As the father of a kid with Autism and a student of ABA, I understand how critical ABA therapy is for kids with Autism. However, when I look around, ABA is not considered the primary treatment for Autism because there are so many misconceptions about ABA therapy. Why do people not consider ABA as the primary therapy for kids or adults with developmental disorders? Researches have proven that ABA therapy is the best treatment option to overcome developmental difficulties?.
What is ABA
Applied Behavior Analysis or ABA is a popular therapy for developmental disorders. The popularity is due to the vast amount of data from scientific research that points to its effectiveness. www.cdc.org states that "A notable treatment approach for people with ASD is called applied behavior analysis (ABA). ABA has become widely accepted among healthcare professionals and used in many schools and treatment clinics.". The Top 10 Reasons Children With Autism Deserve ABA, an article written in 2011 by Ms.Mary Beth Walsh, highlights ABA therapy's benefits. Unfortunately, many of the children in several countries do not get the opportunity to be treated with ABA therapy. ABA therapy is a relatively new field of science, and as every field of science, it also had its share of unpleasant practices during its early years. Today, the science of ABA places utmost priority on the welfare of the patients, and ethical practices drive the treatments. However, many parents still consider ABA with suspicion mainly due to the countless articles about 'what is wrong with ABA' found online. Many of these articles are written by people with Autism, so they influence parents considerably.
Let us take a brief overview of ABA and discuss why ABA has not received the recognition it truly deserves. There are several misconceptions about ABA therapy, and understanding the truth will help us appreciate ABA better. What is ABA, what are the misconceptions about ABA, and why are they wrong?
A new science
Applied Behavior Analysis (ABA) as a discipline formally started in 1968, and ABA therapy was recognized as a possible treatment option in the 1970s. ABA Therapy has been around for half a century and is based on several principles, and one of them is that when behavior is rewarded, it is more likely to be repeated. More recent ABA Therapy research has proven its success, and ABA has evolved into the standard of care for children with cognitive and developmental disabilities.
ABA is a rapidly growing field that is considered the gold standard of therapy for autism spectrum disorder. As the father of a kid with Autism and a student of ABA, I understand how critical ABA therapy is for kids with Autism. However, when I look around, ABA is not considered the primary treatment for Autism because there are so many misconceptions about ABA therapy. Why do people not consider ABA as the primary therapy for kids or adults with developmental disorders, although ABA therapy has proven to be the best treatment option to overcome developmental deficits?
While countries like the USA and Canada are frontrunners in offering advanced therapies like ABA, it remains largely an unknown therapy outside North America. In my second term at the University, I am convinced that it makes a big difference to children. It's a lifesaver. Being an Autism dad and a student of ABA places me in a unique position where I can relate to parents' expectations and, at the same time as a professional can understand how it will teach children to acquire new skills that provide them a better life.
But many parents are not optimistic about ABA therapy, and we can't blame them. If a search is conducted online for ABA, we get many articles that paint a different picture, and some are by people with Autism. Even in the several autism groups where I am a member, I find few takers for aba therapy but find many parents willing to experiment with unproven methods like Nemechek protocol, Son-rise program, or Homeopathy. The efficacy of aba must be conveyed to parents so that kids get this life-changing therapy.
Misconceptions about ABA
There are several misconceptions about ABA. I would like to discuss the key ones.
1. Creating the 'Normal.'
One of the criticisms of ABA is that kids are taught to behave like robots. Many adults with Autism who had undergone ABA therapy in the past have termed it cruel and abusive. The critics have been very vocal and have found sympathy and support in online communities. Like any field, ABA has been influenced by practices prevalent in society. Societies have progressed by adopting better practices throughout their history.
Why do critics of ABA say that it tries to make people normal? What is the truth?
As we know it today, the ABA therapy originated in the 1960s, led by psychologist Ole Ivar Lovaas. He devised programs that taught children skills to students, mask their autism characteristics, and appear typical kids. He was successful in teaching kids new skills, behaviors, and reducing unwanted behavior. Because the kids could not learn from their surroundings or through imitation, they had to be taught everything, starting from alphabets, numbers, words to sentences. They had to be taught how to behave in situations that would not have posed any problem to a kid without Autism. Lovaas' ABA was formulaic, a one-size-fits-all therapy in which all children, for the most part, started on the same lesson, no matter what their developmental age was. In the 1960 or 70s, people with developmental issues ( mental retardation) were institutionalized. Lovaas tried a new treatment when they did not have any hope of improving their lives. ABA therapy has grown leaps and bounds since then and today benefits millions of people.
When a kid faces a situation where he cannot learn any skill, we need to teach them skills from the ground up and follow a well-thought-out program. The critics of ABA therapy advocate for neurodiversity which means that therapists or the public should not try to change them but rather accept them for who they are.
While kids who received ABA therapy in the 1960s and 1970s may be right in criticizing because the earlier years of ABA therapy involved repetitive trials meant to teach children skills like eye contact or communicating with others that followed a specific pattern. The children behaved rigidly without much variability. However, ABA today places much importance on generalization, which means children should exhibit their skills in a natural environment, and the treatment involves ways to bring variability. Today ABA places the interests of children at the forefront and emphasizes teaching them relevant life skills to make them independent in their daily activities. It will be cruel not to teach skills that can help people with Autism succeed in their lives.
For kids with Autism, more or less everything in their life needed to be taught for them to succeed in life. Because of the skill deficits, they may always follow the routine that is taught to them. ABA emphasizes the importance of teaching the same activity in different settings, which would help the child to adapt to different situations. However, every situation is different in its way, and children with Autism tend to stick to the routine to get the task done. For the person with Autism, It's not the means but the end that matters.
2. Cruel Therapy
The aversive training components of the therapy also drew criticism. In the 2011 article, In Memoriam, O. Ivar Lovaas, authors mention that "Like all behavior modification programs, his was 98% positive reinforcement, with only a trace of aversive control. Yet, true to the journalistic tradition, the Life article used only those few photographs showing aversive events, out of the hundreds they had taken".Punishment is not accepted in today's society, and ABA rightfully has moved away from it. Corporal punishments were part of school life a few decades back, and ABA also had adopted the practices prevalent in the society then.
Today ABA does not use corporal punishments. However, they employ punishment tactics that are of a different variety. Punishment here refers to "withholding of rewards." For example, timeout is a procedure where the child is denied access to an environment or event that he was a part of or, response cost where the child likes are removed from them. This is employed to teach the child that inappropriate behaviors do not attract good things that he likes. These things are given to him when the child exhibits the desired behavior.
3. Too Demanding
Another area less understood by parents is the demand for intensive therapies. ABA therapies are successful when kids have about 25-40 hours a week. This is very different from other therapies like Speech or Occupational therapy (OT), where sessions can be as less as 5 hours to 10 hours a week. ABA requires a lot of time as it needs to teach several skills.
While insurance pays for ABA therapy in countries like the US and Canada, most countries' parents have to spend out of their pockets. As ABA requires many hours, the overall costs are high The need for intensive therapy has to be understood first. ABA tries to shape a child's behavior or teach a new behavior to a child. Since there is a process of unlearning old behaviors and learning new behaviors, and that involves multiple trials. Developmental disorders are highlighted by deficits in social and skills and language skills. A child learns by observing his environment or surroundings. When this ability is not available to the child, it is an uphill task to teach the kid with Autism the required skills in different settings and other people.
Many parents do not consider ABA therapies as the primary treatment due to these misconceptions and the low awareness of ABA in most countries. Parents opt for Occupational therapy and Speech therapy as their immediate treatment and thereby deny their child the proven method or the best option available for Autism. ABA is most effective if carried out in the early years. Hence, ABA is considered the primary treatment, and other therapies like OT, Speech can be additional treatments depending on the child's needs.