My proposition is that ABA is inherently unethical.
There are several reasons for taking this position, many of which I voiced recently when reflecting on Danni’s excellent contribution to this series.
At the heart of the problem is how ABA understands the Autistic person, their rights, and their capabilities, and how that understanding is reflected in setting priorities and goals, defining its own remit, selecting methods to use, and measuring outcomes.
This is a problem on a more general level that behaviourism as a whole has had to contend with pretty much from the start. Are there aspects of the human that are unknowable? Can we then ignore their significance? Does evidence that a chosen outcome can be seen mean the process is successful, or that other immediate or future outcomes can be ignored?
Simply put, do the ends justify the means?
Behaviourism has, as an approach to psychology, worked hard on this, taking advantage of insights from cognitive and neuroscience research, and some applications are powerful therapeutic tools. The results have transformed lives, even saved lives.
ABA however, despite trying in some cases to draw in some similar insights, is tied to an ideological lead weight – several actually – that turn what could be “yes, and…” into “yes, but…” acknowledging other perspectives only to undermine them.
Ethical Problem 1: Ignoring Evidence
The biggest lead weight ABA carries is a common one, that Autistic people are inherently disordered and, by implication, need to be fixed. All the components this position relies on have been shown to be gross misreadings, shown to be unconnected to being Autistic, or shown to be symptoms of harm done to mental and physical wellbeing that are common to all humans. There is a large, growing body of research to back this up. ABA practitioners ignore, dismiss, undermine and minimise this research.
This bloody-minded tunnel vision approach might be something we would expect from religious zealots. It certainly has no place in science. It relies not on differences in scientific theory but on blanket dismissal of all evidence that does not fit a single ideological stance. This is not science, and to claim otherwise is unethical.
Ethical Problem 2: Dehumanisation
ABA theory is as extremist application of an already extreme psychological theory, one that says everything between a stimulus and a response is unknowable. Being unknowable, attempts to take account of that ‘black box’ in the middle are deemed futile and therefore should not be attempted. That ‘black box’ however contains everything that makes a human being human – love, fears, aspirations, memories, reasoning… and ethics. By treating humans as nothing more than organic machines that can be tuned to generate ‘products’ called behaviours, every rule of ethics that applies in human society has to be thrown out the window. Treating a whole population like this would be deemed a crime against humanity. Treating a defined community within the population like this would amount to gross discrimination and ruled illegal.
By leveraging common misconceptions about Autistic people, hiding the true nature of ABA behind a wall of pseudoscientific words, and focusing their main efforts on managing the marketing of ABA, practitioners and organisations have reframed rights abuses as therapy. There is no possible way to claim this is ethically acceptable.
Ethical Problem 3: Misrepresentation of data
Science relies on the interaction of multiple approaches to generate ideas, test them, interpret them, modify them, retest, improve, reinterpret, retest… It is an iterative process designed to progressively improve our understanding on a theoretical level and back that up with reproducible evidence. Scientific ethics deal with what is acceptable (including the kind of thing mentioned in Problem 2 above), but also about honesty, diligence and integrity in the process itself. Lots of things fall under this heading, like ensuring experimental methods are not designed with a built-in bias, ensuring conflicts of interest are openly stated, and that resulting data is not falsified or misrepresented.
ABA marketing is focused on the words ‘evidence based’ with the clear implication, and often overt assertion, that behind ABA is a large body of high-quality scientific evidence derived from equally high quality research. Multiple studies have shown that ABA research is almost always inherently biased in method and objectives, published without proper disclosure of conflicts of interest, and that the findings ignore or simply do not have a control group, and present positive results and ignore negative results. ABA research does not look at the wellbeing of its subjects, only at their immediate behaviours. ABA does not look at long term outcomes. To do either, as research by others has shown, would reveal that the alleged benefits of ABA are false, and that it instead causes real harm. None of that is ethical. That the organisations that give ethical signoff are themselves ‘industry insiders’ should be no surprise.
Ethical Problem 4: Regulation and Oversight
While ABA is presented as science, as therapy, as a cure. It says it can make Autistic children “indistinguishable from their peers.” It is not scientific, it is not therapeutic, and it cannot cure anything. It is marketed exactly like any commercial product. ABA is an industry. It is composed of individuals and organisations who are guided by codes of practice that ignore the wellbeing and rights of ‘service recipients’ and focus on media representation, what practitioners can and cannot say publicly… codes of practice that are about generating an image and protecting incomes, not about ensuring ABA does no harm.
Often ABA is carried out by minimally-trained staff who are issued instructions and largely left to get on with it, in care settings, in schools, even in homes. If at any point harm is done, it is the poor low-paid assistant who takes the hit, not their supervisor, not the organisation, not the industry.
Even within the commercial business world, making false product claims and falsifying studies and hiding the damage being done are unethical practices. Regulatory bodies exist to monitor and keep businesses in check. In many instances, wrongdoing results in criminal prosecution, loss of licence, fines. ABA is regulated only by the ABA industry bodies themselves. They can claim anything, do anything, call it anything, justify anything, and face no repercussions. None of that is ethical.
Ethical Problem 5: Blood on Our Hands
ABA has gained a role, not just as a separate industry selling quack remedies for Autistic children, but as part of the training and practice of other professions. ABA methods are taught in degree and diploma courses to therapists, to classroom assistants, to school teachers, to care home staff. The reputation of each individual and each institution and organisation is tied to ABA as a result. The ABA machine relies on others concern for their own reputation, income, professional standing, their reluctance to admit complicity in wrongdoing, and their determination to suppress evidence of wrongdoing in their own minds and in public minds. Nobody wants to admit they were wrong, nor that they did harm, even unknowingly. ABA uses the fear and shame of others to maintain its own status.
Worse, parents of Autistic minors are often encouraged to carry out ABA on their children. No parent wants to admit they were duped, or that they have harmed their child. They are, in fact, the greatest propagandists ABA has. ABA has to be good, because conceding that it does harm means accepting your child has been harmed by your hand, accepting your own distress, and the shame of others finding out.
The threat “you are already implicated, you are already guilty” does not need saying. When doubts arise, that thought arises of its own accord in the minds of individuals, and they act to suppress the thought and the evidence that prompts the thought, for their own interests. The ABA machine can rely on others to be unethical on its behalf. Do I even need to say this is not ethical?
Ethical Problem 6: Scope
Linked to Problem 5 is the issue of scope. One way ABA has ensured its role has been by claiming it is the solution to all ills. Generally, any claim to be a cure-all is the first sign of pseudoscience. It is bizarre that the ABA industry has got away with doing exactly that for decades. The ABA argument is simple – everything humans do is behaviour, therefore behavioural approaches can be applied to everything humans do. There are two huge issues with this. First it ignores the possibility that non-ABA approaches are viable and clears a space to claim or imply that ABA is the only viable approach. The second is the logical skip-hop-jump that ignores that actually not everything is behaviour, not everything needs to be changed, and the biggie – just because something can be classed as behaviour doesn’t mean behavioural methods (never mind extreme radical behaviourist methods) have any role.
Relying on logical dishonesty and the trusting nature of others in order to secure profit is, blatantly, unethical. Yet, this is how ABA claims to be able to address many concerns better dealt with by highly trained specialists using occupational therapy, physical therapy, speech and language therapy, talk therapy, medication or medical treatment, remedial classes… and for that matter loads of ‘problems’ that are not even problems, such as stimming. Not ethical. Dishonest. Harmful.
I could continue this list for another four or five points but it has been a long month. I think the point has been made comprehensively without need to tick every single box. Honestly, ABA really should be banned based on just a fraction of the material we’ve presented here. Half of one blog post on one day should be enough to bring this about. Any one of the ethical issues above should be enough, even without reference to things like the 46% probability ABA will result in long-term PTSD symptoms.
So, why are we still here, in 2021? Why is this still okay? The answer, I think, lies above all in the way society as a whole views Autistics, as inherently a problem, as inherently incapable, and – though nobody (bar Ivar Lovaas, founder of ABA) is willing to openly say they view Autistics as essentially non-human. Subhuman. Animal. Perhaps less than animal.
So, while we plead our case for our inherent humanity, and our basic human rights, look inside yourself and dwell on whether this is something in our society you can live with, what this says about you. Because while we’ve seemed to write about us all month, really what we’ve been doing is laying bare some truths about you and the society you live in. We would like you to help us to change that society to stop our Autistic kin being harmed, but mostly we are asking you to help us because it is the right thing to do. Because it is the ethical thing to do. Because you, our fellow humans, cannot stand by and watch this happen. Because you cannot live with yourself, now you know.
Can you do that?