ABA and Misrepresentation
Every few years the issue of whether ABA is quackery or not kicks up on the Hub. It seems to be cyclical. It is a debate I have been a part of before and seems that I have the opportunity to do so again. Recently some discussion along these lines has popped up again. I believe the dissenter’s criticism can be summarized as one or more of the following:
1. ABA is best summarized as quackery.
2. ABA does not have affirmative research.
3. ABA destroys or reduces a different autistic style of learning.
4. ABA is emotionally traumatic to autistics.
5. ABA intrinsically leads to physical or emotional abuse.
Criticism can be good, it is certainly necessary that criticism be given, but not all criticism has merit. It is our job (that means all of us) to scour what is said for merit. Because the five points listed above are troubling, I believe they deserve to be addressed in a serious and frank manner. I have selected to do so on my blog because it is the most powerful and open advocacy tool I posses and I believe the issue merits it.
My responses:
1. ABA is best summarized as quackery.
Quackery is best defined not by possessing an outlandish theory, but by failing to allow research to inform theory. In quackery the rules are set, the theory is inviolate. The more things change the less quackery does. However, behavior analysis does change in accordance with research. The theory is not inviolate. It adapts. For example as an upper level undergraduate I was impressed and quite taken with some research that suggested that stimulus-stimulus pairing might help non-verbal students increase their vocalizations. It made crystal clear sense theoretically. There was an article or two that showed an effect. So, I busily engaged myself drawing up research that could help replicate or extend the initial research. However, new research appeared by time I began to work on this issue. The research showed little to no effect via this technique.
I was severely disappointed. I had worked hard in the initial stages or writing and now my idea was shot all to pieces. That is the way it goes in science. If you are not willing to look stupid you can’t do science and I certainly felt foolish at the time. But it wasn’t just myself….. others who were interested in the area also moved on when the new research emerged. The field adapted in response to the research.
But there are other examples as well; evidence shows problems with the extinction burst and humans. All of this is discrepant with theory. Further, a major review was done several years past concerning all existing applied research in the area of verbal behavior. The authors found some ideas were well supported, others not so well at all. These are just a few exmaples.
If one searches, one can probably find an anti-scientific or quackish remark from one or more behavior analysts somewhere. Probably even from Dr. Skinner somewhere. I see this as irrelevant however. The best description of the general case of behavior analysis is a field of study that changes in response to research findings. That rules out quackery.
2. ABA does not have affirmative research.
First I want to distinguish between two types of research. Group design and single case design. Both, if designed correctly can answer a question in a powerful and legitimate way. However, it depends on the question and upon the specific design. There is no such thing as a one size fits all research design.
In autism and ABA there have been a number of research examples using group design. Some of these studies have received a fair bit or criticism (of varying merit) some of which has come from other practitioners of ABA. I accept some of the criticism of certain studies as correct, but not so for others.
However, the majority of the work concerning applied research of ABA in autism comes not from group studies, but from single case design. For specific techniques the evidence record is excellent and very broad (well over 1000 studies). One can correctly assess the efficacy of ABA without assessing the single case design. Moreover some techniques researched in ABA are shared concepts with the cognitive paradigm. Mutual exclusivity comes to mind. The research here has even been a cooperative effort for certain research examples. Moreover there are shared research endeavors between speech pathologists and behavior analysts. Again, the research record for certain techniques is very strong.
3. ABA destroys or reduces a different autistic style of learning.
I admit the above idea is possible, but I don’t think so. Nor does it have anything like an adequate proof at this time. But one can make predictions based on the theory and see how well the theory holds up. For example based on this theory we might predict that ABA reduced or destroys an autistic child’s ability to acquire high level splinter or savant skills. But I myself know several examples of children who participated in ABA who acquired savant skills while they were still in ABA or just after. So, already we know from anecdote alone that ABA and the acquisition of savant skills are not exclusive.
However, this does not answer the question of whether ABA interferes to a lesser degree with the acquisition of these skills. The way to test this would be to assess a large group of students in ABA against a large group in an alternative learning situation that is as unlike ABA as possible. A matched pairs design could be used with the matching to be done along the lines of the existence of certain materials in the home and school environment. The numbers children with savant skills could then be compared.
This would be a good first step in proving the above theory. But this burden falls entirely on the shoulders of the advocates of the theory. And of this time, it is merely theory.
4. ABA is emotionally traumatic to autistics.
I have no doubt that this is the case for some autistics. I know of none, but I am sure it is the case. Just like it is the case for certain non-autistic persons going to a mainstream school. However, I believe it is incorrect to generalize from a specific case to the general case in both instances. In my experience it is not true that autistic children in contemporary ABA problems cry more than any other program with children of comparable age. Nor do they seem less happy to from what I can tell. Nor is there any data to suggest that ABA causes PTSD.
5. ABA intrinsically leads to physical or emotional abuse.
This is rubbish pure and simple. There is not a shred of data to support this. I know certain behavior analysts who are incredibly conscientious about this issue. I remember being taught by a well known behavior analyst to avoid even mildly aversive procedures like time-out like the plague and how to “go to a knee” or even sit down to avoid being intimidating to a student if we had to talk about a behavior problem.
I believe this to be relatively close to the general contemporary case. I know there was physically abusive behavior committed by early behavior analysts in the 60s-90s. I feel no inclination to answer for these which I have clearly stated I am against, than I do about physically abusive behavior committed by non- behaviorists during that same time span or even today.
1. ABA is best summarized as quackery.
2. ABA does not have affirmative research.
3. ABA destroys or reduces a different autistic style of learning.
4. ABA is emotionally traumatic to autistics.
5. ABA intrinsically leads to physical or emotional abuse.
Criticism can be good, it is certainly necessary that criticism be given, but not all criticism has merit. It is our job (that means all of us) to scour what is said for merit. Because the five points listed above are troubling, I believe they deserve to be addressed in a serious and frank manner. I have selected to do so on my blog because it is the most powerful and open advocacy tool I posses and I believe the issue merits it.
My responses:
1. ABA is best summarized as quackery.
Quackery is best defined not by possessing an outlandish theory, but by failing to allow research to inform theory. In quackery the rules are set, the theory is inviolate. The more things change the less quackery does. However, behavior analysis does change in accordance with research. The theory is not inviolate. It adapts. For example as an upper level undergraduate I was impressed and quite taken with some research that suggested that stimulus-stimulus pairing might help non-verbal students increase their vocalizations. It made crystal clear sense theoretically. There was an article or two that showed an effect. So, I busily engaged myself drawing up research that could help replicate or extend the initial research. However, new research appeared by time I began to work on this issue. The research showed little to no effect via this technique.
I was severely disappointed. I had worked hard in the initial stages or writing and now my idea was shot all to pieces. That is the way it goes in science. If you are not willing to look stupid you can’t do science and I certainly felt foolish at the time. But it wasn’t just myself….. others who were interested in the area also moved on when the new research emerged. The field adapted in response to the research.
But there are other examples as well; evidence shows problems with the extinction burst and humans. All of this is discrepant with theory. Further, a major review was done several years past concerning all existing applied research in the area of verbal behavior. The authors found some ideas were well supported, others not so well at all. These are just a few exmaples.
If one searches, one can probably find an anti-scientific or quackish remark from one or more behavior analysts somewhere. Probably even from Dr. Skinner somewhere. I see this as irrelevant however. The best description of the general case of behavior analysis is a field of study that changes in response to research findings. That rules out quackery.
2. ABA does not have affirmative research.
First I want to distinguish between two types of research. Group design and single case design. Both, if designed correctly can answer a question in a powerful and legitimate way. However, it depends on the question and upon the specific design. There is no such thing as a one size fits all research design.
In autism and ABA there have been a number of research examples using group design. Some of these studies have received a fair bit or criticism (of varying merit) some of which has come from other practitioners of ABA. I accept some of the criticism of certain studies as correct, but not so for others.
However, the majority of the work concerning applied research of ABA in autism comes not from group studies, but from single case design. For specific techniques the evidence record is excellent and very broad (well over 1000 studies). One can correctly assess the efficacy of ABA without assessing the single case design. Moreover some techniques researched in ABA are shared concepts with the cognitive paradigm. Mutual exclusivity comes to mind. The research here has even been a cooperative effort for certain research examples. Moreover there are shared research endeavors between speech pathologists and behavior analysts. Again, the research record for certain techniques is very strong.
3. ABA destroys or reduces a different autistic style of learning.
I admit the above idea is possible, but I don’t think so. Nor does it have anything like an adequate proof at this time. But one can make predictions based on the theory and see how well the theory holds up. For example based on this theory we might predict that ABA reduced or destroys an autistic child’s ability to acquire high level splinter or savant skills. But I myself know several examples of children who participated in ABA who acquired savant skills while they were still in ABA or just after. So, already we know from anecdote alone that ABA and the acquisition of savant skills are not exclusive.
However, this does not answer the question of whether ABA interferes to a lesser degree with the acquisition of these skills. The way to test this would be to assess a large group of students in ABA against a large group in an alternative learning situation that is as unlike ABA as possible. A matched pairs design could be used with the matching to be done along the lines of the existence of certain materials in the home and school environment. The numbers children with savant skills could then be compared.
This would be a good first step in proving the above theory. But this burden falls entirely on the shoulders of the advocates of the theory. And of this time, it is merely theory.
4. ABA is emotionally traumatic to autistics.
I have no doubt that this is the case for some autistics. I know of none, but I am sure it is the case. Just like it is the case for certain non-autistic persons going to a mainstream school. However, I believe it is incorrect to generalize from a specific case to the general case in both instances. In my experience it is not true that autistic children in contemporary ABA problems cry more than any other program with children of comparable age. Nor do they seem less happy to from what I can tell. Nor is there any data to suggest that ABA causes PTSD.
5. ABA intrinsically leads to physical or emotional abuse.
This is rubbish pure and simple. There is not a shred of data to support this. I know certain behavior analysts who are incredibly conscientious about this issue. I remember being taught by a well known behavior analyst to avoid even mildly aversive procedures like time-out like the plague and how to “go to a knee” or even sit down to avoid being intimidating to a student if we had to talk about a behavior problem.
I believe this to be relatively close to the general contemporary case. I know there was physically abusive behavior committed by early behavior analysts in the 60s-90s. I feel no inclination to answer for these which I have clearly stated I am against, than I do about physically abusive behavior committed by non- behaviorists during that same time span or even today.
posted by Interverbal at 11:20 PM
37 Comments:
Because of other kinds of misrepresentation, I'm going to point out that the positions responded to here are not mine and don't resemble mine.
But I also see no evidence in the behaviour analytic literature to support many claims made in this response. Instead, the claims are supported by anecdotes, and the behaviour analytic signature use of quantity of studies as a replacement for quality.
I suggest as always that those who are interested in the standards of science and ethics in the area of ABA read the ABA literature, including the peer-reviewed ABA journals, the ABA group designs in autism (there are very few), the major autism ABA manuals, the major general ABA textbooks, descriptions by major ABA service providers of their own autism services (there are four books devoted entirely to this), and so on. Reading legal decisions to see how this pans out in law is interesting too.
I also suggest reading the literature about standards of intervention and treatment research which exist outside of ABA and are applied to the nonautistic population. Then contrast this with the standards currently being applied to autistics, and with current efforts by behaviour analysts at the level of standards.
Just in case anecdotes are mandatory, here are some thoughts from a behaviour analyst (grad student) in training at a major ABA university.
Hi Michelle,
This was not a response to your ongoing criticisms. Nor was this a response to any one person's criticism. This is a collection of some of the criticism I have encountered recently. And I would argue that it is fairly representative of that criticism.
"But I also see no evidence in the behaviour analytic literature to support many claims made in this response."
I used a mix of anecdote and reference to the literature to argue my points. And while I believe autistic persons deserve good research, I believe that anecodtes are adequate to debunk "all/every" statements, and that is true for any froup of people.
"and the behaviour analytic signature use of quantity of studies as a replacement for quality."
Is this a general observastion of the field or a specific criticism of this post or both? I certainly never argued that quantity proves anything.
Also, I disagree the standards used by behavior analysts used in the realm of autism are lower compared to other populations. I defy anyone to show otherwise.
Thanks for the link to Matt's blog. I have read that post before now.
This comment has been removed by the author.
Sorry, reposted because I mistakenly published when I wanted to preview...
Briefly... behaviour analysts in the area of autism have both decried anecdotes, and then invariably used them. This is an observation I've accumulated over the years.
The routine (if not ubiquitous) use of quantity of studies (or number of years the field has existed) as evidence that a treatment or intervention is effective is not something I've routinely seen outside of ABA-based autism interventions. In other areas I've seen the opposite, as well as ways of judging a literature as a whole which are not limited to counting number of studies and considering this in itself informative much less definitive.
The standards applied to autistics in the ABA literature do not resemble the standards applied to the typical population in treatment and intervention research. I suggest reading the respective literatures (as I did before).
Good grief Jonathan, that was sloppy. You really opened yourself up to being easily refuted on this one. I'm rubbing my hands at all of the photographic evidence I have to refute what you wrote. Will do so later. I'm working on a new website at the moment.
Jonathan,
Sorry if this posts twice, I'm not sure it went through.
I'm certainly not a specialist in ABA, nor have I read extensively in the literature. My question to you (and to Michelle, if she's reading this) is the following.
Parents who have used ABA with their children have spoken to me about how they see ABA as a teaching tool, rather than a vehicle for promoting "recovery". Is there evidence in the literature that ABA is effective at teaching useful skills to children with autism, i.e. teaching faster or more effectively than regular educational practices? Are there any well designed, blinded studies which show this? I did have a look at pubmed, and maybe I'm not using the right search terms, but I couldn't find anything along these lines.
I do believe that ABA could be considered quackery in that it is widely presented in the popular press as a "cure" for autism, and the work of Lovaas cited to "prove" this assertion. The Lovaas style ABA is no longer used, as you point out - yet the evolved forms of ABA do not have results equal to those of Lovaas. So, at least in the popular press, the theory is inviolate - "47% of autistic children will recover with ABA", and the rules are set - Lovaas-style ABA is assumed. Real science has moved beyond this stage, but this does not stop advocates from engaging in this type of quackery.
I'd be interested in your thoughts on this issue.
While waiting for CS, I thought I'd have a lighthearted look at your five points. Michelle's already done the serious bit.
1. ABA is best summarized as quackery.
In which case, which therapy isn't quackery? RDI is based on? Floortime is based on? ABA is based on? Some very shaky foundations out there.
2. ABA does not have affirmative research.
Sure and practically all of it self generated and using an experimental set-up which could easily be described as data delineated anecdote. I like the pretty graphs of all the trials. When ABA controls even half way adequately for things as basic as confirmation bias, then the research may be worth a second look.
3. ABA destroys or reduces a different autistic style of learning.
Since I don't recall ABA even having a passing interest in autistic styles of learning, must be pretty hit and miss what the outcome is. I thought the grounding was in single subject research design and schedules of reinforcement mostly. Haven't seen a syllable in anybody's BCBA certification about autistic styles of learning. Could be wrong about that but I have read a fair number of syllabuses.
4. ABA is emotionally traumatic to autistics.
Yeah well, DT would be hard on anybody, but that's a thing of the past, right? Mostly? Seems however, that ABA is an attractive environment for control freaks - just reminiscing about the graduate student's musings that Michelle linked to. Control the environment - create the person!
5. ABA intrinsically leads to physical or emotional abuse.
Nah, unless you're Ivar Lovaas and think that doubt in the efficacy of your methods is for lesser mortals.
Hi Michelle,
“Briefly... behaviour analysts in the area of autism have both decried anecdotes, and then invariably used them. This is an observation I've accumulated over the years.”
I see no apparent contradiction in what I wrote at least. I certainly have been on record taking issue with those who prove a treatment or method by anecdote. Yet, at the same time I have made liberal use of anecdote in this post. But look at how I used it. I do not seek to prove a method with my anecdotes I seek to debunk so called strong inductions which I explained in my last post. All it takes to blow such inductions to pieces is a single countering anecdote. And this is hardly unique to me or other behavior analysts. I would recommend reading any variety of science based books to see other examples. Sagan and Gould and Dawkins for that matter, pop right to mind.
“The routine (if not ubiquitous) use of quantity of studies (or number of years the field has existed) as evidence that a treatment or intervention is effective is not something I've routinely seen outside of ABA-based autism interventions.”
Well I have, I can think of a number of examples. They range from medicine, to cosmology, to evolutionary biology.
“In other areas I've seen the opposite, as well as ways of judging a literature as a whole which are not limited to counting number of studies and considering this in itself informative much less definitive.”
Of course, but all the same the number of studies does teach us some interesting things. For example it teaches us that a high rate of science (or something that looks like science) is occurring. It also teaches us that ongoing science, or at least quackery dressed up as ongoing science is occurring. I think this reflects values within the ABA community.
“The standards applied to autistics in the ABA literature do not resemble the standards applied to the typical population in treatment and intervention research. I suggest reading the respective literatures (as I did before).”
Thank you for the advice to continue to read the respective literature, I will take your advice and also reciprocate your thoughtful suggestion. In the mean time I will wait patiently for a cogent compare- and- contrast analysis from you in this regard. Until then I will maintain my open skepticism of your comment.
Thank you Michelle,
Hi CS,
"Good grief Jonathan, that was sloppy. You really opened yourself up to being easily refuted on this one."
Not at all sir. A number of my statements have the distinct advantage of being potentially disproven.
I do not believe in advocacy for ABA at the sake of accuracy. I am willing to be proven dead wrong and to look very foolish. I think it is worth it, if it moves us closer to reality.
That said, I really have no idea what you think you are going to prove with a collection of photos? I suppose I will have to wait to see what you come up with, and then scour it for merit.
Good luck with the new website.
Hi Jennifer,
"Is there evidence in the literature that ABA is effective at teaching useful skills to children with autism, i.e. teaching faster or more effectively than regular educational practices?"
No, or rather only a few exmaples. What is more common is to see a variety of ABA techniques be assessed in the same research. I am currently doing one of these. What ABA does have is research in speific techniques, this type of research is almost entirely absent in the eclectic special education literature.
"I do believe that ABA could be considered quackery in that it is widely presented in the popular press as a "cure" for autism, and the work of Lovaas cited to "prove" this assertion. The Lovaas style ABA is no longer used, as you point out - yet the evolved forms of ABA do not have results equal to those of Lovaas. So, at least in the popular press, the theory is inviolate - "47% of autistic children will recover with ABA", and the rules are set - Lovaas-style ABA is assumed. Real science has moved beyond this stage, but this does not stop advocates from engaging in this type of quackery."
Yes, I agree entirely. But I presented the strongest argument for ABA, not the what I see as the worst. Any legitimate methodology can be ill explained or transmuted into quackery. I can think of dozens of exmaples.
Hi Alyric,
Welcome back to our game show!
“Sure and practically all of it self generated and using an experimental set-up which could easily be described as data delineated anecdote.”
You have my full attention, I await your explanation on how this is so.
“Yeah well, DT would be hard on anybody, but that's a thing of the past, right? Mostly?”
Not really. I use a lot of DT even when teaching typically developing persons.
-Name the 5 axes of the DSM?
-Capital of Russia is?
-3+2=___?
-Find the “G” for me.
It is all DT……
"Seems however, that ABA is an attractive environment for control freaks - just reminiscing about the graduate student's musings that Michelle linked to. Control the environment - create the person!"
Well who shaped Matt's behavior? You can blame me in part. I TA'ed one of his early psych classes. I very likely presented the first serious lesson on autism he ever had.
But I think Matt made some great points. The environment does have a profound affect on our behavior. Nor do I think his stating this makes him a control freak.... far from it.
Can't wait to tear this one apart:
"I know there was physically abusive behavior committed by early behavior analysts in the 60s-90s."
BCBA's are doing it today, even up to just a couple of months ago (I'm not talking about the BCBA's at JRC, as that is a separate issue). I've been sitting on something for a few months. Not only does this particular BCBA physically abuse children, in a school setting no less, he also falsified reports to the police and is currently being sued. And guess what, he did nothing wrong according to the state department of education for this state because he used the procedures put in place by another BCBA who wrote the restraint procedures for the entire state education department. Oh this is a juicy one.
Because there is an anecdote or two, this means that concerns about widespread, mainstream practices and standards in ABA-based autism interventions are not valid? Just checking (to see if I can retire--there's always an anecdote, after all). I also wonder about the priorities here.
There is poor quality intervention and treatment research in many areas. The question is whether it is recognized as such, and how it is responded to. This is where behaviour analytic standards diverge from those devised to guide the conduct and reporting of treatment or intervention research in the general population.
This can be established by reading the respective literatures. This is why I recommend it (I am not sure if this recommendation is a no-no in the world of skepticism-as-we-now-know-it, but when I want to find out something about the standards in intervention or treatment research, I read the relevant literature).
And because it apparently wasn't clear, I was referring to intervention and treatment research (maybe I should gather up anecdotes of behaviour analysts citing astronomy as why recognized standards of science are not useful or necessary in intervention research--just to give an example I've witnessed at a major autism conference). I have not here mentioned standards in research in areas outside of treatment and intervention research.
Hi,
Just wondering if there are any well designed studies, that observe ethical guidelines, and that objectively demonstrate that ABA is, over the long term, more effective than a placebo in teaching autistics?
Morgan
Hi CS,
I eagerly await your analysis.
“Not only does this particular BCBA physically abuse children, in a school setting no less, he also falsified reports to the police and is currently being sued. And guess what, he did nothing wrong according to the state department of education for this state because he used the procedures put in place by another BCBA who wrote the restraint procedures for the entire state education department.”
And how is this any different than any number of other States including the one I am currently in? Those policies are not necessarily always written by a behavior analyst. Moreover the David Mandt the creator of the Mandt training for restraint, which seems to be the most popular method (I could be dead wrong here) is not a behavior analyst.
Hi Michelle,
“Because there is an anecdote or two, this means that concerns about widespread, mainstream practices and standards in ABA-based autism interventions are not valid?”
Yes, quite possibly. I took what has been my experience… and argued against the validity of the concern. I think I will stand by this unless shown a good reason not to.
“Just checking (to see if I can retire--there's always an anecdote, after all). I also wonder about the priorities here.”
If you are going to retire anytime soon, then I am Autism Diva. As to the fact that there is always an anecdote…. So what? You have to scour for what is said as carefully here as in any other situation.
I freely admit that anecdote does not a datum point make and that my use of anecdote is far feebler than you or I might wish (assuming we both care more for reality than politics which I am convinced we do). But I was not arguing against a particularly robust argument in the first place. Now maybe autistics deserve better than such weak arguments, unfortunately I don’t have better data in favor of the idea I presented, nor is the counter argument data based from what I can tell. I presented the best information I posses at this time. That is my priority.
“This is where behaviour analytic standards diverge from those devised to guide the conduct and reporting of treatment or intervention research in the general population.”
I am still awaiting your compare and contrast analysis. Until then my dissent remains.
“This can be established by reading the respective literatures. This is why I recommend it (I am not sure if this recommendation is a no-no in the world of skepticism-as-we-now-know-it”
It is not necessarily a no-no. It depends on how it is used. If it is merely a suggestion then no harm done, but if it is used as a proof, then you would be obligated to back it up.
Thank you Michelle,
Hi Morgan,
“Just wondering if there are any well designed studies”
There are many different research designs that answer a host of very different questions. You pick the design in regard to the question being asked. Right now there are two types of designs that can answer questions about cause and effect. This would be group-logic research and single case design. Much of the work in ABA has been done in single case design. In single case design there are several designs types that have placebo like control, most obviously an Alternating Treatments Design. And yes these do exist in regard to specific techniques in autism ABA. However, much of the research does not have a placebo like control.
However, do not misunderstand the importance of placebo control. There is a no such thing in research as a one size fits all solution. Many group designs (where placebo control is common) are extremely robust even without placebo control e.g. (Solomon four-group design)
“that observe ethical guidelines”
All research conducted in the US that receives some sort of Government funding must pass Institutional Review Boards to be approved. Moreover, many institutions require additional and separate ethical training aside from course-work for researchers or student-researchers, before they are cleared.
“and that objectively demonstrate that ABA is, over the long term, more effective than a placebo in teaching autistics?”
Using the available single-case design research, which makes up the vast bulk of the ABA research you can prove that the introduction of a method caused the change, but you can’t prove that in time, in the methods absence, the person would not have developed the new behavior anyway.
But I suspect that this is not even possible. No study design that I know can do this and still prove causality….. not over the really long term least. Much beyond three years and you are really pushing it. At some point it simply becomes too hard to track all the variables. This is why most longitudinal studies are quasi-experimental or descriptive in nature.
Hope that helps a little bit.
http://oregonspeechandhearing.org/Archives/Ethical1.asp
Ethical Considerations When Asked to Collaborate with ABA “Therapists.”
Allyson Goodwyn-Craine M.S. CCC-SLP
To download this article in Microsoft Word, click here
I recently attended a seminar given by Vincent Carbonne, a proponent of “verbal behavior” training. What he described as the most effective and efficient means of correcting speech disorders in children with autism looked to me to be very similar to articulation approaches used since the 1970’s (complete with food rewards). Indeed, the Skinnerian assertions so passionately presented to the crowd, as “leading edge” were notions I studied in Behavior Mod. 101. The speaker guided the audience through a generic articulation assessment to determine whether or not to teach specific speech sounds based solely on developmental articulation models. He went on to suggest that if the ABA “therapist” did not feel speech was a good option they should prescribe an augmentative communication system, he preferred sign language. My heart sank.
I attended this conference by invitation from an Applied Behavior Analyst who had recently asked for me to assess a child with autism she described as “apraxic”. Imagine my surprise as the analyst presented data from criterion based and standardized speech and language protocols, a developmental articulation analysis and copious data reflecting the efforts of her ABA team to “correct speech sounds”. In this particular case they had also implemented a “fluency program” to address what was initially perceived as stuttering but was now thought to be “apraxia”. The analyst was hoping I could assess the client, offer a differential diagnosis, outline a treatment program for her team to follow and be on my way.
I looked around the room filled with dedicated and concerned parents seeking the best and most immediate treatment for their autistic children. Parents call my practice almost daily seeking services, or the services of my colleagues, only to be placed on ridiculously long waiting lists. These battle-weary and anxious parents are simply looking for someone to help, but who is available to go toe to toe with their child numerous hours a week? Parents have few options and ABA “therapists” fill that void.
What is ABA?
Applied Behavioral Analysis (ABA) is a teaching strategy used by a wide range of disciplines including special education teachers, psychologists, behaviorists and speech-language pathologists using a classic stimulus/response/reinforcement format. Encompassed under the ABA umbrella is a behavioral approach to teach speech and language referred to as “verbal behavior”. Sequential training targets are established using a variety of resources such as “The ME book” by Ivar Lovaas. Nationwide, parents of children with autism rally around ABA services, many with the hope of a cure. This belief is based upon the book “Let Me Hear Your Voice” by Catherine Maurice in which the parent outlines procedures used to cure her child of autism.
Although many ABA practitioners in the field are skilled, the area of ABA is loosely structured and poorly regulated. Board certification has been slow to catch on and essentially anyone can hang a shingle proclaiming expertise in Applied Behavioral Analysis. In the State of Oregon there are only two “board certified” analysts (BCABA). Parents pay between $75-$150 per hour for the services of the analyst who provides diagnostic services and designs treatment plans.
The Behavioral Analyst (or any person) claiming expertise in this area typically employs (or requests families employ) ABA “therapists” to implement a variety of training programs including speech correction and language instruction at a rate of $10-$20 per hour. While these “therapists” often have a B.S. degree the prime “therapist” employee is a student enrolled in Speech and Hearing Sciences programs.
Board certification and graduate programs in Applied Behavioral Analysis do not include coursework in normal language development, language disorders, articulation/phonological analysis, stuttering disorders, oral motor speech disorders or augmentative communication. One behavioral analyst I work with states that the majority of her knowledge (which is admirable) comes from purchasing materials and resources from our field and her own continuing education experiences. When asked why speech and language coursework is not included in their training programs given their interest in creating intervention programs in these areas she answered, “We view speech and language exclusively as a behavior. We are perfectly qualified to correct behaviors.”
The Problem for Parents
Many parents of children with autism are disenchanted with the services provided by speech-language pathologists when we focus exclusively on social-pragmatic interventions. Problems arose because significant budget constraints leading to high caseloads in the public education system and with limited number of treatment hours available with private practitioners most speech-language pathologists can no longer concentrate on all core areas of language development focusing on content AND form AND use. As a result, many concentrate heavily on USE, as it is the most challenging issue for children with autism. They often neglect content and form. Parents often seek other service providers to fill in the gaps. Enter ABA “therapists” who focus heavily on content AND form (speech).
Legal Issues
There is significant debate over the effectiveness of ABA/verbal behavior approaches when compared to social-pragmatic language interventions. While I have seen children with autism benefit from a combination of both, legal and ethical difficulties arise when asked to collaborate with ABA “therapists”.
For example, often ABA “therapists” create and implement oral motor and articulation programs without clinical training in articulation/phonology or motor speech disorders nor are they under the direction and supervision of a licensed speech-language pathologist.
Despite overwhelming requests, I do not enter into a consultant service delivery model with parents of children with autism and ABA “therapists.” I do, however, work alongside ABA teams and have been challenged on many occasions to revisit many of the “old” language instruction philosophies. Instead of engaging in debates, we simply acknowledge our philosophical differences and respectfully move forward. Parents find it comical at times when I state the child is using generative language while the ABA team members are asking, “who taught the child that new word?”
The ABA teams have been willing to move slowly as I navigate my way through several ethical and legal issues. Although team members have been eager to learn treatment strategies to implement during their training sessions they have respected my refusal to provide such training because they are not certified as Speech-Language Pathology Assistants. To be honest, this is very frustrating for me when I observe the skills of particularly talented ABA “therapists.”
Oregon law, however, clearly prohibits assisting or permitting any person to practice speech-language pathology without a license. In the state of Washington, where they have no SLP licensing requirements, many Speech-Language Pathologists engage in transdisciplinary practices with ABA “therapists” based on the ASHA guidelines which state that: “Support services may be delegated to persons who are neither certified nor in the certification process only when a certificate holder provides appropriate supervision.” (Principle of Ethics II, D. ASHA). In the State of Oregon, however, a new statute stipulates that a person must be certified as a Speech-Language Pathology Assistant and provided direct supervision by a licensed speech-language pathologist when engaged in treatment.
In the Real World
I routinely give “speech homework” to the parents of children with autism on my caseload. Several of my colleagues, however, routinely delegate these types of activities to ABA “therapists” when requested by the parents. At first blush, this seems to be a reasonable approach until one considers the potential ethical and legal implications. This practice could be interpreted as a violation because the “therapist” is being paid to work with the child. Unlike a nanny or other paid caregiver, ABA “therapists” are being paid for is to correct speech. Therefore the speech-language pathologist would technically be in violation of state law and on shaky ground with regard to ASHA standards.
Despite the initial requests that I diagnosis, create a treatment plan and promptly exit, the ABA teams have understood my obligation to treat the children directly. However, my hands are tied both ethically and legally when trying to coordinate treatment efforts with the ABA teams since I cannot suggest modifications of ABA verbal behavior (speech and language programs) because it is unclear as to whether these service providers exceed an appropriate scope of practice according to Oregon statutes. Given strict legal definitions some may argue that ABA teams members are practicing Speech-Language Pathology without a license. For this reason many Speech-Language Pathologists choose not to enter into a co-treatment relationship with ABA “therapist” as we routinely do with physical, occupational therapists, and special education teachers for fear this practice be interpreted as “unprofessional conduct.”
More Questions than Answers
These issues raise more questions than answers. Perhaps the most important is: how do these legal and ethical constraints impact the families of children with autism seeking collaborative services? Is collaboration between Speech-Language Pathologists, Behavior Analysts and ABA “Therapists” possible? There is hope. Oregon law clearly prohibits assisting or permitting any person to practice speech-language pathology without a license.
The Oregon Speech Language Association Board of Directors has requested that these issues be brought to the attention of the Ethics Committee, Oregon Speech-Language Pathology Health Related Services Licensing Board and the Ethics Director of the American Speech-Language Hearing Association. All readers are invited to provide feedback, concerns and questions to be reviewed by members of these various boards. Parents of children with autism, SLP colleagues, ABA team members and other interested parties are encouraged to participate in this discussion. Send your response to the email address below.
Allyson Goodwyn-Craine is president elect of the Oregon Speech-Language Hearing Association and a private practitioner in Portland, Oregon. Contact Allyson at Goodwyn464@aol.com.
Alyric: "Yeah well, DT would be hard on anybody, but that's a thing of the past, right? Mostly?"
Jonathan: "Not really. I use a lot of DT even when teaching typically developing persons.
-Name the 5 axes of the DSM?
-Capital of Russia is?
-3+2=___?
-Find the 'G' for me
It is all DT…… "
I'll add my two-penn'orth here.
I trained to teach maths, and I used to get the students who had difficulties learning the material. On assessment, I found that the material had been presented mostly by teachers who were very experienced in the material and who therefore were making unconscious leaps of faith - missing out stages of the teaching process and leaving the students with no idea how one part of the material actually led to the next. And this is why we have task analysis, which is a behaviour analytic technique. Without it, we can end up not including the right steps in our teaching that would help to keep all but the slowest learners in our classes up with us when teaching them anything, especially in subjects as conceptually difficult as mathematics.
I used task analysis in order to understand the actual mathematical tasks we were asking our students to do, and then I fitted my teaching to that analysis; and I did this by using discrete trial teaching... teaching the task in sufficiently small steps as to be within the students' conceptual reach. Without it, they would have gone on to keep having problems. Discrete trial teaching is also a behaviour analytic technique. And it was bloody useful in getting these students through their studies and enabling them to get their GCSE Mathematics requirement (or a recognised equivalent).
Alyric: "Seems however, that ABA is an attractive environment for control freaks - just reminiscing about the graduate student's musings that Michelle linked to. Control the environment - create the person!"
Sadly, a great many things can be that. There were concerns years ago that the good stuff that Lewin researched could be used by totalitarian regimes (essentially regimes run by... control freaks). Point is: it isn't the techniques themselves that form the problem - it's the people using them.
As an educational psychologist, what I disapprove of in Lovaas' work (I use the term loosely) is the aim of it: the aim of 'indistinguishability from peers'. He actually was into this idea of 'control the environment - create the person' (he actually used that as the premise for what he was doing). In education, it is our job to manipulate the environment in order to facilitate learning (mostly by controlling perception as much as we can via controlling that environment)... by creating situations in which our students are more likely to form the gestalts they need to form as part of the learning process.
For me, the problem with ABA-validated techniques for teaching is when they are used in the absence of adequate knowledge about the individual characteristics of the student(s) being taught. That way confusion lies. For the student(s).
When we mix approaches - using some approaches validated through behaviour analysis alongside approaches that have other theoretical backgrounds - we're more likely to facilitate effective learning: it's like the metaphor my ex-wife uses in her work as an applied social-developmental psychologist now, based on her earlier training in botany - certain nutrients need to be in the soil to facilitate growth in the plant (as well as the right climatic conditions, and so on) and, if any of these are missing, that growth will be compromised at least to some extent.
This comment has been removed by the author.
Comment re-posted to correct errors. Sorry. [sigh]
Your views about anecdotes are interesting.
When concerns about interventions or treatments can be dismissed via anecdote, criticism becomes pointless. All such concerns or criticism can be dismissed by anecdote. As I wrote, there is always an anecdote.
And I've seen this approach used by numerous behaviour analysts. Now will a behaviour analyst use an anecdote to dismiss this concern...? [boggles] That would be even more interesting, and would maybe show the pointlessness of adopting low standards because you can (so far as I can tell, that seems to be the reason).
I disagree with you that science (in the relevant area) is about proof. It is about evidence. This is why I referred you to the evidence.
If you're interested in my work in this area, I'm presenting a fraction of it (I only have an hour, which barely allows for an introduction) on Thursday, in Montreal.
"I disagree with you that science (in the relevant area) is about proof. It is about evidence. This is why I referred you to the evidence."
Interesting point. And very valid.
The only science that actually permits proof is mathematics, where proof is based on logic: other sciences have to look at evidence and decide whether the evidence supports an alternative hypothesis and, if not, they have to accept a null hypothesis.
And Michelle is quite right to draw a distinction between 'proof' and 'evidence': they are not the same thing.
ABA is not the same as Dr. Skinner's work, for what it is worth. That said, a lot of Dr. Skinner's work was bunk too, but I think this is what confuses people. People think operant conditioning and ABA are two words for the same thing. They are not.
Hi Michelle,
"When concerns about interventions or treatments can be dismissed via anecdote, criticism becomes pointless.'
Not criticism, but rather the specific criticisms.... and only if one agrees that the anecdotes are sufficient to do so.
"All such concerns or criticism can be dismissed by anecdote. As I wrote, there is always an anecdote."
Thanks for clarifying, but my response is still "so what"? Arguing there is a always an anecdote is no actual rejoinder to the anecdote I offered. You could counter it by offering other anecdotes or better yet using data if you have it, but you can't dismiss it in this case.
"And I've seen this approach used by numerous behaviour analysts. Now will a behaviour analyst use an anecdote to dismiss this concern...?"
Why yes one will as a matter of fact! How in the world, is this cocnern specific to behavior analysis and not a variety of other fields including cognitive psychology?
And I still want to know why the use of anecdotes in a manner of how I did merits a valid concern in the first place?
These scientists use it not because we can, but because it is the best we posses at the time. If this causes you to boggle, then I am sorry, I will leave it to any readers to decide the merit of my argument.
"I disagree with you that science (in the relevant area) is about proof. It is about evidence. This is why I referred you to the evidence."
Wjat are you objecting to specifically? Is it this quote below?
"It is not necessarily a no-no. It depends on how it is used. If it is merely a suggestion then no harm done, but if it is used as a proof, then you would be obligated to back it up."
A proof..... not proof... or the proof. This is a common and acceptable way to forumlate a sentence stating that there is evidence. And while I agree with your statment, I disagree that it applies as a crticism to what I wrote. I don't suspect I would have much patience with being told I may not say "a proof" but instead must say "evidence".
Good luck with your presentation. I hope it goes well and that your peers provide valuable feedback.
To the anonymous poster who posted the Goodwyn-Craine article.
I have read this before, as have a number of us here if memory serves. I don't understand the context of the post except as a counter to the idea that behavior analysts and speech pathologsts always cooperate to a high degree.
Not of that changes the fact that there are multiple examples in the research literature of behavior analysts and speech pathologists fully collaborating. These are a matter of public record.
"People think operant conditioning and ABA are two words for the same thing. They are not."
True, but most ABA will be operant. Very little in comparsion will be classical.
There are three general categories of operant learning situations:
Free operant
Hybrid
DT
The vast majority of ABA and any formal schooling for anyone will involve these three acording to an analysis of behavior.
Thanks for clarifying how you regard anecdotes in behaviour analysis. I disagree with you, again, that serious concerns about ABA-based interventions (or other interventions or treatments) should be dismissed using anecdotes, though I'm now very sure this is your position. For clarity, I also disagree that there is no other possibility.
I also disagree with you that because something is commonly said, one should say it also. But thank you for clarifying your position on this.
Hi Michelle,
“Thanks for clarifying how you regard anecdotes in behaviour analysis.”
Not just in behavior analysis Michelle, but you are welcome in any case.
“I disagree with you, again, that serious concerns about ABA-based interventions (or other interventions or treatments) should be dismissed using anecdotes, though I'm now very sure this is your position.”
Can be….. not should be. And only can be if the anecdote is intact after being scoured for merit.
“For clarity, I also disagree that there is no other possibility.”
An excellent disagreement, but I disagree that there is no other possibility too. The use of anecdotes here is not the only possibility, it is merely the best possibility currently available, and I also argue that it is sufficient for the current task. However, if you believe that there is a better possibility currently available then I promise that you have my full attention.
Any serious concern about treatments and interventions can be dismissed via an anecdote. Then it's a matter of setting priorities, as I wrote earlier, as to whether anecdotes should be used for this purpose.
Also, I disagree that your anecdotes should outweigh what is reported in the behaviour analytic literature (or in other literatures). I take the scientific literature more seriously than your anecdotes, and suggest this avenue to others as well.
I do as always appreciate the information you provide about the standards of science and ethics in behaviour analysis.
"In my experience it is not true that autistic children in contemporary ABA problems cry more than any other program with children of comparable age."
When I worked in an ABA program, I saw the exact opposite.
See? An alternate anecdote. Now what's needed is for someone to do (or find if already done) empirical studies testing whether kids in ABA programs cry more, the same, or less than age-matched controls in similar-sized groups.
"5. ABA intrinsically leads to physical or emotional abuse.
This is rubbish pure and simple. There is not a shred of data to support this."
Those two statements are not synonymous. In order to test that, you'd need to define physical or emotional abuse and then examine how likely it is to see ABA therapists engaging in it, and if it's extremely high, then that statement would not be proved false (although, like most theories, it can't be proved true either).
Hi Michelle,
"Then it's a matter of setting priorities, as I wrote earlier, as to whether anecdotes should be used for this purpose."
Here we agree.
"Also, I disagree that your anecdotes should outweigh what is reported in the behaviour analytic literature (or in other literatures). I take the scientific literature more seriously than your anecdotes, and suggest this avenue to others as well."
As you like Michelle. As for myself, I don't think you are accurately reflecting or generalizing from the behavior analytic literature. I reccomend that any readers wait for you to produce such an analysis, and then scour it for merit.
"I do as always appreciate the information you provide about the standards of science and ethics in behaviour analysis."
Likewise Michelle via cognitive science; thank you for your time.
Hi Ettina,
"When I worked in an ABA program, I saw the exact opposite.
See? An alternate anecdote."
Yes, and this is the first reasonable counter evidence I have seen in this discussion.
"Those two statements are not synonymous. In order to test that, you'd need to define physical or emotional abuse and then examine how likely it is to see ABA therapists engaging in it, and if it's extremely high, then that statement would not be proved false (although, like most theories, it can't be proved true either)."
Quite reasonable. We are in agreement, even if I have some problems with the precise wording.
I would encourage "any readers" to read primary sources, and therefore become better able to verify what is or isn't accurate when claims are made for treatments or interventions, including ABA-based interventions.
Looking at the evidence is better than waiting around for someone else to tell you what it is.
For example, if someone is concerned about the use of various aversive or punishment procedures in ABA, and whether they are a relic of the past, the literature will be informative about this.
I apologize for again failing to provide an anecdote, the only acceptable practice in this discussion.
Hi Michelle,
"I apologize for again failing to provide an anecdote, the only acceptable practice in this discussion."
No apology needed, although I would reccomend re-reading what was said.
You listed 5 common reasons people oppose ABA. May I offer a 6th?
In the words of jypsy (something about us, 2008),
"Do not subject your child to something that you would not subject yourself to."
I'm sure that's vague reasoning to someone who likes scientific explanations. It is all I need.
Is it quackery? Well, I haven't exactly said that, but I've said it has characteristics similar to homeopathy, except there aren't as many trials of different levels of quality in ABA so we could put them in a graph and see what happens with the effect size as the study methodology improves. Nevertheless, and you know I've said this before many times, if you consider the only randomized trial in existence, you have the same pattern you have with homeopathy.
You are a tenacious one, Interverbal!
While all of these points are important, I still feel #2 is of great priority. It is the source of a great deal of controversy in the HUB.
There is a gross failure to recognize any signficance of single subject design research. It is evident in the post above, in which Joseph equates the research in ABA to the research of homeopathy.
Yes, there is a weakness in single subject designs, poor external validity. However, there are weaknesses in all designs. Just ask any statistician what they can do with the numbers, if given enough time!
There is also a propensity to overgeneralize a single example to all who practice ABA. It is an inductive fallacy, and it's rampant with regards to the accusations you brought up in points 4 and 5.
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