Dear Ms. Tung,
We are writing in response to your recent article, “How a therapy once seen as a victory for autistic kids has come under fire as abuse”. We appreciate and thank you for your thorough account of the different perspectives and challenges surrounding the legitimacy and morality of Applied Behavior Analysis (ABA). On one hand, there are proponents for the use of ABA, such as parents who have seen positive results from ABA, while on the other hand, there is the perspective of autistic adults who have undergone ABA and have spoken against its use. These different and sometimes polarized expressions of the ABA experience and outcomes can make it difficult for potential consumers to evaluate whether it’s the right fit for them or their loved one.
In the article it is purported that there isn’t sufficient empirical evidence to support the use of ABA, as there are none that meet the “gold standard” of using randomized controlled trials. However, ABA is one of the few scientifically supported approaches used to teach autistic people. In fact, among the more than 500 marketed treatments, ABA is the most extensively researched and scientifically supported, as evidenced by hundreds of peer-reviewed studies over the past 30 years. For example, a 2019 study in the Journal of Behavioral Education used a randomized controlled trial. The study, “Randomized Controlled Trial Evaluation of ABA Content on IQ Gains in Children with Autism,” found that individuals in the comprehensive ABA group experienced the greatest intelligence score gains. Additionally, a randomized controlled trial published in the Journal of Applied Behavior Analysis demonstrated the effectiveness of ABA on food selectivity in children with autism in 2019. These are just two of the many examples of empirical evidence supporting ABA.
As you pointed out, when ABA gained popularity amongst parents of autistic children in the 1990’s, it was because of its effectiveness in teaching life skills, like using the bathroom or communicating with the people around them. Some of the critiques included in your article were that ABA is compliance driven and centers around promoting eye contact or reducing self-stimulatory behavior, things that can lead to masking and were reported to be traumatic to those who received those interventions. Contemporary ABA approaches involve collaboration between practitioners and the individual being served, in which practitioners attempt to identify areas that are meaningful and important for the client and teach skills that individuals need to engage in self-care, social, and communication skills that can improve their quality of life in a meaningful way. To this effect, we invite your readers to peruse a previously written letter on this topic.
When weighing the morality of ABA, it is, as with most topics complex, requires a more nuanced conversation than simply implying that a practice is inherently good or bad. We acknowledge that is it unfortunate that those experiences occurred, and we are working as a field to listen, learn and grow, and we appreciated the inclusion of practitioners within the field who were able to speak to some of this. We also appreciated your inclusion of the positive experiences that some autistic people and their families had as well. Taken together, these negative experiences which we acknowledge still do not justify the deletion of ABA in its entirety as a potential therapy option for individuals with autism and are hopeful that in articles like yours that offering varied perspectives will provide the readers a comprehensive look at all sides of the discussion.
As scientists and practitioners working in the field of autism, we are open to feedback as we believe all experiences are important for us to grow as a field. We appreciate much of the perspective you brought into your article from autistic folks with lived experiences, parents whose children have or are in ABA programs, and practitioners in the field of ABA. The decision whether to use ABA is one that requires all stakeholders, including the individuals receiving the therapy, to examine the potential for life-changing treatment in a human way.
Sincerely,
Kaitlyn Evoy, B.A., LBS1
Liz Callahan, MA, BCBA
