Applied Behavioral Analysis (ABA) Hurts Autistic People

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The New York Times found a lot of problems at a large chain providing Applied Behavioral Analysis (ABA) to autistic children. ABA is a bad autism service that focuses on changing how autistic children behave. The New York Times talked about what they found in a report, which you can read here. The report gives a lot of detail about abuse that happened to many autistic children at the ABA chain.

Autistic children were:

• Kept from sleeping
• Taken out of school to instead be in ABA
• Physically abused by people working there, such as with biting and hitting

The New York Times also found the ABA chain put autistic children in as many hours of ABA as possible. People who used to work at the chain said this was to make as much money as possible.

States spend a lot of Medicaid money on ABA. Medicaid is a healthcare program in the United States. Medicaid helps disabled people get healthcare and disability services. Policymakers are wondering what to do about spending so much on ABA.

We think ABA does not help autistic people. We think ABA hurts autistic people. Policymakers can do these to help autistic people and not spend as much money on Medicaid:

• Cover autism therapies that are not ABA
• Cover**** services that help caregivers get a break from caregiving
• Cover paid caregiving support for people with disabilities

Home-and-community-based services are important for people with disabilities. They allow us to be independent in our communities. And they keep us alive. Instead of spending less on home-and-community-based services, states should spend less on ABA.

Research does not say children who get more ABA in a week do better than children who get less ABA in a week. But ABA places often make children go through up to 40 of ABA in a week. That is the same amount of time as a full-time job. Children spending more time in ABA means more money for ABA places. More and more ABA places are owned by private equity companies. Private equity wants to make as much money as possible.

40 hours a week is a lot of time, especially for children. This takes autistic children out of the classroom. That hurts their education. It keeps autistic adults away from jobs in their community. It keeps autistic people away from the people they love.

There is not a lot of evidence that ABA works at all. In 2020, researchers looked at many different studies of ABA together. They found that a lot of ABA studies were not done well. When researchers only looked at studies that were done well, they did not find that ABA worked.

We need more and better research about ABA and other autism therapies. Research on autism therapy should focus on how it can make autistic people’s lives better.

One thing we know is that ABA can hurt autistic people. ABA focuses on making autistic people look less autistic, even when those traits do not hurt anyone. ABA is used to stop autistic children from playing in autistic way. For example, lining up toys. ABA is used to stop autistic people from stimming. Stimming helps autistic people. ABA does not focus on helping autistic people. ABA tries to get rid of autistic traits with things that hurt autistic people. For example, upsetting sounds and smells, restraint, and taking away things the autistic person owns. Many autistic adults say ABA traumatized them. Studies say going through ABA may make someone more likely to be hospitalized for mental health.

ABA clinics are also sometimes not safe places. The New York Times found that autistic people had been physically abused many times at the ABA chain they looked at. In February, local news in Florida reported alleged abuse at an ABA place. Colorado’s Department of Health and Human Services found dozens of abuse cases in their state in recent years.

ABA must be replaced with other options for services. ASAN does not endorse any particular autism therapy. We believe all autism therapies must be done ethically and for the benefit of the autistic person. There are therapies other than ABA that focus on helping autistic people and don’t take 40 hours a week. For example, occupational therapy, speech therapy, and Floortime. Covering respite services, personal care for people who need it, and other home-and-community-based services is also very important. Unfortunately, many states do not cover these services well enough. This makes families forced to choose between ABA and nothing. That is not okay.

Spending less on Medicaid services for people with disabilities almost always hurts people with disabilities. Covering alternatives to ABA instead of spending billions on ABA would help autistic people. Policymakers should focus on how the therapies they fund impact autistic people.

They should make sure therapies respect autistic people’s consent. They should make sure therapies focus on benefiting autistic people. They should protect access to the services that help live independently. Policymakers should move funding away from therapies that harm people more than they help people.

Formal Language+

Last week, a major investigation by the New York Times found severe issues at a large chain of Applied Behavioral Analysis (ABA) providers. They found autistic children being signed up for as many hours of treatment as possible, which former employees said was to maximize profits. Autistic children were being taken out of school to get more treatment, kept from sleeping, and sometimes even being physically abused while they were there. These problems are not an isolated incident. They reflect worrying problems with the ABA industry as a whole.

Right now states are spending huge amounts of Medicaid money on ABA, and policymakers are wondering what to do about it. We think ABA is ineffective and actively hurts autistic people. Making more alternative autism interventions available, and covering respite services and direct supports for all the autistic people who need them, would both benefit autistic people and reduce medicaid costs. Instead of cutting home-and-community-based services, which are crucial to keeping people with disabilities alive and independent, states should spend less on ABA.

Analysis of many studies shows no evidence that people who get more hours of ABA have better outcomes than people who get less. However, ABA providers are increasingly owned by private equity companies that want to maximize profits. They often bill for up to 40 hours of therapy per week, equivalent to a full time job. This is a huge time commitment. It takes autistic children out of the classroom, hurting their education. It keeps autistic adults away from competitive integrated employment. It keeps autistic people from simply spending time with their loved ones.

In fact, there is little evidence that ABA works at all. In 2020, researchers analyzed many different studies of ABA together. They found that when they controlled for whether studies were biased or used poor-quality design, there was no statistical evidence that ABA was effective. We need more and better research about ABA and other autism therapies. That research should focus on the actual impact of therapy on autistic people’s wellbeing.

One thing we know is that ABA can cause significant harm. It is fundamentally focused on suppressing autistic traits, even when those traits are harmless (like lining up toys) or actively beneficial (like stimming), not on promoting the welfare of the autistic individual. It suppresses those traits by associating them with aversives, like pain, upsetting sounds and smells, restraint, and taking away the person’s possessions. Many autistic adults report being traumatized by ABA, and studies link it to increased risk of mental health hospitalization. ABA clinics are also sometimes unsafe environments. The New York Times investigation found that autistic people had been physically abused on multiple occasions at the clinic chain they investigated. Local news in Florida covered a horrific alleged abuse case there in February. A recent report by Colorado’s Department of Health and Human Services found dozens of abuse cases there in recent years.

ABA must be replaced with other options for services. ASAN does not endorse any particular autism therapy. We believe all autism therapies must be conducted ethically, and for the benefit of the autistic person being treated. However, there are viable alternatives to ABA, such as occupational therapy, speech therapy, and Floortime, that focus more on patient welfare and don’t treat people for ridiculous numbers of hours. Coverage for respite services for families, hands-on personal care for daily activity needs, and other home-and community-based services is also vital. Unfortunately, many states do not adequately cover these services, leaving families stranded or forced to choose between ABA and nothing.

Spending less on Medicaid services for people with disabilities almost always leads to substantial harm. In this case, covering alternatives instead of spending billions on ABA would actually make autistic people better off. Policymakers should focus on how the therapies they fund impact autistic people. They should make sure that autistic people’s consent is respected, and our wellbeing is prioritized. They should protect access to the services that uphold our independence, and shift away from treatments that harm far more than they help.