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Behavioural method is not an attempt to ‘cure’ autism

Julie with Jack in a film about Applied Behaviour Analysis. BBC/Dartmouth Films/Two Step Films/Fran Robertson

Treetops School in Essex is a state school that uses ABA (Applied Behaviour Analysis) to educate children with autism. ABA has generated controversy and BBC4’s film, Autism: Challenging Behaviour, follows three-year-old Jack and four-year-old Jeremiah in their first term at the school.

ABA isn’t actually an autism treatment, although it can be used to make a positive difference. It can be applied at any age and not just with children with more severe autism. It’s also used in other areas of education and in health, and among other things good parenting uses its principles. ABA has been used to improve safety, train elite athletes and to increase productivity at work.

Difference not disease

Critics argue that ABA is attempting to change autistic behaviour, and challenges the very nature and personality of a child with autism to make them fit our idea of normal. This isn’t helped by autism experts saying things like ABA aims to “take the autism out” of children and being likened by Treetops’ deputy head (initially at least) to “dog training”.

If this were true it would be scandalous. Autism is a difference, not a disease, and ridding someone of it is just not on. But is it true?

Some autistic people who received ABA-based interventions as children talk about negative experiences in the film. One famous study by Ivar Lovaas, a pioneer of ABA in children with autism, described children who were able to participate in life and school after intensive ABA as “indistinguishable” from their non-autistic peers. Add to this that ABA practitioners sometimes describe it as a “treatment” for autism, and research into whether it’s a factor in apparent “recovery”, and the connection is made that ABA equals an attempt to take away a child’s autism.

But critics and some behaviour analysts aren’t describing ABA accurately and in doing so they damage what can be a very helpful and effective technique. Both supporters and critics must develop better ways of communicating the method.

What is ABA?

From scientific research we know how humans learn, and ABA evolved from this basic science. Practitioners use the principles of learning to work with people to change behaviour – to learn new skills, and to help reduce problematic behaviours.

In children with autism, the primary aim is to help children to learn new things by helping to build new behaviours and skills. One particular way of doing this is breaking down complex skills into smaller steps that are taught directly to children by rewarding success. This way they can build towards achieving skills more incrementally.

ABA is more widely used in the US, where it was first used with children with autism in the 1960s. Demand in the UK is high but comprehensive ABA educational programmes are rare in local authority state schools. Some supporters of ABA also argue that it should be intensive, with children enrolled in up to 40 hours per week of contact time. However, such intensity is not a requirement – even a little high quality ABA support can make a big difference to a child’s life.

Changing autism or changing behaviours?

In the film, critics talk as if ABA determines what should be the focus of intervention. However, it is not ABA that “decides” what behaviours to change or what skills should be developed. These learning goals are instead defined by children, their families and others.

When asked, most autistic people and their families identify things they’d like to achieve in life just like everyone else: family/relationships, jobs, favourite activities, the ability to communicate, make choices and live as autonomously as possible. They don’t want their autism taken away. In ABA, a young person might want to learn to use public transport so that they can visit friends, while a parent might prioritise communication skills in a child who cannot speak.

Another way to decide what to teach a child with autism is to understand typical child development. We should ask what key developmental skills the child has already developed, and what they need to learn next. The statutory curriculum in the countries of the UK also tells us what children should learn. Then there are pivotal behaviours that would help further development: teaching communication, social skills, daily living or academic skills that can support longer-term independence and choices.

Despite the critics’ accusations, ABA doesn’t require certain behaviours in autism – specifically repetitive behaviours – to be reduced. Some of these, such as flapping hands may serve an important function for a child, helping them to manage anxiety and they may even be enjoyable. Unless these behaviours are seriously problematic or dangerous for a child or interfere with their own learning and goals, they shouldn’t be a target for ABA. If they are, then it’s an ethical requirement that they’re replaced with other ways the child can achieve the same function.

Education and autism

We need a national debate about educating children with autism because we are failing many of them. Too many are making no progress in school. The different approach of St Christopher’s, another school shown in the film, is clearly well-meaning but raises it’s own ethical issues. Teaching staff saw it as one child’s choice to not eat solid food. But as a staff member pointed out, it was likely that the 11-year-old would probably need to be tube-fed if things continued as they were.

In addition, parents of children with autism tend to be under more stress even than parents of other disabled children – partly due to the increased behaviour problems seen in many children with autism but also other contributing factors including a lack of support from services, and negative reactions from some members of the public.

Add to this the in-fighting within the autism field itself and it’s a disgrace. We must agree on what view of autism drives our educational approaches in the UK: a medical model, where autism is considered like a disease to be treated, or a difference model? If it is the latter, then we, and all the participants in the film, appear to have common ground. Standing together to improve education for autistic people throughout their lives is where we need to be.

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