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Moving Towards a More Compassionate ABA

Written by Brandon Castillo

Eye contact. “Quiet” hands. “Show me waiting.” These are typical goals that most ABA practitioners have used in their programming when working with autistic people. As a generation of autistic children has come of age and grown into autistic adults, it has been hard to disregard the criticisms: eye contact is painful; stimming is comforting and helps me focus; I shouldn’t need to change myself to fit your expectations.    

About 50 years ago, an article was published in the Journal of Applied Behavior Analysis that criticized how the science of behavior analysis was being implemented in society. In the article, “Current Behavior Modification in the Classroom: Be Still, Be Quiet, Be Docile,” authors Richard Winett and Robin Winkler [1] established that behavior analysis was being used to hide the failure of institutions that desperately needed to change. The behavior analysts employed in these institutions were there to keep students quiet, instead of helping them learn. Likewise, they were responsible for ensuring that the psychiatric patients were passive and obedient, instead of helping them integrate back into their communities.

Autism is my super power drawing with paining supplies all around it.

Making a Difference Starts with Understanding

Over the years, things did not get much better. ABA therapy was not consistently personalizing the programming to meet the needs and interests of the patients and families. Far too often, goals and programs target increasing eye contact, decreasing stereotypy (“stimming”), and increasing compliance. The intention behind this seemed pure: teach people how to act in ways we thought would increase the likelihood of acceptance in a flawed, discriminatory society. 

However, research and studies published in the past few years have shown that forcing eye contact or restricting stimming can have adverse effects on autistic people. In fact, stimming has been shown to help people “relieve a build-up of energy,” creating a calming, soothing effect [2]. Knowing that it just doesn’t seem right to prevent someone from stimming. We need to be looking for more effective ways to teach these skills and release pent-up energy that makes sense for the individual.

A person holding a sign that says, we understand your needs.

Additionally, research has shown that eye contact for autistic people triggers the same parts of the brain that deal in anxiety and pain [3]. Forcing eye contact will only further exacerbate these feelings. Instead, what can be done is slow habituation toward eye contact. Why cause feelings of pain and anxiety if there are more compassionate ways of teaching this skill?

And this is the goal—finding more compassionate ways of teaching skills.

Finding More Ways of Teaching Skills

Now, more than ever, it is imperative that the world of ABA changes. There is no hiding from the criticisms, no denying the past traumas the early iterations caused. One quick Google search will reveal the negative side of ABA. But we are responding as a field. More and more there is research and best practice guidelines coming out that are improving how we deliver services. Research and service delivery are evolving. What was considered acceptable in the past is not viewed the same today. Just like how we practice today will be different in the future. As with most fields, we are learning from our past mistakes and making changes to move forward. The important thing is that we are listening, and we are changing.

A women listening to someone's point of view to better understand them.

Listening to What Matters Most

When I entered this field, I was unaware of the negative experiences some individuals went through while receiving ABA therapy. But that’s changed. I’ve done my research; I’ve read the personal stories of autistic people and their families that went through years of ABA and came out the worse for wear. I am doing my best to make sure others are aware as well.

And with my new knowledge, I am making changes to how I practice ABA, how we practice ABA at Shaping Change, and how I train supervisees and staff.

Brandon Castillo, BCBA

Questions that should have been asked from the beginning, I now find myself asking: Is his stimming really a maladaptive behavior? Does she want to do the same things as other kids? Does it really matter if he makes eye contact? How can I tell someone else to stop waving their hands or fidgeting with an object while they’re working when I can’t stop playing with my fidget, and I can’t stop bouncing my leg? Does he really need to make strong, consistent eye contact while talking with his peers? Is that going to be the make-or-break skill that determines success in life?

Focusing on Helping the Autistic Community

As ABA practitioners, we need to start listening to those in the autistic community. How else will we know what needs to change? We need to put a greater focus on what behaviors and skills are important for the individual. Where can we help, so they can build on their strengths and abilities? The world is constantly changing, and the world of ABA needs to change with it so that we can serve our community in the most effective, ethical ways possible. If we aren’t listening, then we aren’t helping.

A child counting numbers and putting them in order during her ABA therapy session.

Becoming Part of The Change

At Shaping Change, we are taking steps to become part of the change. Where traditional ABA may be viewed as sitting at a table and repeatedly running trials on specific targets, we believe in getting away from the table and working as much as possible in the environment—any environment, the clinic, the home, school, the community. Working on matching pictures? Let’s play a game of memory. Learning to follow a series of instructions, requesting appropriately, and sharing with peers? Sounds like arts and crafts. And, while yes, making eye contact can be an important skill, teaching someone to acknowledge a peer or attend to a speaker by positioning their body toward that person and (when possible) verbally acknowledging them is just as appropriate and useful.

We are actively finding ways to teach skills in more compassionate, patient-directed ways. We want ABA to be a positive experience. Sometimes, that may be more of a challenge when we are working with more challenging behaviors, like aggression or self-injury. It is important that behaviors are addressed with strategies that are ethical and effective, while also teaching the needed skills in ways that make sense for each patient and for the family.

Working Towards Common Goals

I am working with our staff to improve listening more to our patients, how we provide services, and how we implement goals. I want us to learn from the past of ABA and not repeat the same mistakes because, the thing is, ABA can be for anyone. ABA can be applied to any individual young or old, that is experiencing behavioral challenges or needs to build skills in the way they learn. In fact, there is an entire sub-discipline called Organizational Behavior Management, or OBM. OBM takes the theories of behavior analysis and applies them to the workforce to improve individual and company performance.

A team getting together to discuss ABA Therapy for their business

ABA Applied Correctly and With Compassion

When applied correctly and with compassion, ABA can be a powerful tool for positive change. As practitioners, we can help others learn skills that improve their quality of life. We can help individuals find alternative outlets for their behaviors so that they don’t harm themselves or others. Together, we can be such a significant impact on the lives of others. We just need to stop and listen. We need to be understanding that everyone is different and that one size does not fit all. That’s what I’m doing when I go to work. That’s what Shaping Change, is every day!

References

[1] Winett, R. A. & Winkler, R. C. (1972).  Current behavior modification in the classroom: Be still, be quite, be docile.  Journal of Applied Behavior Analysis, 5(4), 499-504. 

[2] Steven K Kapp, R. S. (n.d.). ‘People should be allowed to do what they like’: Autistic adults’ views and experiences of stimming. SAGE Journals. 23(7), 1782-1792

[3] Nouchine Hadjikhani, Jakob Åsberg Johnels, Nicole R. Zürcher, Amandine Lassalle, Quentin Guillon, Loyse Hippolyte, Eva Billstedt, Noreen Ward, Eric Lemonnier, Christopher Gillberg. Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017 03378-5

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