Dear Mr. Gould,
We are writing in response to an article that was published about the use of Applied Behavior Analysis (ABA) for individuals with Autism Spectrum Disorders (ASD) on August 11, 2016 on theatlantic.com.
With the growth of the number of individuals being diagnosed with ASD, this article discusses an extremely important topic, the effectiveness and accessibility of therapies for individuals with ASD. The author correctly identifies ABA as being the “best-established form of therapy for children with autism.” Your readers should know that this level of scientific support is in sharp contrast to hundreds of touted therapies that lack any scientific evidence whatsoever. Unfortunately, the article is misleading about what ABA is and is not. It is important to note that while this article focused on individuals with ASD, ABA is used in business settings, educational and medical communities, with athletes and in a plethora of other areas to help solve socially significant problems. We would like to take this opportunity to outline a number of other concerns with this article, concerns that may inadvertently separate people with autism from effective treatment.
Much of the article focused on the premise that the primary goal of ABA and ABA therapists is to “normalize” individuals on the autism spectrum, which is incorrect. As articulated first by Baer, Wolf, and Risley (1968), at its core, the goal of ABA is to improve socially significant behavior to a meaningful degree. Whether that be through teaching basic self-care skills, safety behaviors, or how to complete a job application, one of the primary goals of any ABA intervention program is to help individuals become more independent, self-sufficient, and increase meaningful participation in their communities. There is also a significant improvement in the quality of life when individuals with ASD are able to overcome challenging behaviors. The empowerment that comes with the development of skills and the doors that opens for individuals is disregarded when the conversation is restricted to “normalization.”
A large body of research in ABA focuses on decreasing dangerous behaviors and those that interfere with an individual’s ability to participate in educational and employment settings. Recent research has indicated that individuals with ASD die on average 18 years before the general population (Cusack, Shaw, Spiers & Sterry, 2016). Research has also indicated that individuals with ASD exhibit higher rates of risk taking behaviors than their peers (Cavalari & Romanczyk, 2011) which can lead to significant injury and in some cases death. Failure to recognize dangerous situations, or to be able to communicate effectively during emergency situations is a significant concern for many individuals with ASD. There is wealth of literature illustrating the use of behavioral strategies for teaching safety behaviors and communication skills which can help address both of these issues.
The article also spends a significant amount of time discussing research that was conducted in the 70s and 80s. ABA programs have evolved and improved significantly since that time based on the cumulative efforts of hundreds of researchers who publish their work in peer-reviewed journals. The majority of the article describes only one approach used within ABA, discrete trial instruction (DTI). DTI is one of many approaches covered under the umbrella of ABA and the lack of a more thorough discussion or the current state of ABA research and practice is a significant failure of this article and does an injustice to the reader. It is akin to bastardizing the current field of medicine by hyperfocusing only on early research in one area of study (e.g., 1970s dermatology).
ABA is not prescriptive or “one-size-fits-all” as the authors describe. ABA programs rely on positive reinforcement, thoughtful selection from a broad array of techniques, careful individualization, and data-based decision making to create positive behavior change. The selection of goals and intervention targets is a collaborative and systematic process involving multiple individuals including the therapist, the individual, and the individual’s family. Teaching techniques are also individualized, evaluated and modified based on individual preference and performance. ABA relies on systematic observation and data collection to help identify the strengths, weaknesses, and preferences of each individual to help customize teaching strategies. Individualization and client involvement are such important elements of ABA programs that they are actually written into the code of ethics for behavior analysts. Standard 4.02 requires that clients be involved in the planning and consent for any behavior-change programs and Standard 4.03 requires that those programs be tailored to the unique needs of each individual (Behavior Analyst Certification Board, 2016).
The lack of randomized control trials (RCT) evaluating the effectiveness of any intervention program is a recognized weakness in social services. However, the large number of peer-reviewed published studies using group designs along with the hundreds of single subject design studies carried out by hundreds of independent researchers demonstrating the efficacy of ABA cannot simply be ignored, particularly when contrasted with the dearth of research for most other interventions touted for autism. In fact, a report conducted by the US Surgeon General (1999) concluded, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and increasing communication, learning and appropriate social behavior.” A criticism of the research underlying ABA falls flat when it fails to acknowledge that consumers are bombarded with false promises, dangerous treatments, and ineffective interventions that have never been tested scientifically.
People interested in learning more about what ABA is and how it can be utilized can find more information on a number of well-respected websites such as apbahome.net or bacb.com or asatonline.org or balcllc.org.
Left without correction we fear that this article has the potential to cause great harm to children and families who may erroneously believe that ABA is cruel or detrimental. Please feel free to reach out to the first author via email ecallahan@casproviders.org if you would like more information.
Sincerely,
Emily Callahan, PhD, BCBA-D
Executive Director, Council of Autism Service Providers
Media Review Committee, Association for Science in Autism Treatment
and
David Celiberti, PhD, BCBA-D
Executive Director, Association for Science in Autism Treatment
References
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.
Behavior Analyst Certification Board. (2016). Professional and ethical compliance code for behavior analysts. Retrieved from: http://bacb.com/ethics-code/
Cavalari, R. N., & Romanczyk, R.G. (2012). Caregiver perspectives on unintentional injury risk in children with an autism spectrum disorder. Journal of Pediatric Nursing, 27, 6, 632-41.
Cusack, J., Shaw, S., Spiers, J., & Sterry, R. (2016). Personal tragedies, public crisis: The urgent need for a national response to early death in autism. Retrieved from: https://www.autistica.org.uk/wp-content/uploads/2016/03/Personal-tragedies-public-crisis.pdf
United States Surgeon General. (1999). Mental health: A report of the Surgeon General. Washington, DC: Author.
