ABA – My Position (currently unreferenced)
The history of ABA can be said to have started with Skinner, who looked at the behaviour of animals. Through his work he uncovered natural laws of behaviour and this is well documented and evidenced. At the same time there was the psychoanalysis movement and cognitive psychology which tended to focus on cognitive processes which could not be observed, so had to be theorised. These were criticised by behaviourists to be irrelevant for that reason. For example. you can suggest someone has slow processing but then what? If on the other hand you define it as the behaviour you see, i.e. latency of response, you can design an intervention that gives someone practice at responding faster. Skinner’s work was purely about how organisms behaved and nothing about autism.
Lovaas was a Psychoanalyst who developed Skinner’s work for autism. He began using it for mental health disorders originally, and in amongst them was, at that time, homosexuality. The idea that you could reinforce non-homosexual behaviours and punish homosexual behaviours as he was attempting to do, is quite alarming to thinking about in our times now. The idea that a similar model could be applied to autism also sounds quite frightening in that context.
At that time, and until well into the 80s, our stance on disability was to cure people from them or if they were to be in mainstream society, to normalise people as much as we could. Prosthetics were made to look ‘normal’ despite the fact that the technology existed to make them actually useful to people with disabilities, and people were encouraged to use them or wear them to be accepted. This ideology still exists in some cultures and sections of society. Where ABA was used for children with autism, it often followed similar lines. It was very effective and enabled children to ‘look’ like they fitted in and ‘perform’ as typically developing peers. Not-ABA approaches also followed similar lines but was less effective.
Also, during this time, corporal punishment was used in mainstream schools to punish children who couldn’t or (considered wouldn’t) conform. ABA also used corporal punishment as it was standard educational practice.
Adults who received ABA as children were predominately educated during these years. Many of them report mental health problems and attribute that to ABA. However, many autistics who did not receive ABA also report mental health problems, from a predominately unaccommodating unfriendly anxiety-ridden school experience.
Education has moved on (though we appear to be in a blip where we might be going backwards). ABA has moved with it. In addition there are now 15 years of quality research to show that punishment has nowhere near the effect that positive reinforcement has on changing behaviours.
Changing behaviours means not accepting autism
So, now we might move on to an argument some make that we have no business changing the behaviour of autistics because that means not accepting them. I would argue that the purpose of ALL education is to change behaviour.
Young children do not know how to use a knife and fork, put socks on, sit in a classroom, respond to a teacher until they have engaged in adult-directed teaching. Tantruming toddlers are ignored and distracted and praised for demonstrating preferred behaviours. It’s how they learn and how we instinctively teach. Our education ideology now is that children should learn to be autonomous independent and contribute and that they need certain skills to do this, and so we frame our teaching through behavioural methods that we just use but haven’t applied scientifically in order to teach them.
For typically developing children reinforcement and occasional punishment comes in the form of social praise or punishment. It works because kids care what their parents, teachers and others think of them and of their behaviours. Social praise is internalised and self-reinforced often. Children pick up the small smile or eye contact that teachers give and actively seek it to check they are on the right lines. That is they use their social environment and the clues from other people to enable them to be successful, and behaviourists would say reinforcement and punishment influences their thinking behaviours too. Some others would say it is nothing to do with behaviour but some kind of intrinsic motivation, or maturation (though the rare studies of children brought up by wolves suggest maturation as it is described, without social engagement is unlikely to happen). Unclear also how intrinsic motivation is learned if not learned through behavioural reinforcement, -though some say it is genetic stemming from inherited internal morals or perhaps spiritual granted by God.
Children with autism are often not reinforced (or punished) by social behaviours in the same way, and so need more extrinsic reinforcement until they learn the value to them of social reinforcement. Teachers often wonder why a child continues their behaviours despite being told off. It isn’t because they are rude it is because that has no meaning for them. Earning a token for a preferred activity or a marble for their marble run for sought behaviour has a better effect (provided they are reinforced by something meaningful to them), and eventually this can be paired with and then superseded by adult praise. They just need that extra step of help.
ABA is about normalising
Another criticism, similar to above is that ABA is used to teach skills to make them more like NTs so that they can navigate the world on NT terms, when instead we should be changing the world to accept people with autism. Understanding about behaviour means that you can use behavioural principles to reinforce behaviours we want to see more of and reduce those we do not. There is concern from autistics that NTs are using their understanding of behaviours to force autistics to override their own instincts and suppress their fears in order to avoid punishments, or in order to be reinforced. A misunderstanding of ABA is often that absence of reinforcements are punishments, but this is no more true than a teacher not saying ‘well done’ is a punishment.
But there certainly are ethical questions to be asked about WHAT is taught. Should eye contact be taught? (There is broad agreement that it should not, but have you ever tried ordering a drink at a busy bar without it? I guess one solution is to have a bar ‘end’ that was autism friendly perhaps.) Should choice be taught? Should non-vocal be taught how to verbalise? Should a reluctant writer be taught to use a pencil. These are ethical questions yes, but actually have very little to do with the methodology used. If you decide it ought to be taught you’d just simply go for the most effective way.
To an extent all models of education are still about normalising, or at least about standardising. All children need to learn to follow the rules of a school in order to be effectively taught in those environments, and some will find that easier than others. In my opinion reasonable adjustments should have mental well-being at the heart, not low expectations or excuses.
Another backlash against behaviourism is because of the recent media reports of schools with zero excuses and strict behavioural models who align traditional education with behaviourism. However, I do not see much behaviourism in their approaches, only control. Behavioural interventions need to be about individuals, not whole school conformity. So consideration of what will reinforce a particular student’s learning behaviours so they can get closer to their goals of independence, self-study, confidence speaking out loud, comprehension understanding etc. If you insist on tracking the teacher with your eyes you need to take data on the effectiveness of that on the learning outcome and the mental well-being of the individual learner. Whole school behavioural policies can appear to be more for the benefit of the teachers than the kids.
ABA and LAs
As young children learn exponentially, there is a lot of pressure on families to find some form of effective early intervention before gaps widen between their children and their peers. In the UK very little is offered that has any evidence base for teaching skills, nor commits much in terms of hours or parental training at the very time post diagnosis when parents are most motivated to act, but ABA does. Unfortunately, LAs can find it convenient to listen to the concerns raised above and in many cases reinforce the behaviours of those raising them through promotion until they have become quite authoritarian on the topic and hold positions of power and influence.
SENDIST almost always find in favour of ABA when it reaches that stage but parents have had to usually fund it for some considerable amount of time themselves, in order to evidence that it works for their individual child. This is not necessarily because it doesn’t work for ‘some’ children, but because the particular set up for their child’s programme is individual and based on what the parents can resource. They don’t request ABA in general, they request a particular version, with a particular number of hours etc. that they can produce the evidence for. As a result of these win’s, LAs are then often faced with considerable costs. A programme of learning for one child may reach 40 hours a week with a number of tutors, a supervisor and a consultant, and run 52 weeks of the year. Often though parents start out asking for just 12 hours in term time, or simply for a BCBA to oversee their child’s TA, but as the battle grows and evidence is generated it gets much bigger. But ABA itself isn’t a programme. Direct Instruction, Precision Teaching, PECs etc all come under the science of ABA, as can reward charts, Functional Behavioural Analysis, ABC assessments if conducted by people who understand what they are doing.
Some LAs are starting to acknowledging the fact that they need to develop a strategy. Richmond has a mainstream school with an ABA unit attached. Essex and Thurrock and Reading all have maintained schools which use ABA methodology. Many Independent Specialist schools have Board Certified Behavioural Analysts (BCBA) on their staff. Eagle House, Beyond Autism (aka Rainbow), Treehouse, Jigsaw, Snowflake and both Southwark’s Head of Autism outreach and Head of Communication and Language are BCBAs, and Newham is now developing in-borough provision through their EP service.
However, Local Authorities are often reluctant to promote or advertise any forms of ABA, even when models exist to show that it can be provided with better outcomes for lower cost, as they suffer from the same competition laws that govern schools. If they are seen to be providing good quality provision, or provision that families want for their children with SEND, they risk becoming the national or London provider as desperate families will often move to access it. This creates a very hostile stance towards parents seeking it and an incentive to perpetuate as many myths as possible to deny it.
Conversely, this seems to be occurring at a time when CAHMS are under extreme pressure to not medicate for ADHD, and in some cases not to diagnose, whilst looking to their Education Colleagues to provide positive behavioural support strategies (recommended by NICE) in which they have not been trained, leaving children without either medication or effective behavioural management provision which is likely to trigger increasing applications for EHCPs and TA support.
As from above it is fairly clear that only parents who are both wealthy and desperate are able to access ABA for their children. Whilst in the US, ABA practitioners are plentiful, extensively trained and paid at similar rate to TAs in the UK, here they charge up to around £30 an hour for very little training and experience. BCBAs are often expected in the US to have completed up to 5 years of clinical experience post qualification before they can become a supervisor, let alone a Consultant. Here, many become Consultants as soon as they receive their BCBA certificates. Parents are at the mercy of what is available (Which is of variable and often questionable quality) and what they are charged. Until Educationalists and LAs start to pay attention, develop in-house skills and learn about what it can offer and stop fudging kids provision with ‘eclectic’ which appears to mean unspecified, unmeasurable, unaccountable provision that they make up according to what they want to do whilst blaming lack of progress on the child, then children who have very real potential will be failed both by the state, and by ABA practitioners of dubious quality. I notice in the Journal from the College or Teaching entitled ‘The science of Learning’ there was no mention at all of ABA.
Finally, many good schools do use ABA in their provision (through both trial and error and system design), often without realising it, or knowing that is what they are doing, and with subsequent good impact. Many Special Schools who will tell you they don’t agree with ABA but use PECS to enable children to communicate for example. Many mainstream schools use reward charts/pegs, marbles in a jar to reinforce behaviours, which mean they agree with the concept in principle but somehow feel it is abusive to differentiate for a child with autism and give them individual reinforcement that is meaningful to them when marbles are not. I’m pleased there is a movement now for more critical thinking in teaching and I hope that we can move on from a blind acceptance that behaviourism is somehow ‘how we used to live’ and I hope when we do, there is quality Supervision and Training for delivery.
Footnote: If you’d like to see an example of how ABA ought to work in practice and the refusal of that request simply because it was recognised as ABA, see previous blog: ‘Consultative SALT‘.