Issues with ABA Today.
Solid pink background with blue question mark.
I’ve been in the field of Applied Behavior Analysis (ABA) since 2011 and the field is changing, but not enough to support actual neurodivergent-affirming and trauma-based strategies. As an industry, we need to understand our impact and listen to those that have received ABA first hand. Only then, can we move forward and change for the better.
People that are opposed to ABA but only say “ABA is bad” do nothing to actually help change the industry. If we can pinpoint the specific issues, then things can change. This will not be an exhaustive list and will likely keep building as I think or see more but it is a starting point.
What needs to change with ABA:
Companies that use the buzzwords “Child-led”, “neurodivergent affirming”, or “trauma informed” without backing it up with their actions and trainings.
ABA should look like play - and that does not mean ‘play’ in the traditional sense. It means engaging how the child wants to engage. This can take time and practice but it is so important for the child to feel understood and accepted.
Goals like eye contact, following instructions without being able to advocate for themselves or withdraw assent, forcing or expecting neurotypical play, and others should not be in reports. We need to learn from autistic individuals that have been through ABA before and do better. If it does not serve the child, we should not include it.
Strategies like extinction, token boards, hand over hand prompting, following through no matter what, and others might have their time and place but should not be the first or only option! These are not trauma informed or neurodivergent friendly.
At a company that claims to be ‘child led’, every BT was still asking me for a token board even though it was not in any of my behavior support plans (BSPs). We cannot and should not teach that is the ‘norm’ anymore. Especially as experienced BCBAs, we need to show a better way to ABA.
Copy/Paste Behavior Plans and Goals
Why are we working on prepositions? Why do some still use motor actions in imitation programs that the learner will never actually have to do in real life? Why are we expecting a child to engage with activities they do not like or do not want to do? Why do we use Wh-questions that have nothing to do with the child or their interests?
“It’s on the VB-MAPP” or any other assessment does not mean it needs to be in our goals or behavior plans. We need our programs to be functional and accessible for the child and family. We are not creating little robots or just looking to check every box in an assessment. I know if we took a look at my social skills for my age, I might not score 100% and that is ok!
As BCBAs, we need to be able to move away from what we are taught and to think critically about what is actually important or necessary for this particular child.
The first line behavior plan can really make or break a relationship with a child. We need to make sure we are meeting them where they are at and working with them. Especially, for situations where the child has experienced trauma (and being an autistic person can lead to trauma on its own!), PDA, older children or teens, we need to recognize that behavior plans are not ‘one size fits all’.
Companies that only “Hire from Within”
Many of the large companies only hire from within. While that may be better for morale within the company, it only leads to the same old ideas being perpetuated and confirmation bias.
It also leads to BCBAs that have not been in the field very long moving up to positions of power and training others - even though they have not found their own voice or ideals yet.
I was with a company where I was relatively new but had more experience than many of the ‘higher ups’ in the company. I tried to advocate for more neurodivergent-affirming, trauma-informed, and child-led strategies and training and was screaming into the void. It was heartbreaking to try and help the company but they obviously did not see the need or desire to actually listen or implement what I was suggesting.
By bringing in BCBAs with different backgrounds, these companies could learn a lot but will be continuously stuck in their old ways thinking they are doing right by the clients they serve.
As BCBAs, we only improve by learning from others, hearing new strategies or experiences, or connecting with others with similar interests. By having outside BCBAs with a lot of experience come into these types of rolls, we can better shape these large companies because they can give outside perspective and news ways to improve.
Recommendations without meeting the child or that interfere with other important services.
This is not ethical and should be called out.
Many companies, especially the ones that are just looking to make money and grow, will say the child needs 40 hours per week in a clinic based setting on the intake call! There is no way to know what the child could actually benefit from before completing the assessment, listening to the family and child, and collecting data on behaviors and current skills.
If the company is also recommending that you take your child out of school, out of speech, out of OT, or to use all your free time with ABA sessions, RUN AWAY! ABA is not more important than any of these things and you can see progress with as little as a few hours of ABA per week with the support of these other services. They are just as important as ABA.
With any new ABA provider, make sure you as the parent ask all of the questions. You are putting your childs well-being into the hands of other people and you should feel very comfortable doing so. If the company or provider gets annoyed or angry with your questions, RUN AWAY!
Companies are leading to their own high turnover
Many companies, especially the larger ones, are not doing a good job about showing someone what it actually means to be an RBT or BT before they join the company.
This is a hard field! Especially if you are working in-home. The first tantrum, bite, kick, etc. can be very scary - if we just portray ABA to be all fun and games, we are doing a disservice to the RBT/BT and the family.
It can be intimidating when the child is upset and the parent is looking to you for support. It takes time and the right personality to be able to do this job.
Hiring ‘people with child care experience” is a start but these companies need to do better with explaining exactly what ABA is. Far too many staff quit before the end of training or after their first session because the company did not explain what ABA actually was.
The company then needs to hire even more people to account for the people who leave during training or within the first few weeks.
High turnover is detrimental for families and BCBAs
It is so embarrassing and heartbreaking as a BCBA to share with a family that the BT was there for one session and will never be there again because the company did not do a good job setting the staff member up for success.
These families want help and want people who care about their children at these companies. With this high turnover, ABA will never be successful for the family or the child.
As a BCBA, I might train 3-4 (or more!) new BTs on a client per month due to the high turnover. This is not ok. We know that a child, especially a neurodivergent one, learns best when they are connected with the person they are with. We are only teaching the child that the adults will leave them due to the high turnover.
Needing to train new BTs and RBTs, only to have them leave, is creating so much more work for BCBAs who already have so much to do.
Not listening to the children’s communication or assent withdrawl
What child is compliant 100% of the time? None of them. We should not be holding autistic children to that standard.
Especially if the child can not communicate, we need to take their body language and behaviors as communication.
If we attempt hand over hand prompting and the child pulls back their hand, we should not keep trying it.
If we are trying to clean up an activity and the child says ‘no’, we can give them a few more minutes.
If the child keeps running away from an activity, let’s figure out why they don’t want to do it and help them. Forcing them to do the activity and following through will only cause behaviors for them and frustration for them.
If the child prefers a break on their own, let them do it! It is a lot to be followed around by a person for 3-4 hours - breaks in a quiet, safe space should be encouraged.
Listening to them and supporting them will only help the relationship and you will see more progress and engagement this way. I guarantee it.
Private Equity Ownership and Company Growth
I can say from first hand experience, the companies that are trying to grow (especially the ones trying to grow quickly) are worse than the ‘mom and pop’, smaller ABA companies.
These companies are often blinded by the opportunity to grow and make money, rather than what the children we serve would actually benefit from.
So many bandaids are put on the problems, it is impossible for them to see what the problems are or fix them. Pair this with the issue that they only hire from within, and it makes sense why some of these companies are so bad.
Add to the fact that many of these companies only hire from within (especially for higher up positions) so the customs, ideas, and products of these companies are only perpetuated further.
Strategies that are not kind or are extreme
Extinction (especially without teaching a replacement!)
Every new BCBA will put extinction on their BSPs but I see so few actually teaching what to do instead. With any behavior, we need to have a replacement for them to engage in instead. These are some ideas for each function:
Attention: calling someone’s name, tapping them on the shoulder, saying “look at this/me”, telling a joke, doing a magic trick, engaging in conversations or play, asking for help or to play with someone.
Escape/Avoidance: asking for a break, saying “all done” or “no”, asking for help, asking for an example, asking for more time with the current activity before transitioning, asking to do something with someone, asking for sensory items or other support to better engage with the activity.
Access: asking for the item, asking when they can have the item, playing with multiple items (so they are not just focused on the one item), working on transitions away from preferred items, setting up a calendar or visual schedule with them so they can see when they can have the preferred item.
Automatic (Sensory): asking for the item (headphones, a fidget, the trampoline, etc.) , asking for a break (to engage with the item), asking to go for a walk, asking to standup and complete the task, asking to do the activity in a different way or location (due to sensory aversions like loud noises or crowed spaces).
Extinction is no longer providing reinforcement for a previously reinforced behavior. Sure, if you’ve asked for 5 candy bars today and got them, I’m going to have to say no at some point. If the child is looking for connection with their parents since they have been at work all day, putting the behavior on extinction will only cause more stress and worry for the child.
To be honest, I don’t even use the word extinction on my BSPs any more. I use something like
“ensure safety for the child and those around them. Use a neutral facial expression, tone, and body language. Wait for 5-10 seconds of calm or reduced intensity behavior. Prompt them to request what they are asking for. If is it not available, praise them for asking, give a simple explanation of why is it not available, and then offer two choices (hopefully two that meet the same or similar need and are preferred)”. You can add something like “model deep breathing or other self-regulatory activities but do not prompt or expect the child to engage in them” - again, we are not adding to the stress of what is happening but sometimes modeling these strategies can help in the moment.
For the candy bar example, at some point we would need to deny the request because you can’t have a million candy bars.
My behavior plan would say something like this “if the child asks for something that is not available, let them know it is not available, give a simple reason why, and then offer two choices that meet the same or similar need (with at least one being preferred to help redirect from the ‘no’)”
This would look like the adult saying “we are all done with the candy bars today, you can have one tomorrow. Do you want some fruit or crackers?” If using this strategy, ensure you are telling the child the truth - that they will not get any more candy bars today and that they do get one tomorrow. This will only work if the child feels understood and not tricked. You may need to communicate the limit or instruction to other adults in the location to ensure the child does not just go ask the other adults for one and gets it.
Full blown extinction (withholding all attention or all items) is also nearly impossible for parents or other caregivers to do with fidelity. They do not want to see or hear their child crying for hours - let’s give them a better way to move through behaviors. We know that BSPs need to be implemented with fidelity by all involved so let’s make that possible.
Token Boards
Token boards are a way to create expected or forced compliance.
A child may be having a really hard time but are trying their best to get through just to get their preferred item or a break. Why not just give them that break when they actually need it rather than pushing through to the point of no return?
They may have their time and place but should never be a first attempt with a child.
Use things like visual schedules, first/then statements, or other ways to create a connection and understanding - but still look for signs of assent withdrawal or becoming overwhelmed. It is much better for the child to know and understand that we are looking out for their best interest rather than expecting compliance.
Redirection and Correction at the height of behavior
A child, or anyone for that matter, is not in their thinking, rational brain when upset. They will not be able to negotiate or talk effectively at this time.
The best thing you can do is be there for them - no, this does not mean offering all of their favorite things or giving them access to the iPad. This means being a calm, supportive presence - it is ok to cry and it is expected for children to cry as an appropriate developmental behavior, especially if they are not able to communicate their wants and needs.
If you ask me to do something when I’m upset, you won’t like my answer either. We need to be more aware of the additional demands we are placing on children when they are upset. Try using the steps above in the extinction section if you are looking to better support your child. We all need time and space to calm down and that is ok!
Following Through, especially if assent was withdrawn
Listening to autistic individuals that have been through ABA state that this and eye contact are two of the worst things about ABA in their experience.
When I started in ABA, this was the norm. Since then, I have reflected on my own upbringing and experiences, listened to these first-hand accounts, and done my own research about what would be better.
If the child is not wanting to do something or does not like something, that is ok and should not be punished by expecting them to complete the activity.
You will get so much further and progress more if you recognize when the child is hesitant or worried, when they do not like or want to do something. You can label this “I see you want more time”, “It looks like you want to do it on your own”, etc. to help them understand what we see what they are attempting to communicate. If the child is not yet escalated, prompt then to ask for what they need (sign language, vocal requests, vocal approximations, pointing, AAC, using visuals, etc - not just vocal communication). It is ok if they don’t repeat or copy you - we are modeling without expectation. Over time, if you are doing this effectively, they will start to see that they have an alternative, rather than crying or screaming to get out of your request.
Electroshock or other forms of inhumane punishment
While this may seem crazy or outdated, this is still occurring. Many BCBAs and professionals are speaking out against The Judge Rotenberg Center in Canton, Mass. for using it and refusing to attend events where they are associated or a sponsor. They do a great job on their own social media accounts, removing any sign or picture (including blurring pictures to remove the device), but we know better. Here is an article from the Autistic Self Advocacy Network speaking out about it. https://autisticadvocacy.org/actioncenter/issues/school/climate/jrc/
Even before I was diagnosed with ADHD, there were strategies or goals that I disagreed with. I knew I only wanted sessions to be fun, to create connection and understanding, to focus on what the child wants to learn or do, to not be ‘cookie cutter’ with my approaches just because it was how I was trained or because companies I worked for used them as examples in their trainings and documents. And while this seems to be a ‘no brainer’, it is still the norm, especially with larger companies.
We should always focus on child-led sessions, focusing on assent, allowing stimming (as long as it is not harmful to the individual) and not expecting compliance. Parents need to be able to identify what is “good ABA” and what they should stay far away from. As an industry, we can shape ourselves to be better but we have to be able to call out and identify the negatives that are perpetuating the “ABA is bad” idea.