History

The history of civilization is a continuous story of the abuse of power. Throughout the ages,
powerful people have used the reinforcers and punishers at their disposal to control the behavior
of people who had fewer reinforcers and punishers to deliver or the means to deliver them
contingent on selected target behaviors. The effect of this tradition has been to increase the
reinforcements occurring to the more powerful at the expense of those occurring to the less
powerful.
Because of this cultural history and because of people’s personal experiences with others who
have abused their power, people have learned to react negatively to overt attempts to manage
behavior. It should not be surprising, therefore, that in its early years, the term behavior
modification evoked many negative reactions ranging from suspicion to outright hostility.
These early reactions were exacerbated by the tendency to mistakenly equate behavior
modification with such invasive procedures as electroconvulsive shock therapy, brainwashing,
and even torture. For example, a survey of the New York Times indicated that over a 5-year
period in the 1970s, the term behavior modification was used incorrectly approximately 50% of
the time (Turkat & Feuerstein, 1978). Today, as reports in newspapers, television, and movies
illustrate, the general public is more aware that behavior modification—including behavior
therapy, cognitive behavior therapy, and applied behavior analysis
Various groups and organizations have addressed the ethical issues involved in the application of
behavior modification. Three highly reputable organizations that have done so are the
Association for the Advancement of Behavior Therapy (AABT), now called the Association for
Behavioral and Cognitive Therapies (ABCT); the American Psychological Association (APA);
and the Association for Behavior Analysis (ABA), now called the Association for Behavior
Analysis International (ABAI)
The use of ABA in persons with autism was popularized by Ivar Lovaas, Ph.D. at the University
of California Los Angeles (UCLA) where the use of sterile clinic rooms, robotic repetition of
learning trials, and highly artificial delivery of awards and punishments were reported. 
Increasing social skills and decreasing repetitive behavior were among the goals of the UCLA
Young Autism Project. Lovaas applied the principles of behavior in the treatment of individuals
with autism.  However, the interventions he used have been criticized for their harshness and
some goals to “normalize” or reduce “autism-like” behaviors have been criticized as
inappropriate.
Who determines what behaviors are socially significant, if the interventions applied are
acceptable, and what degree of behavior change is meaningful?  In other words, who determines
social validity (Wolf, 1978)?  The issue of social validity is at the heart of the controversy over
the use of ABA in the treatment of individuals with autism.  Society, including clients,
caregivers, and other consumers, determines the social validity of behaviors targeted for
intervention, procedures used, and outcomes obtained. Behavior analysts merely serve as the
vehicle.
Social validity is subjective and society’s perceptions are constantly evolving.  While Lovaas’
initial research was initially received as groundbreaking, “normalization” of children with autism
and the use of aversive procedures are now viewed by many as unacceptable.
Wolf (1978) predicted that by placing importance on social validity, behavior analysts “will
bring the consumer, that is society, into our science, soften our image, and make more sure our
pursuit of social relevance” (p.207).  It seems as though many behavior analysts have forgotten
the importance of social validity.  Rather than listening to criticisms of ABA with curiosity and
compassion, behavior analysts have publicly gone on the defensive and simply explained why
and how critics’ perceptions of applied behavior analysis are wrong.  In doing so, we are missing
the point.  If applications of behavioral principles are not aimed at improving behaviors that
clients, caregivers, and consumers view as socially significant or do not improve behaviors in
ways which are meaningful, by definition, applied behavior analysis is not being practiced.
INTRO:
I propose we view the controversy surrounding the use of ABA in the treatment of individuals
with autism as progress.  Controversy can serve as a catalyst for change.  Baer, Wolf, and Risley
(1968) hypothesized that the dissemination of the applications of behavior analysis “may well
lead to the widespread examination of these applications, their refinement, and eventually their
replacement by better applications.  Better applications, it is hoped, will lead to a better state of
society” (p. 91).  We have an opportunity and responsibility to respond to our clients, their
caregivers, and consumers and advance our field in a way that embraces the changing views that
celebrate diversity and individual differences.  We can hope that these advancements “lead to a
better state of society”, but only society can make that determination.
1. Aversive Strategies
We stress that ABA is a science and like many sciences in the world, it has evolved over time
according to current research findings. We now note that the use of aversive strategies is no
longer effective in teaching desired behaviours. It is interesting to note as well that in the original
Lovaas
research, a commitment to reduce the use of aversive was made reflecting an early understanding
that it is not effective as a teaching method. To add to the above, current regulatory frameworks
that controls and/or prohibits the use of aversive strategies. These include both legal regulatory
frameworks as well as code of ethics by professional credentialing bodies. Despite the field of
autism being a young field in Malaysia, we at EAP believe in ethical and responsible practice. It
is our policy that we do not practice aversive strategies as part of our programme. It is
additionally our policy as well that we do not condone aversive practices. As such, where we do
observe these practice we will take the necessary measures to advice and equip on effective
strategies. In extreme circumstance of continued use of aversive strategies, the decision to
terminate services will be considered.
The aversive training components of the therapy also drew criticism. Many found the idea of
punishing children for ‘bad’ behavior such as hand-flapping and vocal outbursts hard to stomach.

Robotic, Rigid and Poor Generalization

Another common criticism of ABA is that it results in robotic and rigid ways of behaving. One
of the founding basis of this criticism is the association that many parties have made between the
practice of ABA and operant conditioning of training animals (i.e. Pavlov experiment). We note
as well that the use of the commonly misinterpreted table top teaching principle; Discrete Trial
Teaching (DTT) can further compound this belief that ABA results in robotic and rigid learning
and behaving. The above however is a poor representation of the practice of ABA. Whilst
operant conditioning is a component of the practice of ABA it is not the entirety of it. Whist the
DTT is a component of the practice of ABA, again it is not the entirety of it. It is important as
well to note that the application of both the principles of operant conditioning and DTT as well
would differ depending on the individual child. In other words, these are principles that are then
individualized in its implementation depending on the child. A comprehensive ABA programme
will reflect incorporation of natural learning opportunities away from the table and structured
learning environments. A comprehensive ABA programme will also include a generalization
mastery. BACB guidelines note that a comprehensive ABA programme should include steps for
generalization (fluid practice of skills). Confusion however may stem if one were to observe
poor quality ABA sessions. Confusion may also stem if one were to observe sessions where the
individual has not completed the necessary steps for a particular skill to be considered mastered.
Other aspects of the practice of ABA to overcome robotic, rigid learning
and poor generalization is family participation. This is something that is highly encouraged so
that families learn the same strategies and apply these in other environments as well to support
generalization of skills. Here at EAP, we pride ourselves in providing high quality individualized
ABA programmes. To ensure that we do not shape robotic, rigid learning and hinder the
generalization process, generalization mastery is part of our curriculum. We note as well that
generalization mastery is part of each programme that is introduced for our children.
3. Intensive Hours
You would come across criticism that ABA treatment can be very intensive. It requires high
commitment of hours. We stress that this is not a criteria of the ABA practice but rather
reflective of research findings on supporting individuals with learning/ special needs. The need
of intensive hours is beneficial for all individuals with learning/ special needs irrespective of
diagnosis as well as irrespective of treatment approach.
Here at EAP, we pride ourselves in ensuring our clinical practice is up to date with current
research findings. Our recommendation for intensive hours is in keeping with clinical
recommendations put forth by many institutions including National Institute of Mental Health,
CDC as well as supported by various policies across countries/ governments. The rational for
intensive hours is to provide the child with the best opportunity to catch up on skills to the best
of their individual ability.
4. Reliance on External Rewards
There is criticism on the use of external rewards in the practice of ABA. The question of will the
child still engage in desired behavior in absence external rewards is frequently posed. There is
also the contention that we are bribing or forcing the child to learn. We maintain that rewards
play a pivotal role in shaping desired behaviors. We maintain as well that research shows that we
learn behaviors/skills through the gradual shaping of successful practices.
Sessions are conducted on a 1:1 basis, which hinders socialization              
Another criticism of ABA is that it is conducted on a 1:1 basis which hinders the individual’s
socialization. A common question that would be asked is why do we not do group learning? We
note that individuals on the autism spectrum have delays in certain skill sets. We also know that
individuals with autism may not learn at a rate that is at par with typically developing
individuals. As such, where a typically developing child may be able to observe and pick up
from their environment, a child on the autism spectrum may not be able to do so. Teaching in a
1:1 setting thus provides for a successful learning environment. This however is not the end goal
and a comprehensive ABA programme will include a systematic transition plan to transition
from 1:1 setting to small groups then bigger groups. The concern of 1:1 sessions hindering
socialization is also not reflective of a comprehensive ABA programme. We note that 1:1
sessions here refer to 1:1 support which can take place in a variety of settings including learning
time at the tables and during peer play sessions. As such, we can continue to target socialization
however with provision of 1:1 support. We argue as well that this level of support is necessary
for an individual with autism who may be less inclined to interact with others. Having 1:1
support provided ensures that these individuals are not left on the fringes in a group but is
prompted and guided to interact with others. This makes for a successful experience for the
individual with autism.
6. Too Expensive
One last common criticism of ABA is that it can be costly. Due to this, there may be some
families who may opt for treatment that is less frequent and thus more cost effective. One reason
for the high cost of an ABA programme is that it is conducted typically on a one-to-one basis. It
is noted through research that this allows for more intensive and focused teaching providing the
child with the best opportunity to catch up on their skills. In many countries like the United
States and United Kingdom, it is noted that where children with autism had the opportunity to
receive ABA treatment from an early age, this significantly reduced the cost of services they
require across their lifetime. The question that we put forth is this. Should we: Spend more on a
treatment proven to be effective but for a short timeframe? OR Spend less on non-intensive
treatment and/or multiple treatment but for a longer timeframe? We must also take into
consideration that the longer we wait, the bigger the skill gap becomes. Time is always of
essence for children with autism. Time in addition to finances is a resource that must be used
wisely when supporting individuals with autism. It is because ABA has been proven to be
effective that many governments and insurance companies in the United States and United
Kingdom provide coverage for it. It is because the benefits of ABA supersedes the cost of not
providing effective treatment to individuals with autism.

Conclusion
Today, Lovaas is viewed with the same kind of respectful ambivalence afforded Sigmund Freud.
He’s credited with shifting the paradigm from hopeless to treatable. “Lovaas, may he rest in
peace, was really on the forefront; 30 years ago, he said we can treat kids with autism and make
a difference,” says Susan Levy, a member of the Center for Autism Research at the Children’s
Hospital of Philadelphia. Without his passion, says Levy, many generations of children with
autism might have been institutionalized. “He has to get credit for going out on a limb and saying
we can make a DIFFERENCE
Ne’eman and others also reject what they say was Lovaas’ underlying goal: to make children
with autism ‘normal.’ Ne’eman says that agenda is still alive and well among ABA therapists,
often encouraged by parents who want their children to fit into society. But, “those aren’t
necessarily consistent with the goals people have for themselves,” he says.
The core problem with ABA is that “the focus is placed on changing behaviors to make an
autistic child appear non-autistic, instead of trying to figure out why an individual is exhibiting a
certain behavior,” says Reid, a young man with autism who had the therapy between ages 2 and
age 5. The therapy was effective for Reid. In fact, it worked so well that he was mainstreamed
into kindergarten without being told he had once had the diagnosis. But he was bullied and
picked on in school, and always felt different from the other children for reasons he didn’t
understand, until he learned in his early teens about his diagnosis. He had been taught to be
ashamed of his repetitive behaviors by his therapists, and later by his parents, who he assumes
just followed the experts’ advice. He never realized these were signs of his autism.

Reid says he worries ABA forces children with autism to hide their true nature in order to fit in.
“It’s taken me a long time to not be ashamed of being autistic, and that only came because I got
the chance to learn from other autistic people to be proud of who I am,” he SAY’S

One source of criticism stems from the fact that the earliest form of applied behavior
analysis developed for autistic children by Dr. O. Ivaar Lovaas in the 1960s, called Discrete Trial
Training (DTT), was not wholly based on positive reinforcement for desired behaviors.
“Dr. Lovaas used principles of both positive reinforcement and punishment to reduce self-
injurious behaviors in residential settings, treating severely impaired persons,” explains Dr.
Susan Epstein, a clinical neuropsychologist. Use of aversive reinforcement methods, which
included electric shocks, are not considered acceptable today.
Too tough on kids?

While use of aversive reinforcement is generally gone, there is still a complaint that ABA
therapy, which can involve a lot of repetition, is tough on the children, and the skills they learn
don’t necessarily generalize to other situations.

The stereotype is that the therapists are demanding taskmasters. But Dr. Catherine Lord, director
of the Center for Autism and the Developing Brain at Weill Cornell Medical College & New
York Presbyterian Hospital, notes that most therapists doing traditional ABA are trained to be
super-animated and fun. “If anything,” she says, “they’re over the top. Sometimes you do see
someone who is just humorless. But that’s just bad teaching, not ABA.”

Answers to criticism :

And most ABA therapists and programs now don’t use the DTT format, where the child sits at
the table, but are play-based. Sara Germansky, a board certified behavior analyst or BCBA —
the highest certification given to those who are trained by the ABA professional organization —
gives this example:

“I might set up something where we’re playing with cars, and if I’m working on colors with a
kid I might have two cars in front of me — one that’s red and one that’s yellow. And he’ll say,
‘Can I have a car?’ And I’ll say ‘Oh, do you want the red car or the yellow car?’ And then he’ll
have to expand his language by saying ‘I want the red car.’ And then I’ll say, ‘Which one’s red?’
And he’ll have to identify the color. So there are ways of manipulating the environment so that
kids are more naturalistically learning these skills.”

And, she adds, kids are more able to generalize skills learned in a naturalistic situation beyond
the therapy sessions and take them out into the world with them.

ABA is also almost never implemented 40 hours a week, as Dr. Lovaas first recommended.
“Most kids are either given 10 hours a week or 20 hours a week,” says Germansky, who works
with young kids on a one-on-one basis in New York City. “The more severe the behavior or
delays the more hours they’re given. I will see kids usually every weekday for about two 

Too focused on eliminating behaviors?

Another criticism of ABA stems from a failure of some practitioners to focus on development of
skills along with trying to reduce or eliminate problem behaviors. Tameika Meadows, an
Atlanta-based BCBA, says she sees this problem when she visits some schools to consult on the
ABA procedures they are implementing.

One of the first things she notices, she says, is whether the focus is on getting rid of behaviors.
“What are the students learning to do? What are they supposed to do instead of tantruming, or
instead of trying to escape the building during the day?”

Ari Ne’eman, a leading autistic self-advocate, objects to ABA on the grounds that it focuses on
making autistic people appear to be “indistinguishable from their peers” — an expression he
draws from Lovaas. As such, he argues, it discourages behaviors without acknowledging their
emotional content.

“The emphasis on things like eye contact or sitting still or not stimming” — i.e. self-stimulation
such as flapping hands — “is oriented around trying to create the trappings of the typical child,”
he says, “without acknowledging the reality that different children have different needs. It can be
actively harmful when we teach people from a very early age that the way they act, the way they
move is fundamentally wrong.”

Ne’eman, who is president and co-founder of the Autistic Self Advocacy Network, does not
object to structured early intervention for autistic children, and he acknowledges that self-
injurious behavior — one of the things ABA is designed to reduce — is a serious problem. But
he argues that other structured interventions that are aimed at speech and language may be more
valuable to the child, especially children who are nonverbal, for whom the behavior is a form of
communication.

Trying to eliminate differences?

Defenders of ABA argue that it isn’t aimed at taking away autistic children’s neurodiversity but
at enabling independence.
“ABA is based on the premise of manipulating environmental variables to bring about behavior
change,” Germansky says, “so we aren’t trying to change the person, we aren’t trying to change
how they think, we aren’t trying to change how they feel.”

That’s the experience Stephanie Kenniburg has had with her son Holden, now 6, and his ABA
therapy. “What I like is that they’re trying to help him live as independently as possible but
they’re not trying to take his autism away,” she says. “Like there are certain parts of his autism
— the way his brain works, the way he thinks — and they’re not looking at that as something
negative that needs to go away. They’re looking at it as ‘this is how he thinks so this is how
we’re going to teach him how to live in the world.’ ”

Kenniburg says the whole family has learned how to help Holden develop skills via ABA. “I like
that they’ve accepted his neurodiversity and that they’ve accepted him as a person,” she says.
“They’ve really helped us as a family teach him how to be more independent.”

Serious overreach[edit]
“”When I was six years old, people who were much bigger than me with loud echoing voices
held my hands down in textures that hurt worse than my broken wrist while I cried and begged
and pleaded and screamed.

—Julia Bascom[41]

“”I tried everything I could to see if there was a way I could do ABA without running into
ethical issues, but I repeatedly found that I had to make a choice between doing the ABA and
respecting the child.

—"Steph," an ex-therapist[42]

The "behaviors" that ABA targets can be anything the therapist chooses. An autistic person may
be expected to stop playing,[43] make eye contact (which is frightening or painful to some autistic
people[44][45]), sit perfectly still,[46] act like nothing is wrong when they feel tired or overwhelmed
or desperate for a break,[47] hug on command, or stop making calming repetitive movements.[6]
And they can't just ignore it when a therapist demands something unreasonable. Not when the
therapist is constantly getting in their face. [48] Not when ABA is supposed to happen for 40 hours
per week.[49] Not when pleasing the therapist might be the only way to get food or their teddy
bear. Not when the therapist might use physical force.[50][51]
And then there is the question of ABA therapists reporting parents for child abuse just for
taking their autistic kids out of ABA therapy.[52]
Research shows that autistic people who were exposed to ABA are much more likely to show
signs of Post-Traumatic Stress Disorder,[53] though the study's methodological quality has been
heavily criticised by behaviour analysts.[54]

“”People worry a lot about their “violent” Autistic children as they get bigger and stronger and
harder to control. But far too often, the “violence” is stirred up by years of very frustrating
therapy…. There’s only so long that a person can take being pushed into sobbing meltdowns of
frustration before they are willing to do whatever it takes to get the torment to stop.
 —Maxfield Sparrow, an autistic adult who underwent ABA-style therapy[61]
“”About six months after the therapy started, Jennifer said Adam began to act aggressively.
When he got upset, he'd hit, bite and pull people's hair – acting out in ways he'd never done
before. Sometimes, when [the therapist] arrived, he would refuse to go downstairs.
—Leah Hendry[62]
Concerning responses to criticism[edit]
When hearing "some children have been abused and traumatized," the typical ethical human
response would be "that sounds awful and we need to investigate this and ensure it never
happens again."[citation  NOT needed] Yet ABA professionals tend to turn defensive at the hint of
suggestion that the ethics of their profession might need reviewing.
Check the comments in a discussion about abuse in ABA (even one that discusses a specific
incident) and you'll see comments that boil down to "not my ABA" or "that's not real ABA and I
want to ensure you don't think that about all ABA" (instead of maybe "give us the name of where
this happened so we can investigate those horrifying allegations"). [65][66] "Honestly, the hostility
we get for sharing our negative experiences should really say it all," an autistic Reddit user has
pointed out.[67]

ABA to become synonymous with "autism therapy",

Chemotherapy for autism"[edit]
Some ABA proponents claim that autism is like cancer and ABA is like chemotherapy. [30][31] This
is ignoring the facts that
1. autism isn't fatal,
2. autism can't be "cured,"
3. there are other therapies and approaches for autism,
4. doctors don't profit from chemotherapy the same way ABA agencies profit from giving
ABA, and
5. cancer survivors aren't criticizing chemotherapy en masse the way autistics are criticizing
ABA.
Some people do seem to seriously believe it is the cure to autism. [33] This ABA cure thing
is absolute pseudoscience. Some parents seem to take too far with 40+ hours therapy per week
and forcing their children on the spectrum to act completely normal — which many autism
acceptance activists argue is cruel.[34] They claim that things like harmless stims are in fact
beneficial to the child as it provides comfort. Canadian based researcher and activist Michelle
Dawson has worked hard to have ABA banned as an autism treatment and has written in detail
about its pitfalls.

The bad side[edit]

“”I’ve seen people call ABA “dog training for children.” When I see that, I tend to go on Twitter
rants in reply to it, because from everything I have read and seen of ABA, it is NOT “dog
training” for children. …I would never treat a dog that way.
 —Carol Millman, professional dog trainer

ETIHCS
In 2001 the BACB produced a set of Guidelines for Responsible Conduct for Behavior Analysts.
Minor revisions to these guidelines were made in 2004 and 2010. Bailey and Burch (2011)
provide an excellent discussion of the BACB Guidelines for Responsible Conduct for Behavior
Analysts including practical advice, illustrated with numerous examples, on how to adhere to the
guidelines. An important point that they make is that at the base of all ethics is the golden rule:
treat others as you would like to be treated or treat others as you would want people significant to
you to be treated under similar circumstances. The following discussion points for the ethical
application of behavior modification are based on the reports by Stolz and Associates (1978) and
Van Houten and colleagues (1988), and the 2010 revision of the BACB Guidelines for
Responsible Conduct for Behavior Analysts.
Qualifications of the Behavior Modifier
Definition of the Problem and Selection of Goals
Selection of treatment
record Keeping and ongoing Evaluation