Current

Fact and Fiction in ABA/ABT

Vera Bernard-Opitz

Unfortunately, prejudices against behavior therapy/ABA (Applied Behavior Analysis) and ABT (Autism-specific Behavior Therapy) tend to prevail, especially in Germany (see Graf, 2021, booklet of the German Autism Society). Therefore, the following statement aims at clarifying misconceptions and prejudices about ABA/AVT. One fear of critics is that these approaches change personality due to changing the behavior of affected individuals. It is also emphasized that individuals with autism should not be subjected to therapies aiming at normalization, but that tolerance to differences should be practiced. Above concerns are clarified by pointing out current ABA/AVT methods and practices.

 

1. Criticism of the so-called "Lovaas Therapy".

  • Lovaas initially worked with non-verbal and self-injurious individuals and showed - as early as the 1960s - that children with autism could learn to speak using the Discrete Learning Format (DLF) and later be successfully integrated into mainstream classrooms.
  • These were mainly so-called children with "early childhood autism" (formerly "Kanner syndrome"), because the diagnosis "Asperger syndrome" or "autism spectrum" was not yet known at that time.
  • Initially, Lovaas used punitive measures, which is neither the current practice of German behavior therapists nor of internationally certified behavior analysts. The former are bound by their professional code to treat clients in an appreciative manner, the latter by a binding code of ethics (https://www.bacb.com/ethics-information/ethics-codes/).
  • The emphasis on punitive measures was acknowledged as a mistake of the early days. This should not be taken out of historical context and should by no means be applied to current ABA. As early as the early 1980s, Lovaas replaced punitive consequences with extinction and positive reinforcement (Lovaas, 1981).
  • Also during this time, Lovaas' students expanded the DLF with "Natural Learning Format" (NLF) methods, "Model Learning", Verbal Behavior (VB) approach, and Visual Methods (Sundberg, 1982; Koegel et al, 1987; Leaf & McEachin, 1999).  Shortly thereafter, parenting became the focus (Laski et al, 1988) and the so-called "Positive Behavior Support" ("PBS", Carr et al, 2002) was developed. This stresses the need for prevention as well as the exclusive use of positive consequences. Learning key behaviors ("Pivotal Response Training" (PRT), Koegel & Koegel, 2006) as well as the development of predictors of treatment success for specific strategies are also part of the history of learning theory-based autism approaches (Sherer & Schreibman et al, 2005).
  • In any case, to understand the current use of ABA principles in the autism field, developments beyond the early days must be considered, such as the quote that was already common during Lovaas' lifetime, "Even Lovaas stopped doing Lovaas therapy a long time ago."

 

2. Critique of Discrete Learning

  • DLF is a method based on learning theories that uses simple repeated instructions, effective prompts, and reinforcers. This allows for successful learning, especially for children with severe impairments (formerly "Kanner Syndrome"). The DTF is usually not necessary for people with high-functioning autism (formerly "Asperger's syndrome").
  • Methods based on ABA are diverse and should not be reduced to the Discrete Learning Format (DLF) of the early days, the so-called "Lovaas Therapy". With the introduction of the term ABT (Autism Specific Behavior Therapy, Bernard-Opitz, 2009), it was stressed that the spectrum of evidence-based and practice-based methods includes various strategies focusing on the various needs of individuals on the spectrum of autism, e.g., Functional Behavior Analysis, Discrete Learning Format, Precision Learning, Social Skill Training, Visual Methods, Video Modeling, Cognitive Behavior Modification, etc. (Hume & Odom, 2011). Compare to the rainbow logo above as well as contributions to the "AutismConcrete" series published by the Kohlhammer-Verlag, in which evidence-based methods are now available to German readers in short practical booklets.
  • In the context of schools or individual therapies (as well as occupational therapies or physiotherapy), it can sometimes be useful for students with high-functioning autism to use targeted DLF exercises to compensate for deficits or to provide motivational aids, such as to learn vocabulary or history facts, correct pencil posture, or  to learn certain movement sequences. However, this is not a malicious "adaptation to normality", but a common method in any form of support/therapy or even regular school lessons.
  • Just as a person with dyslexia receives targeted help, a person with autism should not be left alone with motivation, learning or social problems. Here, various learning theory strategies are considered generally accepted.

 

3. Critique of educational and therapeutic approaches that conform the individual to the norms of society.

  • Societies have norms and children (as well as any traffic participants, for example) are given cues to conform to them from the very beginning. Through model learning and reinforcement, children develop behaviors that make it easier for them to develop skills such as language, make friends, build and expand school skills, etc. Why not give children these suggestions specifically when they are on the autism spectrum. 
  • Of course, tolerance for difference is meaningful and important, and only those behaviors that significantly limit or hinder the development of the individual or his or her environment should be changed. Support is therefore only given if the child/adolescent or adult suffers from his/her problem or his/her integration into society/family/etc. is threatened by his/her behavior and the reference person therefore asks for help.
  • For example, it may be appropriate to provide an alternative form of communication to a student who is disrupting the classroom by persistently shouting.  On the other hand, there is no need to take action with the student who waves his hands in class without causing problems for him or his classmates.

4.  Critique of the lack of consideration of personality in ABA/AVT/VT strategies.

  •  Some critics of ABA claim that ABA therapists deny personality of affected individuals because of their deficits in communication and social behavior. This is not true. Here concepts are confused and there is a danger that long outdated statements of the 60s are applied to current ABA in the autism field. Again, from a historical perspective, there is a danger that current ABA strategies will be misunderstood. Also, the "difficult concept of the person" (Gordijin, 1999) should first be clearly defined.
  • At the heart of ABA is Functional Behavior Analysis, which involves a very complex understanding of the individual, his or her social context, and problems. Perceptual characteristics, interests, motivation, organic and psychological variables, etc., naturally enter into the analysis (Bernard-Opitz, 2009, 2018).
  • The goal of Functional Behavior Analysis is to understand why a child exhibits a behavior in a given situation and how he or she could achieve his or her goal through more socially appropriate behavior. Causes and functions of behavior therefore play a very crucial role in Behavior Therapy/ABA. They form the basis for building alternative behaviors (as they do, by the way, with any problem behavior for which clients seek help from therapists).
  • Many parents and concerned individuals seek help for severe behavior problems such as self-injury, aggression, temper tantrums, or even toileting problems, to promote independence and to build basic communication.
  • Often, the self-determined goal of older affected individuals is to be able to live more freely from compulsions or fears, to improve friendships, communication or team skills, or even to have chances for a satisfying partnership or job. An ethical approach here also includes considering the consequences of doing nothing as "failure to help".
  • From my point of view, a central part of every good AVA/AVT has always been - and will continue to be - to think from the perspective of the other person or - if possible - to ask about the inner view of the person concerned. In this attempt "to walk away in my shoes" one at least gets quite close to the person who needs help.

Summary

  • It is positive that people at the higher end of the autism spectrum demand acceptance of their difference and inclusion. However, the opinion of a media-active group of anti-ABA advocates should not jeopardize one of the most effective and scientifically accepted supports for the majority of individuals with ASD through unwarranted criticism of outdated ABA strategies. Children, adolescents and adults with "early childhood autism" have the right to appropriate therapy and support. Their parents are fighting for the opportunity for effective ABA/AVT treatment and for a life with their children that can be as normal as possible.
  • Especially parents of children and adolescents with severe behavioral disorders often wish for nothing more than a "normal" everyday life without having to bury their hopes under the cloak of "tolerance for otherness".
  • ABA/AVT - comparable to behavior therapy or psychotherapy - by no means excludes tolerance for otherness, but tries to develop therapy goals with empathy and respect for the person with ASD. This should be oriented towards the goals of the person concerned and his environment and increase the self-efficacy of the person.
  • Just as there were questionable educational methods in schools in the seventies and there are certainly still black sheep among educators, psychotherapists or behavior therapists at present, the same is true for individual behavior analysts who claim to practice ABA while not including new developments.  Nevertheless, the majority of concerned colleagues are committed to serving this group through structured learning opportunities, ABA/AVT programs, social training, etc., using evidence-based and field-tested methods. We have come a long way in this regard compared to the days of Bettelheim, the beginnings of pedagogy, or behavior therapy sixty years ago.