As autism diagnoses soar -- 1 in 36 U.S. children is now considered autistic -- providing therapy is a booming business, writes Beth Hawkins on The 74. Most children go to an ABA ( applied behavioral analysis) therapist. But some researchers, therapists and autistic adults say ABA is ineffective and sometimes harmful.
"Proponents of other approaches and some educators — as well as the U.S. Education Department — have expressed frustration over the depth with which ABA has become ingrained, to the exclusion of other therapies and the potential detriment of potentially hundreds of thousands of children," she writes. The evidence base for ABA is thin, concludes the Project AIM meta-analysis. But ABA is covered by insurance while parents have to work very hard to get coverage for other approaches.
ABA is behavior modification. Therapists try to get students to stop behaviors such as head banging or hand flapping, using positive or negative feedback. They may reward children for making eye contact or speaking.
Changing behaviors "does nothing to address the underlying causes or teach coping skills, and comes at a tremendous psychological cost," say many autistic adults who've been through the therapy. ABA may overstimulate "the portion of autistic children’s brains that is primarily responsible for anxiety," then deny them the means to cope with anxiety by "stimming," movements such as hand flapping and rocking.
Trying to appear "normal," called "masking " or "camouflaging" by autistic adults, is exhausting. ("On the spectrum" is out. The term of choice is "autist.")
Many parents strongly support ABA, and say it enabled their children to stop dangerous behaviors, reports Hawkins. "Last summer, a group of Indiana parents staged a protest after being alerted by their kids’ therapy centers that the state wanted to cut reimbursement rates." They carried signs: "ABA is the Way."
Amelia Hill writes in The Guardian about other therapies and treatments.