This is a big subject, and there are a few questions in this that need answering.
To a first approximation, yes. This is because it (in the form of the ABA associations) is really good at marketing itself to desperate parents and bewildered doctors as the last best and only hope for those poor doomed children. And the association, and its halo of “researchers”, and the parents who think it helped, and the doctors who read all the papers, all combine with the lobbyists who schmooze with the politicians (especially the politicians who are also worried autism parents) to get it codified into health plans and state/federal laws and guidelines as the one and only authorised “evidence based” (remember that term) treatment program.
“Evidence based” is a dog whistle, and a term of art, and a baton with which to rhetorically beat any naysayers. To the people who support ABA, it is “evidence based” on two levels:
- generally by lots and lots of research papers and journals and studies, and
- specifically by its ethos that the individual experience is on gathering data and applying techniques “proven” in step 1 to change “challenging behaviour”, and testing whether that’s worked or not.
The trouble is that both these aspects are bullshit.
The research is, when you go look it up, and then chase down the authors, then chase down their associations and affiliations, and follow the map of red threads, then what you tend to find is that they are all, directly or indirectly, working in the field of ABA therapy, their citations are all ultimately to each other, and their experimental theses are along the lines of “which is more effective: ABA, or waving this paper fan?”. The experiments are “evidence based” in that they don’t compare therapies, placebo, or even against null: they are case studies which say “we set out to test whether a 40hr/week intensive one-on-one
therapy training with rewards and punishments had measurable effects in desired behavioural changes”, and the answer is of course it fucking did!
When the question is “did it help?”, the answer seems to be “Not really.”
The real question comes down to why.
First: what is ABA? The short answer is: applied Skinner Behaviouralism. As in, ABA was developed by Ole Ivar Lovaas, who was a personal student of B.F. Skinner. And Skinner’s Behaviouralism explicitly only cares about behaviour. Why one performs an act is irrelevant, only that the act occurs. (I think the idea is that if you can’t get a ruler and measure someone’s internal state, there’s no point caring about it. So according to Lovaas’ strictures and method, once a behaviour has been targeted for “extinction” or encouragement, all that matters is that the behaviour happens or not.
That’s not even the worst of it. Lovaas said in an interview once that he didn’t see autistic children as “people”, just as “person shaped”, and that it was his job to build a person from these raw materials. In an interview entitled “After you hit a child, you can’t just get up and leave him; you are hooked to that kid”. (No, seriously, read the interview: it’s worse than you think.)
This is the theoretical core and underpinning of all ABA.
So it doesn’t matter if a stim is calming, or is being used to stifle overwhelming stress: the stim is determined by the therapist to be pathological, and must be “extincted”. If suppressing the stim results in other stims, or other coping mechanisms, then they also will be extincted. The goal is normality, as defined by and measured by the therapist.
What the autistic child learns from this is People in Authority will punish you for things you don’t understand and demand that you thank them for it. Indeed, they will train you to thank them for it. They will not explain what they want, they certainly will not explain why they want it, they will just punish you until you do what they want, whether you know what you’re doing or not. Comprehension is not required, only compliance. They don’t care how much stress or pain or anxiety or fear you’re in. They not only don’t care, they will punish you if you allow them to find out. Suppress all your fear and pain and never let anyone see. They will train you, over hours and days and weeks and years that you don’t get to decide how you react to things or deal with things. Saying “no” is not an option. Saying “no” is wilfulness and will be punished.
Think about that: part of the point of ABA is that vulnerable autistic children are trained not to say “no”.
The proportion of people who’ve undergone ABA who then have PTSD is higher than the proportion of Vietnam veterans with PTSD.
Now, I’ve had interactions with self-described ABA practitioners, who, when I describe all this, are horrified, who would never do that sort of thing. Even when I point out what Lovaas’ standards were.
The upshot is that these people, who largely are not monsters, and really do think they’re doing the best for these children, think they’re applying ABA but, in sometimes really important ways, aren’t.
So much for “Evidence Based”. And the closer it is to Lovaas’ standard, the more monstrous it is. The Judge Rotenberg Clinic is applying strict ABA principles by strapping tasers to children. And the ABA guiding body, ABAI (Applied Behavioral Analytics International) has voted to oppose the process of strapping tasers to children… a couple of days ago.
Most autistic people are somewhere between “not supporting ABA”, and “think ABA is a crime against humanity”. Autism Speaks loves ABA, because it ties in with their general attitude that autists aren’t people and their opinions don’t matter, only the feelings of their parents.
I can’t support ABA; not because I’ve undergone it, but because I believe the words of the people who have. Those who claim to be providing ABA “but not like that”, almost by definition aren’t providing ABA. Which is fine, because it probably wouldn’t have done much useful either way.
The real, and only pertinent question is what those issues are, who has them, and whether there’s some way of addressing them, and I can’t give a better answer on that without knowing what they are. (And, given that I’m not a therapist of any description, I probably couldn’t help even then.)