialogue is essential; as painful as these conversations may be, they can be the beginning of a reciprocal conversation. Progress is only made when we listen, convey respect, and combine our perspectives together to form a more holistic overview of what steps need to be taken in order for ABA treatment to be applied more pragmatically, humanely, and compassionately.
References
Daly, K., & Celiberti, D. (2021). It takes a village to stand for science: Showcasing some allies Science in Autism Treatment, 18(12).
Gould, S. J. (1996). Mismeasure of man. WW Norton & company.
Gover, H. C., Hanley, G. P., Ruppel, K. W., Landa, R. K., & Marcus, J. (2023). Prioritizing choice and assent in the assessment and treatment of food selectivity. International Journal of Developmental Disabilities, 69(1), 53-65.
Hanley, G. P. (2010). Toward effective and preferred programming: A case for the objective measurement of social validity with recipients of behavior-change programs. Behavior Analysis in Practice, 3, 13-21.
Herrnstein, R. J., & Murray, C. (2010). The bell curve: Intelligence and class structure in American life. Simon and Schuster.
Krutch, J. W. (1954). The measure of man: On freedom, human values, survival, and the modern temper. Grosset & Dunlap.
Rajaraman, A., Austin, J. L., Gover, H. C., Cammilleri, A. P., Donnelly, D. R., & Hanley, G. P. (2022). Toward trauma‐informed applications of behavior analysis. Journal of Applied Behavior Analysis, 55(1), 40-61.
Rohrer, J. L., Marshall, K. B., Suzio, C., & Weiss, M. J. (2021). Soft skills: The case for compassionate approaches or how behavior analysis keeps finding its heart. Behavior Analysis in Practice, 1-9.
Sidman, M. (1989). Coercion and its fallout. Boston: Authors Cooperative.
Skinner, B. F. (1964). Behaviorism at fifty. In T. W. Wann (Ed.) Behaviorism and phenomenology (pp. 79-97). Chicago: University of Chicago.
Wolf, M. M. (1978). Social validity: the case for subjective measurement or how applied behavior analysis is finding its heart 1. Journal of Applied Behavior Analysis, 11(2), 203-214.
Citation for the article
Lehmann, R. & Clay, C. (2023). Advocates and analysts seeking to bridge the gap: A poet and a scientist-practitioner’s take on the current pushback to ABA. Science in Autism Treatment, 20(6).
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