ABA Controversy

[cara susanna]

Hi all,

I found this petition Sign the Petition which led to my reading this article Is ABA Really “Dog Training for Children”? A Professional Dog Trainer Weighs In. | The Aspergian | A Neurodivergent Collective

I know that ABA has been controversial for a while. I remember that study that showed PTSS in adults with autism who had gone through ABA (linked in that petition, I believe). I would love to hear thoughts from people in the field, especially those who are trained in ABA.

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[WisNeuro]

Last time this was brought up here, I believe the idea was that some people that were claiming to be practitioners of ABA, were not really following the principles of ABA. Just like Dr. Oz is a medical doctor, but I'd hardly generalize his shady and oftentimes harmful practices to all physicians.

 

[PsyDr]

1) I can't imagine trusting the opinion of a dog trainer for pretty much anything. Including training a dog.

2) There is no such thing as PTSS. That's a purely political thing. Either there are formal diagnostic criteria for psychiatric disorders, or there's not. The latter is a very dangerous thing.

3) PTSD requires "Exposure to actual or threatened death, serious injury, or sexual violence ". ABA therapies do NOT qualify for criterion A. Any psychologist immediately knows this. Any who don't are incompetent.

 

[WisNeuro]

2) There is no such thing as PTSS. That's a purely political thing. Either there are formal diagnostic criteria for psychiatric disorders, or there's not. The latter is a very dangerous thing.

I have PTSS from a combination of my PCS and CFS, now I need my ESA!

 

[erg923]

A Neurodivergent Collective

Its hard to even get the motivation to read this when part of title seems like it was brain-stormed in a room of overly over-sensitive/overly PC high school students.

Otherwise, if my kid learn the same way as a dog does (and obviously they do), what the inherent problem?

 

[cara susanna]

Well, that's the thing, a lot of this sounds along the same lines as "exposure is torture!" But I work primarily with adults so I don't acknowledge myself as an expert. I can definitely agree with the complaint about calling things PTSD when they don't meet Criterion A. I'm pretty stringent about using the terms PTSD or even the word "trauma."

 

[DynamicDidactic]

Apparently someone wrote a response

 

[erg923]

Apparently someone wrote a response

Without reading all this noise (and I promise I will later), I admit I am getting hung up on the title, and maybe the semantics?

So what if your your child is trained in the same way we train dogs? Don't we use classical condition for bedtimes? Eating behaviors? Don't we use operant conditions principles for like,...everything else with our kids behavior before age 6?! What am I missing here?

Your child ultimately learns in the same way dogs, pigeons, and rats do. Yes, we are capable of much more on-top of that...but principles of learning and behavior extend across species. This is more than plainly obvious to anyone who has children. And probably even to those who don't? That's just the way it is. We didn't just invent operant learning from thin air. Same with classical conditioning. I really think we need to change the title of these articles, or else its just going to come across as cheapened click-bait.

 

[PsyDr]

Without reading all this noise (and I promise I will later), I admit I am getting hung up on the title here, and maybe the semantics?

So what if your your child is trained in the same way we train dogs? Your child ultimately learns in the same way dogs, pigeons, and rats do. Yes, we are capable of much more on-top of that...but principles of learning and behavior extend across species. This is more than plainly obvious to anyone who has children. And probably even to those who don't. That's just the way it is. We didn't just invent operant learning from thin air. Same with classical conditioning. I really think we need to change the title of these articles, or else its just going to come across as cheapened click-bait.

Some television channel makes a TV show about how to train your kid, using behavioral techniques. They use "like a dog", because... you know.. media. The same group that threw a bunch of Amish people in times square.

Young lady with Aspergers gets employed as a dog trainer. Lady writes an article that basically says that ABA therapy doesn't help with emotional outcomes for individuals with ASD. Article cites an article that shows individuals with ASD who undergo ABA therapy have a negative response to trained adversive stimuli. Somehow this is PTSD, even though it doesn't meet criterion A. Article doesn't seem to realize this is de facto proof that conditioning works. Article then says that the point of ABA therapy is to make kids with ASD act like "normal" kids. Article says that a bunch of adults with ASD have said online that they are not happy, even though they underwent ABA therapy. Articles doesn't seem to understand the concept of a control group or sampling. Article then uses a lot of strained logic to say because adults who underwent ABA are reporting they are unhappy, this means ABA therapy is not only ineffective, but that it hurts individuals' emotional health. Article also says a good solution is to just let individuals with ASD engage in associated behaviors, and everyone just needs to embrace it.

The world embraces the opinions of a dog trainer, because....?

 

[FreudianSlippers]

The world embraces the opinions of a dog trainer, because....?

The same reason the world embraces opinions of political pundits about climate change and the economy, rather than scientists and economists ,

 

[Sanman]

Some television channel makes a TV show about how to train your kid, using behavioral techniques. They use "like a dog", because... you know.. media. The same group that threw a bunch of Amish people in times square.

Young lady with Aspergers gets employed as a dog trainer. Lady writes an article that basically says that ABA therapy doesn't help with emotional outcomes for individuals with ASD. Article cites an article that shows individuals with ASD who undergo ABA therapy have a negative response to trained adversive stimuli. Somehow this is PTSD, even though it doesn't meet criterion A. Article doesn't seem to realize this is de facto proof that conditioning works. Article then says that the point of ABA therapy is to make kids with ASD act like "normal" kids. Article says that a bunch of adults with ASD have said online that they are not happy, even though they underwent ABA therapy. Articles doesn't seem to understand the concept of a control group or sampling. Article then uses a lot of strained logic to say because adults who underwent ABA are reporting they are unhappy, this means ABA therapy is not only ineffective, but that it hurts individuals' emotional health. Article also says a good solution is to just let individuals with ASD engage in associated behaviors, and everyone just needs to embrace it.

The world embraces the opinions of a dog trainer, because....?

Well, you know some people had bad outcomes. Thankfully, there are no adverse reactions or negative side effects when using psychotropic medications, especially in the long-term for chronic mental health issues. That's why they enjoy such widespread use.

 

[LadyHalcyon]

#fakenews

1) I can't imagine trusting the opinion of a dog trainer for pretty much anything. Including training a dog.

2) There is no such thing as PTSS. That's a purely political thing. Either there are formal diagnostic criteria for psychiatric disorders, or there's not. The latter is a very dangerous thing.

3) PTSD requires "Exposure to actual or threatened death, serious injury, or sexual violence ". ABA therapies do NOT qualify for criterion A. Any psychologist immediately knows this. Any who don't are incompetent.

 

[ClinicalABA]

This is not evidence of a controversy. It’s an opinion piece.

 

[cara susanna]

Oh, I know, but it's not the first time I've heard the opinion that ABA is unethical and tantamount to torture, especially on social media.

 

[PsyDr]

@LadyHalcyon Let's buy Greenland! Highest suicide rate in the world. Endless referrals! It'll be huuuuuuuuuuuuuuuuuge.

@cara susanna @Sanman People complain because it does look awful. That doesn't mean it's unhelpful. The merit of painful things to achieve positive outcomes is recognized in medicine, physical therapy, personal training, all of education, etc. We should be wary for trends that try to avoid sacrifice to achieve.

 

[ClinicalABA]

@LadyHalcyon Let's buy Greenland! Highest suicide rate in the world. Endless referrals! It'll be huuuuuuuuuuuuuuuuuge.

@cara susanna @Sanman People complain because it does look awful. That doesn't mean it's unhelpful. The merit of painful things to achieve positive outcomes is recognized in medicine, physical therapy, personal training, all of education, etc. We should be wary for trends that try to avoid sacrifice to achieve.

If done correctly it really shouldn't "look awful" or be "painful."

 

[StellaB]

@cara susanna @Sanman People complain because it does look awful. That doesn't mean it's unhelpful. The merit of painful things to achieve positive outcomes is recognized in medicine, physical therapy, personal training, all of education, etc. We should be wary for trends that try to avoid sacrifice to achieve.

I think there can be legitimate questions about cost/benefit ratios when the patient population is vulnerable (e.g. children), and/or when the effects of a treatment are more beneficial to the people around the patient than the patient themselves (e.g. some treatments for SMI). I don't do ABA and don't have a specific opinion on it. My only point is that if some of the people who have been treated with it really felt that it was awful/not beneficial, that experience deserves at least some cursory respect and curiosity on our part. There are a lot of unskillful practitioners out there. I don't feel like I have to stretch my imagination all that far to picture a scenario in which properly applied ABA is effective and helpful, while ham-fisted attempts at the same treatment could be harmful or demeaning.

 

[WisNeuro]

while ham-fisted attempts at the same treatment could be harmful or demeaning.

This could be said for most psychological or medical treatments. Is there anything specific about ABA, or should we just say that we need to examine every treatment and training protocol?

 

[deleted343839]

There are a lot of unskillful practitioners out there. I don't feel like I have to stretch my imagination all that far to picture a scenario in which properly applied ABA is effective and helpful, while ham-fisted attempts at the same treatment could be harmful or demeaning.

There is some money to be made in the field, especially as more state legislatures have adopted autism treatment mandates requiring payers to cover costs of ABA. The hierarchical structures of these clinics, wherein the cheapest and least trained staff spend the most face-to-face time with patients, can make them profitable. In my city there are several large ABA clinics and they all have weak reputations. I agree with @WisNeuro, though, that this is mainly a problem of implementation and not a sign of something disproportionately risky about ABA in particular.

Article also says a good solution is to just let individuals with ASD engage in associated behaviors, and everyone just needs to embrace it.

There are effective and reasonable arguments favoring greater accommodation and inclusion of folks on the spectrum. On the more extreme side are juvenile-sounding demands to unilaterally renegotiate the social contract, which has more to do with characterological issues than ASD. This article seems more like the latter.

 

[StellaB]

This could be said for most psychological or medical treatments. Is there anything specific about ABA, or should we just say that we need to examine every treatment and training protocol?

The thing that is "specific about ABA" is that it is typically administered to patients with reduced / no choice in the matter. In those cases, I don't think the appropriate response is simply dismissing complaints out-of-hand as people being unwilling to make sacrifices for eventual gain. Maybe the complaints are meritless, of the anti-vax or safe-space avoidance-of-everything variety. Or maybe there is something to this. I'm only advocating a curiosity mindset rather than a prematurely closed one, given the people who receive this treatment are typically children at the time.

I'm thinking about all the dismissals of complaints about Larry Nassar. Do we need to examine every treatment and training protocol? No, probably not. Is there research about the effects of poorly applied ABA, and are parents / practitioners aware of any potential negative effects? (Not rhetorical, I do not know the answer to this). I think in general we have a tendency to assume that therapies don't have side effects or negative consequences - or the conditions in which we study them are so tightly controlled that we don't have an accurate sense of what the treatments really look like in the community. When I was an undergrad and looking for psychology-related jobs, there were a LOT of ABA-type jobs with potentially minimal training. So, should something be examined? IDK, maybe.

 

[WisNeuro]

The thing that is "specific about ABA" is that it is typically administered to patients with reduced / no choice in the matter. In those cases, I don't think the appropriate response is simply dismissing complaints out-of-hand as people being unwilling to make sacrifices for eventual gain.

The healthcare system provides treatments/procedures to patients with reduced/no choice/no medical decision making capacity millions of times a day. Once again, is there something specific about ABA? I'm all for curiosity, but I'd rather that curiosity come from some substance, rather than baseless claims that can be made about literally anything in healthcare.

 

[PsyDr]

I think there can be legitimate questions about cost/benefit ratios when the patient population is vulnerable (e.g. children), and/or when the effects of a treatment are more beneficial to the people around the patient than the patient themselves (e.g. some treatments for SMI). I don't do ABA and don't have a specific opinion on it. My only point is that if some of the people who have been treated with it really felt that it was awful/not beneficial, that experience deserves at least some cursory respect and curiosity on our part. There are a lot of unskillful practitioners out there. I don't feel like I have to stretch my imagination all that far to picture a scenario in which properly applied ABA is effective and helpful, while ham-fisted attempts at the same treatment could be harmful or demeaning.

Yeah, I see significant problems with that line of reasoning.

1) If you change the diagnosis, it doesn't hold.
a. ODD
b. ADHD
c. selective mutism
d. childhood schizo

2) I am unaware of any "real" studies that show that ABA is harmful. Or that such complaints are common, but I am not an autism guy. Furthermore, the treatment might have actually improved the functional level of the individual, but not the mental health. We will only know if a true study is performed with controls. Maybe that's been done, I dunno.

3) Something being extremely unpleasant is a non-issue. If you've ever treated phobias, OCD, intrusive thoughts, PTSD, etc, you'll recognize that the treatment is unpleasant. But they work.

4) IMO, you conflated "demeaning" with harmful, but that is an extremely important aspect.

a. Behavioralism works. This is recognized in most finance and AI firms. AI firms use these concepts in their programming. And they are constantly hiring consultants for this.
b. The concept that there are non-informational/didactic ways of learning can be considered demeaning. But that is a substantial basis for the field. Remember Skinner conditioning whatshisname with head nods in that debate? Seen generic sleep hygiene stuff? Seen testing that shows tendencies outside of our subjective awareness (not projectives)?. Similar ideas. There are behaviors outside of our awareness. Many people find this concept hostile.

5) The concept of greater accommodations and inclusion is aspirational. And potentially dangerous. It would be great if every person with ASD spontaneously developed verbal behavior. But that isn't the case. There are normative behaviors. In general, one's ability to navigate life is significantly affected by one's ability or willingness to engage in the normative behaviors. Things like sitting in an MRI don't have work arounds, but they improve one's life.

 

[ClinicalABA]

As an ABA practioner, supervisor, and faculty, I believe it would be irresponsible to dismiss criticisms out of hand. Similar to the rest of psychology/ psychiatry, our past wasn’t always stellar, and our present is certainly impacted by factors such as poor training, limited resources, renegade practitioners, etc. Current clinical practices (at least in the home-based, autism, insurance funded world are pyramidal in nature, with most direct services provided by BA level, non-certified staff, supervise by a MA level clinician who is certified (by the BACB who certifies at the national/international levels) and increasingly licensed by the state. Ratios of direct service to supervision hours for early intensive behavioral intervention (EIBI) is- or at least should be- 10:2. Things can go wrong, and poor supervision can make them go “wringer”.

All that said, if ABA services are consistently causing pain or discomfort (or are consistently being implemented against active resistance) something is not right (with the possible exception of interventions for severe self-injurious behavior). It has been my experience, having worked and researched in a variety of setting with a variety of clients across the lifespan that it is more often than not the ABA practitioner who is advocating against coercive or restrictive interventions in favor of function-based treatments with the goal of increasing adaptive functioning and overall contentment and well-being. On the other side of that argument are often other disciplines, such as nursing, medicine, education, etc.

Also, if someone reaches adulthood and is still having legitimate difficulties with social skills, emotional regulation, etc, is such that is more likely due to a lack of appropriate services rather than an overabundance of ABA.

 

[DynamicDidactic]

I think in general we have a tendency to assume that therapies don't have side effects or negative consequences

I think this is a very interesting point. I do not know if anyone has looked at how practitioners view harm from psychotherapies. Conversely, there is a relatively large literature on harm from psychological treatments. Some of these are well-supported by empirical work (e.g., CISD, or at least the early iterations of it) and others don't have a strong empirical basis but lots of theoretical and anecdotal support (e.g., conversion/reparative therapies). Other treatments have been debated without consensus (e.g., grief therapy). I'll steer clear of talking about the harm from psychopharmacological treatments.

When working with developmental disabilities there is a long history of unethical and harmful treatments. For those not familiar, here is a background on Willowbrook in Staten Island, NY (note: some sad stuff going on here): The horrors of Willowbrook State School and you can still find practitioners of debunked treatments like facilitated communication (for a synopsis: Facilitated Communication and Autism - Interventions - Research Autism).

All this means is that I would love to see an empirical examination (as others have stated) with controls on the harm/efficacy ratio of ABA from certain problems. I'll keep my mind open that, potentially, ABA can be harmful to someone. I have no evidence to cite but the school that shocks their students as the modus operandi always troubled me (). Again, I don't know how harmful this is but it definitely doesn't sit right with me.

 

[ClinicalABA]

I have no evidence to cite but the school that shocks their students as the modus operandi always troubled me (). Again, I don't know how harmful this is but it definitely doesn't sit right with me.

Oh- it can be be pretty harmful. Ripe for abuse/overuse by staff, ineffective for long-term reduction of certain behaviors in the absence of shock, and also negative impacts on the well-being of the person delivering the shock.

Let me just say that shock and other such use of aversives to change human behavior have been around for millennia, while ABA has only been around- as a formal discipline- for half a century or so. JRC is the only place in the country that uses shock. You will not find a behavior analyst outside of that place who uses such an intervention, nor will you find many behavior analysts outside of that place who endorse such an intervention. Technically and historically it may be ABA, but then again technically and historically it is also psychology. As such, it would be kind of unfair to lump in practitioners of aversive shock treatment with those who do, say, systems focused couples therapy. As an aside- I have been to JRC on a few occasions professionally- I found the place a bit creepy and the experience unnerving. I did not see any shock administered, but the the backpacks on the students with the devices and the switch boxes with the staff were a reminder of what goes on there.

You also mention Willowbrook. I currently teach Ethics in ABA, and Willowbrook is used as the example of what not to do (it was abuse, not therapy- ABA or otherwise) and one of the reasons why it is important for our field to have documented ethical standards and codes of conduct.

 

[erg923]

I think this is a very interesting point. I do not know if anyone has looked at how practitioners view harm from psychotherapies. Conversely, there is a relatively large literature on harm from psychological treatments. Some of these are well-supported by empirical work (e.g., CISD, or at least the early iterations of it) and others don't have a strong empirical basis but lots of theoretical and anecdotal support (e.g., conversion/reparative therapies). Other treatments have been debated without consensus (e.g., grief therapy). I'll steer clear of talking about the harm from psychopharmacological treatments.

When working with developmental disabilities there is a long history of unethical and harmful treatments. For those not familiar, here is a background on Willowbrook in Staten Island, NY (note: some sad stuff going on here): The horrors of Willowbrook State School and you can still find practitioners of debunked treatments like facilitated communication (for a synopsis: Facilitated Communication and Autism - Interventions - Research Autism).

All this means is that I would love to see an empirical examination (as others have stated) with controls on the harm/efficacy ratio of ABA from certain problems. I'll keep my mind open that, potentially, ABA can be harmful to someone. I have no evidence to cite but the school that shocks their students as the modus operandi always troubled me (). Again, I don't know how harmful this is but it definitely doesn't sit right with me.

Point taken. But we cant keep doing the "I'm really sorry about what we used to do" stuff as an effective way to counter current gross misconceptions. I guess its part of the historical narrative, but it really doesn't address the current criticisms. Because, obviously, we dont do that stuff anymore and haven't for a long time.

 

[cara susanna]

In general reinforcement is more effective than punishment, so wouldn't effective ABA be less focused on aversion methods?

 

[foreverbull]

In general reinforcement is more effective than punishment, so wouldn't effective ABA be less focused on aversion methods?

The author argues that even negative reinforcement can be harmful (i.e. hurting the dog so the dog will bite on the dumbbell = increasing biting on the dumbbell behavior because it removes an aversive stimulus; this was an mentioned as an example of how they used to train service dogs, I think?).

I don't disagree with what's been said here, but want to hearken back to one point the author makes about client well-being language or the lack thereof in the ABA guidelines (as someone generally unfamiliar with ABA): does ABA fall under APA's ethics code? Are there more explicit guidelines somewhere that she isn't quoting about minimizing harm? If not, I would just say that clarity in language can go a long way in protecting children from improper application of ABA principles and/or abusive practices.

 

[ClinicalABA]

...does ABA fall under APA's ethics code? Are there more explicit guidelines somewhere that she isn't quoting about minimizing harm? If not, I would just say that clarity in language can go a long way in protecting children from improper application of ABA principles and/or abusive practices.

Practitioners are subject to specific professional ethics codes and standards based on their credentialling/licensure. As a licensed psychologist and licensed/certified behavior analyst, I'm subject to the APA code and the BACB (Behavior Analyst Certification Board) code. Most ABA is overseen by masters level BCBAs who are subject to the BACB code (related questions make up a substantial portion of the BCBA certification exam). I teach Ethics in ABA, and we focus on the BACB code.

That said, there were and are non-psychologist, non-BCBA practitioners of ABA (e.g., teachers, school counselors, to a lesser extent MDs) who have ABA within the legal scope of their practice. They are subject to whatever they are subject to.

Let me emphasize again- At least in the areas in which I practice (home based EIBI; public school consult). ABA is primarily (and almost exclusively) antecedent manipulation and positive reinforcement based. Heck, I actually have to spend time in my class emphasizing that punishment is not, in fact illegal, and that there are situations when it is the most ethical approach (I'm not talking about shock and other physical aversives). The field largely emphasizes function based approaches, and punishment is distinctly non-function based. In most agencies and systems, the use of punishment requires an extreme level of approval and senior clinical peer review (MUCH more scrutiny and oversight than your typical psychologist doing ERP is going to have, by the way). In the case of the shock at JRC, it requires court approval following guidelines for substituted judgement.

I will say that your typical BCBA does not receive training in identifying signs or symptoms of any psychiatric disorders or conditions. Clients, families, systems, etc, who are relying on your friendly local behavior analyst to identify and treat symptoms of emotional or characterological conditions are making a mistaking. Conversely any BCBA who is providing psychodiagnostic assessment and treatment is working beyond the scope of their practice and most likely committing the crime of practicing psychology without a license.

 

[ClinicalABA]

In general reinforcement is more effective than punishment, so wouldn't effective ABA be less focused on aversion methods?

Actually, it depends on how you define "effective." Punishment will lead to the most rapid reduction in behavior, as well as a much more lasting effect as long as the punishing contingency remains highly likely. Problem is it that it can come with some pretty nasty side effects for both the recipient and deliverer. It could easily be argued that in the history of mankind, punishment has been the most widely used and abused method of behavioral control (perhaps only second to the old sword or arrow to the heart). As clinicians we most take into account these side effects as well as client and social acceptability.

I keep saying this- very little (inconsequentially little) of the effective ABA that I and others like me do involves punishment. Even the use of artificial reinforcers is avoided whenever possible.

 

[foreverbull]

Let me emphasize again- At least in the areas in which I practice (home based EIBI; public school consult). ABA is primarily (and almost exclusively) antecedent manipulation and positive reinforcement based. Heck, I actually have to spend time in my class emphasizing that punishment is not, in fact illegal, and that there are situations when it is the most ethical approach (I'm not talking about shock and other physical aversives). The field largely emphasizes function based approaches, and punishment is distinctly non-function based. In most agencies and systems, the use of punishment requires an extreme level of approval and senior clinical peer review (MUCH more scrutiny and oversight than your typical psychologist doing ERP is going to have, by the way). In the case of the shock at JRC, it requires court approval following guidelines for substituted judgement.

I will say that your typical BCBA does not receive training in identifying signs or symptoms of any psychiatric disorders or conditions. Clients, families, systems, etc, who are relying on your friendly local behavior analyst to identify and treat symptoms of emotional or characterological conditions are making a mistaking. Conversely any BCBA who is providing psychodiagnostic assessment and treatment is working beyond the scope of their practice and most likely committing the crime of practicing psychology without a license.

Thank you for clarifying.
I don't recall the author ever actually stating what happens in ABA in the article, it seemed more like a hypothetical concern based on the history of the founder & radical behaviorism and the language in the treatment purpose. It doesn't sound like the author ever observed ABA in action, which I think creates the disconnect and extreme position-taking on her part. If she had actually seen it in practice, would she feel that it is as dehumanizing as she makes it sound? Anything taken to an extreme can be unhealthy, but in the real world, there's more leeway and flexibility. We (humans) use principles of behaviorism all the time (and rarely--if ever--is as robotic and as impersonal as behavior theory sounds on paper).

 

[DynamicDidactic]

Because, obviously, we dont do that stuff anymore and haven't for a long time.

Plenty of practitioners still practice harmful therapies (e.g., facilitated communication, CISD).

Let me just say that shock and other such use of aversives to change human behavior have been around for millennia, while ABA has only been around- as a formal discipline- for half a century or so.

I am not trying to support the original article and don't think that ABA is generally harmful. I am in support of questioning potential harm from treatments considered standard practice. I believe vigilance is key.

 

[ClinicalABA]

I am not trying to support the original article and don't think that ABA is generally harmful. I am in support of questioning potential harm from treatments considered standard practice. I believe vigilance is key.

No thoughts that you did on my part. I also couldn't agree more with your point about questioning harm from what we do.

 

[WisNeuro]

No thoughts that you did on my part. I also couldn't agree more with your point about questioning harm from what we do.

I also wholeheartedly agree with this. But I return to one of my earlier points, I'm ok with studying this when it's based on something real, and not an agenda with no substance. Just like medication studies, any RCT for a psychological intervention should examine adverse outcomes, in the short and long term. Unlike pharma studies, we would do it without inappropriate analyses to minimize these effects, when they exist.

 

[ClinicalABA]

I also wholeheartedly agree with this. But I return to one of my earlier points, I'm ok with studying this when it's based on something real, and not an agenda with no substance. Just like medication studies, any RCT for a psychological intervention should examine adverse outcomes, in the short and long term. Unlike pharma studies, we would do it without inappropriate analyses to minimize these effects, when they exist.

Yep- the article cited did not represent and actual "controversy," nor did it clearly identify any specific ABA therapy that anybody actually received. There are no citations or evidence for many of the statements (e.g., "ABA can't explain language").

Having worked (and still working) in both ABA and psychology (though that distinction is not a clear as one might think) it has been my observation that ABA does a much better job of clearly operationalizing treatment goals, objectively measuring progress, and revising or discontinuing treatment in the absence of progress or the presence of non-desirable side-effects. ABA is, in my experience. also less likely to negatively label clients who do not make progress.

 

[cara susanna]

I remember my Learning professor, who was a hardcore and passionate behaviorist, said that Chomsky didn't really refute behaviorism because behaviorism never really claimed what Chomsky was disputing. I can't remember specifics though...

 

[clausewitz2]

I remember my Learning professor, who was a hardcore and passionate behaviorist, said that Chomsky didn't really refute behaviorism because behaviorism never really claimed what Chomsky was disputing. I can't remember specifics though...

As a former theoretical linguist while I find ACT approaches compelling therapeutically and clinically, the actual RFT explanation of human language is hilariously inadequate to account for 50+ years of data gathered by generative linguistics at this point. Where it is not obviously not cutting the mustard it is bending over backwards to smuggle some kind of abstract rule-governed underlying cognitive structures into it's account without calling them that.

Of course if RFT is not typical of modern behaviorist accounts of human language I am very open to having my mind expanded.

 

[DynamicDidactic]

Thought this would be useful to post

FDA Takes Rare Step to Ban Electrical Stimulation Devices for Self-Injurious or Aggressive Behavior

The U.S. Food and Drug Administration today published a final rule to ban electrical stimulation devices (ESDs) used for self-injurious or aggressive behavior.

www.fda.gov

 

[ClinicalABA]

Thought this would be useful to post

FDA Takes Rare Step to Ban Electrical Stimulation Devices for Self-Injurious or Aggressive Behavior

The U.S. Food and Drug Administration today published a final rule to ban electrical stimulation devices (ESDs) used for self-injurious or aggressive behavior.

www.fda.gov

Attended the Connecticut ABA conference last month, where a group from the Judge Rotenberg Center *JRC) presented. They are the only program in the US, AFAIK, that uses skin shock aversives. The conferences was a few days after this FDA ruling. The presenter said that they were planning on, in conjunction with their parent organization, suing the FDA over this ruling.

JRC continuously promotes the position that skin shock punishment is used as a humane treatment for severe self injurious behavior. Things like retinal detachment, biting own lips off, ear disfigurement, etc. However, I have worked with ex-students of theirs where it was used to "treat" obsessive thoughts and verbalizations associated with OCD, food seeking behavior in individuals with Prader-Willi, and general non-compliance with staff directives. I have visited the program, and it is striking to see student walking around with backpacks that contained the batteries for the shock mechanism (known as the GED). There were also, at the time, some pretty extreme dietary policies and food restrictions being used as well.

I actually was interviewed by someone from amnesty international regarding JRC and their use of shock. The interviewer was somewhat amazed that she had spoken with ex-students (and their families) who supported its use.

 

[DynamicDidactic]

Great information @ClinicalABA

Interesting to see what happens.

 

[Fan_of_Meehl]

Hi all,

I found this petition Sign the Petition which led to my reading this article Is ABA Really “Dog Training for Children”? A Professional Dog Trainer Weighs In. | The Aspergian | A Neurodivergent Collective

I know that ABA has been controversial for a while. I remember that study that showed PTSS in adults with autism who had gone through ABA (linked in that petition, I believe). I would love to hear thoughts from people in the field, especially those who are trained in ABA.

In the immortal words of Timothy Vollmer, "punishment happens" (whether it hurts our feefees or not, LOL).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1284411/pdf/12555920.pdf

 

[Sanman]

Does someone want to write an article entitled Is Dog Training Really “Child Training for Dogs”? A Professional ABA practitioner Weighs In. We can discuss the ethics of using behavioral techniques meant for humans on animals. I mean dogs are often cuter and some are already treated better than many humans. No one would come to check if I had a fenced yard when bringing a child home from the hospital. I'm sure PETA would publish it.

 

[Fan_of_Meehl]

Does someone want to write an article entitled Is Dog Training Really “Child Training for Dogs”? A Professional ABA practitioner Weighs In. We can discuss the ethics of using behavioral techniques meant for humans on animals. I mean dogs are often cuter and some are already treated better than many humans. No one would come to check if I had a fenced yard when bringing a child home from the hospital. I'm sure PETA would publish it.

Too busy trying to dodge the punishment of my work environment (delivered on a variable interval schedule) to write anything other than progress notes, mental health suite treatment plans, and suicide safety plans.

 

[Sanman]

Too busy trying to dodge the punishment of my work environment (delivered on a variable interval schedule) to write anything other than progress notes, mental health suite treatment plans, and suicide safety plans.

Not at acceptance or learned helplessness, huh? Don't worry, you'll stop trying to dodge it eventually.

 

[Fan_of_Meehl]

Well, that's the thing, a lot of this sounds along the same lines as "exposure is torture!" But I work primarily with adults so I don't acknowledge myself as an expert. I can definitely agree with the complaint about calling things PTSD when they don't meet Criterion A. I'm pretty stringent about using the terms PTSD or even the word "trauma."

Okay, so I brought myself to read the article (as much of it as I could stand without signaling for escape).

As I see it, the author shamelessly conflates a TECHNOLOGY (ABA, which can be used for 'good' or 'evil' depending on the wielder of that technology) with IDEOLOGY (the author complains that the (straw man) applied behavior analyst doesn't 'value' the 'well-being' or 'emotions' of the client receiving ABA services).

It's a Sophistic tactic that is employed all too often these days (even in professional articles, if we pay attention). The formula goes:

(1) make a public display of 'aligning' yourself with some marginalized/victimized group that automatically evokes sympathy in the average person (e.g., 'I'm an 'ally' for autistic people, or veterans, or whomever)
(2) put forth a position that subtly 'begs the question' involving the veracity/efficacy of your proposed policy (ABA bad, or...requiring 10 pages of rigid suicide assessment procedures/questions everytime a veteran blinks is 'good' and 'quality assessment')
(3) claim that anyone with an alternate opinion (ABA good, or...maybe 'quality' suicide risk assessment can be somewhat flexible and context-dependent especially when conducted by a doctoral-level professional who knows the individual case history) doesn't 'care for autistic people' or 'wants to be careless in suicide risk assessment for veterans and therefore 'doesn't really care enough for veterans'

 

[mypointlesspov]

Reviving this thread after falling down a Wikipedia rabbit hole about Judge Rotenberg Center. I vaguely remember hearing about them over the summer, but it didn't register until now.


There's a new book coming out about JRC's use of electric shock (‘How could that be legal?’: Book examines Mass. facility that uses electric shock on residents) and I'm wondering (with numerous deaths, legal issues, attempts to close the center, and a *condemnation from the UN on its use of torture*) how the eff is this place still operating, especially with a bunch of seemingly legitimate psychologists/BCBAs on their board of directors?


Am I missing something? I'm not a BCBA, but I worked as a behavior tech for years before and during grad school. My postdoc was in an entirely behavioral setting (my primary supervisor was a BCBA-D), so I'm not an anti-ABA person by any means. How is this okay though? Apologies if I'm coming off as ranting, but I'm utterly horrified.

 

[WisNeuro]

Am I missing something? I'm not a BCBA, but I worked as a behavior tech for years before and during grad school. My postdoc was in an entirely behavioral setting (my primary supervisor was a BCBA-D), so I'm not an anti-ABA person by any means. How is this okay though? Apologies if I'm coming off as ranting, but I'm utterly horrified.

With the sheer amount of pseudoscience and harmful treatment that is out there across the spectrum, I am not surprised at all that it is still in business.

 

[FruitLover2.1]

I haven’t read the article yet but wanted to give my two cents. Based on my experience working as an ABA therapist and now studying clinical psychology, I can see how ABA is different in some ways from other types of evidence-based therapy. However, I believe whether ABA can be harmful for individuals receiving them largely depends on the individual treatment plans/goals and the therapists, just like many other professions. I’ve heard of stories where ABA therapists work on goals like increasing the length of client’s direct eye contact and rewarding such behavior or punishing the lack-thereof, which in my opinion may be harmful because I know this can be really uncomfortable or even painful for some individuals with ASD. Goals like this attempting to “normalize” individuals with ASD are what I really don’t agree with and I think are the “bad apples” that people talk about. The treatment plans I worked on largely were about practicing coping strategies, anger management, parent training, and some functional training such as washing hands and eating a more balanced diet. Interested to hear other ABA therapists’ and those who received ABA’s experience!

 

[DynamicDidactic]

how the eff is this place still operating, especially with a bunch of seemingly legitimate psychologists/BCBAs on their board of directors?

I think it is as simple as Wikii states:

Judge Rotenberg Center - Wikipedia

en.wikipedia.org

Attempts to shut down or cripple the JRC at the legislative level have been made in every legislative session since the late 1980s. However, none have passed due to a combination of lobbying from the JRC and the protests of parents.[64] At one time, a group of parents sued the state for $15 million, contending that the state's attempts to close the institute violated their children's rights to treatment.[47] Additionally, Massachusetts state Representative Jeffrey Sanchez, whose nephew, Brandon, has been detained at the JRC since 1992, is a major proponent of the JRC and their practices. Sanchez has repeatedly blocked the passage of legislation that would threaten the center.[64]

There is no FDA for behavioral/mental health treatment. So, unless a state bans a practice (e.g., therapies designed to change sexual orientation in minors, which is partially or fully banned in about half the states) then almost anything could be done. The only concern is being sued for harm but that does not seem to be an issue here since the caregivers of the individuals at the JRC are very supportive of the practices.

 

[ClinicalABA]

There have been multiple mis-steps in the effort to shut this place down. At one point, the MA Dept of Mental ******ation (now Dept. of Developmental Services), was having regular meetings to discuss ways to hamstring and close the place. Turns out that courts don't look too kindly on regulatory agencies having private meetings about closing places they have lawfully licensed to be in business. The "Judge Rotenberg" in the name was the judge in one of the initial hearings about the place (it was originally called Behavior Research Institute, and was located in Rhode Island). One result of some of the early legal stuff was that any use of skin shock "therapy" must be approved by a the courts using the standard of "substituted judgement" (which is, incidentally, a similar legal process to that used for prescribing anti-psychotic medication to legally "non-competent" individuals). In 2020 the FDA banned the use of the skin shock device, but that ruling was just vacated by the federal courts on the grounds that it illegally interfered with the ability of healthcare practitioners to practice medicine. Although i don't approve of the skin shock prcedures, I do think that it was a legally justified and important ruling, in that bureaucrats should not be involved in making medical decisions.

As others have said, there is strong family advocacy for the use of the skin shock procedure. The families often state (and I believe them) that no other facility will work with their family member other than by using significant chemical and/or physical restraint. The argument is that relative short durations of shock are a trade-off for relatively larger (compared to other settings) durations of freedom of movement and not being "snowed" by psychotropics. I'd be more amenable to that argument had I not seen firsthand some of the misuses (or read credible reports of the abuses) of the technology.