How is ABA harmful and ableist?
Introduction
When the norm takes priority, those who do not meet the standard are left behind. I have seen a student scolded at for singing in art class, because singing is not a valid form of communication, only to build a working model of a ferris wheel the next day. I have witnessed a teacher complain that a she had to do the student’s work for him because he wasn’t capable, but lead his group to safely cross a busy street a week later. I watched as a teacher told another staff member we cannot trust when a student says they do not need help because nine out of ten times their work is not up to standard; the student she was referring to nailed all of her lines and notes in The Sound of Music play a few months prior. Why is that these students are being treated so unfairly? Did this school hire a bunch of cold-hearted people or could it be something else? I believe these staff members stop using their better judgment and turn off their compassion when they must go by the standards of ABA therapy.
Background and Authorities
Applied Behavioral Analysis (ABA) therapy was formed from the branch of psychology known as Behaviorism by Ivar Lovaas and Robert Kroegel around 1970 at UCLA to treat people with autism spectrum disorder (ASD). “ABA is the applied use of behavioral principles to everyday situations with the goal of either increasing or decreasing targeted behaviors” (What is ABA?). Lovaas had some “success” with ABA therapy but the results were based off children receiving 40 hours of therapy a week from a well-trained therapist and continued therapy from their extensively trained parents for the rest of their waking hours (Lovass, 1987, p. 5). In a 1974 interview with Psychology Today, it is clear he regarded people with autism as less than human, which his treatment methods reflect, “You have a person in a physical sense — they have hair, a nose and a mouth — but they are not people in the psychological sense” (Lovaas, 1974). This dehumanizing outlook on people with autism contributed to cure based research on treating autism and ultimately the acceptance of ABA as the best treatment option. Part of the problem with Lovaas’ method of treating ASD is that it was created around the medical model of disability. Areheart (2008) stated:
[The medical model] relies on normative categories of "disabled" and "non-disabled,” and presumes that a person's disability is "a personal, medical problem, requiring but an individualized medical solution; that people who have disabilities face no 'group' problem caused by society or that social policy should be used to ameliorate. The medical model views the physiological condition itself as the problem. In other words, "the individual is the locus of disability.” (p. 185)
The medical model regards ASD as a medical condition that interferes with “normal” functioning that must be treated and ultimately cured. An extension of this is the concept of ableism, the idea that those who are ''more able'' are ''more includable'' into mainstream educational environments as well as greater society. (Shyman, 2016, p. 3) Ableism also discourages students from taking self-protective actions, which puts their safety at risk. This is further explained in this quote by Smith and Harrell (2013):
In addition to contributing to the higher rates of sexual abuse against children with disabilities, ableism has structured our responses and supports for children with disabilities around notions of their dependency as opposed to supporting more independence. This has resulted in a culture of compliance that surrounds children with disabilities. Although all children are trained to be compliant to authority figures in our society, compliance is stressed to an even greater degree for children with disabilities. In this environment, children with disabilities are denied the right to say no to everyday choices such as what they will wear or eat, leaving them completely unequipped to say no when someone is trying to hurt them. (p. 6)
There are more humanistic approaches to treating autism such as Occupational Therapy, Speech Therapy, or the DIR Floortime Model. The DIR model is the Developmental, Individual-differences, & Relationship-based model that has become the foundation for understanding child development and providing support and intervention that helps children reach their fullest potential (DIR).
Methods and Constraints
I obtained permission from a school for children with disabilities to use their Behaviorist manual for my research project. The school uses ABA Therapy to treat the students who have autism. The manual, that is specifically made by behaviorists at the school for the school, contains forms and procedures the behaviorists use to go about working with the students. The manual outlines different types of plans that will be used to work on students’ behaviors. The two main types of plans are Positive Behavior Supports (PBS) and Behavior Intervention Plans (BIP). Some other plans for more specific behaviors are outlined as well data collection and assessment is broken down. It also contains guidelines for consequences and how to handle students with aggressive tendencies. Here I analyze the language in the manual to bring to light the ableist language so we can begin to see how this affects how we treat people with autism.
Findings
On the page that describes a PBS and BIP there is an implied argument made by these two types of plans. (PBS/BIP)The argument is that the students’ behavior must be changed because it is not acceptable as is. A PBS is developed to “increase appropriate behavior” which implies there is a standard for appropriate behavior. If we are trying to increase a student’s appropriate behavior we are therefore trying to suppress their natural responses. When focusing on normalizing, one is using the medical model where ASD is regarded as a disease “that is to be treated or even cured in order to provide a basis for a person to attain normality” (Shyman, 2016, p. 6),
One example given is on-task behavior, which is regarded as a behavior to be achieved, not an issue to be investigated. (PBS/BIP) Oftentimes, when targeting on-task behavior, the idea is to eliminate what behaviorists consider off-task behavior, which is often self stimulatory behaviors. This plan implies that a student cannot be on task while engaging in self stimulatory behaviors which is simply false and neglects to consider the self regulating necessity of self stimulatory behavior. Another example is food tolerance which refers to the student being unwilling to eat certain foods. (PBS/BIP) People with autism often have sensory differences which causes them to not favor many food textures, but this plan would force them to try and tolerate certain foods. Although there is an understandable concern for one’s child not eating nutritious foods, when food tolerance is treated as a behavior to be rewarded or punished, there is a lack of autonomy and consent.
There is a form that lays out how they will use an Aversive Treatment Plan. The first thing to fill out is the target behavior that they are trying to get rid of. Under “description of aversive treatment procedure” it states the parent chooses what type of aversive will be used and gives the examples of a noise or taste. The existence of this plan argues that it is okay to subject a person with sensory differences to an undesirable and potentially painful aversive to make them behave in the desired manner. It clearly states that there will be side effects to this but does not explicitly list them. It asks the parent to observe for side effects to see if the behaviorists need to reassess, which argues this could be a risk to their safety that would need to be stopped. In order to use this method a parent signature is required, which gives consent for treating their child. This does not give the student a say in their safety and wellbeing. The people our students should trust most, the staff and their parents, are knowingly putting their child at risk without the child having a say in it, which teaches a lack of self autonomy.
On the next page there is a data sheet where a staff member would record what happens before, during, and after the aversion plan is used. The listed/most common antecedents to the undesirable behavior, were: “given direction, transitioning locations, transitioning from preferred to less preferred activity, denied access/told no, waiting, attention not given when wanted, presence of a specific person, peer engaged in problem behavior, or other” (Aversive Data Sheet). This list of antecedents are the most common reasons why a “problem behavior” might occur that then results in the student receiving an aversive. The fact that the presence of a person might cause a bad behavior and lead a student to receive a potentially painful aversive teaches a student that their safety is not a priority and they must submit to the will of others to be safe. This goes for all of the antecedents, in order to be safe and not receive the aversive, the students cannot react in their natural way to undesirable situations. The “reaction to aversive” section states the common reactions as being: “no reaction, turns away, spits out, yells/cries, aggression, or other. So it is expected that the student will cry in pain or react angrily” (Aversive Data Sheet). Their safety is not a priority in this treatment plan and therefore it is a violent and endangering attempt to get a student to behave in a way the behaviorists, parents, and society have deemed acceptable. Enduring pain for the sake of normalizing is a very harmful effect of ableism.
Staff members record data on the antecedent, behavior, and consequence for students on The ABC Data Collection Sheet.
The antecedents listed are the same common ones as the Aversive Treatment Plan data sheet. The behaviors listed include: “crying/whining, screaming, cursing, kicking, flopping, bolting, property destruction, hits self, hits others, verbal refusal, and spitting” (ABC Data Collection Sheet). The consequences are: “physically guided to comply, ignored problem behavior, kept demand on, count and mand procedure, removed from activity/location, given another task/activity, interrupted/blocked and redirected, left alone, physically restrained, verbal reprimand, or time-out” (ABC Data Collection Sheet). Physically guided to comply means forcing a student against their will to do as they are told. Once again this takes away their autonomy and choice. This teaches them that it is okay for people to put their hands on them and force them to do activities they do not want to do. Children with disabilities are many times more likely to be physically or sexually abused (Smith & Harrell, 2013). A majority of abuse against children is committed by someone they know and those who prey on children with disabilities are often socially connected to them by their disability (Smith & Harrel, 2013, p. 7), so therefore when people they should trust are forcing them to do things against their will they’re not being taught consent and how to protect themselves. This is dangerous on many levels and also dehumanizing. Being physically restrained also sends the same message. Another consequence was keeping the demand on the student. If a student is becoming distressed, which likely increases problem behaviors, and the demand is kept on them, this can cause an extreme amount of emotional distress. Many people with autism who have gone through ABA have been reported to have PTSD and other trauma from being forced to do activities that are not natural to them (Brown, 2012).
The Student Review Form is a form where the staff and student’s behavior is evaluated at the same time. There is a “yes” or “no” option for the question of if the BIP/PBS for a student is being run properly. If this was marked as a “no” and the student’s behavior is not being monitored properly, the staff could be at fault for the student receiving consequences that are out of their control (Secondary/YAP Student Review Form). There are many places under “staff behavior” where staff could go wrong and any slight discrepancy could result in students bearing the burden of the staff’s actions. As for the student section, the first part is a checklist determining whether or not they’re displaying acceptable social behaviors such as: greeting appropriately, responding to greetings appropriately, initiates/maintains conversation, appropriate conversation topics, and engages in leisure skills with peers. Students must interact with others how the behaviorist, who is guided by societal norms, sees appropriate. This is not natural, but a way to have the student mimic social norms and appear normal instead of acting how they feel comfortable. Stereotypical behaviors such as motor stereotypy (stimming) and vocal stereotypy (scripting) which are natural ways a person with autism communicates and self soothes are “reviewed” and therefore determined if they will need to be extinguished for the student to appear more normal (Secondary/YAP Student Review Form). On task behavior is also judged which includes: “eyes orientated towards instructor, correctly responds within 5 seconds and appropriate sitting” (Secondary/YAP Student Review Form). This argues that if one’s eyes are not looking at the teacher they are not on task or paying attention, which assumes eye contact is directly correlated with paying attention. It also argues that responding correctly within 5 seconds is the only acceptable way to answer questions even though ASD is characterized by processing delays which may cause the person to take longer to process and respond.
In the Disciplinary Actions section of the manual, there are procedures for giving consequences to the students. A consequence for physical aggression is having to go to the Calming Down Room (CDR). If a student resists it states a behaviorist will assist them into the room. They will be physically forced into the room where the door is shut and they are monitored from outside the room. It states if a student takes his/her shoes off they will need to be taken away, which argues the student will most likely be in a state of high mental distress (Consequence Procedures). In order to leave, it states the student can either verbally state, in a calm voice, that they are ready or they must comply with given directions. This teaches the student compliance but not does not focus on reasons behind the mental distress. On the next page it goes into detail about certain holds you can or cannot do on certain sized students. Physically restraining a child in anyway is not teaching consent or control over their bodies.
Conclusions
Overall the language of manual causes the staff to treat the students like a summation of their data instead of as people, which can be very dehumanizing. I found that many of these documents contain ableist methods and are often used to normalize and suppress behaviors. There is a presumption that the ''symptoms'' of autism are “negative and denigrating,” and must be treated and reduced in order to increase one's quality of life. This has not, in any way, been validated or even suggested by quantitative or qualitative research (Shyman, 2016, p. 8). It focuses on changing and managing their behaviors to fit the norm. Suppressing behaviors typical to those with ASD, such as stimming and lack of eye contact, and replacing them with more “normal” or “socially appropriate” behaviors is ableist and serves no purpose other than for appearances. (Shyman, 2013) Ableism is similarly harmful to other common “isms” because it creates a power imbalance that places “more abled” lives as more valuable. The manual also teaches that a student’s right to their own autonomy, wellbeing, and safety becomes a privilege until compliance is taught, which can be especially dangerous for children with disabilities.
In conclusion, ABA isn’t the only option of treatment out there. Behaviorism was first used to train and experiment on animals and it should be left there. The DIR Model focuses a lot more on building relationships and nurturing the natural tendencies of the child to help them develop in new ways. Occupational Therapy is a more holistic treatment that works with a student's sensory needs and focuses on developing skills needed for daily life. Speech therapy can provide a wide range of services such as developing communication skills, using AAC devices, and even sensory issues related to swallowing. Building relationships and treating people with respect is a much more humane way to interact with any person. If we can get ABA out of schools and therefore rid them of ableism, the medical model can become an idea of the past and acceptance can begin to happen.
When the norm takes priority, those who do not meet the standard are left behind. I have seen a student scolded at for singing in art class, because singing is not a valid form of communication, only to build a working model of a ferris wheel the next day. I have witnessed a teacher complain that a she had to do the student’s work for him because he wasn’t capable, but lead his group to safely cross a busy street a week later. I watched as a teacher told another staff member we cannot trust when a student says they do not need help because nine out of ten times their work is not up to standard; the student she was referring to nailed all of her lines and notes in The Sound of Music play a few months prior. Why is that these students are being treated so unfairly? Did this school hire a bunch of cold-hearted people or could it be something else? I believe these staff members stop using their better judgment and turn off their compassion when they must go by the standards of ABA therapy.
Background and Authorities
Applied Behavioral Analysis (ABA) therapy was formed from the branch of psychology known as Behaviorism by Ivar Lovaas and Robert Kroegel around 1970 at UCLA to treat people with autism spectrum disorder (ASD). “ABA is the applied use of behavioral principles to everyday situations with the goal of either increasing or decreasing targeted behaviors” (What is ABA?). Lovaas had some “success” with ABA therapy but the results were based off children receiving 40 hours of therapy a week from a well-trained therapist and continued therapy from their extensively trained parents for the rest of their waking hours (Lovass, 1987, p. 5). In a 1974 interview with Psychology Today, it is clear he regarded people with autism as less than human, which his treatment methods reflect, “You have a person in a physical sense — they have hair, a nose and a mouth — but they are not people in the psychological sense” (Lovaas, 1974). This dehumanizing outlook on people with autism contributed to cure based research on treating autism and ultimately the acceptance of ABA as the best treatment option. Part of the problem with Lovaas’ method of treating ASD is that it was created around the medical model of disability. Areheart (2008) stated:
[The medical model] relies on normative categories of "disabled" and "non-disabled,” and presumes that a person's disability is "a personal, medical problem, requiring but an individualized medical solution; that people who have disabilities face no 'group' problem caused by society or that social policy should be used to ameliorate. The medical model views the physiological condition itself as the problem. In other words, "the individual is the locus of disability.” (p. 185)
The medical model regards ASD as a medical condition that interferes with “normal” functioning that must be treated and ultimately cured. An extension of this is the concept of ableism, the idea that those who are ''more able'' are ''more includable'' into mainstream educational environments as well as greater society. (Shyman, 2016, p. 3) Ableism also discourages students from taking self-protective actions, which puts their safety at risk. This is further explained in this quote by Smith and Harrell (2013):
In addition to contributing to the higher rates of sexual abuse against children with disabilities, ableism has structured our responses and supports for children with disabilities around notions of their dependency as opposed to supporting more independence. This has resulted in a culture of compliance that surrounds children with disabilities. Although all children are trained to be compliant to authority figures in our society, compliance is stressed to an even greater degree for children with disabilities. In this environment, children with disabilities are denied the right to say no to everyday choices such as what they will wear or eat, leaving them completely unequipped to say no when someone is trying to hurt them. (p. 6)
There are more humanistic approaches to treating autism such as Occupational Therapy, Speech Therapy, or the DIR Floortime Model. The DIR model is the Developmental, Individual-differences, & Relationship-based model that has become the foundation for understanding child development and providing support and intervention that helps children reach their fullest potential (DIR).
Methods and Constraints
I obtained permission from a school for children with disabilities to use their Behaviorist manual for my research project. The school uses ABA Therapy to treat the students who have autism. The manual, that is specifically made by behaviorists at the school for the school, contains forms and procedures the behaviorists use to go about working with the students. The manual outlines different types of plans that will be used to work on students’ behaviors. The two main types of plans are Positive Behavior Supports (PBS) and Behavior Intervention Plans (BIP). Some other plans for more specific behaviors are outlined as well data collection and assessment is broken down. It also contains guidelines for consequences and how to handle students with aggressive tendencies. Here I analyze the language in the manual to bring to light the ableist language so we can begin to see how this affects how we treat people with autism.
Findings
On the page that describes a PBS and BIP there is an implied argument made by these two types of plans. (PBS/BIP)The argument is that the students’ behavior must be changed because it is not acceptable as is. A PBS is developed to “increase appropriate behavior” which implies there is a standard for appropriate behavior. If we are trying to increase a student’s appropriate behavior we are therefore trying to suppress their natural responses. When focusing on normalizing, one is using the medical model where ASD is regarded as a disease “that is to be treated or even cured in order to provide a basis for a person to attain normality” (Shyman, 2016, p. 6),
One example given is on-task behavior, which is regarded as a behavior to be achieved, not an issue to be investigated. (PBS/BIP) Oftentimes, when targeting on-task behavior, the idea is to eliminate what behaviorists consider off-task behavior, which is often self stimulatory behaviors. This plan implies that a student cannot be on task while engaging in self stimulatory behaviors which is simply false and neglects to consider the self regulating necessity of self stimulatory behavior. Another example is food tolerance which refers to the student being unwilling to eat certain foods. (PBS/BIP) People with autism often have sensory differences which causes them to not favor many food textures, but this plan would force them to try and tolerate certain foods. Although there is an understandable concern for one’s child not eating nutritious foods, when food tolerance is treated as a behavior to be rewarded or punished, there is a lack of autonomy and consent.
There is a form that lays out how they will use an Aversive Treatment Plan. The first thing to fill out is the target behavior that they are trying to get rid of. Under “description of aversive treatment procedure” it states the parent chooses what type of aversive will be used and gives the examples of a noise or taste. The existence of this plan argues that it is okay to subject a person with sensory differences to an undesirable and potentially painful aversive to make them behave in the desired manner. It clearly states that there will be side effects to this but does not explicitly list them. It asks the parent to observe for side effects to see if the behaviorists need to reassess, which argues this could be a risk to their safety that would need to be stopped. In order to use this method a parent signature is required, which gives consent for treating their child. This does not give the student a say in their safety and wellbeing. The people our students should trust most, the staff and their parents, are knowingly putting their child at risk without the child having a say in it, which teaches a lack of self autonomy.
On the next page there is a data sheet where a staff member would record what happens before, during, and after the aversion plan is used. The listed/most common antecedents to the undesirable behavior, were: “given direction, transitioning locations, transitioning from preferred to less preferred activity, denied access/told no, waiting, attention not given when wanted, presence of a specific person, peer engaged in problem behavior, or other” (Aversive Data Sheet). This list of antecedents are the most common reasons why a “problem behavior” might occur that then results in the student receiving an aversive. The fact that the presence of a person might cause a bad behavior and lead a student to receive a potentially painful aversive teaches a student that their safety is not a priority and they must submit to the will of others to be safe. This goes for all of the antecedents, in order to be safe and not receive the aversive, the students cannot react in their natural way to undesirable situations. The “reaction to aversive” section states the common reactions as being: “no reaction, turns away, spits out, yells/cries, aggression, or other. So it is expected that the student will cry in pain or react angrily” (Aversive Data Sheet). Their safety is not a priority in this treatment plan and therefore it is a violent and endangering attempt to get a student to behave in a way the behaviorists, parents, and society have deemed acceptable. Enduring pain for the sake of normalizing is a very harmful effect of ableism.
Staff members record data on the antecedent, behavior, and consequence for students on The ABC Data Collection Sheet.
The antecedents listed are the same common ones as the Aversive Treatment Plan data sheet. The behaviors listed include: “crying/whining, screaming, cursing, kicking, flopping, bolting, property destruction, hits self, hits others, verbal refusal, and spitting” (ABC Data Collection Sheet). The consequences are: “physically guided to comply, ignored problem behavior, kept demand on, count and mand procedure, removed from activity/location, given another task/activity, interrupted/blocked and redirected, left alone, physically restrained, verbal reprimand, or time-out” (ABC Data Collection Sheet). Physically guided to comply means forcing a student against their will to do as they are told. Once again this takes away their autonomy and choice. This teaches them that it is okay for people to put their hands on them and force them to do activities they do not want to do. Children with disabilities are many times more likely to be physically or sexually abused (Smith & Harrell, 2013). A majority of abuse against children is committed by someone they know and those who prey on children with disabilities are often socially connected to them by their disability (Smith & Harrel, 2013, p. 7), so therefore when people they should trust are forcing them to do things against their will they’re not being taught consent and how to protect themselves. This is dangerous on many levels and also dehumanizing. Being physically restrained also sends the same message. Another consequence was keeping the demand on the student. If a student is becoming distressed, which likely increases problem behaviors, and the demand is kept on them, this can cause an extreme amount of emotional distress. Many people with autism who have gone through ABA have been reported to have PTSD and other trauma from being forced to do activities that are not natural to them (Brown, 2012).
The Student Review Form is a form where the staff and student’s behavior is evaluated at the same time. There is a “yes” or “no” option for the question of if the BIP/PBS for a student is being run properly. If this was marked as a “no” and the student’s behavior is not being monitored properly, the staff could be at fault for the student receiving consequences that are out of their control (Secondary/YAP Student Review Form). There are many places under “staff behavior” where staff could go wrong and any slight discrepancy could result in students bearing the burden of the staff’s actions. As for the student section, the first part is a checklist determining whether or not they’re displaying acceptable social behaviors such as: greeting appropriately, responding to greetings appropriately, initiates/maintains conversation, appropriate conversation topics, and engages in leisure skills with peers. Students must interact with others how the behaviorist, who is guided by societal norms, sees appropriate. This is not natural, but a way to have the student mimic social norms and appear normal instead of acting how they feel comfortable. Stereotypical behaviors such as motor stereotypy (stimming) and vocal stereotypy (scripting) which are natural ways a person with autism communicates and self soothes are “reviewed” and therefore determined if they will need to be extinguished for the student to appear more normal (Secondary/YAP Student Review Form). On task behavior is also judged which includes: “eyes orientated towards instructor, correctly responds within 5 seconds and appropriate sitting” (Secondary/YAP Student Review Form). This argues that if one’s eyes are not looking at the teacher they are not on task or paying attention, which assumes eye contact is directly correlated with paying attention. It also argues that responding correctly within 5 seconds is the only acceptable way to answer questions even though ASD is characterized by processing delays which may cause the person to take longer to process and respond.
In the Disciplinary Actions section of the manual, there are procedures for giving consequences to the students. A consequence for physical aggression is having to go to the Calming Down Room (CDR). If a student resists it states a behaviorist will assist them into the room. They will be physically forced into the room where the door is shut and they are monitored from outside the room. It states if a student takes his/her shoes off they will need to be taken away, which argues the student will most likely be in a state of high mental distress (Consequence Procedures). In order to leave, it states the student can either verbally state, in a calm voice, that they are ready or they must comply with given directions. This teaches the student compliance but not does not focus on reasons behind the mental distress. On the next page it goes into detail about certain holds you can or cannot do on certain sized students. Physically restraining a child in anyway is not teaching consent or control over their bodies.
Conclusions
Overall the language of manual causes the staff to treat the students like a summation of their data instead of as people, which can be very dehumanizing. I found that many of these documents contain ableist methods and are often used to normalize and suppress behaviors. There is a presumption that the ''symptoms'' of autism are “negative and denigrating,” and must be treated and reduced in order to increase one's quality of life. This has not, in any way, been validated or even suggested by quantitative or qualitative research (Shyman, 2016, p. 8). It focuses on changing and managing their behaviors to fit the norm. Suppressing behaviors typical to those with ASD, such as stimming and lack of eye contact, and replacing them with more “normal” or “socially appropriate” behaviors is ableist and serves no purpose other than for appearances. (Shyman, 2013) Ableism is similarly harmful to other common “isms” because it creates a power imbalance that places “more abled” lives as more valuable. The manual also teaches that a student’s right to their own autonomy, wellbeing, and safety becomes a privilege until compliance is taught, which can be especially dangerous for children with disabilities.
In conclusion, ABA isn’t the only option of treatment out there. Behaviorism was first used to train and experiment on animals and it should be left there. The DIR Model focuses a lot more on building relationships and nurturing the natural tendencies of the child to help them develop in new ways. Occupational Therapy is a more holistic treatment that works with a student's sensory needs and focuses on developing skills needed for daily life. Speech therapy can provide a wide range of services such as developing communication skills, using AAC devices, and even sensory issues related to swallowing. Building relationships and treating people with respect is a much more humane way to interact with any person. If we can get ABA out of schools and therefore rid them of ableism, the medical model can become an idea of the past and acceptance can begin to happen.
