No, Neurotypicals Don’t Hate Autistic People – Examining Sasson et al. (2017)

There’s a clip floating around Tik Tok from Devon Price’s Unmasking Autism.

Sasson and colleagues (2017), for example, found that neurotypical people quickly and subconsciously identify that a stranger is Autistic, often within milliseconds of meeting them. They don’t realize that they’ve identified the person as Autistic, though; they just think the person is weird. Participants in the study were less interested in engaging in conversation with Autistic people and liked them less than non-Autistics, all based on the brief moment of social data. It’s also important to point out that the Autistic people in the study didn’t do anything “wrong”; their behavior was perfectly socially appropriate, as was the content of their speech. Thought they tried their damnedest to present as neurotypical, their performance had some key tells, and was just slightly “off,” and they were disliked because of it.

Unmasking Autism, pg 185

It’s a powerful clip. I remember hearing Dr. Price’s words echo as I walked away from another social interaction feeling awkward and defeated. This clip out of context really negatively affected me. And it wasn’t long before I saw others on Tik Tok post about how their mental health suffered hearing that.

For many, it seemed like a no-win scenario. If allistic people viewed my behavior as automatically less comfortable to be around, what hope did I have when socializing? My social interactions suffered under this self-fulfilling prophecy. I saw myself as unable to interact with others, which made my interactions worse.

Dr. Price’s suggestion to this was the follow-up study by Sasson and Morrison (2019), where disclosure of the person being autistic improved social outcomes. This leaves a bit of a predicament. For those that do not want to disclose their autism, are they then doomed to be seen as less likable than their peers? What about undiagnosed autistic folks? Do these findings generalize to those with comorbid intellectual disabilities?

I want to preface this article because this is not a direct critique of Unmasking Autism. There are a lot of valuable pieces of advice and information in that book. However, this addresses the combination of factors that led to the idea that neurotypical people hate undisclosed autistic people. Dr. Price’s book does not conclude this, but it has been taken out of context to imply this.

This conclusion has been drawn partly because Dr. Price is a compelling writer who wrote this conclusively without addressing limitations. Part of it is how the studies themselves have presented the evidence. And the most significant contributor is how Tik Tok can spread (mis)information so quickly.

This is common for interpretations of autism studies both on Tik Tok and other media sources. Autism is political in the sciences and as a consequence gets summarized in non-scientific language that may not convey the complete picture of how a study was conducted.

So, let’s break down why we need to take the studies about neurotypical perceptions with a massive grain of salt.

Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments

Sasson and colleagues ran three independent experiments, published together in 2017. Different methodologies were used to attempt to generalize the findings along with “natural” interactions of autistic adults and children with researchers. All ASD stimulus participants were “intellectually capable,” according to the study.

Experiment 1

The first experiment videotaped 20 autistic adults and 20 “typically developed” adults performing a mock audition for a game show. 214 typically developed undergraduate students then rated the participants on whether they were smart, trustworthy, dominant, awkward, attractive, and likable. They also had “intention” measures of whether the rater would live near the person taped, hang out with, sit next to, and talk to them.

They separated the format that the undergraduate raters watched by transcript, audio-visual, audio only, silent video, and static frame (pictures from the clips). They found that autistic people were rated less favorably in all measures except in trustworthiness, intelligence, and living near (though sitting next to them was also close).

This experiment seems compelling, but there are some key factors that we need to consider here as far as limitations. The first significant factor is that the raters were undergraduate students. It didn’t specify what the undergraduate students majored in, but considering that most recruitment happens through psychology and similar fields, it was most likely that.

This is a huge issue. This doesn’t mean that neurotypical people view autistic people as less likable. It means that a sample of undergraduate students saw autistic people as less likable.

Another issue (which the author acknowledges in limitations) is that the participants were videotaped. This doesn’t translate to real-life social interaction. And this likely had to do (particularly with static frames) with facial features and other atypical physical characteristics of autism, not with social interaction.

Even though the sample size was adequate, the sample itself was flawed and can’t be generalized. The stimulus was also limited. It’s hard to know if the twenty people in the sample were viewed negatively because of autism or if other variables could explain the difference in ratings.

For example, it’s well documented that physical attractiveness affects rater perception. While audio-only and speech content could mitigate this bias, this effect could have greatly affected the other measures. We don’t know anything about the stimulus participants except their diagnosis (or lack thereof). There are too many variables here to conclusively say that autism was why the stimuli were rated poorly, even if there was an association between autism and rating.

Experiment 2

The second experiment took 12 autistic adults (2 female, 10 male) and 17 typically developed adults (7 female, 9 male) that had to have a conversation with the experimenter about open-ended get-to-know-you type questions (like “Have you seen any good movies lately?”. They were filmed in POV style with a program that took 10 random pictures through the interaction (excluding blurry photos, etc.).

37 undergraduate students that received credit from participating then rated the frames on measures of “how awkward,” “how approachable,” and “how likely to be friends.” Participants were matched by gender, which is concerning considering there were only 2 autistic female stimuli. The raters were shown multiple clips of the same individuals to test if impressions shifted with repeated exposure.

Raters responded more favorably to the three measures to typically developed individuals, regardless of how often they saw an individual.

Again, these were undergraduate students. We’re examining one sample of undergraduates from one university. They received credit, so we can also presume they were in social sciences. This cannot be generalized.

The researchers acknowledged that repeated exposure does not translate to familiarity. So, knowing someone better may improve scores even if seeing pictures of the same individual didn’t produce a more favorable score.

The problem of visual perception affecting trait rating was especially relevant for this experiment. Again, they didn’t give us any info about the stimuli other than diagnosis, so we have no idea how much physical presentation and related factors played into trait rating. Pictures of interactions do not provide much social information, so concluding that this was evidence of autistic people being rated poorly for social cues is not accurate.

It makes me wonder if we arbitrarily grouped neurotypical people into two groups, would we see similar effects? In other words, how much are individual differences affecting these ratings?

Experiment 3

The third experiment consisted of 7 autistic boys and 7 typically developed boys as the stimuli. For this experiment, they had 98 adults and 33 typically developed teens as the raters. The ages of the adults were 19-64, and the teens were 10-16.

Stimulus participants were recorded telling a story of happiness, fear, surprise, and anger. One sentence was taken from those videos where all four emotions were expressed. The boys were rated as likely to start a conversation, have many friends, get along well with others, spend time alone, and have awkwardness. The autistic participants were rated less favorably on all measures by both adults and teens (though not significant on awkwardness for teens).

This sample actually had enough diversity to be decent. The teen sample was not large, but it was recruited through a large sampling database.

I think it’s interesting that they said that autistic individuals were rated less favorably on “spending time alone” (meaning they were seen as spending more time alone). I think that shows a bit of researcher bias as it was implied that this trait was perceived as a negative social trait.

The stimulus sample was the smallest of the three experiments, so individual differences could have played into judgments, similar to the other experiments. The content of speech would have also been very relevant, but the researcher didn’t provide any examples. Also, all stimuli were boys, so this can’t draw any conclusions about how young autistic girls are perceived.

This experiment had some flaws, but less than the other two. Overall, I think this was the best conducted of the three.

Problems with the researcher’s conclusion

One of the factors that went into how Dr. Price wrote their excerpt essentially had to do with how the study was presented.

The researchers presented all three experiments to conclude that neurotypicals create negative first impressions of autistic people, as demonstrated by the various methodologies and samples.

It seems like by using the three studies in conjunction, they were hoping that the limitations of each would be mediated by similar findings in another study.

Considering similar limitations existed for all three (limited stimuli and heavy reliance on visual presentation), and undergraduate students were the raters in the first two studies, concluding that the evidence is “strong” that neurotypical peers view autistic social presentation negatively is not substantiated.

My issues with this conclusion are validated by a follow-up study that Morrison et al. (2019) did that found rater association with autism affected the rating more than traits of the autistic stimuli.

Follow-up study questions their conclusion

The same 20 autistic adult videos from experiment one were used with 505 undergraduate raters. The undergraduate raters were given a series of traits assessments that measured their level of connection to autistic individuals and willingness to interact with autistic individuals the raters had.

They found that among this sample, the higher stigma of autism significantly predicted negative ratings of the videos of autistic participants on all measures except dominance. More stigma was also associated with higher negative ratings when the videos were labeled as autistic.

So, disclosing an autistic diagnosis may only produce a positive outcome if the person the autistic person interacts with doesn’t hold a stigma against the condition. I’m sure this is not surprising to most autistic people, as I do not disclose my diagnosis in every situation (for good reason).

Meanwhile, higher autism knowledge only produced more favorable outcomes when an autism diagnosis was disclosed.

Limitations of this study were the undergraduate sample and not including typically developed videos, so it’s hard to make a direct comparison.

Conclusion

There are many studies to consider when examining how neurotypicals feel when interacting with autistic individuals. There are more studies cited in Dr. Price’s book that I don’t have time to examine in one article. Since the focus is on Sasson et al. (2017) in the video circulating Tik Tok, I felt it was important to break down that particular study.

I also think it is unfair to Dr. Price to take a couple paragraphs from a 300-page book and pick apart the wording of it. That is why this isn’t a review of Unmasking Autism. This directly criticizes this excerpt’s use and the greater trend of misconstruing science in media.

I hope you leave this article feeling slightly less fatalistic about how autism affects your interactions, knowing that the study cited doesn’t apply to all autistic people. It also affirms (and what I think Dr. Price’s greater point was) that autism education is essential to help improve communication between neurotypical people and autistic people.

I Want to Leave ABA – Alternative Careers for RBTs

  1. Where can I work if I only have my HS diploma?
  2. What can I do with an associate’s?
    1. Associate’s in a specialty:
    2. Associate’s in a general field:
  3. Bachelor’s Degree

I cringe when I see ads from my college to join their ABA clinic. I see the appeal. They market it as a way for psychology (and related majors) to get experience in their interested field without a bachelor’s degree. That’s very attractive considering that most psychology jobs require a master’s to practice.

It appeals to the desire to help others and advance your career. “Help these poor children with autism have a better life and gain experience in your field!”

They don’t mention how they can pay you less because you don’t have a college degree. They don’t mention the controversy surrounding ABA or how underprepared most RBTs are because of their level of education and experience.

I get the appeal. It’s the whole reason I was in ABA in the first place. I wanted to work in my field and help people. I didn’t know anything about autism beforehand and ABA was sold to me as this novel way of improving people’s lives. I was young, naive, and my labor was exploited as a consequence.

One of the most common questions I get is, “I want to leave ABA, but I don’t know where to go. How do I get experience in my field?”

It’s a question that I also struggled with when leaving ABA. It seemed like I was walking away from a golden opportunity to be prepared when I entered graduate school and my career.

I regret how long I stayed in ABA. The longer I stayed, the more unethical situations I encountered, and the worse my burnout became. In the moment I couldn’t see anything except how much I’d be missing out on by leaving. I didn’t realize how many opportunities exist for working in my field without a degree that doesn’t require me to work against my values.

Where can I work if I only have my HS diploma?

If you’re in a similar situation, you have a high school diploma as it’s required to work as an RBT. So, let’s start there.

  • Mentoring (avg. $16.24 /hr) – the first job I took after leaving was a mentoring position. These positions typically involve working with youth and providing support, academic guidance, or chaperoning. If working with students with disabilities is your passion, you may look into your college’s disability center, schools in your area, or youth camps.

  • Special needs nanny (avg. $21 /hr) – often parents of kids with disabilities have difficulty finding reliable individuals to babysit or watch their kids. Nannying can pay well, especially if you’re required to have a more intensive care role. This will allow you to bond with a disabled child without the pressure of practicing any type of therapy.

  • Direct support staff (avg. $15.23 /hr) – direct support staff work in-home or at a center dedicated to treating individuals with disabilities. I recommend this with caution. Many direct support places for individuals with disabilities have inhuman treatment and services. Many can be equal to or worse situations to work in than ABA clinics. And many undertrain their staff, the work is intensive, and they don’t put in enough safety protocols to maintain wellbeing. That being said – if you can find a reputable company that treats their employees well, this can give you experience working with individuals with disabilities and be meaningful work. Edit – I was informed by a reader that direct support staff are sometimes trained using ABA materials and techniques. Keep this in mind when looking for companies.
  • Respite staff/personal care attendant (avg. $12.75/hr) – respite staff work one on one with clients with disabilities and usually help in the home with care tasks, recreation, and other needed tasks. This is similar to direct support staff in both type of work and job risks (emotionally and physically demanding, with many exploitative companies), but the work can be very rewarding and allows you to get to know an individual better than a group home where you would typically be in charge of multiple people.
  • Rehabilitation aide (avg. $15.71 /hr) – rehab aides help physical therapists with patient care and miscellaneous office tasks.

  • Research assistant (avg. $20.8 /hr) – research assistants help perform research of all types. A psychology research aide may help conduct research, analyze, or prepare manuscripts.

  • Tutoring (avg. $18.31 /hr) – tutoring is another great direct support role with kids. There are centers dedicated to special education, usually focused on reading and writing.

  • Social services (social work) assistant (avg. $19 /hr) – social services assistants provide general support for patients in clinical settings. This can include helping fill out paperwork, coordinating care, or other office tasks. While only a high school degree is required, some companies require an associate’s or higher degree.

  • Accessibility staff (avg. $17 /hr) – this has different names depending on where you work, but accessibility staff provides support for people with disabilities in businesses or other locations. For example, if you are an accessibility staff at a college, you may be in charge of reading tests or assignments, taking notes, and talking to professors to get support for your client. Look into accessibility services at whatever location you’re interested in working in.

  • Paraprofessional (avg. $15 /hr) – paras help students with disabilities in the classroom and during other activities during the day. You may have some teaching responsibilities, but most of your duties will be assisting students with their needs and helping with academics. Some paras do provide ABA. It depends on the school, district, and special education classroom that you work in.

  • After-school teaching or teaching assistant (avg. $14.5 /hr) – teaching generally requires an advanced degree, but teaching after-school or summer programs typically doesn’t. This can be a great flexible part-time job, especially if you’re pursuing school. Teaching assistants have similar flexibility but have much more to do with assisting the professor or teacher in their tasks than directly interacting with students. Teaching assistants for special education will generally involve more direct interaction.

  • Case manager assistant (avg. $23 /hr) – case management assistants work under the guidance of a case manager and will often meet with clients to find out their unique needs. They will often locate resources, contact providers, advocate for clients, and support the needs of the case manager.

  • Crisis line worker (avg. $21 /hr) – if you can handle the stress of a job like this, crisis lines can be a meaningful way of helping people in the community. Crisis line workers typically answer calls of people experiencing mental health crises and talk with them to help de-escalate the situation.
  • Volunteer – this may not be the most feasible option depending on your situation, but it can be a great way to build experience in your chosen field. Because you are giving your time, generally, there are not a lot of barriers to becoming a volunteer, and as long as you follow the organization’s rules, you don’t have to worry about being “fired.” This can be part-time while you work in an unrelated field and act as a springboard into a more permanent position.

Read on for information about what associates you can get to pursue a long-term career.

What can I do with an associate’s?

There are not many human services careers you can do with an associate’s that you can’t do without one. There are two sections here I want to talk about. If you don’t already have an associate’s, there are some specialties you can get one in that can become full-time careers. If you already have an associate’s, there is also an option for you.

Associate’s in a specialty:

  • Occupational therapy assistant (avg. $30 /hr)- if you go through an occupational therapy assistant program, you can help implement an OTs plan for a client. This is similar to an RBT in that you are implementing therapy, however, you have two years of schooling specifically about the profession to help aid you in the best and ethical choices. OT assistants work in a variety of settings, similar to an OT.

  • Speech-language pathology assistant (avg. $24.5 /hr) – similar to occupational therapy assistants, SLPAs implement speech therapy under the direction of an SLP.

Associate’s in a general field:

  • Mental health or psychiatric technician (avg. $17 /hr) – mental health technicians oversee patient care and administer. There are four levels, with the higher the level allowing for more specialization. Level 1 requires a high school diploma, 2 requires 480 hours of college, level 3 requires 960 hours, and level 4 requires a bachelor’s degree. Some mental health/psychiatric tech jobs require certification courses.

Bachelor’s Degree

With a bachelor’s degree, you gain access to many more careers in psychology.

  • Mental health rehabilitation specialist (avg. $22 /hr) – MH rehab specialists work with people experiencing difficulty with their mental health and help people learn how to cope and manage their illness.

  • Case manager (avg. $20 /hr) – case managers are responsible for managing cases for individuals with disabilities. They connect people to services, organize accessibility support and ensure that their care is optimal.

  • Child development specialist (avg. $20 /hr)- these specialists monitor and evaluate children’s development. Based on their evaluation, they work with parents and other providers to implement activities to support the child’s development.

  • Disability policy worker (avg. $23 /hr) – policy workers lobby for laws that support disabled people’s rights and advocate in the public sphere for better treatment of disabled people. While this has less of a caregiver position, it can be a good way of making a societal change to improve the lives of disabled people.

  • Psychological stress (polygraph) evaluator (avg. $28 /hr)- a psychological stress evaluator monitors and administers polygraph tests to indicate the truthfulness of statements.

  • Victim’s advocate (avg. $18 /hr) – advocates help victims after a crime has happened and will help connect the person with community resources. They can be a source of emotional support for victims and often provide various help, including legal support, intervention with employers, and submitting applications for government help.

  • Partial care worker (avg. $17 /hr) – partial care workers typically operate out of live-in facilities, help provide outpatient groups, support the facility’s scheduled activities, provide care and advocate for patients.

  • Teacher (avg. $26 /hr) – even if you didn’t get your degree in education, most places allow teachers to obtain a provisional license with any bachelor’s degree, provided you can pass the exam. Look up your area’s requirements for teaching licensure.

  • Social services specialist (avg. $20 /hr) – social services specialists interview families or individuals and determine risk, needs, and intervention scope. They arrange services, contact relevant agencies, and help arrange placements in facilities if needed. They may also help organize vocational help and other employment assistance. Many places allow you to work in this role with a bachelor’s degree and experience in the field, though some sites require a master’s degree.

Hopefully, this gives you an idea of some alternatives to working in ABA that allow you to still care for disabled people. If any of the information above is inaccurate or incomplete, please let me know so I can adjust. Or, if there are any careers I missed, feel free to add!

Acting Childish – What is Age Regression?

This post contains affiliate marketing links.

CW: This article references adult topics, including kink. Reader discretion is advised.

I received a notification from Tik Tok that my video had been taken down. It was my video on little alters.

I did a series showcasing different types of alters, and for each video, I dressed and acted like the type of alter in the video while providing helpful information.

So in the little video, I held stuffed animals, had a pacifier, and acted childishly. It got taken down for “adult nudity and sexual content.”

I was able to appeal and get the video restored, but I was not surprised at this reaction. When people see adults acting like children, they automatically think it’s related to pedophilia.

My entire life, I have been complimented for seeming mature and grown-up. Now that I’m an adult, I’m bombarded with the need to experience childhood. I needed a safe space to be cared for as a child.

Age regression is a complex topic that we don’t know a lot about. Science has almost no research on voluntary age regression, and the little that’s been explored has been on involuntary or hypnotic regression.

Social media has shed light on age regression, showing a community of people coping similarly.

What is age regression?

Age regression is the voluntary or involuntary experience of reverting to a childlike state (little space); mentally, emotionally, and somatically. It is not a sexual experience but a coping mechanism for dealing with stress, particularly if the person has experienced childhood trauma.

Age regression is exhibited in many mental conditions, including anxiety, BPD, PTSD, DID, OSDD, autism, and more.

Involuntary age regression is often the result of trauma and may be a cognitive/primary sensory flashback. This may look like going temporarily mute, suddenly having a reduced vocabulary or higher pitch, being flooded with childhood memories or emotions, craving that a loved one “makes it better”, or any other behavior that is regressive to your usual state of being. This is done without a conscious effort or control over the reaction.

Conversely, voluntary age regression is an intentional state of regression that is a coping mechanism to de-stress and regulate.

In many ways, age regression is a form of self-hypnosis, where you enter a trance-like state to achieve mental relief.

There is a hypnotic therapy technique that involves a therapist initiating age regression but has been critiqued for its tie to false memory recovery. Voluntary age regression is different as it is not for memory recovery or necessarily done with a therapist.

Since there is not enough literature to conclude whether voluntary age regression is healthy, the subject remains controversial among therapists. Some worry that it is a state of avoidance to distract from difficult processing, whereas others believe it’s a healthy coping mechanism that allows the individual to return to homeostasis.

I agree with this second school of thought, where as long as it’s being practiced safely, I think there are health benefits.

Age phenomena

Age regression is a small piece of much broader “age phenomena.”

The one that age regression is most commonly compared to is age play. Age play is a sexual kink dynamic where two consenting adults usually pretend to be a child and caregiver. However, age play can be any age, and some will play out other dynamics involving being older than they are, etc.

Age play has a negative stigma because many view it as tied to pedophilia. Age play does not involve minors and is usually done for the power dynamic and level of care the “caregiver” provides the “little.”

This can be confusing compared to age regression because many littles in this dynamic describe “little space” as an age regressor would, where they are cognitively similar to the age they are roleplaying. The most significant difference is that age play is for sexual intent, whereas age regression is strictly not.

Another commonly confused term is “little alters.” Little alters are alters in a DID/OSDD system that is cognitively like children and often stuck in time. Littles do not regress, they are generally permanently that age. Regressors, however, revert back to the adult age they are when the session is over.

The last confusing term is age sliders. Age sliders are also unique to DID/OSDD systems, and they describe alters that are not a set age but switch ages depending on the circumstances. They may regress, but they stay that age cognitively until they decide to slide back. Some can also slide to be older than they are, so it flows in both directions.

While many of these terms are used interchangeably like “littles”, “little space”, “caregiver” and “regress”, context is important for determining the type of age phenomenon being discussed. Depending on whether discussing systems or non-systems, sexual or non-sexual, you can determine whether what is happening is age regression or something else.

Benefits of age regression

Age regression can be very beneficial for establishing a good relationship with a caregiver, engaging the parasympathetic nervous system to calm down, return to a state of homeostasis, and heal the neglected needs of your inner child. It can help process difficult emotions or as a form of temporary escape.

It can also be powerful in engaging play, which improves brain functioning, connection, and well-being. Especially when someone has experienced childhood trauma, play can become a foreign experience, and returning to a childlike state can help facilitate this.

How to safely age regress

I’ve mentioned safety several times in this article. What does age regressing in a safe way entail?

The most significant safety consideration is regressing alone vs. regressing with a partner (referred to as a caregiver in the age regression community). Regressing alone gives you more freedom to do whatever you need in the space and prevents harmful dynamics from forming. However, you lose out on the connection to a caregiver, and it can be harder to exit if you’re unfamiliar with your own triggers.

Regressing with a partner gives you the experience of being taken care of and can be a powerful bonding experience. Many adults are uncomfortable taking on this role, which may force someone to look online or in other public spaces for a caregiver. This is where safety really comes into question.

While most age-regression spaces forbid sexual content, many predators lurk on the forums looking for vulnerable individuals under the guise of non-sexual regression. That’s why it’s crucial to vet the person you want to regress with. I would highly discourage minors from looking for caregivers. For this reason, it’s much safer to regress by yourself. Never bring a non-family adult into your regression if you’re under 18.

Another safety concern is that you should not be in little space when interacting with children, as this violates the boundaries between adult/child relationships. Even if you may feel cognitively similar in the moment to the child, you have the brain and body of an adult. Little space should be achieved in your own time, in a designated environment.

As for regressing by yourself, a big part is letting go of feeling like you’re doing something wrong. Our society looks down on children, so people are critical when an adult desires to act childlike.

One of the most helpful ways of regressing is using kids’ toys and materials to help enter little space.

I set up my closet with a soft rug and rainbow lights. I replaced the door with a shower curtain and a comfy chair to give me the space to regress.

Some of the products that I would recommend:

Entering and Exiting Little Space

Something to watch for when trying little space is what takes you in and out of it. You should choose activities and items that will help you regress in a controlled manner and take you to a comfortable level. There’s no hard and fast rule on how to get there. You’ll just have to observe your own state as you regress. I’d recommend starting with items or activities you enjoyed doing as a child.

The other important part of regression is to have triggers to pull you out. That way, if there’s an emergency or an interaction you have to be an adult in, you can quickly come out of the headspace. After all, if you think of this as hypnosis, it would be very irresponsible of a hypnotist to leave you hypnotized without pulling you back out.

Some exit triggers could be entering a new room, engaging in a more complex task, having a ritual for putting away your little space stuff, setting a timer that signals the end of regression time, counting up from 10, or having a cool-down activity like playing with play-dough to re-gain your mental capacity if you have time.


Age regression can be an amazing tool for healing a wounded inner child and regulating the emotional demands of adult life. Understanding that age regression is a healthy, non-sexual coping mechanism can help fight the stigma against it.

DID Integration – Accepting My System’s Cohesion

My life was in pieces when I started therapy with my incredible therapist three years ago. I had a suicide attempt only two weeks prior. I was housing insecure, I had been unemployed for months following one of the worst psychological breakdowns I’d ever had, and I was still experiencing uncontrollable amnesic switching.

My therapist furiously took down everything that first session, letting me fill her in on my extensive trauma history. One of the initial green flags was that she stayed until I was done, which was thirty minutes past the session. She cared about me more than the “therapy hour” (45 min session) that all the previous therapists I had lived by.

It’s bittersweet writing this because I’m now in a place where I am stable, have achieved more than I ever thought I would, and have to say goodbye to someone that helped me change my life.

One of the things that amazed me about this therapist is that she had worked with clients with Dissociative Identity Disorder (DID) in the past. She knew exactly how to treat my symptoms and work with all of my alters.

It’s satisfying walking away from this relationship knowing that she helped me achieve integration, all while I was completely unaware it had happened.

What is integration?

Integration is often confused with many other terms by both clinicians and people with the condition.

The ISST-D cites Kluft (1993) for the definition of integration.

[Integration is the] ongoing process of undoing all aspects of dissociative dividedness that begins long before there is any reduction in the number or distinctness of the identities, persists through their fusion, and continues at a deeper level even after the identities have blended into one.

Kluft (1993)

Put simply, integration is alters working towards cohesiveness without dissociative or amnesic barriers.

Since integration is a process, there isn’t a distinct endpoint. Each person can decide where they are in that.

A term this is most commonly confused with is fusion. Fusion is when two or more alters fuse together to become a new identity made up of those identities. In many communities, the concept of fusion is compared to gem fusion in Steven Universe. I like this analogy best, but some systems feel that the SU analogy sensationalizes fusion.

The final form of this is called “final fusion.” This is when all alters fuse to become a singular identity. Final fusions aren’t recovery from DID as someone can un-fuse or split new alters during stress or trauma. All fusions have the potential to un-fuse later, but many don’t.

There aren’t any specific therapies to fuse. There hasn’t been any formalized process either. Most systems that experience fusion describe it as happening randomly and without control. It can be a scary experience and come with a sense of grief from losing distinct parts.

We haven’t had any fusions in our system. We all have bets on who’s most likely to fuse, though. 😉

Since fusion is a scary and unstable process, when it’s conflated with integration, it can give integration a bad reputation. Integration is one of the best-known treatments for DID and doesn’t necessarily involve any loss of identities.

Therapists work on reducing amnesic and dissociative symptoms and help the system work united. This typically involves identifying alters and their needs, coming up with solutions to meet those needs, building communication between alters, and confronting trauma in a safe environment as it organically comes up.

Many systems say they are against integration and for functional multiplicity. What is functional multiplicity?

It’s integration. Or at least integration without fusion. Functional multiplicity is alters working together with limited or absent amnesic or dissociative symptoms. It’s seen as affirming since the focus is not on trying to make alters an inseparable identity but instead to have all remain distinct and allied.

So much of the hate towards integration comes from a misunderstanding in literature and community language.

Why do we call our system integrated?

Why call our system integrated if integration is a process without an endpoint?

For us, saying we’re an “integrated system” is another way of saying we’ve achieved functional multiplicity. I like integrated over functional multiplicity because it better describes how our system acts as a whole. Our switches are so seamless now that while we are still separate, we function as if we weren’t most of the time.

Every system can choose to define their system the way that they want. We have no problem with someone using functional multiplicity to describe themselves.

It took a while to accept that we are integrated. It wasn’t a big event. There was no finite moment where we knew. It was a gradual process over years of therapy and working together.

When reflecting on our current levels of amnesia and dissociation, it became clear that it doesn’t happen often. We don’t experience amnesic switching anymore. Our dissociation is minimal and typically related to autism. We have some memories that aren’t accessible to the host but aren’t causing distress and will be recalled in their own time.

We are still on the path of integration. Memories will continue to arise, and we will definitely have lapses throughout our life. We hope to eventually achieve fusion. But we also have made incredible progress and can remain integrated through periods of high stress and instability.

Being integrated is so rewarding and allows all of us to live the lives we want while being ready for anything. We can use our alters’ strengths to face any challenge without losing time or being at odds.

If you believe you can’t achieve integration or functional multiplicity, we didn’t think we could either. Check out our system resources for help accomplishing this process.

Different Types of Flashbacks in PTSD and Complex Trauma

After a stressful event at work, I sat in the hall gasping for breath. I rationally knew what had happened. I had been yelled at, which triggered my PTSD. That didn’t stop my body from shaking and going through the panic of feeling helpless to save myself.

Talking about triggers in popular culture sounds like people being so sensitive to little events. You hear it thrown around as a buzzword and politicized as a way to diminish valid emotional reactions.

Trigger refers to an event or experience that reminds you of a traumatic event in your life. It brings up painful emotions.

Many years ago, I thought of triggers as their own PTSD symptoms, separate from flashbacks or other symptoms. Flashbacks were those “video clip” moments where your brain forces you to watch in vivid detail. That’s how they were described in all the resources I could find. I wasn’t familiar with complex trauma at the time.

Then I learned about emotional flashbacks. As the term implies, emotional flashbacks are emotion-focused flashbacks where you experience similar emotions to a traumatic period in time without necessarily getting clear images or somatic experiences.

While sitting in this hallway at work, I was having an emotional flashback triggered by the event. It was like being a child again, helpless and afraid. I likely would have regarded the situation as a panic attack a few years ago. But panic attacks aren’t tied to specific trauma triggers.

I tried looking into the different types of flashbacks further. If there were visual flashbacks and emotional flashbacks, were there other types?

The scientific literature didn’t have much to offer for variations on the “typical” flashback, reliving the moment in detail.

PTSD research has focused on single trauma cases, especially since, in the U.S., the DSM-V doesn’t have a classification for complex trauma. Often when going into a new therapy office, I have to indicate which trauma is my “worst trauma” since many of our therapy models rely on dealing with the singular root trauma. There isn’t room to see trauma as compounding, reducing trauma to very defined events of what can count as trauma.

Since practice falls behind research, it hasn’t caught up with the current understanding of things like minority stress, “social traumas,” or other complex traumas.

So, it’s not terribly surprising that research on types of flashbacks is nonexistent.

With all of that in mind, this is an article on a blog. I can try my best to provide a theory based on the current literature, but that theory is not scientific (yet).

To understand flashbacks, we need to understand the senses.

What are the senses anyway?

Oh! That’s an easy one. We learn this in kindergarten – eyes, ears, mouth, nose, and touch. Later on, we may have been exposed to other senses like vestibular (movement awareness) and proprioception (spatial awareness).

Often these are introduced as an accepted understanding of the world. The issue is that they’re phenomenological. And whenever you’re dealing with classification, it’s really tricky to say with any certainty that your classification system is an accurate representation of the world. As a consequence, a lot of the accepted “science” is a bit hazy, and mostly proposed theories with backing for some of the most major.

For example, Aristotle is credited to have first categorized the five senses. Other neurologists have identified and supported other systems. But depending on who you talk to there can be between 5-53+ senses.

This graph by New Scientist does a good job illustrating what senses are generally accepted in science. It also highlighted what “radical” senses have been proposed and a conservative understanding of the senses.

Graph showing conservative, radical, and accepted senses in science. Breaks senses into vision, hearing, smell, taste, touch, pain, mechanoreception, temperature, and interoceptors.

So, why does this matter to our discussion of flashbacks? Flashbacks are categorized by an individual’s somatic/sensory experiences, which requires a solid agreement on what senses count in that experience.

Flashback categories

CW: The following sections contain brief examples containing a variety of traumas.

A study compared flashbacks to regular auto-biographical memory. It found that flashbacks contained more visual, sensory, emotional, and other perceptual content than autobiographical memory. To people that have experienced traumatic flashbacks, this is far from surprising.

From examining the available literature and through my own experience, I’ve divided the types of flashbacks into Primary Sensory, Vestibular, Proprioceptive, Interoceptive/Emotional, Nociceptive, and Cognitive.

While these types of flashbacks may stand alone, most flashbacks are going to contain multiple types. The categories can be thought of as “Sense-Focused” flashbacks instead of as the only sensory experience of the flashback.

Primary sensory flashbacks

These flashbacks are what are most typically studied. They include the five senses as the focus.

The previously mentioned study found that visual information was the most common, followed by auditory for people experiencing flashbacks. Smell and taste were relatively rare. Touch falls under proprioceptive, so I’ll examine that more there.

Primary senses are the easiest to understand regarding flashbacks, so I won’t provide examples.

Vestibular

Vestibular-focused flashbacks are flashbacks that focus on the experience of movement. Motion can relate to the position and speed of you, people, or things around you.

Examples of vestibular-focused flashbacks may feel like hypervigilance, where you feel like your aggressor is following you. It may be like feeling the speed of a car coming at you, the feeling of body parts moving towards you, or your own body moving. It could also explain physiological descriptions of flashbacks like feeling dizzy, nauseous, off-balance, or like you’re falling.

Proprioceptive

Proprioceptors are nerve endings present throughout your whole body that identify things like touch, pressure, and your body in space.

Proprioceptive flashbacks may feel like someone or something touching you, like your body is present in that traumatic moment, weight on your body, or your skin crawling. It can also happen when someone touches you somewhere triggering, causing an acute sensation like being back in that moment.

Interoceptive/Emotional

Interoception is a wide array of internal experiences, including emotions, sense of time, and internal processes like blood pressure or hunger.

Primary emotions like fear, helplessness, etc., are more common in flashbacks than secondary emotions like guilt or anger.

Interoceptive flashbacks may feel like you’re experiencing the emotions from the trauma. In triggering your fight or flight, it may feel similar to the pounding heart and higher blood pressure you experienced at that moment. It commonly affects your sense of time, like moments are disconnected like a dream. Feeling like you’re in that time is also an interoceptive response.

Nociceptive

Nociceptive is the system that senses pain. A study found that individuals who went through a traumatic event experienced pain after the event. They also experienced pain later when recalling the event.

Nociceptive flashbacks are characterized by pain in areas that may have been affected by the trauma or stress-related pain. It can appear unexplained and may be written off as “psychosomatic.” If you only started having pain following a traumatic event, it’s worth considering that the trauma likely affected your nociceptive system.

It could also relate to other descriptions of pain during a flashback, like feeling like you’re burning, shocked, or being pulled apart.

Cognitive

Cognitive flashbacks are not a sensation so much as a pattern of behavior. A CBT therapist might tell you to examine cognitive distortions after a traumatic event, like feeling like people are out to get you, etc.

I think it is worth considering that this is a type of flashback. You may have distinct thoughts and related behaviors that you experienced during the trauma. It may also describe compulsive actions like trauma re-enactment, which may result in thinking you’re gaining control or can prevent the trauma.

Cognitive flashbacks may also affect your mental understanding of a situation like you’re back in the trauma or thoughts like “I deserve this.”

How autism interacts with trauma

With all the different systems involved in flashbacks, it’s important to note that autistic people have a much higher likelihood of over 40% (this varies greatly across samples, but all agree that it’s much higher than the gen pop) vs. 4% in the general population to have probable PTSD.

The reasons for this are unclear, but it’s theorized that autistic individuals encounter a lot more traumatic social situations and non-DSM-V traumas. Non-DSM-V traumas are any events an individual feel was traumatic but are not currently considered traumatic under diagnostic criteria. Bullying, mental health problems, and cumulative minority stress may be considered non-DSM-V traumas.

Since assessment for PTSD is not built around autistic communication, there can also be an underdiagnosis of PTSD in autistic individuals.


Autism is characterized by an “abnormal” perception of sensory information. It also has many co-occurring conditions that affect perception, like alexithymia, hyperphantasia, and synesthesia.

A recent study indicated that Grapheme-Color Synesthesia, where individuals associate numbers or letters with colors or images, is associated with PTSD. Sensory systems play into the way PTSD symptoms affect an individual.

I couldn’t find any literature indicating whether autism affects the severity of PTSD symptoms, but there was evidence indicating PTSD affected autism symptom severity. Things like social skills and other emotional regulation skills were affected by PTSD, creating the appearance of more pronounced autistic symptoms as a result.

There needs to be more research into how the somatic experience of autism interacts with the experience of PTSD. Until we have more research, it is unclear how being autistic may affect flashbacks.

An exercise for flashbacks

While many coping skills can be helpful in dealing with flashbacks, I’ll leave you with my favorite.

The technique is called “what’s different?”. In the flashback, you ask yourself, “what’s different?”. You keep naming different things about the room until your body returns to the present. It can be anything like “it’s colder”, “there’s this person with me”, “the walls are a different color”, “I’m laying down”, etc.

While it sounds simple, it can be beneficial during flashbacks to remind yourself where you are.

How Do I Know if I’m Experiencing Burnout?

I’m burned out. Between the constant grind of school and work, moving, and the current state of my country, I am completely drained.

I am not alone. In 2021, 79% of U.S. employees reported experiencing work-related stress. Nearly 3 in 5 reported being negatively affected by work, including lack of energy, motivation, and cognitive fatigue.

There are many reasons for stress to pile up in modern life. Having constant access to the news 24/7, being isolated in individualistic cultures, collective traumas like the pandemic, a culture of productivity, and our personal history all contribute to this mass feeling of exhaustion.

What is burnout?

Burnout is a syndrome, not a disorder. This means that any person can experience it at some point in life and generally can process it without intervention from a professional.

To count as burnout, it needs to have three dimensions A person needs to be exhausted, experience cynicism or depersonalization, and have a negative self-view of performance.

Burnout is talked about in the literature solely as related to work. It was first coined to explain the collection of symptoms common among therapists and other service workers that experience chronic stress. Presumably, stressors outside of work can also cause burnout.

Burnout vs. trauma vs. depression

Burnout has a lot of shared symptoms with trauma and depression. It can make it difficult to pinpoint what the cause of the problem is and get proper treatment. Many people use the term burnout when they’re actually experiencing other issues.

The chart above is not exhaustive, and specific symptoms are subjective in where they fall.

Shared characteristics are exhaustion, depersonalization, cynicism, irritability, anxiety, helplessness, headaches, withdrawal from social, and numbness or emotional outbursts.

Some key differences about burnout are that it is usually short-term, that you can pinpoint the source of the stress, and that self-care can prevent it. You can also start with burnout, which leads to depression if prolonged enough.

If your symptoms last a while, you’re experiencing suicidality, you’re getting intrusive thoughts and flashbacks from the source of stress, you have physiological changes, or you’re feeling down most of the time, you should seek professional help. This would indicate you are not experiencing burnout but are experiencing something else.

Common causes of burnout

Something that is not often discussed in the context of burnout is that it is mainly organizational. We typically put it on people as their responsibility to fix their burnout when the organization has a climate that leads people to burnout.

Sweden provides employees paid time off for burnout and other stress-related illnesses. Burnout researchers found that although they got this time off to rest, many employees still didn’t want to return to the workplace. You cannot fix a poor organizational structure or fit by taking time off.

In one study, employees rated their bosses and found that for every point increase in leadership score, there was a 7% decrease in burnout and an 11% increase in job satisfaction.

The most common work structure factors that lead to job satisfaction or burnout are:

  • Workload – how much you’re doing
  • Reward – work incentives/meaning
  • Control – how much autonomy you have
  • Community – the work culture and relationships
  • Fairness – if employees are treated equally
  • Values – your personal values vs. the company’s

If any of the above areas is poor in a given work environment, you will experience stress and less job satisfaction.

Autistic burnout vs. occupational burnout

While autistic and occupational burnout shares a name, the two are distinct. Autistic burnout is a relatively recent term, so the clinical literature is sparse, but the available research points to autistic burnout being longer lasting (up to years), decreased tolerance to sensory stimuli, barriers to treatment preventing relief, and issues with living independently.

Autistic people can also experience occupational burnout, contributing to autistic burnout. The symptoms look similar, but autistic burnout is more severe and enduring.

Like other forms of minority stress, contributions to autistic burnout are the cumulative load of expectations combined with systemic barriers to treatment Things like masking, transitions, dealing with the debilitating parts of autism, and social expectations fray the rope of stress management. Being dismissed by others, poverty, poor boundaries and self-advocacy, and not taking a break causes no relief from the stressors.

More research needs to be done on the condition and the best recovery methods. The early research on autistic people’s perspectives indicates that setting boundaries, asking for help, doing wellness activities, and recognizing autistic traits/diagnosis all alleviate autistic burnout.

Solving Burnout

You’ve tried all the self-care under the sun, and you’re still burned out. You’ve been told repeatedly that you need to take time off to solve your problems when that would only lead to more problems. You’re stuck in a cycle of waking up, dreading work, going home, dreading work, and going to bed.

I get it. Burnout is really hard. And unfortunately, there isn’t a magical solution.

You cannot self-care your way out of burnout. Self-care is meant to be preventative, not an intervention.

The first question you have to answer is: is it me or my job? If you look at the lists above and see that your company is missing several crucial dimensions, it may be time to start job hunting. Trying to solve burnout when the organizational problem is like that art installation where the robot is trying to clean up a constant pool of blood.

If it’s not an organizational problem, here are some tips that can help.

  • Disconnect from your phone. Set digital wellness timers, limit the content you’re seeing, and take a break from the news.
  • Prioritize responsibilities. Think of your responsibilities as juggling balls. Some are made of glass, and others are made of plastic. Figure out which ones are glass and focus on making sure those don’t drop. You’ll be fine if you drop the plastic responsibilities for a bit.
  • Take your breaks at work. Use PTO. Think of it as investing in your productivity.
  • Talk to someone, preferably a therapist. Verbally processing your situation can help you realize what will work.
  • Have a physical outlet. Our bodies naturally try to physically shake off stress, but we often inhibit it. Animals shake in the wild to relieve acute stress.
  • Do the wellness activities you can. You can’t do everything, but choose what’s most important.
  • Set time between responses. Most communication doesn’t require an immediate response.
  • Engage the parasympathetic nervous system. “Tricking” your body into calming down will boost your energy and mood.
  • Do nothing. Boredom can be beneficial in sparking creativity and letting your mind rest.

Remember, you are worth more than your job. Your inherent value is not tied to your productivity. You are worth just as much when you’re burnout as when you’re at your peak productivity.

FAQ 2: Why is Applied Behavior Analysis Controversial?

For definitions of terms, please check out FAQ 1.

Table of Contents

  1. What is “New ABA”? – A brief history of ABA
  2. Why is it controversial?
    1. Requirements for Practice
    2. Issues with Consent/Assent
    3. Reducing Humans to Animals
    4. Suspect Evidence Base
  3. How does ABA differ from parenting?
  4. Is there any “Good ABA”?

What is “New ABA”? – A brief history of ABA

CW: This section describes abusive practices in ABA. Reader discretion is advised.

Historically, ABA was known for harsh punishments (aversives) like beatings, spray bottles, verbal harassment, withholding food, public shaming, and shock treatment. The original goals of ABA can be summed up well by the most-attributed “founder of ABA,” Ole Ivar Lovaas.

“[Y]ou start pretty much from scratch when you work with an autistic child … they are not people in the psychological sense.”

Ole Ivar Lovaas, attributed ‘founder of ABA’

One of the major criticisms of “original ABA” is that its methods heavily influenced Lovaas’s involvement in The Feminine Boy Project, which was foundational to conversion therapy for gay and trans youth.

The rhetoric of ABA initially promoted itself as the only known “cure of autism.” Since the punishments were seen as preferable to institutionalization, the harm was rationalized and widely supported by the medical field and parents.

When considering the rise of Autism Speaks through cure rhetoric, it explains why the two are often connected. Autism Speaks has also pushed legislation to get ABA mandatory insurance coverage in many states, legitimizing the practice. ABA set the stage rhetorically for Autism Speaks, and the two mutually benefit from pushing parents towards seeing autism as in need of immediate intervention before it’s “too late.”

ABA also positioned itself as the only scientifically supported autism therapy, shunning other therapies as pseudo-scientific and ineffective. This is similar to how behaviorism arose from rhetoric regarding it as the sole objective psychological science. It was later recognized as lacking crucial dimensions (like unobservable, internal states) to treat holistic mental health.

Over time, original ABA methods like Discrete Trial Training (DTT) were missing crucial components like the generalizability of outcomes. New methods like Naturalistic Environment Teaching (NET) along with a wide array of variants like EDSM, PRT, PBS, and PECS were introduced. The aversive punishments received negative attention and were regarded as inhumane.

ABA outwardly shifted to focusing on naturalistic, child-led, rewards-focused interventions in an attempt to ethically practice ABA. The original goals remain the same; improve communication/adaptive skills, and reduce “problem behaviors.”

This coincided with the first wave of people that went through ABA becoming adults; many spoke out about the traumatic experiences where they were forced to stop being autistic at threat of violence.

While there is no set period in time where this change emerged, from my understanding, there was a progressive shift in ABA to distance itself from its historical past.

If you talk to most ABA therapists, they would agree that the “old ABA” was bad. They claim that the “new ABA” is good, pointing to advancements in naturalistic techniques that are not as explicitly punitive. This “old ABA” vs. “new ABA” has served to silence people that experienced ABA, regarding them as having old ABA and therefore not having an informed perspective on current ABA practices.

Autistic ABA survivors and others in the community point to how many of the techniques that caused harm are still present and that because the goals are still the same, they still punish autistic expression and favor making autistic children more like their neurotypical peers.

It is also worth noting that there are still ABA organizations highlighted at major ABA conventions practicing electric shock torture at the Judge Rotenburg Center (JRC). They recently went after an autistic-run non-profit for publishing statements regarding the inhumane treatment. The “old ABA” is not so distant as ABA therapists tend to argue.

Why is it controversial?

Requirements for Practice

Currently, only 31 states in the U.S. require a BCBA to be licensed with the state (with a few states with proposed legislation). This means that, unlike other therapy professionals, many states have no external body of regulation for ABA professionals. They are still required to get certified through the BACB to practice, but the BACB is an independent body that can decide the rules for certification and what qualifies.

Considering other blatant unethical processes in the field, like the JRC, the BACB has some apparent conflicts of interest in judging ethical conduct. This is why an external regulation body is necessary to maintain ethical conduct.

Another concerning aspect is that currently, no states require a license for RBTs. They are essentially practicing therapy without a license, with minimal training, and all under the guise of being supervised by someone with more credentials. I can’t think of the equivalent of an RBT in any other type of therapy because it’s broadly recognized that the level of experience and training necessary to practice is far beyond what an RBT has.

There are also no strict guidelines for learning about autism or child development for any ABA therapist.

Below, I’ve created a table using Washington State, one of the 31 states with licensing requirements for BCBAs, RBTs, and Licensed Mental Health Counselors (LMHC). While there are different pathways for BCBAs and LMHCs, I used the most common technique for obtaining licensure for each.

Supervised Practice HoursDirect SupervisionContinuing Education (Every 2 years)
BCBA (WA State, USA)1500 hrs75-150 hrs32 hrs
RBT (WA State, USA)40 hr classroom training (not practice hours)5% of hours post credential, 2.5% individual0 hrs
Mental Health Therapist (WA State, USA)2500 hrs100 hrs36 hrs
Licensure Eligibility Requirements for BCBAs, RBTs, and LMHC

Another concern is that many ABA interventions inherently don’t offer the option to consent or even punish when a client does withdraw consent.

Some ubiquitous issues with consent in ABA are pairing, improper understanding of accessibility needs (including minimal verbal options for non-speakers), punishing “vocal non-compliance,” and using fidgets, breaks, food, or other needs as reinforcers. Many also don’t present a choice to engage with the intervention, use restraint and seclusion, remove loved reinforcers from home to “make them more effective,” and don’t understand meltdowns or how to prevent them.

In theory, the behaviors targeted for reduction and increase should be purely for the client’s benefit. However, many clinics use the parent’s perspective to form goals. Many providers (often unconsciously) set goals to help make the parents’ lives easier, like teaching them to say hello to their parents or stop screaming to help parents focus. Taking parents’ thoughts into consideration isn’t inherently a bad thing. When ABA often uses rigid behaviorism tactics, you force compliance regardless of their interest if it is not for the client’s benefit. It would only take one goal not made for the client’s benefit in the 40 hours per week of ABA for it to become unethical. Not many other therapies give the therapist so much control over their client.

Nothing in the ethical code directly specifies in which contexts the client is the kid vs. the parent. This also leaves murky areas for prioritizing the parent as an ethical choice.

The prompt hierarchy is another example of issues with consent. One of the issues with the prompt hierarchy is that it assumes all behavior is willful or incompetent. It believes that if someone isn’t doing something you’ve asked, they either do it because they don’t want to or don’t know how to. Working with a population with many co-occurring disabilities necessitates determining if the behavior isn’t happening due to motor, physical, or other unseen interworkings. It also requires physical force to complete a task if a child isn’t responding.

For example, when I worked in ABA, a child struggled to put on their shoes. I was supposed to work through the prompt hierarchy, but I paused and considered the environment. I realized that the kid was embarrassed, as he had two adults pressuring him to put on his shoes, a behavior he already knew how to do but was struggling with that day. I waited for him and let him know there wasn’t a rush to the next activity, and immediately he was able to put on his shoes and looked incredibly relieved.

Reducing Humans to Animals

Another concern about ABA is that it completely ignores internal states. It believes that humans can be reduced to behaviors that can be explained and manipulated. There is no room to analyze emotions or other physiological states that can’t be observed. This is also why there is sparse research examining ABA’s psychological and emotional effects in the short and long term.

Take the four functions of behavior, for example. While the four functions of behavior may appear logical, it is reductivist and only sees human behavior as four categories. Since it is phenomenological, you can point to anything as “evidence” for those categories.

I could categorize human emotions into good, bad, and weird. I could categorize my feelings as happy, content, and excitement are good; sad, lonely, and angry are bad; and confused, off-put, and deja vu are weird. Obviously, there are only three human emotions now! The evidence is that every feeling I experience can fit into these three categories.

It’s rational to see how this line of thinking is faulty.

Suspect Evidence Base

Methodologically, behaviorism created single-subject designs to measure baseline and subsequent behaviors, and this has been the foundation of much of ABA’s evidence base.

While single-study designs can help prove a behavior has successfully changed, they are not generalizable to broad populations. They also only prove that the behavior successfully changed. They don’t adequately address any effects of the intervention beyond behavior change.

Beyond this, a proper control group is not typically used in multiple subject designs in ABA research. There are only groups where children receive interventions and no groups that show whether the behavior would have developed without the intervention.

There are many Conflicts of Interest (COIs) not disclosed in ABA research. One study examining ABA literature found that 87% of the 70 studies with no declared Conflict of Interest found at least one author who provided ABA services or consultancy for ABA providers (clinical/training COI). They also found that only 5 studies out of 180 were group designs instead of single-case designs.

It is worth noting that there is a lack of transparency about the widespread methodological issues. That is significant considering that this evidence base has been used to receive government funding, support from the medical field and the public, recognition from the largest autism non-profits, and hundreds of thousands of dollars from insurance and parents. It has also contributed to other therapies for autistic children not being covered by insurance companies and disregarded by the court system, forcing many families into needing care with ABA as the only option.

How does ABA differ from parenting?

While the two may look similar, ABA differs in application, goals, and systemic power.

I do not have children. I will be very clear that my perspective of parenting may be incomplete.

Most parents’ goal is to raise a happy and pro-social child, where they are secure in themselves and actively try to better the community. Obviously, this isn’t the case for all parents, but when comparing the two, it’s easier to establish a baseline.

ABA is not simply reinforcement. We use reinforcement regularly in our daily lives, which is very important in parenting.

To examine the differences, it’s helpful to look to ABA “parent training,” where therapists will often come to the parent’s home and teach the parent how to practice ABA when the child is not with the therapist. The therapist will often instruct parents to make reinforcers sparse so that the child has to communicate for them. The therapist will instruct parents on how to apply reinforcement and punishment, how to gain the child’s attention, the prompt hierarchy, identifying the functions of the behavior, and the motivating operations (circumstances that make reinforcers work better).

In parenting, typically, this level of structure is absent. Suppose we’re discussing “gentle parenting” (authoritative parenting). In that case, it advocates for natural consequences and rewards — which with NET may be similar but is not similar to other types of ABA. Authoritative parenting would place boundaries around access to reinforcement but would recognize giving access to loved items without demands is necessary for warmth and would never withhold food for the sake of compliance.

Gentle parenting would believe in errorless teaching but likely wouldn’t resort to physically restrictive methods like hand-over-hand. Authoritative parenting doesn’t reduce a child’s actions into behaviors with functions but instead notices the emotional motivations and is empathetic to the child’s internal states.

So, ABA is more akin to authoritarian parenting, which requires compliance and lacks warmth. ABA differs from any parenting style in that it has systemic power. It can be used to take kids away from parents if they don’t comply with treatment, regardless of how much it costs. It uses rhetoric discussed earlier to lure parents into believing their child is broken. It has legislative power allowing it to exist instead of therapy without a therapy licensing board.

Parenting is not ABA. Even authoritarian parenting.

Is there any “Good ABA”?

If you converse with an ABA provider about ABA, you will quickly hear the argument, “I practice good ABA.” Every provider believes they do. To be fair, there are many risks to examining your own practice and whether you are practicing “ethical ABA.” Most ABA providers go into the field because they genuinely care about other people and see ABA as a way to help. But, many ABA therapists still practice the problematic interventions I’ve identified here.

This is the heart of the ABA controversy. Is there any such thing as good ABA? I’ve interviewed autistic ABA practitioners and ABA survivors. Many people don’t believe that there is an ethical form of ABA. At its core, ABA does believe in changing behaviors with disregard for internal states, which is manipulation. And while manipulation can be used for the benefit of someone, how can we say that it’s in the client’s benefit when so many are coming forward with hidden harms of ABA (both new and old)?

That’s not to say that individual people have not benefitted from ABA. Some people have. There’s a lot of nuance to the conversation when considering the client’s racial, cultural, socioeconomic, location, clinic, and accessibility needs. As a consequence, it’s hard to say for sure what the appropriate action is.

Many call for an overhaul of ABA and go about it differently. Some believe they can change it within the field. Others believe the field is too corrupt to fix. Some risk their licenses or livelihoods in the pursuit of ethical treatment. And many more are complicit in a demonstrably unhealthy environment.

There are some critical changes that the field needs to make before it can be considered safe. And it needs to be a field where the unethical practices are not so pervasive that trying to pick an ABA provider is a minefield because you can’t tell on the surface which is the “good one” vs. the “bad one.”

Another question is, if the field does change so significantly that it becomes ethical, would it even be able to be called ABA? When some foundational techniques (behavior manipulation on vulnerable populations) have such a high potential for harm, can we ever be confident that we can ethically practice this goal?

Some practice ABA in name alone. Unfortunately, there’s not much one can do with a degree in ABA outside of ABA, and many insurances do not cover any autism therapy outside of ABA. So, some providers will provide other services and still call themselves ABA providers since that is what they’re certified in. This further complicates which ABA providers are “good ABA.”

This is not a new debate. This debate has been around as long as behaviorism, with psychodynamic therapy taking its place. Behaviorism on its own is generally not practiced outside of ABA. Therapists have considered it unethical when practiced alone without a multi-modal approach.

Regardless of the solution, it seems like ABA will have to become multi-modal, have better regulations, methodology, procedures for consent, education, humanistic goals, and consideration for the autistic community to start being an ethical field.

FAQ 1: What is Applied Behavior Analysis (ABA)? + Glossary of ABA Terms

Glossary of ABA terms at the bottom. FAQ 2

Table of Contents

  1. What is ABA?
  2. How is ABA done?
  3. Glossary

I was asked recently for a definition of ABA. I quickly found that when googling “What is ABA?”, the results are heavily weighted in ABA’s favor. The top result was Autism Speaks (a notorious anti-autistic, fear-mongering organization). Autism Speaks paints a lovely picture, pointing to increased language and adaptive behaviors, ABA being around since the 60s, individualistic, “evidence-based,” and how qualified BCBAs are doing the programming.

It neglects to mention any prevalent controversies or professional complaints in the field. It leaves out the emerging evidence that long-term ABA has adverse effects. And it conveniently doesn’t mention the RBT’s role in ABA or the suspect nature of ABA research.

No wonder this person was having a hard time finding a comprehensive definition.


Since major ABA organizations like ABA-I have taken over the conversation on what ABA is, there is a lot of misunderstanding in every community.

ABA practitioners often have a rosy view of ABA, unaware of a movement from the autistic community against it.

Parents are thrown into a position where every doctor and autism resource is catastrophizing their child, telling them their child will never be able to care for themselves or communicate if they don’t act now.

Autistic people, especially newly diagnosed, may have heard of the controversy and use catchy slogans like “ABA is conversion therapy” that they’ve seen in the community without a real understanding of what ABA is and why it’s problematic.

Which makes informed, nuanced conversations between these groups nearly impossible.

What is ABA?

Applied behavior analysis is an extension of the field of behaviorism. Put simply, behaviorism believes in shaping human and non-human animal behavior through rewards and punishments. ABA uses reinforcers to change behavior according to the social, motor, and other functional/adaptive goals that the client sets. It also seeks to decrease “problem behaviors,” which are loosely defined but typically include behaviors like self-harm, aggression, eloping (running away), and “vocal non-compliance” (which can involve saying no, screaming, crying, etc.)

ABA does not focus on the emotional domain, as it is a purely behavioral-focused therapy. Only cognitive therapies like cognitive behavioral therapy (CBT) handle cognitive/emotional processes directly. While ABA and CBT may share the name “behavioral therapy,” the method and focus of the therapy are very different.

Behavioral therapies like ABA aim to create greater socialization, self-sufficiency (often referred to as adaptive skills), and communication skills through changing behavior with rewards and punishments. The problem is defining those goals as they are subjective goals that ABA therapists attempt to make objective.

ABA can be applied across various contexts. Many ABA providers are trying to re-contextualize it to treat substance abuse, alter education, or provide treatment for other mental health disorders. Despite this, the most widespread use of ABA is on young autistic children, usually between the ages of 2-7. As such, this is the ABA that I am talking about. My concerns about it applied elsewhere stem from my worries about assent from minors/vulnerable populations, but my focus is ABA on autistic children.

How is ABA done?

ABA is used as a description of a field of many practices, so there is no one way that ABA is done. All ABA, however, share some characteristics and are based on the same fundamental principles.

The structure of ABA involves a board-certified behavior analyst (BCBA) who possesses a master’s degree and has obtained certification from the Behavior Analyst Certification Board (BACB, which isn’t confusing at all /s). The BCBA usually meets with the parents and child and does an assessment of some type. The assessment typically assesses the skills the child currently has compared to what the assessment determines is typical for the child’s age. The broad term for this process (including parent interviews, observation, and formal assessment) is a Functional Behavior Assessment (FBA).

They may also do something called a Functional Analysis. A Functional Analysis seeks to scientifically determine the function of a behavior. To determine this, they test a child using things that are known triggers to see if the child reacts. This is to determine if the “problem behavior” is for the function of access, escape, attention, or automatic reinforcement. Because it uses children’s triggers and is often used on non-speaking children, ethical issues can be very prevalent in my experience.

The function of access, escape, attention, and automatic reinforcement believes that ALL behavior (and in the context of the therapy, ALL autistic behavior) falls into four categories. Access believes the child is doing something to gain something (typically tangible, like a toy). Escape believes they are doing it to avoid something (typically unwanted tasks or sensory). Attention believes they are doing something to get attention (get a reaction). Automatic reinforcement is doing something to return to homeostasis (like stimming).

Following this assessment, a treatment plan will begin targeting behaviors using these functions. Generally, if something is for the function of access, you make the thing the child wants access to unavailable until they provide the desired behavior. If it’s escape, you return the child to the task and model appropriate ways of asking for escape or not letting them up until they finish. If it’s attention, many therapists will use planned ignoring, where the therapists ignore a child until they stop doing the attention behavior or display the “appropriate way” to ask for attention.

The ones actually performing this therapy are called Registered Behavior Technicians (RBTs). They are currently only required by the BACB to have a high school diploma, complete a 40 hr training, and pass the RBT exam. They are not allowed to create the programming, but they are the ones implementing the program. Generally, most training programs very minimally prepare RBTs to handle behaviors such as aggression (with emphasis on restraint in many places) and very little information about autism.

RBTs must have 5% of their hours supervised, but only half of those have to be individual. So if an RBT works 40 hrs a week, only 4 hrs per month have to be individual supervision.

The RBT (generally one-on-one) will run the child through their goals, collecting data from trials. For NET, they will follow the child around and figure out ways to incorporate goals. This may look like stopping a child at a slide and saying “go” before letting the child down the slide or bringing the child to sit next to another child and play alongside them. For DTT, they would sit the child down with flashcards or objects and have the child label them. A kid would be rewarded with a wanted item, break, or other reinforcers for labeling correctly.

All ABA therapists use the “prompt hierarchy” (also called errorless teaching). The prompt hierarchy consists of verbal, second verbal, gestural, model, partial physical, and full physical. This means you work from “least restrictive to most restrictive” until the child performs the desired behavior. For example, if I want a kid to put on their shoes, I would remind them to put them on, tell them again, gesture at the shoes, model grabbing the shoes and putting them on, touch the kid’s hand to prompt them to put them on, and finally, grab the kid’s hands and have them put on their shoes.

The final concept crucial to all ABA I’ll present is the ABCs of behavior. The ABCs of behavior is antecedent, behavior, and consequence. All behavior has the factors immediately before that elicit a response, the behavior, and the consequence of that behavior. This is why behaviorists look for the function of the behavior. It’s to see what is reinforcing a behavior to later manipulate it into happening more or less often.

Please let me know if I missed any terms in the glossary or if the definition isn’t correct, more information in part 2.

Glossary

ABCs of Behavior – The ABCs of behavior is antecedent, behavior, and consequence. That is, all behavior has the factors immediately before that elicit a response, the behavior, and the consequence of that behavior.

Adaptive Skills – Skills of self-sufficiency like personal hygiene, day-to-day activities, interacting with others, managing money, and other functions required to take care of yourself.

Allistic – Not autistic.

Applied Behavior Analysis (ABA) – ABA focuses on shaping behaviors through reinforcement with the goal of improving communication, social, and adaptive functioning. Since it is a branch of behaviorism, it does not focus on the emotional domain or other internal states. It also seeks to decrease “problem behaviors” (as defined by the individual ABA provider). There are many different types and settings.

Aversives – harsh or abusive punishments like beatings, spray bottles, verbal harassment, withholding food, restraint, seclusion, public shaming, uncomfortable noises/sensory stimuli, and shock treatment.

Behavior Analyst Certification Board (BACB) – The independent body overseeing all ABA professionals and programs. It creates ethical standards, tests, requirements and publishes updates about ABA.

Board Certified Behavior Analyst (BCBA) – possesses a master’s degree and has obtained certification from the BACB. The BCBA usually meets with the parents and child, does an assessment of some type, and creates programming for the client that RBTs implement.

Behavioral Therapies – Behavioral therapies like ABA aim to create greater socialization, self-sufficiency (often referred to as adaptive skills), and communication skills through changing behavior with rewards and punishments.

Cognitive Behavioral Therapy (CBT) – CBT is a cognitive therapy that takes a multi-modal approach. It helps people identify their cognitions and consequent behaviors, allowing them to gain better emotional recognition and self-regulation. While ABA and CBT may share the name “behavioral therapy,” the method and focus of the therapy are very different.

Cognitive Therapies – Only cognitive therapies like CBT handle cognitive/emotional processes directly. Cognitive therapies are helpful if the client’s concerns are emotional issues, cognitive distortions, or self-regulation skills.

Conflict of Interest – A personal relationship of a researcher to an organization or consequence that would bias the results. They must be disclosed, but only certain types like financial conflicts of interest are commonly disclosed. One of the most common in ABA is clinical/training conflict of interest, where working in ABA or consulting ABA providers may bias the researcher towards a favorable result.

Desensitization – The process of exposure to an aversive stimulus. It is intended to be done in small iterations of the feared object/sensation but is often practiced as forced exposure to the item/sensation. Improper desensitization practices are traumatic for the client, making it a controversial technique.

Differential Reinforcement – Reinforcing one behavior over another behavior. There are four types, DRI, DRO, DRA, and DRL. DR of incompatible behavior (DRI) seeks to reinforce a behavior that is incompatible with the one the therapist doesn’t want (like chewing gum prevents whistling). DR of other behavior (DRO) reinforces when a behavior doesn’t happen over a period of time. DR of alternative behavior (DRA) reinforces alternative behaviors to the one the therapist wants to reduce (like raising your hand instead of yelling). DR of low rates (DRL) reinforces lower rates of a behavior instead of eliminating the behavior.

Discrete Trial Training (DTT) – Commonly included in old aba. The client is shown many flashcards with requirements to label them, point to the correct one, or do another similar task. After a certain number of correct answers, they are provided with a reinforcer, though punishment is also sometimes used to deter wrong answers or increase the effectiveness of a reinforcer. It is practiced less often due to its historically abusive nature and lack of generalizability.

Discriminative Stimuli (Sd) – An Sd is a stimulus that indicates what behavior someone should be doing. If I call your name, that is an Sd for you to respond.

Early Denver Start Model (EDSM) – Commonly included in new ABA. EDSM was proposed to target younger children (between 18 mo – 5 yrs) to start fostering skills as young as possible. It is highly effective at teaching skills but is questioned for the vulnerability of the population it’s used on.

Extinction Burst – The immediate increase of behavior after a behaviorist has targeted behavior for reduction. This is somewhat controversial as it can also indicate a withdrawal of consent.

Extinction Plan – A plan a BCBA sets to reduce a “problem behavior” through punishments and reinforcers.

Four Functions of Behavior – The function of access, escape, attention, and automatic reinforcement believes that ALL behavior falls into four categories. Access believes the child is doing something to gain something (typically tangible, like a toy). Escape believes they are doing it to avoid something (typically unwanted tasks or sensory). Attention believes they are doing something to get attention (get a reaction). Automatic reinforcement is doing something to return to homeostasis (like stimming). It is phenomenological, making it difficult to provide evidence for the categories.

Functional Analysis (FA) – A Functional Analysis seeks to scientifically determine the function of a behavior. In order to determine this, they test a child using things that are known triggers to see if the child reacts. This is to determine which of the four functions of behavior are reinforcing the “problem behavior”.

Functional Behavior Assessment (FBA) – The assessment a BCBA or other professional administers to determine the skills and behaviors the child currently has compared to what is typical for the child’s age. This includes parent interviews, observation, formal assessment, and may include a functional analysis. FBAs are not exclusive to ABA.

Group Design – A study design involving more than one participant.

Judge Rotenburg Center (JRC) – An ABA organization that is highlighted at major ABA conventions currently practicing electric shock torture . The shocks they administer are four to twelve times stronger than a police taser. They recently went after an autistic-run non-profit for publishing statements regarding the inhumane treatment.

Motivating Operations – the environment and/or circumstance that will make a reinforcer more or less motivating. For example, if I present a cookie when you’re full, you’re going to want it a lot less than if I present it to you when you’re hungry.

Naturalistic Environment Teaching (NET) – Considered part of the new ABA. Developed in the 80s, NET tried to address the issues with generalizability in DTT. The therapist follows the child and attempts to implement goals using natural reinforcement. It still shares a lot of ABA techniques that were used in DTT.

New ABA – A loosely defined cut-off in time for the evolving field of ABA. ABA therapists often claim that the “new ABA” is good, pointing to advancements in naturalistic techniques that are not as explicitly punitive. The “old ABA” vs. “new ABA” debate has served to silence people that experienced ABA, regarding them as having “old ABA” and therefore not having an informed perspective on current ABA practices.

Non-speaking/Non-speaker – A person that does not communicate verbally. People who did not speak used to be referred to as non-verbal, but this is inaccurate because many non-speakers have verbal abilities to communicate. They may not reliably speak or speak at all.

Non-verbal language – Communication without words, like body language, gestures, or silence.

Old ABA – A loosely defined cut-off in time of what was considered historical ABA. It generally encompasses a conglomerate of unethical practices like the rigidity of DTT, aversives, and punishing autistic behavior like stimming. If you talk to most ABA therapists, they would agree that the old ABA was bad. The “old ABA” vs. “new ABA” debate has served to silence people that experienced ABA, regarding them as having old ABA and therefore not having an informed perspective on current ABA practices.

Ole Ivar Lovaas – One of the attributed founders of ABA. He believed that autistic children were “not people in the psychological sense” and that they responded best to manipulating behavior. One of the major criticisms of “old ABA” is that its methods heavily influenced Lovaas’s involvement in The Feminine Boy Project, which was foundational to conversion therapy for gay and trans youth.

Pairing – The process where a therapist tries to establish themselves as a reinforcer for the child. The therapist gives children non-contingent access to reinforcers like their favorite items, activities, and even food preferences. The therapist provides the child with their full attention and doesn’t make any new demands, showing interest in whatever they are doing. After the child is bonded to the therapist, reinforcement and attention becomes contingent on fulfilling demands. The child has to comply with demands to receive this loving support to which they’ve grown attached. Therapeutic rapport is a more ethical way of establishing client relationships.

Picture Exchange Communication System (PECS) – An ABA speech therapy that involves a child exchanging a picture for a reinforcer. This is highly controversial among speech therapists as generally only a very limited number of communication options are given, and it makes communication contingent which can have a punitive effect on not communicating “the right way.”

Pivotal Response Training (PRT) – Commonly categorized in “new ABA”. PRT sets crucial developmental skills for different ages and attempts to teach children those pivotal skills through reinforcement and punishment. The biggest critique of this therapy is interpreting what skills are pivotal and implementing allistic versions of these skills.

Planned Ignoring – The therapist intentionally ignores the child until attention is requested “the appropriate way” or the child stops doing the behavior the therapist targets for reduction. Highly controversial, but commonly practiced.

Positive Behavior Support/Intervention (PBS or PBI) – Commonly categorized as “new ABA”. System-wide implementation of an ABA approach, generally used in schools. Its goals are to examine the structure and environment, target a specific group using ABA techniques, and finally examine individuals and correct behavior on the individual level. While it does take ABA a step in the right direction by examining the environmental structure, it still contains the problem of ABA ignoring non-behavioral factors.

Problem Behavior – A loosely defined concept that each ABA provider sets for the client. Typically this includes behaviors like self-harm, aggression, eloping (running away), and “vocal non-compliance” (which can include saying no, screaming, crying, etc.). Problem behaviors can be reductivist and generally eliminates the behavior without eliminating the cause.

Prompt Hierarchy (also called errorless teaching) – The prompt hierarchy consists of verbal, second verbal, gestural, model, partial physical, full physical. You work from “least restrictive to most restrictive” until the child performs the desired behavior. For example, if I want a kid to put on their shoes, I would remind them to put them on, tell them again, gesture at the shoes, model grabbing the shoes and putting them on, touch the kid’s hand to prompt them to put them on, and finally grab the kid’s hands and have them put on their shoes.

Punishment – Anything that reduces the frequency of a behavior. Punishment is sorted into two categories, positive and negative (which can be aversive or natural). Positive punishment adds something negative as a consequence to a behavior. Negative punishment removes something as a consequence.

Reinforcer/Reinforcement – Reinforcers/reinforcement is anything that increases the likelihood of a behavior. This similarly has positive and negative. Positive reinforcement means adding something the person likes as a consequence. Negative reinforcement means removing something the person doesn’t like.

Single-Subject Design – A study containing one subject. Behaviorism created single-subject designs to measure baseline and subsequent behaviors, which has been the foundation of much of ABA’s evidence base. While single-study designs can help prove a behavior has successfully changed, they are not generalizable to broad populations. They also only prove that the behavior successfully changed. They don’t adequately address any effects of the intervention beyond behavior change.

Verbal language – Using words to convey meaning, does not have to be spoken.

The Abuser Within – Persecutor Alters in Dissociative Identity Disorder

CW: Suicide attempt

During my freshman year of college, I sat in my biology course, taking a final. Somewhere in the back of my mind, something clicked into place. I knew enough about my triggers to know I was suicidal, but I didn’t want to die.

As if my body weren’t my own, I floated home. I knew today was the day. I made my preparations and woke up four days later after being put in a medically induced coma.

I felt light and told everyone that I felt so much better. I wasn’t lying. The me that was inhabiting my body didn’t want to die.

So, how did I go from depressed but wanting to live to making an attempt on my life on the same day?

At that time, I didn’t know I had someone inside me that learned that death was a coping mechanism.

So, when I first learned about my system, this conflict arose. This person was willing to risk our lives and well-being. They would control from behind the scenes and take over the body. And during that initial high amnesia time, I would often wake to a horror scene of terrible coping mechanisms.

I hated them. I wanted them gone from the system, locked away forever. And most of the system agreed. We turned against this alter, telling them we didn’t want them in the system. This increased amnesia and this power struggle. They fronted (took over the body) more often, and I lost more time, waking to destructive actions.

Then I saw this video. This alter was a persecutor.

What are persecutors?

Persecutor alters typically hold trauma and cope in destructive ways, often jeopardizing the system’s safety.

Persecutors often engage in anti-social behaviors. They may burn bridges with relationships, engage in self-harm or suicide, berate the system, use drugs, alcohol, sex, or other addictive behaviors, lash out at inappropriate times, or do unsafe things and put the body at risk of harm.

They can be a direct reflection of real abusers in the system’s life (introjects), children with a lot of trauma, fictive villains, non-humans, or other less savory self-parts.

Persecutors sound like the worst, don’t they? That’s often how (particularly new) systems view their persecutors.

When an abuser is outside the body, the system is well equipped to handle them by any means necessary. When that abuser is inside the body, it becomes a sort of auto-immune response. The system will often self-destruct in an attempt to rid it of this perceived pathogen.

In reality, persecutors are nothing more than protectors with harmful coping mechanisms.

Breaking down the wall

Once I understood that my persecutor was just an injured part of me, it was easier to know how to help them.

I sat with myself and meditated as part of self-therapy, holding space for them to come forward.

Marion (Host/”Me”): I know you’re hurting.

Zed (Persecutor): You don’t know sh*t.

Marion: You have a lot of pain from everything they did to you. All the pain you’ve gone through.

Zed: Oh yeah? And how would you know that? All you’ve done is said how awful I am and how I’m ruining your life.

Marion: I’m sorry, I shouldn’t have done that.

Zed: …

Marion: That trauma you went through, I can feel it. I know how hard that was for you. I’ve experienced trauma too.

Zed: You don’t understand me. Stop trying to pretend you do.

Marion: Do you want proof I’ve suffered? Do you want to see how I know?

Zed: I don’t believe you understand me.

Marion: (Describes my trauma in detail)

Zed: I’m… sorry.

Marion: Yeah, I understand what it’s like to hurt as badly as you do. It’s horrible, isn’t it?

Zed (crying): yes, yes it is.

Marion (crying): It’s so tiring, trying to act like everything is normal when your pain is hanging over you every minute. Come here.

Zed: (hugs)

Marion: That’s why I’m here. That’s why we’re all here. We are here to keep you safe. And we are safe. This is all that’s happened and why we’re safe.

Zed (nods): okay…

Marion: What if we find something that could help you process the hurt you’ve been through? I remember you like sewing and crafts?

Zed: Mmhm.

Marion: Okay, we’ll go to the store, and you can pick out ANYTHING you want to work on. And I’ll give you some time to front so you can work on it.

Zed (crying): thank you.

This wasn’t the only conversation we had. We talked over months, and I got to know that part of myself. They were a trauma holder that was only a child. They were trying their best to cope with the overwhelming emotions they experienced and were trying to keep us safe. They were also dealing with mental health issues that the rest of the system didn’t experience.

They didn’t need more people labeling them as dangerous and bad. They needed genuine connections to people that loved them. We stopped calling them a persecutor after that conversation. Persecutor painted them as an enemy against the system when they were really a protector and trauma holder.

But what our persecutor has done is REALLY bad

All things considered, my system was lucky that our persecutor was a child. Zed still had access to adult coping mechanisms and did many things I won’t discuss here, but they mostly did damage internally. They very rarely took out their trauma on other people.

Other systems may have persecutors that act in much more destructive ways. If they’re an introject, they could be very triggering, reminding you constantly of abuse you’ve endured. They may have caused you to lose jobs, material support, or even be involved with the court system.

System accountability is essential. All members are accountable for what one has done. And that may require owning up to difficult actions that don’t feel like you did.

A part of you did. And you should accept that as if you had done it. Take whatever steps you have to to be accountable in whatever your situation is, especially if external people were harmed.

Beyond that, recognize that this persecutor is part of you. They are you. There is no distancing or cutting them off, and any attempt to do so will likely backfire.

Recognize why they’re acting the way they are. What trauma did they endure to react this way? How old are they? What do they think the consequences of their actions are? Do they realize how it impacts others in your system, or do they only consider themselves?

Dealing with persecutors as a system

While I don’t know your situation and what is necessary for you, there are some universal principles in dealing with persecutors.

  • Reframe your way of thinking about them. They’re not persecutors, they have a role in the system. They exist for a reason. Do they hold a trauma you couldn’t function if you lived with? Have they learned harming you or others is a way to stay safe?
  • Hold a meeting through whatever communication you can. Send whatever alter they are most likely to get along with. Find out what they need and who they are.
  • If you can’t communicate, examine their behaviors. What coping mechanisms have they been using? What is this communicating?
  • Remember, they’re part of you. Resisting them only hurts the system. Work with them and accept them as they are.
  • Set boundaries. Accepting them doesn’t mean letting them do things that harm the body. If a gatekeeper or other alter needs to step in or a rule needs to be set, do it.
  • Give them a safe space. That could be a hobby, a change in scenery, or personal items. Once they trust you, they will be open to other coping mechanisms.
  • Swallow your pride. It’s really easy to dismiss them as the worst, out to get you, and the problem. Be open to the fact there’s likely more to them that you haven’t seen.

Dealing with the system as a persecutor

  • Have patience. They often have a hard time understanding why you’re doing what you’re doing to keep yourself (and them) safe.
  • Be open to their attempts to communicate. You don’t have to agree with them, just hear them out. And if they disrespect you, you can tell them to f*ck off.
  • Consider your body as shared. While you do have the right to make decisions for yourself, others may be negatively impacted if you don’t consider them. Just like they shouldn’t have the right to alter the body without consulting you, don’t do the same.
  • Know that most of them hold trauma too. They may be acting out of their own trauma responses.
  • Let them know what you want directly. What is it that you’re trying to get? What do you need? How will you get it?
  • Pick an art form. It could be painting, music, writing, knitting, theatre, designing shoes, dancing, etc.
  • Connect with others. Is there a group that would understand you better than your system does? If the system has a therapist, could you be honest about how you feel about the system?

“There is a way out of the suffering. It’s a hard route that requires both the system and the persecutor(s) to face aspects of themselves they may not like and trauma that hurts beyond recognition.

But the other side is so much better. It’s worth the work. And it’s like breathing for the first time in your life. It doesn’t mean it never hurts, but it no longer becomes unbearable because you have the support of a whole system to carry that pain.

I’m sorry you went through what you did. We deserved better.” – Zed (“reformed” persecutor)

Is ABA Therapy a Cult? – Examining ABA Through the BITE Model

Unfortunately, the question doesn’t have a simple yes or no. The BITE model (which I define later) is helpful because few organizations are cleanly “cult” or “non-cult”. The cult-like behavior exists on a continuum, highlighting aspects of unhealthy organizations.

ABA as an organization of leadership, “doctrine”, and widespread behavior shows a startling number of unhealthy, controlling behaviors.

My story of leaving ABA and Mormonism is not universal, but it is also not unique.

I hope that no one walks away from this article saying, “Yes, ABA is a cult!” or “No, it is not a cult.”

This article is intended to highlight areas that ABA needs to change to become an organization that’s healthy for its members and its clients.

My Experience

My supervisor(s) called me into her office. I had recently confronted her about an unethical situation, and we had argued about whether it was handled adequately. I argued that the way my coworkers discussed the kids as manipulative showed a much larger disregard for their humanity than just an isolated incident. She claimed she had handled the situation by posting a written protocol for feeding.

I sat quietly for an hour as she and another supervisor detailed how I was a terrible employee. They critiqued my autistic traits, complaining that I didn’t make eye contact, didn’t understand subtext, was insubordinate, and detailing how my coworkers hated me. My immediate supervisor went off about how I had “so many behavioral issues,” that I didn’t respect him and his wife, and they talked about me at home (yes, he and his wife were BOTH my supervisors) and that I “hadn’t improved my behavior.”

Ten minutes before the confrontation with my other supervisor (the BCBA above him), he praised me for how I had made significant improvements, that he was “seeing me put in the effort to ‘fix’ my behavior” (like making eye contact with him), and that he and his wife felt like I was really listening to them. I hadn’t changed any of my behavior other than staying silent. His judgment was purely perception-based, which is why it changed so quickly.

The only thing that had changed was expressing discomfort with how management handled vulnerable children. I was being punished for autistic advocacy and my superiors’ wounded egos.

The clinical director called me that evening via Zoom. Off-record she cut me a deal. She would excuse the $800 training costs if I left now, and we could “avoid some difficult conversations.” She wanted me to quit, telling me that all I had to do was walk away and “put this unpleasant situation behind us.” I declined, knowing I only had a few weeks left at the job. How bad can 3 weeks be? I thought to myself. I certainly didn’t consider myself a quitter and needed to pay rent.

That led me to the most significant situation, which gave me PTSD from the job. I was able to speak out against the situation, but at the cost of my job and wellbeing. I shook my head that I had declined the silencing deal but glad I stuck around long enough to expose the clinic.

I had left terrible jobs before. I had abusive bosses in the past, terrible working conditions, and soul-sucking dread of going to work. Somehow, leaving ABA was different. I couldn’t put my finger on it until it dawned on me.

It was just like leaving Mormonism.

A Shelf-Breaking Parallel to Leaving Mormonism

I had a similar sense of guilt and secrecy of information that went against “what the leaders said.” Ostracization from my peers for not doing things “the right way.” Others speaking for my experiences. Invasive questioning about my past to be used against me. Getting my needs met ONLY when I did things they wanted me to. The threat of losing material support for leaving. And the constant pressure to stop being autistic.

I even had a “shelf-breaking” moment in ABA. A shelf-breaking moment is referred to in ex-Mormon communities as an analogy for all the slight cognitive dissonances and questions you can’t answer placed on a mental shelf. Eventually, your shelf gets too heavy, and one thing “breaks the shelf,” exposing all the things you had been ignoring. Generally, once someone’s shelf breaks, they leave Mormonism because their entire life is thrown into upheaval.

It’s no surprise that a clinic in the heart of Utah with overwhelmingly Mormon leadership operated like a church. The same power structures enabled toxic in-group behavior and scrutiny of any perceived threats to the hierarchy.

The B.I.T.E. Model

The BITE model is a proposed theory for explaining how cults use control tactics to brainwash people into believing in an ideology and remaining part of a group.

Hassan (2020) proposes four main tactics. Organizations use behavior, information, thought, and emotional control to influence thinking.

He presents the idea on a continuum, from mind control tactics that range from healthy and constructive for the individual to destructive and unhealthy. Mind control tactics that maintain the individual’s free will and sense of self can be helpful (e.g., trying to control those areas to help a person with substance abuse abstain from substances).

Conversely, you have cults and other harmful organizations that utilize these tactics for retaining and gaining influence.

There are three levels that the BITE model examines as well. Traits of control for individuals, leaders, and organizations.

Mormonism tends to fall into the BITE model cleanly (organizationally, not necessarily individually). My experience with the organization is that it seeks homogeneity, is elitist, is deceptive (about history in particular), has an authoritarian structure, and asserts there are no legitimate reasons to leave. While this exists for the organization as a whole, it is especially pervasive in Utah, where the organization has legal control.

While the BITE criteria are too lengthy to list (you can find them here), the more criteria the organization meets, the more destructive and unhealthy it is.

Since ABA is a field, it is tricky to know what counts and whether such a broad structure of many different types of settings, practices, and ideals can be singly defined.

This is why I want to analyze this from the perspective of the ABA organization, which entails the authority groups in the field like the BACB and how they lead the field of ABA as well as widespread behaviors in the field. I will not be counting control behaviors that I experienced personally but will call attention to my experiences to highlight how dogmatic principles appear in application.

Behavior Control

Behavior control is the most obvious control tactic within the field of ABA. Since it is steeped in controlling behavior, it follows that it would exist at a structural level too.

From my experience, these were the criteria that working in ABA met. While this could exist in any hostile working environment, it is worth noting that autistic practitioners in the field have been met with similar experiences.

My ABA clinic made me financially dependent by not paying enough (which is common for RBTs). It also didn’t provide good health insurance, which I need as a disabled autistic person. I was in a terrible catch-22 because I was never making enough to have that amount of money to leave. Turnover for RBTs is common, and a widespread complaint of parents in ABA.

Since ABA is a work environment, the majority of time is spent there. That means the pro-ABA propaganda that circulates significantly influences a particular way of thinking.

Rewards and punishments are used to modify staff behavior. This seems to be almost universal. It’s unfortunately common for ABA clinics to use ABA on their employees. Many view it as good management without considering violating consent and professional boundaries.

Advocacy is often punished, encouraging group-think.

4/22 Pretty alright.

Information Control

The second criterion is how the organization restricts access to dissenting information. The way that autistic people who talk about their ABA experiences are often dismissed as radical, one-offs, or a relic of the past comes to mind.

I would argue that ABA meets the criteria for deception. A major complaint of parents, providers, and survivors is that ABA is not transparent about its outcomes. The ABA industry is not clear about the integrity of its research and hides behind jargon that effectively dismisses critiques of someone that is a novice to the field.

The ABA industry withholds information that disagrees with the field, including research indicating long-term negative effects, diminishing the scientifically dubious emergence of ABA, and rhetoric surrounding recovering from autistic behavior.

It also isn’t upfront about the current harmful practices and uses systems (like credential training) to instill a rosy view of ABA from the beginning.

The BACB does not go after individuals for social media posts, but many individuals in the field weaponize reporting dissent of the field in an attempt to de-credential practitioners. Many current practitioners are afraid to come forward about their experiences as a consequence.

Case-loads are often an issue because BCBAs tend to be overworked, and RBTs are not given adequate training to handle their clients. This creates an environment where practitioners are often too busy to think about what they’re doing or question ways that their practice may be contributing to harm in the field.

Countless sources are promoting ABA, including many official journals, newsletters, and other media. They often misrepresent positions of ABA critiques and requests from autistic people.

3/6 – This is a problem.

Thought Control

The third criterion focuses on how an organization uses rhetoric, values, and rituals to control the thoughts of its members.

ABA requires members to internalize the group’s “doctrine” as truth. It uses previously mentioned information control techniques and threatens credentials for dissenting opinions.

In this same vein, ABA encourages members to view the world phenomenologically from an applied behavioral perspective, confusing many practitioners into saying that non-ABA constructs are ABA innately.

It develops an us vs. them mentality between members and autistic individuals/dissenters of ABA. It recontextualizes ethics, encouraging an “ends justify the means” approach to therapy.

One of the most significant thought control tactics is reducing complex topics into platitudes to stop critical thinking. I’d be hard-pressed to find an ABA practitioner that hasn’t heard at least one of these phrases: “all behavior is communication!”,”quiet hands”,”what’s the ABC?” or “if a dead man can’t do it, it ain’t behavior!”.

ABA as an organization discourages reality checking, using denial of the potential (and documented) harms, rationalization, and justification of current harm.

A major autistic organization facing legal weaponization from the most unethical facility in ABA (JRC) while ABA-International continues to support the facility shows that critical questions about the organization are not looked at fondly.

And anyone with any familiarity with ABA knows of the claims that it is the only and/or most effective autism therapy, shunning other autism therapies with a considerable evidence base.

6/11, not good.

Emotional Control

The last section focuses on how an organization manipulates emotions to create loyalty.

The first criteria that ABA meets are that it often blames individual members for any faults and never holds itself or its leadership accountable. Many times when criticisms are brought up by former members, both leading organizations and current practitioners flood to talk about how those were “isolated incidents”, “individual clinics” or “the rare unethical practice.” I have never seen the head of any ABA organization acknowledge and accept current criticisms of ABA.

They promote feelings of guilt by discouraging members from affiliating with the critical autistic community or negative opinions. Social guilt is often employed to hold the group accountable, pressuring practitioners into feeling they’re doing an immense disservice to their coworkers or organization if they leave. Many practitioners also fear losing their current professional connections if they speak their critiques or decide to leave.

People that leave are often seen as less scientific or swayed by “emotional appeals” and that they couldn’t have reasoned their way out of the organization. This creates pressure that there are no good reasons to leave. Many ABA practitioners mention it’s “such a shame I’m not part of the field anymore.” They see my critiques as more helpful if I were in the field and that by leaving, I have squandered my opportunity to change the field. Part of this stems from other control methods like viewing ABA as the only way.

4/8 yikes.

So, is the ABA organization a cult?

If you are an ABA therapist brave enough to tackle this article, I encourage you to reflect on your experience with leadership and the experiences you hear from others. Why do so many autistic people disagree with ABA? Is there something there that might be worth exploring? Do you recognize any of the behavior described?

If you are not an ABA practitioner, I hope you can see where ABA needs improvements and what change should be pushed for.

I think the end goal for everyone is the utmost ethical treatment of autistic people. Let’s dismantle the unethical structures that currently exist and hold leadership accountable.

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