ABA Therapy: Weighing Up the Pros and Cons

An aspiring occupational therapist discusses the potential pros and cons of Applied Behavior Analysis Therapy (ABA).

Applied Behavior Analysis (ABA) is a therapy that focuses on improving specific behavior skills. In the 1960s, ABA had its beginnings when Ivar Lovaas came up with the idea of a therapy called The Lovaas Method or Applied Behavior Analysis. ABA is typically used for those diagnosed with autism spectrum disorder (ASD) and is referred by a physician.

After an individual is referred to undergo ABA, an assessment is done. This is undertaken by a Board Certified Behavior Analyst (BCBA) who then designs a program to cater to the specific needs of the individual (What is ABA?, 2019).

Treatment goals can cover areas such as: communication, social skills, motor skills, self-care (hygiene), playing, and learning skills (Applied Behavior Analysis, n.d). ABA can be done through in-home visits, in school, or in the community. The BCBA and other therapists will oversee the patient throughout the program—documenting and measuring their progress.

Support from research

A research study concluded that 40 hours of ABA therapy over the course of several years has a 90% success rate (Lovaas, 1987). However, through the years the controversy surrounding ABA has spiked and it has brought up questions pertaining to whether or not the therapy is as helpful as claimed. The issue seems to be that ABA therapy could have more negative effects on patients than realized before.

Those advocating the success of ABA seem to believe the positive effects (such as significant social-communication skills) are more significant when therapy is started early. Health insurance companies often provide coverage for such therapeutic services for individuals with autism.

Not everyone agrees that ABA is beneficial. Some in the autistic community feel strongly about their own traumatic experience with the therapy. They speak about the negative effects because of post-traumatic stress disorder (PTSD) measured in children and adults exposed to ABA therapy. This may be because it uses theories of compliance and presents an idea of individuals needing to appear “normal”.

ABA success stories

The debate and controversy surrounding ABA are important to consider. Negative effects reported should be taken seriously, but successful outcomes also deserve mention. There are a couple of specific benefits mentioned by individuals who endorse ABA therapy.

• A study Ivar Lovaas did in 1987 illustrated significant social-communication gains for individuals who participated in early behavior interventions (Lovaas, 1987). Through interventions at a young age, children developed behavior strategies and academic skills with increasing positive gains as the children grew up
• The next positive effect is that many health insurance companies have begun providing coverage for therapeutic services for individuals with autism (Baller et al., 2016). This is not only beneficial for families needing this coverage but it also helped practitioners to specifically market their services towards the autistic community
• The last positive effect pertaining to this therapy is based on what ABA is. ABA is not a specific set of interventions but rather a scientific approach to teaching and learning that can reach a wide range of learners (Trump et al., 2018). This is a key feature because ABA therapy is less about specific rules and guidelines that need to be followed and more about developing an approach that will be the most effective for a specific individual

Contradicting research studies

While research tells us about the success of ABA, it also warns us of the potential danger and possible negative side effects. A study from 2018 showed that “nearly half of ABA-exposed respondents (46%) met the diagnostic threshold for PTSD” (Kupferstein, 2018). Kupferstein (2018) also mentioned that “respondents of all ages who were exposed to ABA were 86% more likely to meet the PTSD criteria than respondents who were not exposed to ABA”.

PTSD from this type of therapy was the main issue post ABA users had. The negative effects may be more pronounced if therapy commences at a young age, and if therapy is not performed properly.

Another issue is that ABA applies theories of compliance. Compliance is defined as ‘the act of conforming, acquiescing, or yielding”. In therapy, for example, a child will get their favorite toy or snacks taken away until they do what the therapist asks of them. It is similar to the rewards system, “if you do what I say, I’ll give you what you want”.

This is not necessarily harmful to the patient at the time but later on in life they may adapt certain behavioral methods or coping skills because of it. Sandoval-Norton and Shkedy (2019) felt that “a lifetime of punishment and reward without an understanding of the task that is being asked, can create individuals who are compliant and conditioned to obey others, independent of the given task. It creates individuals who lack intrinsic motivation, self-confidence, or self-esteem to successfully engage in any task” (Sandoval-Norton & Gary Shkedy, 2019).

Fortunately, depending on how long the individual has been in therapy, this method can be reversed. It might be a challenge if an individual is more adapted to it but it is possible.

The last reason for the controversy surrounding ABA is the idea or expectation of needing to appear “normal” that may be imposed on and developed in the individual. Society makes people feel like they need to “fit in” at all times. If someone looks different, speaks differently or dresses differently they are made to feel like they do not belong.

Autism and autisic behaviors ARE normal for people on the spectrum. Placing a child into therapy to train them out of their normal behaviors so they can appear neurotypical has the potential to be harmful. Instead, therapy should benefit a child by harnessing their strengths and providing strategies to help them thrive.