APPLIED BEHAVIOR ANALYSIS
ABA has a lot to offer when it comes to understanding and helping people, and positively impacting the world around us. Our science is evidence based, it works, and our practitioners care deeply about the people we support.
Many people have demonstrated significant improvements in quality of life as a result of ABA services, but some have been hurt in the evolution of our practice.
The former in no way justifies the latter, but understanding and addressing the issues at hand in a vacuum has problematic implications looking forward.
The purpose of this article is to provide context for some common critiques of ABA and strategies for overcoming them.
WERE/ARE THE VALUES OF ABA PRACTITIONERS COMPARABLY WORSE, BY TODAY’S STANDARDS, THAN OTHERS?
As times change, healthcare and educational standards change with it. What we consider as “best practices” and socially acceptable practices change over time. Some therapeutic or medical procedures, language, and ideology that once prevailed are no longer acceptable.
Across all aspects of life (religion, medicine, education, parenting) normalization was a common goal, punishment was an accepted practice, and the concept of patient-centered care, at least as interpreted by today’s standards, was relatively foreign.
The actions and belief systems being called into question today are part of a broader cultural ideology from a time and mentality that’s fading from popular culture. These things are not, and were not, specific to ABA.
One could look to psychiatry, medicine, psychology for analogues in healthcare. In education, teachers, principles, psychologists, and others were all part of the same value system. It wasn’t uncommon in schools for educators and administrators to implore behavior analysts to prioritize aversive procedures such as extinction, time out, and punishment procedures, where those same behavior analysts sometimes advocated instead for reinforcement based procedures. In fact, this was an important part of positive behavior support’s history.
I strongly encourage behavior analysts who’ve only started practicing in the last 10 years or so to speak to parents and a variety of professionals if they question this claim. (Be sure to approach this systematically!)
“TODAY’S ABA”
Dr. Hanley provided context for “Today’s ABA” in his post “A Perspective on Today’s ABA From Greg Hanley” (linked below). He elaborated on that in a Behavioral Observations podcast (Session 160, also linked below).
I thought Dr. Hanley very nicely characterized the evolution we’re seeing in collective ideologies, values, and practices.
That said, I believe the manner in which some members of our community have carried that forward may prove counterproductive.
My concern is with the rebranding of our discipline around this terminology, and how some who embrace this rebranding contextualize it relative to our practice and history in the broader context.
The defining characteristics of ‘Today’s ABA’ aren’t the product of some cladogenesis, or some sudden shift away from yesterday’s practices by today’s enlightened professionals. They also aren’t specific to ABA, despite anti-ABA propaganda embraced and perpetuated by some people in and outside of our field, that would suggest otherwise. They are the result of our science and practitioners knowing more and therefore doing better. That’s an ongoing learning process and part of any discipline’s evolution.
These changes may be due in part to advances in evidence based science/research, change in collective societal values, and feedback from various stakeholder communities.
Messaging to suggest values or standards now being called into question were specific to ABA are misleading, and have adverse implications.
Specifically, impacts are erosion of trust in our science, our discipline, and our colleagues, and subsequently steers prospective beneficiaries of ABA services away from effective, validated, evidence-based services that can positively impact their quality of life.
FURTHER CONSIDERATIONS OF ALTERNATIVE TERMINOLOGY FOR A DISCIPLINE DISTINCT FROM ABA
For those embracing the concept of a new ABA as a means to address the segment of autistic adults who harbor anti-ABA sentiment due to personal experiences, consider how this approach may seem insincere. It might present as a public relations stunt to disassociate from outdated and hurtful practices, and draw effort and attention away from more actionable alternatives.
Treating “Today’s ABA” as some terminus rather than just where we are in our discipline’s timeline risks drawing focus away from “tomorrow’s ABA” and the wonderful science yet to come that will make what we’re doing today appear as going the way of the dinosaurs.
Johnston, Jacobson, Green, & Mulick (2006) discuss what I see as a comparable ‘campaign’: Positive Behavior Support (PBS). They also discuss some of its movement’s implications – pros and cons – which can apply here as well.
There is still work to do and there always will be. Surface level rebranding efforts don’t equate to real action, and even risk dismantling and therefore minimizing the collective historical and potential future impact of behavior analysis for the short term gain to any one generation of practitioners and businesses.
Science and practice are ever changing and improving. When tomorrow comes (i.e. as we learn and improve), today’s ABA will inevitably become yesterday’s ABA.
There will always be stragglers. Those who fall into this category won’t realize it. Nobody says “hit me up if you want 80’s style therapy”. People will inevitably assume they are offering the highest quality and most current practices. It would make sense that over time, the newly adopted language will lose its meaning.
NECESSARY ACTION
In my view, we need to play the long game, and the long game ain’t always easy. We need to accept responsibility when applicable, learn, and improve. As the saying goes, ‘when you know better, you do better’.
Quality will be demonstrated by engaging in practices that are based on the best and most current scientific evidence and also prioritizing and reporting out on measures that align with client/patient standards. The prevailing community of autism service providers have evolved with our culture’s predominant ideology to prioritize concepts of patient-centered, value-based, and compassionate care, (regardless whether they use that terminology), but we’ll continue to do even better as we learn more. “The proof is in the pudding”.
This doesn’t mean we don’t focus on our ‘brand’ and effective marketing of our science and discipline. Just that we are more thoughtful in doing so. Perhaps a greater shift in emphasis to patient-centered outcomes. Not at the expense of, but in addition to other clinical outcomes.
Consider your website’s landing page highlighting “clients meet x percent of their treatment goals and report a 5 out of 5 on their experience and satisfaction with our team! Their parents report the same!”.
I believe that keeping ethics and client/patient values, experience, and satisfaction as guiding beacons for our research and practice, and central to all that we do and all that we are, is bound to best reflect our sincerity and achieve the best long term outcomes all around.
SUMMARY
As I reflect back knowing what I do now, there are extinction bursts I would have avoided, autistic client voices (including those who were non-verbal) I would have weighed so much more heavily, and treatment plans I would have approached differently. I don’t say this lightly. I remember, and so I’m confident my clients do too.
But there are also people who I know have good memories. People who are doing things now, it was said they’d never do. People living safer and healthier lives and having opportunities and successes they’d have otherwise not had. Autistic adults and parents I’ve spoken to who praise their therapists from years ago.
I have memories of schools whose policies and practices I was able to help shift toward more appetitive and reinforcement based practices. I did this working with, not against, district educators and administrators.
This isn’t justification for any outdated, hurtful practices. It’s a basis for a more balanced historical context.
Brandon Herscovitch, Ph.D., LABA, BCBA-D
Partners Behavioral Health supports ABA practice leaders and advocates for our discipline.
REFERENCES
Johnston JM, Foxx RM, Jacobson JW, Green G, Mulick JA. Positive behavior support and applied behavior analysis. Behav Anal. 2006 Spring;29(1):51-74. doi: 10.1007/BF03392117. PMID: 22478452; PMCID: PMC2223172.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223172
