Is ABA therapy harmful? Common misconceptions explained
Applied Behavior Analysis (ABA) is the most common type of therapy for children and teenagers diagnosed with autism. For decades, it has been used to help young people improve their social skills and learning skills. But if you’re a concerned parent who’s been researching ABA therapy, you may have come across some criticisms of certain aspects of the treatment.
So, what’s the true picture of today’s treatment methods? Is ABA therapy harmful or helpful, and how can you be sure that you’re making the right decision for your child? Below we’ll address some of the common concerns and misconceptions about ABA therapy and help you ascertain whether it’s right for your child.
Is ABA therapy harmful?
ABA therapy has been recognized as an effective ASD treatment by the US Surgeon General and the American Psychological Association. So why do some people think of it as doing more harm than good? Critics of ABA therapy say that it can be intensive and repetitive, and that it tries to make children diagnosed with autism fit a preconceived idea of what ‘normal’ looks like. But how valid are these criticisms when it comes to modern, progressive forms of ABA therapy?
“I think criticism mainly comes from adults who were diagnosed with autism and experienced ABA as young children,” suggests Sydney Finkenbine, Clinical Director of Illuminate ABA Therapy in Michigan. “And a lot of their past experiences of ABA were unfortunately not very positive.
“Some of these autistic adults feel that their stim or self-stimulatory behaviors, the things that help them regulate, are what ABA providers were trying to work away or suppress. There is also something called Discrete Trial Training, which typically requires a child sitting at a table for long periods of time, working on skills that are very repetitive.
“But as ABA therapists, we really have grown as a field and our approach to therapy has changed over the years. Anyone that we see today is treated as an individual, and deserves the autonomy to be able to guide their own therapy.”
ABA therapists at Illuminate treat each child as an individual. “The services that we provide focus on helping them be successful, so we look at the skills they need to work on, not what box can we fit them into,” says Sydney. “A really great ABA program offers a balance of teaching strategies based on that person’s needs, and on interventions and support based on their preferences.
“Some children and teens who come to us don’t have the ability to make food on their own, for example. Obviously, there’s a healthy balance to be struck, so we’re teaching them how to make snacks and salads and things that are good to fuel their body. But if their preference is baking brownies, well, we’re going to teach them that skill because it’s one that they value. It’s all about finding a balance between the skills that are going to help them day to day, and what motivates them to enjoy life.”
How safe is ABA therapy?
When you’re considering any form of therapy for your child, safety is certain to be your prime concern. So just how safe is ABA therapy?
“Speaking on behalf of myself and the staff at Illuminate, we provide a very safe form of ABA treatment,” Sydney explains. “We involve everyone in the process of treatment planning, and if there is any sort of behavioral intervention that needs to be put in place then we consult with every single person that we can, just to make sure that we’re implementing it in the best possible way.
“I want to say that unfortunately not every clinician or provider is that way, and it puts a lot of responsibility on the family and the individual to know who they’re going to and if it’s going to be the right fit. But through Illuminate we prioritize safety and we want to make sure that the person is being consulted in every which way.”
The physical safety of a patient is of course paramount. “When we onboard a new ABA therapist to the team, they’re given the opportunity to do CPR/First Aid training and crisis management training,” adds Sydney, “so that they can support an individual when they’re in a high-crisis situation, and maintain dignity and safety for everyone involved.”
Finding the right ABA therapist
In order to practice ABA therapy professionally and safely, providers need to have industry-standard qualifications – as well as a high degree of empathy. Some therapists often start out as Behavior Technicians after having completed a 40-hour Registered Behavior Technician (RBT) course. To progress to Board Certified Assistant Behavior Analyst (BCaBA) requires a BA degree, 1,500 hours of supervised fieldwork and successful completion of a board-certified exam. Fully qualified Board Certified Behavior Analysts (BCBA) must have completed 2,000 hours of fieldwork and an exam, in addition to a Master’s degree.
Just as important as formal ABA training is a therapist’s ability to connect with the children whom they will be working with. “At Illuminate we reach out to the technicians we have in mind who would be a good match for the client, but we always say that it’s a getting-to-know-you process,” explains Sydney.
“Ultimately, we want the family and the individual to be comfortable with who they’re seeing because they’re going to be seeing them quite a bit each week. So we’re not offended if someone says they’re not a good fit, whether that’s clinicians, therapists or whoever.”
Involving the family
As Sydney highlights, ABA can involve a number of hours of therapy each week – but is it as intensive as some critics suggest?
“As I always say to families, we all work 40 hours a week, and how exhausted are you by Friday? We’re not trying to do that to your child, to your loved one – you know, make them go to school and then come straight to therapy. But we also try to find a balance. If a child could really benefit from a lot of intervention and support, then we can help. When they get into their teenage years, we may be focusing on independent living skills, so we don’t need as many hours. Or maybe we simply support them in going to church on a Sunday.”
If ABA therapy conjures up an image of flashcards on a table in a bare therapy room, then it may be time to rethink that too. “We really do value teaching children in a natural environment and having sessions that aren’t so repetitive and long-lasting,” says Sydney. “There may be moments where we have to sit down at a table and do homework, but we won’t create a controlled, ‘white walls’ kind of environment. I think that sort of approach is very distressing for families.”
Sydney adds that she loves to include other family members as much as possible. “Generalization of skills is really important,” she explains. “We’re teaching the child all of these skills in therapy, but they need to be able to generalize it to their everyday life. So training caregivers such as the parents, grandmother, babysitter or other folk who will be the person’s support network is really helpful, and the hope is that the individual values that support.”
Insurance typically covers six-month periods of ABA therapy, with treatment being evaluated towards the end of each period. “We always have the ability to be able to assess sooner than that if necessary,” says Sydney, “and evaluation of all of the goals and progress towards those goals is typically done weekly.”
So what happens if your child isn’t responding well to ABA therapy? “It’s really all about finding the right type of intervention,” reassures Sydney. “Not every intervention, not every scientific approach within the field is going to work for every person, so it’s finding the right fit and the right type of ABA program for them.”
Sydney suggests that it’s time to assess external factors if progress with ABA therapy stalls. “It goes back to the whole team approach,” she says. “Does the child have the right team around them? Do they like female therapists over male therapists, or vice versa? Do they need fewer hours? Is the setting the right place?
“We’re constantly evaluating all of those external things, so that hopefully we don’t get to the point. But it’s important to have open communication with the whole family, and ensure that they feel comfortable being able to question any aspect of the support.”