Because the very honest, very difficult truth is— ABA is problematic. ABA is abuse.
This is a difficult post to write. It’s hard because it’s not just one thing that’s the problem. It’s not even one group or organization. It’s the entire “autism industry”. It’s Applied Behavior Analysis (or ABA). And I’m a part of it. I’m a Board Certified Behavior Analyst (BCBA). I have my master’s degree in special education and behavior analysis.
And I still believe in what we do, even though the industry is corrupt.
The “industry of autism” is really all about money and power and influence. ABA therapy is a billion dollar industry. Places like the Judge Rotenberg Center (JRC) made over $90 million dollars last year. And they use pain-causing aversives (electric shocks) on people with autism. There are other places that use restraints and seclusion rooms. And they’re all making money off of it. ABA – which should be about helping people – has become something else entirely.
Reading the book “Pain and Shock in America“ by Jan Nesbit changed my life. It was hard to read about all of the things that have happened in our field – and are still happening. The book discusses JRC and how there have been attempts to close them down for many, many years. It was graphic and horrible and every single statement is backed up with evidence. I read about children being beaten for hours, about a staff member who looked for spaces without bruises to circle with magic marker so that they would know where to hit, about being restrained for months, about food deprivation and six young people dying of “natural causes”…
I read nearly 400 pages in a single night. I spent hours watching videos, reading page after page in Lydia Brown’s living archive. I read articles from the United Nations, Fox News, CNN, the Guardian… I read about 50 years worth of advocates’ attempts to close JRC, about lawsuit after lawsuit, legal intimidation and more. And there was so, so much more that I hadn’t even touched. The entire time, my heart broke. Families send their children here because they believe there are no other options. The system has failed them. We have failed them.
And then… it got deeper. I learned about the ties between the Association for Behavior Analysis International (ABAI) and JRC. How many years JRC has sponsored their conventions, how they even once gave them an award. How many of JRC’s board of directors are intertwined with leadership at ABAI. How their statement on restraint and seclusion almost endorsed the practice of punishment. And I came to that harsh, sad truth– that it’s always, always been money and power and control. It’s never been about helping people, not at the highest levels. Not when we’re talking about billions of dollars instead of lives.
It doesn’t matter that my focus isn’t autism. It doesn’t matter that I do my best to practice neurodiversity-affirming ABA, that I don’t do “eye contact goals” and I don’t target stimming. It doesn’t matter because one bad apple poisons the whole bunch. And let’s be clear– this is not a problem limited to JRC. They are not the one bad apple. They are just the largest, most obvious bad apple.
It’s not an exaggeration to say that this realization utterly crushed my spirit. I got into this field to save lives. I got into this field because I love seeing the first words from a kid, love seeing their relationships grow with their families, because I love learning about their special interests and sharing my own with them. I have felt so incredibly blessed to have found my calling in using applied behavior analysis to show the world there are no bad kids, there are only bad situations, there are only untaught skills, there are only people desperately trying to meet their needs in the only way they know. And yet– despite that– I’m complicit. And if you’re a behavior analyst or a technician or whatever you may be– so are you.
I spent days pacing and signing to myself and fidgeting around — stimming. I cried. I looked at alternative grad schools. I thought about quitting everything. I wondered if I even wanted to keep those four letters after my name, even though I had worked so hard to get here. I was consumed by the sole thought that I needed to do something. I had to do something.
Finally- I realized that perhaps the legal system had failed. It failed Autistics. It failed disabled people. It failed humanity.
But I still believe in behaviorism. And I know you do, too, even though you’re tired and weary and your heart hurts. Even though you’ve just been trying to do your best. Even though maybe your practice doesn’t use the “old ABA”. So let’s change the world together. Let’s use behavior analysis to… well, change behavior analysis.
I think that starts with you and I.
What are you doing right now? Not right now right now, but what are you doing as a practitioner? What techniques and interventions do you use? What is your work and who is it with? What does your day look like?
What do you value? Or more simply, what do you care about? What do you care about so deeply, so intensely, that it is your heart, no matter what?
How do you want to be? Does your behavior align with your values? It’s okay if they don’t because we often engage in cognitive dissonance (or incongruent verbal relations, if you want to get RFT about it) where when our beliefs and behavior don’t align… we reject new information, we explain it away, we do everything in our power to explain why it’s OK that they’re different. So it might have escaped your notice too. But… now you know and the next step is up to you. (For more about this, check out ACT resources!) What do you do next?
Highlight Autistic Voices. Listen to them. Learn from them. Fight the urge to say “yes, but” and just… listen to what they have to say. Yes, they will say all ABA is abuse. It’s hard to fight the defensiveness — the cognitive dissonance — when you see yourself as a helper and you’re being called abusive. But push past that and listen. You might be surprised what you learn.
Recognize your own biases. Autistic people are a distinct cultural group, even those who haven’t met other Autistics yet. Stimming isn’t bad. Eye contact isn’t necessary. Question every program and why you do it. Is it truly to improve the client’s life? Will it give them skills they need? Or is it to make you or their family more comfortable?
Educate Others. This one is tricky because it’s easy to become the “ABA police” and try to force people to see the light and be more like you. But that won’t work and it’ll just turn people away. Share your story. Be open about what you do and why you do it but also listen to their story and their questions. You might be surprised what you learn from them, too.
Do No Harm. We’re not perfect but that doesn’t mean we can’t strive to be better. But we should always be trying to Do No Harm and leave the client better than when we found them. Examine your practices and make sure they align with your values (hint: if they don’t, that might be a sign to change something). Research new techniques and find out what’s been shown to be harmful. And beyond research, realize that evidence-based practice doesn’t mean best practice. Evidence of something working has nothing to do with its social validity or benefit to the client. And sometimes there are things that might not have evidence. Be open to change and new information. And most importantly, remember that you’re not perfect and that’s okay.
These are just some of the ways we can begin to make changes. But it starts with each and every one of us taking a good, hard look at ourselves and our practices. And if you feel, like I do, that it’s not enough, okay. You’re right. It will never be enough but we have to keep trying.
Does your FaceBook group (or other social media groups, pages etc.) allow advertisements or information from places that use aversive interventions (such as skin shocks, noxious mists, any procedure designed solely to cause pain, withholding meals etc.)? Do they allow these places to post job advertisements?
Add a policy. If you’re an administrator or moderator of a social media group, add a policy that disallows these things. If you see them, call it out. In the same way many groups do not allow Multi-Level Marketing, take a stand against aversives. We know that ABA is not a single intervention or set of interventions. It’s a way of thinking, a philosophy. And as such, it can be used to promote humane and ethical practices or it can be used to legitimize abuse. The choice is up to us. Here’s an example policy that you could use:
We do not allow posts, pages, or events from organizations which engage in practices that are harmful to clients (such as the use of procedures designed solely to cause pain, Contingent Electric Skin Shock, noxious mists, the withholding of meals for punishment).
People will always try to justify it– that the parents consented or that this was the only way– but as professionals, we have a duty to the client. We understand that parents are put into very difficult situations where they may feel this is their only choice. We understand that people do so because they genuinely believe this their child’s last option. But we also know that desperate families and parents are a very vulnerable group who may be taken advantage of by other professionals. It is our duty to prevent inhumane practices and abuse in our field regardless of their efficacy.
Does your company, agency, school, organization etc. have a policy prohibiting the use of aversive interventions (such as skin shocks, noxious mists, any procedure designed solely to cause pain, withholding meals etc.)?
If not… add one! And while you’re at it, take a critical look at the practices of your team. Do they align with your values? Does it center human dignity? Is there any harm being done? If your center was on TV, would you be proud or ashamed of what people see?
Yes, it’s taking a stance, but being a BCBA doesn’t mean we have to be open to anything and everything. It means we think critically about the ethics of the procedures we do. Many of the people who support aversive interventions or who write the literature are doing so from a research standpoint, not an applied one. And we know that research lags behind practice. Here’s an example statement you could use, and some statements I was able to find online.
We follow the BACB’s Ethics Code for Behavior Analysts. In alignment with the core principles of maximizing benefit to others and do no harm, treating others with compassion, dignity, and respect, behaving with integrity, and working within the boundaries of their competence and scope, we prohibit the usage of harmful interventions including but not limited to: those which are designed specifically to cause pain; those which elicit obvious signs of physical pain experienced by the individual; the usage of Contingent Electric Skin Shock; the withholding of meals as punishment; noxious mists, sprays or unpleasant tastes designed to create aversive physical sensations.
For Contingent Electric Skin Shock in particular, the FDA has classified the ‘Graduated Electric Device’ (GED) as a medical device. BCBAs do not receive medical training and such devices are proven to cause short- and long-term health risks. Other similar electric shock devices are used in medical settings (such as in chemotherapy or Electroconvulsive Shock Therapy). Therefore, it is outside of the BCBA or RBT’s scope to utilize these devices.
If you’re a university student, do your professors have any affiliation with JRC? Talk to your department and see if there are opportunities to discuss more ethics and our field. You are the future. What can you do to teach others about this issue? Consider starting a book club around “Pain and Shock in America“ by Jan Nesbit, which is a historical analysis and likely one of the most balanced views on the topic.
Does your state have a law prohibiting the use of aversive interventions? Do they also prevent students from being sent out-of-state to institutions using aversive interventions?
Talk to your congress people. PUT UP A FUSS. It matters. We have to make noise and fight for the rights of the most vulnerable. You can look up who your Congress people are at this link. There are a number of action items that have been put together by activist AutisticSciencePerson. These include scripts you can use!
Have you seen anyone using aversive interventions?
This is against the BACB’s Ethical Code. First, consider if you’re able to talk to them and resolve it that way. The BACB says: “If there is any indication that a direct conversation with the individual could resolve the issue or concern, you should have that discussion before submitting a Notice. In many cases, simply having a conversation about the potential ethics violation can resolve the issue, as the individual might not be aware of the violation or might not understand that their actions are perceived as a violation by others. If you attempt to address the issue directly, please document all attempts and outcomes. If the issue is not resolved after you attempt to address it, please submit that documentation with your Notice.”
As we’ve discussed earlier in this post, there are many well-meaning individuals who may cause harm because they do not realize that they are. Gently addressing this can make a difference. We know why we got into this field- to help. Remind them of their values and their behavior. How can they do better?
If this does not work, then consider reporting them to the BACB as an ethical violation. You do not need to list a specific requirement that you think is violated, simply what the situation and context are. The BACB does generally require reports to occur within 6 months of knowledge of the violation, but this can be longer for instances of abuse. You will need documentation and generally a first hand account. You can also contact the ABA Ethics Hotline for guidance.
Another concern is that many are afraid to speak out over fears that they may receive a cease and desist letter or lose their certification.
First, the truth is an absolute defense to defamation, so if what you’re saying is true, then you have nothing to worry about. SLAPP laws also protect you from frivolous lawsuits designed to silence you. SLAPP stands for “Strategic Lawsuit against Public Participation” and is when public organizations use their positions of power and wealth to silence people who speak out against them. There are laws in place to protect you. Another fear is that you may lose your certification because you speak out. This is not true. I even called the ABA Ethics Hotline myself to discuss this very issue– your first amendment rights trump the Code. And what exactly would you be doing wrong in calling for the humane treatment of people with disabilities?
Write to the BACB. “Do No Harm” was only added to the Code recently and went into effect this past January. We need the BACB to take a stronger stance. You can also write to organizations like BHCOE, CASP, etc. who set many of the standards for our practice.
The field of Applied Behavior Analysis is one that is full of passionate individuals. We all got into this line of work because we want to help others. We’ve seen the amazing things that ABA can do, but we also know that there’s something wrong with the system. The current state of ABA is one where harmful practices are still commonplace. This is a harsh truth, but it’s one that we need to face if we’re going to make any real change. This is just the beginning but it’s a start. I hope you’ll join me in this fight.
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