Does The Popularity of Applied Behavioral Analysis (ABA) Oversimplify Autism Treatment?
John McLaughlin sits down to discuss recent news surrounding Applied Behavioral Analysis (ABA) and the unfortunate tendency to pigeonhole the field of autism. McLaughlin warns against limiting therapy methods in favor of a “check box” approach made popular by insurance companies looking to set pricing and organize treatment protocols.
Dr. Berger: John, I’m starting to see more conversation about special needs, recently. I don’t know if you agree with me or not, but any conversation when it comes to looking at special needs, and the way we’re working with children on the spectrum, is positive. At least we’re having conversations when there was a time where we weren’t having nearly as many public discussions.
There was a story out recently regarding a common therapy, ABA and I wanted to come to you to get your take on it. Any news is good news when we’re talking about therapies to support children on the “spectrum” or am I wrong?
John McLaughlin: Yes, I think it is. I think talking about this is good. Even the disagreements that are out there are good because it means that we’re either refining our positions or defending our positions. It’s really good to have ABA and the treatment of children with autism in the public eye. It’s one of the cool things about this era that we’re living in and not just Applied Behavioral Analysis or children with autism, but many, many social issues come to the surface because of our ease of communication. Social media with people being able to coalesce and form interest groups is both good and bad. But I think it’s far more good than bad because people come together to discuss issues no matter where they live, and geography is minimized to some distance.
For Instance, you may have a support group with people from Israel, Brazil and Kansas, altogether. The negative (a little bit off topic of ABA) is you can find like-minded people and support each other in views that are absurd or proven wrong via science. But that’s the downside of it.
The fact that we are talking about this is good overall. But this recent article on Applied Behavioral Analysis showed a dark side or tough side that was really interesting, and I enjoyed reading it. But it’s kind of like saying, “Christianity is bad because this group doesn’t allow people to dance.” I think, “Oh, wow.” Or this group doesn’t allow people to drink, or this group says you can only marry within a certain Christian sect.
DB: Are you saying that they painted it with broad strokes when there’s more to it. There’s more complexity involved. It’s easy to make an argument against something using broad strokes, is that what you’re saying?
JM: Yes, I think so. Or maybe not too much painting ABA too broadly but it’s narrowly focusing on one type of Applied Behavioral Analysis. That’s one of the challenges right now for the field of Applied Behavioral Analysis (ABA) – my parallel is Christianity. Inside of Christianity, there are many flavors of Christianity. We’re not just talking Catholics and Protestants. We’re not just talking about Baptist or Lutherans. There are thousands of subgroups within Christianity, organized and recognized subgroups.
There are not thousands of subgroups within AppliedBehavioral Analysis, but there are scores, tens to forty subgroups inside of AppliedBehavioral Analysis. ABA takes on many, many different forms. The verbal behavioral analysis is an area that I’m most familiar with it. It’s quite different than the treatments described in the article, and I understand those procedures. They’re repetitive treatments. It’s the kind of stimulus-response that keeps on a child until the appropriate behavior is reached. Reward them for that behavior, make that behavior standard, and then move on.
That’s one form. That’s an early form if you will. But it’s not the only form. To think that represents ABA is like thinking Presbyterianism is Christianity. That’s an approximate parallel.
When we begin to characterize a faith as broad as Christianity, there are lots of areas for believers to feel comfortable, with 2 billion in the Christian faith. It’s true forApplied BehavioralAnalysis.
When Ivar Lovaas brought Applied Behavioral Analysis in, I liked the fact that the recent article stemmed the fact that it came from Skinnerian psychology through another applicant at the University of Washington and Lovaas. His joy and his gift were the gifts of hope to families who before Lovaas’ ability to apply Applied Behavioral Analysis to children were closed. There was very little hope. But his application created hope even though it was early on and could be repetitive and tough on children and families.
From that has sprung other ways to use Applied Behavioral Analysis in working with these children that work with older children or younger children or children with certain behavioral characteristics that need to be addressed.
It’s become much more of a clinical toolbox or a clinical approach to study. The University of North Texas, comes out with X philosophy, and you study at Florida Tech, another or you study at UCLA, still another philosophy.
If you had a medical issue and you went to the doctor, and he said, the answer is amputation. Well, there’s a good chance you would seek a second opinion before you amputate.
DB: Yes. (laugh)
JM: The doctor may say, “You know, gee, what you need to do is go to France where they’re further ahead of us on the treatment of this issue. I think you won’t have to amputate to be better.”
And another doctor may say, “Go to Mexico where there are experimental drugs to use.” Maybe someone says, “Go to John Hopkins; they’re cutting edge on this.”
You get different opinions. That’s something I think families were getting to, not so much a marketplace of Applied Behavioral Analysis, but as this industry grows and as the practitioners grow, families will have more choice. Practitioners might say, “This is my way of treating children, but you might go over to Bob’s services or Sally’s shop over there because she’s really good with children like yours. I’m better with X type of child. That’s not your child.”
It’s good if we get more practitioners in the field. We’ve got to remember; there are less than 20,000 people in the United States that are Applied Behavioral Analysts. Less than half of the states in the union license this profession. That’s not to say it’s not a good profession. It’s a young profession.
JM: No one became licensed until around ten years ago. Now, we’re gaining momentum. I would think in the next ten years; every state will license Applied Behavioral Analyst. The profession is also forming its practices. “What is Applied Behavioral Analysis?” Not that it’s going to become Orthodox, but insurance companies are now paying for these services, and they want to know what they’re buying, what are the treatment protocols, what the prognosis is for a child, and how long will this therapy take.
DB: Is that a challenge, John? Is there a challenge when you look at the comments in the story the people have very, very strong opinions about the story itself. I think they’re almost losing sight of the story title. They’re laying out a controversy that there are different opinions. It’s not that they’re stating an opinion, or at least that’s not the initial goal of the article.
People are talking in the comments in a variety of ways. We’re talking about diversity; it’s called spectrum for a reason. We have to understand that there are types of presentations. Part of the challenge is working in a world where insurance companies bottle things up, categorize, place on shelves and check boxes. But not every child is going to present the same. Likewise, there are going to be professionals that may gravitate towards different types of therapy based on their skills, their natural tendencies, and abilities.
JM: Absolutely, Rod. Absolutely. It’s even more complicated. Yes, we are gravitating toward a world of “check the box.” We also have people like R.E. Neuman that’s mentioned in the article, who wants people with autism to be accepted as they are with no or minimal correction or treatment to make them more, quote-unquote, “normal.”
There is a growing group of academics and people with autism that wants to celebrate their “otherness” that we accept them, and we learn to love them as they are, not as they fit more normally or more easily into the quote-unquote, “the normal world.”
DB: Yeah, this goes back to a point in a previous CoffeEd where we were talking about redefining even what normal is within the context of society, placing those expectations around the ways in which we want to experience other human beings.
JM: Well, indeed, indeed. In our Western world, in our American world, we have a pretty narrow definition of normal. And we have a lot of people who fall outside of normal in a lot of ways. Usually “outside of normal” is threatening, dangerous and inappropriate and we like to lock those people up in jail, put them away in institutions, allow them to live in the corner of our community, or let them live on the street. We have a pretty strict standard of “normal.”
For other cultures, there is a greater acceptance of diversity, and what’s inside of their culture. We don’t, and I think that’s a loss of our culture. I think that’s a loss for us that we aren’t able to celebrate this ability to be distinct and different, not by choice but by birth, if you will. If you’re distinct by choice, we do accept that a fair amount.
But Rod, the area of “check a box” is a challenge for Applied Behavioral Analysis. That’s going to be a challenge for the treatment of children with autism, for those families that choose treatment, that there will emerge not this year, not in the next few years but the next ten years, there’s going to appear standard therapies. Right now, Applied Behavioral Analysis has won the race, so to speak. They’ve been organized, they have journals, they have a scientific validity that behavioral analysis changes behavior. It does, but so do other types of treatment that can help children with autism. They don’t have the organizational structure that Applied Behavior Analysis has built over the last decades.
DB: They don’t have a business plan.
JM: Yes. They don’t have a business plan. Journals, Professional Organizations, and now Insurance, has recognized Applied Behavioral Analysis as the preferred treatment method. The licensure and certification process that have emerged in the industry has allowed them to kind of control the industry. They have built the industry. It’s not because it’s necessarily the best science. It’s the most evolved science. You have other voices in the autism community saying, “Wait, wait. DIR/Floortime is excellent for children. We don’t have the science. We haven’t built the industry around Floortime, but we still help kids.”
There’s a fleshing out process. I know this is a rough parallel, a little bit like the Christianity and the faiths of Christianity, but I know every year in April, every local news story does a little piece on the local news about, “Hey, we took our tax return to 10 different accountants. We got ten different amounts that we owed and what we were getting back.” And all of those accountants see that tax return through their lens of experience and their lens of knowing what forms to use or what deductions apply to a person. All 10 of those probably would pass the IRS test. They’re not going to get audited; they’re not getting kicked out because they were wrong. That’s what variation there is in our tax code to interpretation.
And in some regards, that’s how autism is going, right now. It’s subject to a lot of interpretation. Maybe in our society, as we kind of began this conversation with the way in which social media allows us to communicate around the world so easily, yet allows kind of the people with bad ideas to support one another and draw strength from one another, maybe this is just the new normal. There may always be a more fractious division of thought and action because it’s so easy to coalesce around ideas.
DB: Yes, from my perspective, John, I hope we continue to see more stories and more opinions to force those that potentially have not coalesced as a therapy, as a program, as a right, to stand up and say, “We may need to look at this.” It may improve practice on both sides of the fence, but at least we’re having the conversation. Once again, another great in-depth discussion. Thanks, John.
JM: You’re welcome, Rod. I always enjoy it.
John M. McLaughlin, Ph.D., directs the Research & Analytics unit of ChanceLight Behavioral Health and Education ( a client of MindRocket Media Group). Dr. McLaughlin holds a BA, MA and Ph.D. from Peabody College of Vanderbilt University, the University of Chicago and the University of Minnesota respectively.
He was a certified geography teacher and secondary school administrator in Tennessee where he served as a teacher. He then spent the last ten years of his work in that state as principal in an alternative high school.In 1977, he founded Benton Hall Academy, a school in the Nashville area for students in need of a small and caring environment.From 1993 to 2000 he published The Education Industry Report, a monthly summary of investment activity in the education arena.
He has been interviewed by virtually every major newspaper, magazine and broadcast media in the U.S. for his insights on the interface of public education and free enterprise. He has been published several times throughout his career. His most recent writing includes an article, Alternative Education’s Impact on Office Disciplinary Referrals (with Eva Gillham) in The Clearing House, September 2012; a book of fiction, The Last Year of the Season, 2014, North Star Press; and We’re In This Together: Public-Private Partnerships in Special and At-Risk Education (with Mark K. Claypool), 2015, Rowman & Littlefield Education.
This post includes mentions of a partner of MindRocket Media Group the parent company of edCircuit