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!

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.

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.

Autistic ABA Practitioners – The Canary in the Coal Mine

[I]t was a traumatic experience as an RBT and can’t imagine how these kids feel getting the “treatment”. I will never forget my time there and how I was treated. It will stay with me forever.

Nancy Cervara, autistic ex-RBT

This experience reflected my own. I will forever be impacted by how working in Applied Behavioral Analysis (ABA) traumatized me, and I was troubled to hear that I was not alone.

Something that is very rarely explored in the ABA discussion is the clinician’s experience with it. I am unaware of a source that has examined autistic ABA practitioners’ perspectives.

I was pleasantly surprised at the outpouring of support from autistic ABA clinicians and ex-clinicians that wanted to share their perspectives. There has been a valuable voice missing from a nuanced dialogue.

“New ABA” is at the heart of contention, with parents and providers swearing it’s changed so fundamentally that it is now ethical and safe. ABA survivors and autistic people have warned that it is the same therapy with a new coat of paint.

One of the significant problems in this conflict is that most survivors of ABA abuse experienced what has been cleverly categorized as “old ABA.” Often, their experiences are dismissed by parents and ABA providers alike because they didn’t go through this “new ABA.”

One group of autistic adults has an inside look at exactly what the “new ABA” is all about.

Autistic ABA practitioners. One of the most hated groups in all of ABA. They are patronized and subjected to ableist situations daily by their peers and rejected and despised by their own community. And yet, they are one of the most valuable resources in reflecting the current state of ABA.

A common critique of ABA is that there aren’t enough autistic individuals represented in leadership and research.

Why is that?

I obtained interviews from six current or former ABA practitioners that provide valuable insight into barriers autistic people face in the field and changes that need to be made.

Who Was Interviewed?

Current Practicioners5/6
Practiced Discrete Trial Training (DTT)6/6
Practiced Naturalistic Teaching (NET)5/6
Worked in “All” Settings (Clinic, School, Home)3/6
Diagnosed After Working in ABA5/6
Has/Had BCBA Credentials4/6
Interview Demographics

Barriers Placed by Neurotypical ABA Peers

Weaponizing Professionalism

“I told the HR director that that supervisor was in violation of the ADA and that individual’s rights…I pointed out that if the organization claimed to be trauma-informed then they needed to be trauma-informed for both their learner and their employees. The HR director was not happy with me, and later on, before I left, there were attempts to entrap me with write-ups for things that had been resolved months before, which I resolved as soon as they were brought to my attention.” – Brian Middleton, BCBA

“I opened my mouth about how I did not like the things we did. Someone told on me and I was harassed for two weeks and they lied about me leaving kids in dirty diapers and other things. They eventually had forced me to quit and told me that if I ever want to come back to the company, that write up will follow me.” – Nancy Cervera, ex-RBT

“I would like to be quoted anonymously…Too many good people in the field have had their credentials questioned. Sad that I have to fear for my credentials but I do.” – Anonymous BCBA of Divergence and Dissonance

“The director of one of the companies I worked at is the president of our state licensing board and I am concerned I could face repercussions for speaking out against her, as I know other people who already have.” – Anonymous BCBA 1

Anti-Autistic Sentiments

“I was definitely discriminated against for common characteristics of autism-my direct way of speaking, especially-and it was always a situation with an overly sensitive neurotypical person. I was always giving them the benefit of the doubt… but they never did the same for me when it came to how direct I am. They automatically assumed I meant the worst.” – S. Adams, BCBA

“Disclosures about my challenges have most often resulting in people trying to manage me so that my challenges impact them less. Usually in ways that are not only unhelpful, but also make my job harder.” – Anonymous BCBA 1

Woman holding head in hands, looking at computer screen with multiple notebooks. She looks frustrated.

Do you think ABA is a safe environment to work in as an autistic person?

“No, not in the slightest.” – Anonymous BCBA of Divergence and Dissonance

“Yes and no. It depends on whether the people in charge of the organization understand what autistics need or not.” – Brian Middleton, BCBA

“No, definitely not. I am autistic and knew it was terrible the moment I stepped in for my first day. I didn’t know I was autistic then, but realized it after.” – Nancy Cervera, ex-RBT

“No. Based on my experience, its an unequivocal no. I honestly believe that the stress and trauma I have experienced in this industry has contributed to me developing fibromyalgia.” – Anonymous BCBA 1

“As long as the environment is genuinely supportive and provides accommodations, it should be safe. Every clinic is not the same, but I can’t confidently say that most are genuinely safe spaces for autistic voices…If you’re a neurotypical person reading this, you can make ABA a safe place for us to work by first listening to our voices. It’s possible.” – Tee (she/her), RBT

Reactions of the Autistic Community

“I’ve received death threats. I’ve been called racial slurs, and I’ve been called an abuser.” – Tee (she/her), RBT

“I have received a lot of hate. It hurts, but I understand why. I have been told that I am a token. I have been compared to someone who has been through conversion therapy. I have seen the ban lists where my name was next to some other people with whom I completely disagree. I have received hateful messages, including some threats… I have learned that my best course of action is to keep teaching and modeling how to be a humanistic behavior analyst.” – Brian Middleton, BCBA

What Needs to Change?

Woman holding a microphone and talking into it pointed directly at a man

Better Education

“More well-rounded educational requirements for clinicians, higher standards and better training for RBTs, required learning directly from autistic people in some format.” – Anonymous BCBA of Divergence and Dissonance

“First, inclusion on extensive training on autism & neurodiversity awareness, acceptance, and inclusion training in all ABA programs, and a requirement that all BCBAs that serve such populations received that training as well… Second, there needs to be extensive training on how the commonly accepted and used techniques used in behavior analysis can and do cause harm. This includes training and demonstrating how assent-based interventions work in a contrast to compliance training.” – Brian Middleton, BCBA

“I firmly believe that extensive knowledge of childhood development and psychology should be required to work in this field of work. When you understand and acknowledge these subjects, you will understand why specific ABA techniques and expectations are problematic.” – Tee (she/her), RBT

Focus on Self-Advocacy and Autonomy

“[G]reater focus on self advocacy and autonomy and less focus on “problem” behaviours that are generally symptomatic of a problematic environment and unmet needs.” – Anonymous BCBA of Divergence and Dissonance

“The goal should not be compliance; the goal should be cooperation. We should be working to improve the quality of life of the autistic individuals we serve.” – Tee (she/her), RBT

“[T]here needs to be an emphasis on self-management, autonomy, and generalization practices in behavior analysis. There is extensive research in ABA on these topics, yet there is not a lot of it being applied.” – Brian Middleton, BCBA

Better Success Measures

“I also think a way needs to be found to shift away from productivity and worth being measured in hours, an arbitrary social construct that is meaningless to large numbers of ND people.” – Anonymous BCBA 1

“[B]etter social validity measures involving the client rather than just the stakeholders.” Anonymous BCBA of Divergence and Dissonance

It Can’t Change

“I would eradicate ABA completely. The worst type of “therapy” there is.” – Nancy Cervera, ex-RBT

“I’m honestly in a place where I’m not sure if the field can be reformed…” – Anonymous BCBA 1

“[I]t is more than obvious to me that advocating against the oppression of Autistics (mainly children and those with high support needs in various life areas) within the field of ABA is toxic and detrimental to one’s mental and emotional health. ” – NT ex-practitioner*

* NT ex-practitioner wasn’t formally interviewed but I requested to use their quote as I felt it was a good summation of some of the other sentiments expressed here.

Silver Linings

“When I realized that this field of work had caused so much damage and destruction, I had a major meltdown that caused a downward spiral for a few months. I didn’t think there was a way to practice ABA ethically, but there is. It’s not necessary to use intensive interventions; it’s not even essential to use punishments. We can change motivation from extrinsic to intrinsic. It’s hard work, but it’s possible and worth it.” – Tee (she/her), RBT

“I believe that ABA can be a humanistic approach to learning and teaching. I believe that there is a better way. I am committed to making it so that the dominant species of ABA is one where the autonomy and individuality of the individuals served are respected. I fully accept that I will be hated and reviled by people on both sides for my view, and I also hope that there will be meaningful change in this field sooner rather than later. In fact, I am already seeing it. That, more than anything else, tells me that ABA can be and is able to do and be better.” – Brian Middleton, BCBA

“I’ll likely choose to leave the field at some point, but at the moment I try to improve my own work and provide ethical and affirming supports. The work I am taking on allows me a great deal of freedom to do so.” – Anonymous BCBA of Divergence and Dissonance

“I guess I could walk away from all of this by recognizing that the rigidity and ableism in this industry is what exacerbated my struggles to the degree that I was actually able to recognize I had a disability. I was able to cope and mask effectively enough to get by until ABA made it abundantly clear that I was not enough and was not valued.” – Anonymous BCBA 1

Is “Pairing” in ABA The Same As Therapeutic Rapport?

CW: The following article discusses the implementation of ABA interventions. Reader discretion advised.

I was sitting with my non-speaking client, him holding up some blue edible playdough his mom made. I smiled back, and we both snuck a bit to eat, enjoying the salty-sweet-doughy taste.

I had spent weeks just playing with him, developing a relationship. He felt safe and loved because I played with him and gave him my full attention.

A couple weeks after that, I began implementing his programming. Our fun playdough time of making weird shapes and eating the playdough turned into a rigid activity to teach him letters.

I asked him, “touch A!” as I laid out letter stencils. If he chose the correct one, I would press it on the playdough, and we would get to play with it. He enjoyed our game and responded correctly the first few times.

I was inexperienced and didn’t understand autism well enough at the time to understand the following events. He seemed happy, grinning at me and playing with his playdough. I felt pressured to get in as many trials as possible, counting them on my iPad because they proved to my superior that I was a good therapist.

I pushed him repeatedly, rewarding him only when he gave the correct answer, or I grabbed his hand and had him touch the right answer. I followed the prompt hierarchy like I was supposed to.

Suddenly I asked him, “touch O!” and he threw himself onto the ground, banging his head and crying. I was distressed, trying desperately to calm him down. I put safety mats under his head and panicked, telling him it would be okay. Eventually, I learned that if I stopped talking, he was able to self-regulate.

I didn’t understand how our positive relationship had instantly turned into a distressing one. It seemed like the behavior “came out of nowhere.” I didn’t understand the stress he felt when I switched from showing him unconditional positive regard to suddenly making it conditional. He wanted to do what I asked because he cared about me, but I wanted more and more and more.

I was doing a process called “pairing” in ABA. Pairing is the process when a practitioner develops a relationship with a client to become a source of reinforcement themselves. When the therapist is a reinforcer, success in changing behavior in ABA skyrockets.

Often the first few weeks with clients are spent exclusively pairing. From an ABA therapist’s standpoint, the benefits seem like a no-brainer. The kid should want to spend time with you and enjoy your time together. You should learn what they like and don’t.

For survivors of ABA, the motives are more sinister. Pairing has been called manipulative because many therapists then weaponize that relationship to gain compliance.

Both have strong arguments with significant consequences. Therapeutic rapport is well documented as one of the most necessary steps in therapy, but it creates harmful results if it is manipulative.

So, is pairing manipulative or good therapy?

Therapeutic Rapport

Therapeutic rapport has been long established as a necessary part of successful therapy and medicine.

Research on therapeutic rapport suggests that to develop rapport, a therapist or other healthcare provider should use active listening, maintain an open posture, be honest, and alter their behavior so their client can interpret it (pg. 151).

Clinicians must focus on cultural competency with therapeutic rapport and considering their client’s unique circumstances. When there is a discrepancy in power, whether cultural, economic, or social status, there’s an increased need for caution. A therapeutic relationship could quickly become manipulative or harmful if these factors are ignored.

Altering behaviors so clients can interpret them is especially relevant to autism. A therapist’s body language must be able to be interpreted by their autistic client, and consideration taken for whether their body language can be easily decoded. Without this, the therapist could easily convey meanings that are not intended and/or further distress the client.

Eye contact is also something that should not be present in therapeutic rapport for autistic individuals, though this is often recommended. With non-speaking clients, active listening of vocal language may not be possible; though active attention to non-vocal signals is necessary.

So, therapeutic rapport for autistic people is necessary for robust therapy. Is pairing a good way to go about it?

Why do Some People View Pairing As Manipulative?

Love bombing is the process in which the person in the relationship is showered with gifts and positive regard with the goal of emotional dependence. After the person develops feelings for the person they’re with, the gifts and attention are removed and become conditional, creating an inconsistent, stressful environment. This can further lead to abusive situations if the person doing the love bombing isn’t receiving compliance.

“Lieu, this sounds pretty extreme. Weren’t you just talking about therapeutic rapport and its benefits to clients?”

You’re right, it is an extreme comparison. But it is necessary to understand the difference between healthy therapeutic rapport and manipulative rapport that fosters dependence on the therapist.

Pairing gives children unconditional 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 demands, showing interest in whatever they are doing.

After the child is bonded to the therapist, the reinforcers are conditional. The attention is contingent. And the child has to comply with demands to receive this loving support to which they’ve grown attached.

Add to this the power dynamic between an adult in complete control of the child’s access to their preferred items, with the powerlessness of the child to control what is targeted in therapy. The relationship is set up to create ethical issues.

That isn’t to say every relationship with children after pairing will become manipulative. But all it takes is one therapist who doesn’t apply a goal correctly, acting under the wishes of a parent over the child’s interests, or is facing pressure to meet a quota of goals. It becomes clear how this relationship could easily be weaponized.

Practices like “planned ignoring” and “extinction plans” require therapists to withhold their positive regard or access to reinforcement until the child completes the behavior they need to see.

This creates a distressing environment because children are desperate to get back into the therapist’s favor. They want that positive attention and want to feel loved by their therapist. Making that contingent teaches children several problematic lessons like compliance as love, non-compliance as unworthiness, and positive regard being conditional.

“Pairing is Just Therapeutic Rapport!”

Now that we’ve examined therapeutic rapport and pairing, it is necessary to understand why pairing should not be considered therapeutic rapport.

One of the key things that separate it from therapeutic rapport is the intentional removal of reinforcement.

Imagine starting therapy with a cognitive therapist who showed unconditional positive regard, openness, and altered their behavior to help you interpret it. You feel comfortable expressing your vulnerabilities and may even cry, breakdown, or tell them things you’ve never told anyone.

After five sessions of doing this, the therapist suddenly becomes cold and closed to you. They tell you for therapy to work, you have to stop crying when you come into therapy. It’s labeled as a “maladaptive behavior” and targeted for reduction. When you go the whole session without crying, she smiles at you and shows you the same level of attention you received in the beginning. You may feel confused or distressed by this sudden switch in demeanor.

Would you go back to this therapist? What if you didn’t have a choice?

There’s no point in therapeutic rapport in any other therapy type where the aspects of therapeutic rapport are reversed.

Further, suppose this is at a clinic where the therapists receive little to no education on aspects of autism. They may be incapable of modifying their behavior to be interpretable to clients. They may assume that their behavior is perfectly fine and it’s the client that is refusing to make an effort to interpret.

“My Client Loves Being Around Me, I Would Never Harm Them”

It’s a thought I had when I was in ABA. How could I be harming anyone if I was met by smiles, excitement, and unprompted bids for attention?

I certainly had no intention of harming anyone. I was there because I wanted to help, and in my mind, I was! I was taught that a behavior change was a marker of success, so I was clearly succeeding through a tangible measure of progress.

I ignored how “maladaptive behaviors” that clients experienced during my sessions may be an indication that everything wasn’t rosy. I ignored the meltdowns, the non-responsiveness, the times when I pushed too hard or didn’t understand the cause of their behavior. I ignored my contribution to the behaviors that “seemed out of nowhere.” And I saw it happening with other therapists, but no one seemed to see anything wrong.

It’s a scary thought, but you can harm someone without intending to. And if you’ve dedicated years to something to try to help someone, you have a lot of incentive to ignore those adverse outcomes.

If you’ve read this far and are an ABA therapist, I genuinely applaud you. It’s hard to examine your own flaws, and it’s clear you’re trying to do better. Otherwise, you wouldn’t be here.

If you’re looking to do better, look into how to develop therapeutic rapport. Do research on autistic traits and how to make your behavior easier to interpret for an autistic person. And replace pairing with developing evidence-based therapeutic rapport.

Clients deserve transparency in their therapy, including their expectations beyond initial impressions. Don’t set a false expectation of the treatment you’re practicing through pairing.

One Year Traumaversary of My Job at “The Good ABA”

Here is my experience with ABA: https://lifeoflieu.com/2022/01/22/i-was-part-of-the-good-aba/

Working in ABA was genuinely traumatic for me. Every night, I woke up in a sweat, nightmares plaguing me with how I was treated and my powerlessness. When I worked my next job, I had a hard time expressing myself because I was so scared of being hated for being autistic. I didn’t just burn out, I imploded.

To gain sanity with a situation where I was gaslit daily, I started speaking out. I never intended to become an advocate, but I naturally found myself in advocacy when I needed validation that what I was experiencing was as bad as I felt.

It’s incredible that it’s been a year since I left my job in ABA. So much has been accomplished in such little time. I’ve been able to tell my story to over a million people, have received letters from countless practitioners thanking me for helping them understand the problems in their field, and was able to get an autism diagnosis.

But the first-year traumaversary is always the worst. You start getting triggered over the most random things, nightmares rear their ugly head, and emotional flashbacks come in waves. So, to put that energy somewhere productive, I’ve come up with some takeaways from my experience.

While reflecting on this year, here’s a list of 5 things I learned about myself and ABA.

1. Don’t sign a contract that requires you to pay money if you quit.

When you want to work a job badly enough in a field you’re passionate about, it’s easy to overlook the warning signs. Seems obvious, and yet I still did it, so you could too. It indicates high turnover and locks you into the company. It’s the “don’t marry a man you just met” of the professional world.

Because ABA often hires young 18-22 yrs old fresh out of high school, many are inexperienced with the professional world. This leaves them vulnerable to exploitation from their companies and toxic power dynamics with their superiors.

I’d imagine my experience with this is also not uncommon. Companies that do this restrict their practitioners from leaving which leads to bad outcomes for everyone involved.

2. ABA is omnipresent and restricts access to services.

ABA is EVERYWHERE. It has dominated autism therapy. Even other therapies like occupational therapy and speech-language therapy are now using ABA. If you don’t want ABA, you’re out of luck in most places.

ABA shuts down valid critiques by dismissing them as “not understanding ABA” or having some vendetta against the science. It has portrayed itself as the “only cure to autism” to the point that other therapies are no longer available and shuts down the voices of the population it serves. I’m not the only one that believes this. Researchers have remarked that it’s “ideological warfare.”

Callahan et al. (2009) ran a study where they de-identified ABA and TEACCH (a therapy focused on working on the underlying elements of the behavior of autistic people) and showed that when they removed the labels ABA and TEACCH, people rated the treatment by their descriptions as equally effective. This finding was contrary to the “ABA is the only way” advocacy done by ABA professionals and parents. ABA advocates present non-behavioral interventions as not evidence-based, which is just false.

This attitude is pervasive among ABA professionals and parents. I remember ABA presented as a miracle cure for autism. This evidence supported changing problematic behaviors like self-harm and aggression while increasing communication.

It came as a shock to me later that there weren’t investigations into outcomes other than behavioral as far as what was considered successful. ABA was replacing other evidence-based practices and claiming it was the only one. It made all of these claims and yet didn’t educate its practitioners on fundamentals like communication, autism characteristics, and other therapies.

3. Unethical practice isn’t usually committed by “Unethical People.”

“It requires conducive social conditions, rather than monstrous people, to produce heinous deeds.” – Albert Bandura.

To sum up my experience, people that cared deeply about autistic children committed the unethical practices I witnessed. This care doesn’t excuse their actions, but it was astonishing to watch the step between having excellent intentions and doing horrible things. The two are much closer than is comfortable.

So, how does abuse happen? When you believe what you are doing has such profound consequences that you are saving another person, it’s easy to justify any “momentary discomfort.”

Discomfort is inevitable in life. What becomes necessary discomfort vs. unnecessary? It’s easy to see how someone might believe what they are doing is necessary discomfort when comparing it to the usual things we encounter in life. Particularly if that person is neurotypical, they may not fully grasp the physical pain experienced by sensory stimuli that they find as just annoying.

My supervisor wasn’t a monster. She was an overworked, underpaid practitioner who genuinely wanted to help the children she worked for and tried to study contemporary literature/practice. She was in a clinic run by a woman who viewed herself as saving her son with “severe autism” through ABA, which enabled the social conditions for anything to be justified in pursuit of a cure.

And that’s why my supervisor objected to me “calling her actions abuse.” In her mind, it wasn’t abuse. It was “allowing mom a moment of free time,” “keeping the child safe from extreme behaviors like self-harm,” and “teaching him to tolerate the sensory harshness of the real world.”

I want to emphasize that what she did was absolutely abuse. She tortured a kid for 20 mins to make them cry and laughed about his PTSD symptoms exhibited after. But, it’s understandable how she committed that unethical act despite her attempting to be an “ethical person.”

4. The BACB is one of the most ineffective ethical bodies.

The BACB has incredibly loose guidelines around ABA’s ethics, allowing almost anything to count as ethical. Most of the ethics focus on treatment fidelity, not on client dignity. And for them to investigate a case, you must come with documentation. They will not investigate themselves, only look over the evidence you present. It’s why I ended up not reporting.

They are also not overseen by any department. State to state, there are differences in how licenses are involved, but there is no overarching licensing body that is not tied to ABA. Unlike therapists, they are not required to report to a “state ABA licensing board”. And even in states that allow BCBAs to be grandfathered in as licensed practitioners, RBTs are often not.

And that’s not to mention they allow shock devices to be used with autistic people due to this loose ethical code like in the case of Judge Rotenberg Center. Shock devices. In 2022. This isn’t the “ancient” history of doing barbaric things to psych patients. This is modern history and not only legal, but ABA’s main ethical body also approves of it. If that’s considered an acceptable aversive, pretty much anything goes.

Carol Millman puts it well: “Only three subsections in the Behavior Analyst Certification Board’s professional code of ethics even address the wellbeing of the learner…The BACB says nothing about inflicting pain. There’s nothing in the BACB ethics code [that] says you can’t use electric shock. In fact, it doesn’t say anything at all about what type of ‘aversives’ are acceptable.”

I remember first learning about shock devices as a practitioner, and my gut reaction was, “well, our clinic doesn’t do that!”.

To practitioners reading this, listen closely. The problem is more extensive than shock devices (though that should be a red flag). The problem is that the governing ethics body allows the use of shock devices, which means that there’s a lot of unethical conduct that they also allow.

Just because you haven’t had the BACB contacted, or you have, and they deemed your actions ethical, does not mean that you are acting ethically. And that’s a poor standard for an ethics body.

5. Trust your gut.

Okay, this one seems obvious, but it’s easy to lose yourself at a job. Capitalism is a cruel master that conditions you to trust your boss and enforces a strict hierarchy. As an RBT, you are motivated to shut up and listen to your BCBA. This creates a culture of compliance. I’ve seen it now in other clinics and the one I worked at where BCBAs will try to use ABA on the RBTs they supervise. This is wildly inappropriate and not within their scope of practice. Not to mention is a massive break in consent.

Something deep inside you lets you know whether what you’re doing is moral. We’re all biased towards believing we are moral (and often ignore signs that we’re not), but if you’re questioning whether a decision you made is ethical, it’s a sign to take a step back and assess the situation. Get opinions outside your field, especially from the clientele you serve. Reach out to ethics hotlines and ask the internet. Find information from unbiased sources. And listen to your gut. If something feels off, it probably is.


I’m so grateful to be out. I’ve learned a lot from my experience, and I hope this can shed light on others’ situations so they don’t have to learn the lesson I did the hard way.

It’s funny how the most traumatizing experiences can fundamentally shape your life. I can thank my old clinic for that. It showed me I was autistic by ruthlessly punishing autistic expression and gave me a direction for the therapy career I’m pursuing. So thanks, I guess.

The Self-Harm Bogeyman in ABA

CW: The following article may be triggering to people that struggle with self-harm and contain descriptions that may not be appropriate for everyone.

“ABA has helped this autistic child so much. They’ve stopped self-harming!”

The phrase is beaten like a drum by pro-ABA advocates. It’s an anthem that proclaims, “ABA isn’t bad because it stops harm!” The problem is it doesn’t address what lengths ABA is going to stop that harm. And does harm need to be stopped behaviorally in the first place?

Autistic people are three times more likely to self-harm in both children and adults than the general population. An estimated 42% of autistic people engage in self-injury. It’s clearly behavior that requires attention.

I think most neurotypicals (in the broad sense, not mentally ill) view self-harm as an irredeemable behavior that needs to be stopped at all costs. It’s a visual representation of how abnormal someone is acting. It’s unfathomable; why on Earth would you ever want to hurt yourself? Isn’t that against the integral drive of self-preservation?

Let me be clear, I do not advocate for self-harm, nor do I think that it’s bad to stop it. Certain self-harm behaviors pose a threat to safety and long-term well-being. Some people struggle with head-banging so severe they cause concussions or worse. There are interventions that help with this that are more humane than ABA, but I will get into that in a minute.

In my own experience, I have self-harmed both for sensory seeking reasons and for “mental health” reasons. There are many reasons people self-harm, and most people don’t really think about why someone might use it as a coping mechanism.

For me, my self-harm during meltdowns comes in the form of hitting my head or hitting my head against things. I’m old enough now to regulate my environment, so I can choose soft things to headbang against. I also used to self-harm as a teenager during acute panic attacks. So, why would I self-harm?

It Starts with Understanding What a Meltdown is Like

Think of the most unpleasant busy place you go. Maybe it’s a post office full of people. Maybe it’s the department store the weekend before Christmas. Or maybe it’s a kid’s party where every child is screaming and running around. Now imagine your least favorite song. It can be anything, just that song that when you hear it, you feel angry. Maybe it’s Baby Shark or Let it Go for the 100th time. Got it? Now imagine you’re hungry and tired on top of all of that.

So, putting that all together, you’re at another child’s birthday party, and someone just brought out the cake, and so everyone is screaming. In the background, Cocomelon is blasting at an unholy volume. You skipped breakfast because you were running late trying to take your kid to this f*$&!^@ party, and you worked late, so you got 6 hrs of sleep. Spend a moment here. Hear the screaming, feel the full-body ache of hunger and tiredness, feel the bristling of hearing that song.

It’s horrible, isn’t it? Makes you want to “bang your head against the wall”? That’s it. Now you understand why an autistic child in similar circumstances may actually bang their head against the wall.

For me, it feels like a million sirens are going off in my head all at once, which is physically painful. All I want to do is stop the noise. What stops the noise? Hitting my head. That hard sensation quiets things, even if only for a moment.

Other forms of self-harm do the same thing. They create a sensation so extreme that it can take away the pain for a minute. Like the tongue-in-cheek adage of “Your finger hurts? I’ll hit your leg with a hammer and I promise your finger won’t hurt anymore.”

I’ve also heard from others that sometimes they physically can’t feel the self-harm during a meltdown. If everything is cranked up to a 10, what normally would register as a 10 with banging your head isn’t going to register.

And then there’s the aspect of anxiety. Going back to the kid-birthday-party-hell scenario created earlier, imagine how you would feel. It’s such an overwhelming situation you’d likely feel incredibly anxious. Particularly if you were a child and couldn’t control the situation or remove yourself when the anxiety started to build. Or, maybe you don’t know what “anxiety” feels like, so you’re not sure why you suddenly feel bad all at once and don’t know what to do with it. On top of that, adults around you are freaking out and telling you to stop and wanting you to fulfill all sorts of demands.

What do you do with that anxiety when you don’t know how to cope with it? I’m sure you’re starting to see how self-harm might make sense to cope with anxiety. The body doesn’t process how harm is caused differently when you’re the one causing the harm. It just registers it as harm. And what happens when harm is caused? Endorphins are released.

Self-Harm and Self-regulation

One study examined people’s endorphin levels before and after self-harming (Störkel et al., 2021). They found that people before self-harm had significantly lower endorphin levels. Endorphins after self-harming weren’t significantly higher than daily life. This suggests that self-harm may be an attempt to get back to homeostasis, the baseline endorphin level that we experience daily.

Another interesting finding was that the severity of the injury was tied to the level of endorphins released, which has implications for more severe levels of self-harm in autistic people.

Self-harm serves a purpose. So, when ABA “trains” self-harm behaviors out of a person, it doesn’t address the purpose. There is no physiological intervention done. There is no cognitive intervention done. It only removes the behavior. So, where does that anxiety or sensory overload go?

The truth is, we don’t know. It’s not something that ABA research has studied. ABA research has been so focused on behavioral outcomes that we don’t know the effect of ABA on anxiety. We know that CBT (cognitive behavioral therapy) and ACT (acceptance and commitment therapy) effectively reduce anxiety in autism. But these differ from ABA in that they are cognitively based.

We have no evidence to support that the anxiety and sensory overload experienced during meltdowns goes away when self-harm is trained out of someone. What kind of harm is caused if we’re not teaching cognitive coping skills to deal with these feelings?

This is the last time I’ll bring you back to the kids-birthday-party scenario, but bear with me. Imagine that state of overwhelm happens frequently, and you don’t have any means of coping with it other than self-harm.

Then, imagine someone comes along and takes away your phone until you stop self-harming. You learn over time that you can get your phone back if you don’t self-harm (or not get it taken in the first place), so you learn not to self-harm. Does having your phone stop you from feeling overwhelmed at the party?

No, having your phone doesn’t stop anything from happening around you. It just gives you access to something that you are really reinforced by. But it was successful because you stopped self-harming, right?

Outside the Scope of ABA

Woman with glasses and a labcoat looking through a microscope with a large plant and test tubes next to her.

Many clinics don’t train staff at all to deal with sensory meltdowns. As an RBT (registered behavior technician), I asked my BCBA (board-certified behavior analyst) to train us on sensory meltdowns. I noticed staff were often making meltdowns worse. She said, “no, that’s outside our scope.”

If a fundamental symptom of autism is outside the scope of an ABA therapist, and kids are spending 20-50 hrs a week with these therapists, how do we expect them to handle meltdowns? Many behaviorists believe that ABA can fix meltdowns through behavioral mechanisms. I saw this with my coworkers.

We were trained to assume the meltdown was caused by the function of access, escape, or attention.

When they thought it was access, they wouldn’t give the child access to regulating items (stim toys, etc.) until the child performed another task so it “wasn’t contingent on the self-harm.” When it was escape, they’d force the child to do whatever task they were doing before the self-harm, so “we didn’t reinforce them to self-harm.” And when it was attention, they would take the kid to a padded room and then ignore them until they stopped.

I watched the staff do this, and the kids get increasingly agitated, if not immediately meltdown. They would often start with smaller behaviors like crying, which escalated to self-harm when they weren’t given the tools to regulate. The staff was causing meltdowns by not knowing how to handle them.

The level of education ABA therapists have (or don’t) causes real-life consequences. Since I have personal experience dealing with meltdowns, I knew how to help the kids cope.

One kid was violently self-harming and aggressing against others. I dimmed all the lights, helped him get to a safe space and started giving him sensory items I knew he liked. This was the opposite of how I was “supposed” to help him because I was reinforcing his self-harm by giving him coping items. All the other staff was panicking, trying to figure out what to do, and there were about seven adults in the room trying to calm this one kid.

I showed him a sand video and he calmed down almost instantly. I reversed the meltdown because I showed him how to sensory cope. Because we had a good relationship, he wasn’t agitated by me being close to him like some other staff. He stopped self-harming and stopped being aggressive towards others.

Alternative ways of coping

There are ways to deal with self-harm that are humane. And not every self-harm behavior needs to have an intervention. I don’t stop myself from self-harming anymore unless there’s a real risk of harm. I’ve learned sensory coping. I taught myself ways to “harm” that won’t leave lasting marks, like headbanging on soft items, holding ice cubes, flicking myself with a hair tie, or hitting myself in ways that won’t bruise.

Occupational therapy, non-ABA TEACCH, art therapies, and cognitive therapies (like TF-CBT, ACT, and DBT) are all options for reducing harm ethically. These are humane, opposed to ABA because they help address the cause of the behavior. An OT might help you find a space at the party that’s quiet. A non-ABA TEACCH interventionist may teach your family how to help you regulate in the overwhelming environment. An art therapist may have you draw, listen to music, or create something to help you regulate your feelings. And a cognitive therapist may teach you the mental techniques you can use to help bring you back to a state of homeostasis without self-harm.

So, when you hear, “this child is so much better off because ABA fixed their self-harm behavior!” you should be asking, “what skills did they learn to regulate the cause of the behavior?”. For self-harm to be truly addressed, we cannot solve it through further harm.

I Was Part of the “Good ABA”

I became an RBT because I saw a real opportunity to help people.

A coworker mentioned that she had been looking into the voices of the autistic community. She said that there was a big push away from ABA. In training, they presented all the research that supports how much better autistic lives are because of ABA; reduced self-harm, aggression, greater adaptive functioning, and less family stress. With that kind of evidence, who could possibly be against ABA?

Our clinic was a part of the new “good ABA.” It checked off all the boxes of what to look for in ABA clinics; “child-led,” “natural environment teaching,” “reinforcement, not punishment focused,” “communication driven,” and “not discrete trial training (DTT).” I was part of a force for good, part of the cutting edge of the field where ABA was seeing true reform.

Content Warning: this article contains descriptions of abusive therapy. Reader discretion advised.

It still haunts me hearing that electronic voice say “granola bar.”

The longer I worked there, the more I started seeing the red flags that weren’t visible when I initially wore those rose-colored glasses. It started with one of my favorite students, a nonspeaking child who was incredibly intelligent and very funny.

I could tell that he was bored with his programming. 90% of it was maintenance. He already knew how to perform the desired behaviors. They were still there because the BCBA and others couldn’t reliably get him to produce the behaviors.

We were encouraged to run DTT-style trials with him, where he would get frustrated easily to the point of self-harming. He was doing this with every tech three times a day, 40 hrs a week.

I started seeing other coworkers gossip about him, discussing how he was “manipulative” because he would seek reinforcement without performing “desired behaviors he knew how to do.” I couldn’t help but laugh at the idea of a 7-yr-old being “manipulative” of adults around them.

That kind of thinking was what led to my first instance of seeing something so morally abhorrent that it was impossible not to speak up. I shadowed another RBT and watched the student request food on his AAC device. Previously, the supervisor had set up an eating schedule for the kids to eat their lunches during the school day, and he was out because of training.

The RBT gently told him no, that he would have to wait for lunch, and he went and played. He continued returning to his AAC, asking for food, and the RBT continued to deny him. I watched this slowly escalate over 30 minutes until I saw the student start breaking down crying. He brought her to his snacks and pointed at them, and the RBT continued to say no.

I urged her to let him, but she brushed me off, saying that it would be “reinforcing maladaptive behaviors.” He went to other staff and brought them to his snacks, and everyone ignored him because he was exhibiting “attention-seeking” behavior. He manded over and over again, and it still haunts me hearing that electronic voice from his AAC device say “granola bar.”

I had enough and sat him at the table and gave him food. He continued to cry softly as he ate his snacks, so emotionally overwhelmed he couldn’t stop. I told my supervisor about the incident, and she wrote up a “training protocol” that was posted on the door of how lunchtimes were flexible.

I asked if she was planning on telling his parents, and she said, “What is there to tell? A kid having a problem behavior for food? That’s nothing new. We don’t report that kind of thing in our clinic, and if we did, there’d be way too many things to write reports on!”

 “It’s like he had PTSD or something!”

That’s not where it stopped. Shortly after, another supervisor bragged in a staff meeting about their research on the IISCA and a functional analysis they ran on a nonspeaking child.

The child had a history of self-harm and aggression, so they were trying to target the behavior so they could “turn it on and off at will.” They first gave the child homework and a bunch of puzzles all mixed together, so there was no solution.

In response, he didn’t have a “maladaptive behavior,” so they were forced to escalate. They started yelling at each other from across the room (knowing this kid had extreme hypersensitivity to noise) and banging items around the room. They brought in a speaker to blast music that the kid hated. The music was so loud it could be heard in other rooms.

He continued to self-regulate and didn’t have a maladaptive behavior. They started forcing him to watch clips of TV shows he hated and did all of these aversives combined, trying desperately to produce a behavior.

Finally, what broke him after 20 mins of what I can only describe as torture, they let him get up as if to let him leave and then forced him to sit down when he had reached the door. The kid started crying, and they considered the functional analysis a success.

I was horrified as my supervisor enthusiastically told me how much better he was making this child’s life. All I could feel was the deepest pit in my stomach, knowing how horrible my own sensory problems were and imagining that on a child who could not stop it.

In a staff meeting, the BCBA joked that “it’s like he has PTSD or something” when discussing him avoiding the room they were in, both supervisors and the RBT who were present at the time. She discussed how frantically he would act when she would even start to blast music to “turn on the behavior” and how quickly he would scream “my way, my way, my way!”

She said all of this laughing and boasting about it, and I looked around and saw my coworkers laughing with her. They didn’t understand how cruel it was. They had no training on dealing with sensory regulation in autistic children.

Every clinic considers itself to be the “good ABA.”

This clinic considered itself part of the “good ABA” and still does. I had no idea how to report it and was traumatized by my experience. I had heard about how stringent the BACB was with documenting events to take a case seriously.

At the end of this, I didn’t have enough documentation to feel like they would genuinely do much, especially hearing their inaction at even more significant ethical violations like JRC’s use of GED shock devices. I could already envision the slap on the wrist or, worse, complete dismissal “proving” my supervisor in the right.

I went public with the information, knowing I would be terminated.

Statistically and anecdotally, not every clinic can be the “good ABA.” It’s so easy to lose sight of what’s happening when you’re hearing things described in more appealing language. When valid criticisms are raised, ABA therapy has historically been morally disengaged.

I urge practitioners to watch the reaction of refusing to acknowledge harm when presented by autistic people, by coworkers, by supervisees, and by that feeling in the gut that something isn’t quite right.

It’s time the field listened to autistic people, especially when it’s difficult.

%d bloggers like this: