Content note: This post is about the difference between intense behavior therapy and more typical forms of rewards and punishments used with typically developing children. It contains graphic examples of behavior programs, and is highly likely to be triggering to ABA survivors.
A reader asked:
I just read your thing about people with disabilities and their interests. Don’t people do the same thing to typical children? Restrict access to things enjoyed until act ABC is completed? For example, growing up, I was only allowed to watch tv for 1 hour a day IF I finished all of my homework and schoolwork related things first.
It’s not the same (although it has similar elements and I’m not a huge fan of the extent to which behavior modification techniques are used with typically developing children either.)
Here’s the difference: Most children actually should do their homework, and most children have interests other than television. Typically developing children are allowed to be interested in things, and supported in pursuing interests without them becoming behavior modification tools.
(Another difference: intense behavior modification is used on adults with developmental disabilities in a way that would be considered a human rights violation if done to typically developing adults.)
Using behavior modification tools for one or two things in a child’s life isn’t the same as doing it with everything in someone’s life. Intense behavior therapy is a violation on a level that it’s hard to describe.
Intense behavior therapy of the type I’m talking about typically involves:
- Being surrounded by people who think that you’re broken, that all of your natural behavior is unacceptable, and that you need to be made to look normal in order to have any hope of a decent future
- Having completely harmless things you do pathologized and modified (eg: having hand flapping or discussing your interests described as “a barrier to inclusion”)
- Having those things conflated with things you do that actually *are* a problem. (eg: calling both head banging and hand flapping “sensory seeking behavior” and using the same reinforcers to eliminate both)
- Being forced to stop doing things that are very important to you, by people who think that they are pointless and disgusting or “nonfunctional” (eg: using quotes from TV shows to communicate)
- Being forced to do things that are completely arbitrary, over and over (eg: touching your nose or putting a blue ball in a red box)
- Being forced to do things that are harmful to you, over and over (eg: maintaining eye contact even though it hurts and interferes with your ability to process information)
- Having everything you care about being taken away and used to get compliance with your behavior program (eg: not being permitted to keep any of your toys in your room)
(Behavior therapy often also involves legitimate goals. That doesn’t make the methods acceptable, nor does it make the routine inclusion of illegitimate goals irrelevant.)
Here’s an explicit instruction from a behavior expert on how to figure out which reinforcers to use for autistic children:
Don’t assume that you know what a child with ASD likes. It is important to ask a child, observe a child or perform a preference assessment. When asking a child about reinforcers, remember that multiple reinforcement inventories can be found on the Internet.
You can also simply sit down with a child and ask them questions like “What do you like to do after school?” or “What’s your favorite food?”or “What toys do you like to play with?”
When observing a child, set up a controlled environment to include three distinct areas: food, toys, and sensory. Then allow the child somewhat free access to this environment.
Watch and record the area that the child goes to first. Record the specific items from this area that the child chooses. This item should be considered highly reinforcing to the child.
Continue this process until you have identified three to five items. Remember that simply looking at an item does not make it reinforcing, but actually playing with it or eating it would.
Notice how it doesn’t say anything about ethics, or about what it is and isn’t ok to restrict access to. This is about identifying what a child likes most, so that it can be taken away and used to get them to comply with a therapy program. (Here’s an example of a reinforcement inventory. Notice that some examples of possible reinforcers are: numbers, letters, and being read to).
People who are subjected to this kind of thing learn that it’s not safe to share interests, because they will be used against them. That’s why, if someone has a developmental disability, asking about interests is often an intimate personal question.
This isn’t like being required to do your homework before you’re allowed to watch TV.
It’s more like:
- Not being allowed to go to the weekly meeting of the science club unless you’ve refrained from complaining about the difficulty of your English homework for the past week
Or, even further:
- Not being allowed to join after school clubs because you’re required to have daily after school sessions of behavior therapy during that time
- In those sessions, you’re required to practice making eye contact
- And also required to practice talking about socially expected topics of conversation for people of your age and gender, so that you will fit in and make friends
- You’re not allowed to talk about science or anything else you’re actually interested in
- You earn tokens for complying with the therapy
- If you earn enough tokens, you can occasionally cash them in for a science book
- That’s the only way you ever get access to science books
Or even further:
Being a 15 year old interested in writing and:
- Being in self-contained special ed on the grounds that you’re autistic, your speech is atypical, and you were physically aggressive when you were eleven
- Having “readiness for inclusion” as a justification for your behavior plan
- Having general education English class being used as a reinforcer for your behavior plan
- Not being allowed to go to English class in the afternoon unless you’ve ~met your behavior targets~ in the morning
- Not being allowed to write in the afternoon if you haven’t “earned” the “privilege” of going to class
- eg: if you ask questions too often in the morning, you’re “talking out of turn” and not allowed to go to class or write in the afternoon
- or if you move too much, you’re “having behaviors that interfere with inclusion”, and not allowed to go to class or write
- or if you mention writing during your social skills lesson, you’re “perseverating” and not allowed to go to class or write
Or like: being four years old and not being allowed to have your teddy bear at bedtime unless you’ve earned 50 tokens and not lost them, and:
- The only way to earn tokens is by playing in socially expected ways that are extremely dull to you, like:
- Making pretend food in the play kitchen and offering it to adults with a smile, even though you have zero interest in doing so
- You gain tokens for complying with adult instructions to hug them, touch your nose, or say arbitrary words within three seconds; you lose two for refusing or not doing so fast enough
- You lose tokens for flapping your hands or lining up toys
- You lose tokens for talking about your teddy bear or asking for it when you haven’t “earned” it
- You lose tokens for looking upset or bored
Or, things like being two, and loving books, and:
- Only having access to books during therapy sessions; never being allowed unscripted access to books
- Adults read to you only when you’re complying with therapy instructions
- They only read when you’ve pointed to a picture of a book to request it
- You’re required to sit in a specific position during reading sessions. If you move out of it; the adult stops reading
- If you rock back and forth; they stop reading
- If you stop looking at the page; they stop reading
- If you look at your hand; they stop reading
- Adults interrupt the story to tell you to do arbitrary things like touch a picture or repeat a particular word. If you don’t; they close the book and stop reading.
Here are a few posts that show examples of the kind of thing I’m talking about:
- Would you accept this behavior towards a non-autistic child? (A post by an augmentative and alternative communication specialist about common problems she observes in the way behavior therapists treat children)
- Quiet Hands (an autistic person’s description of an incredibly common violation in ABA therapy, as she has experienced and observed being done to others)
- A post by a JRC survivor with a scan of their treatment plan (the means used to achieve these objectives are somewhat uncommon these days, the target behaviors to be modified are not)
- Teaching Children With Autism To Play (a post by a behavior therapist describing how to make your autistic child play in the ways stereotypically expected by children, and to look typical while they do so)
- Behavior Week: Sensory Behaviors (instructions on how to use positive reinforcement to stop children from doing harmless things like waving their hands in front of their eyes, on the grounds that it “limits opportunities for inclusion”)
- Evidence-based behavioral interventions for repetitive behaviors in autism (an academic paper taking for granted that it is important to stop autistic people from stimming, even though it’s widely agreed among autistic people that stimming serves an important function)
Short version: Intense behavior therapy has some things in common with methods that are used with typically developing kids, but it’s not actually the same. Intense behavior therapy involves violation and a degree of control that is not considered legitimate with typically developing children.