After much discussion on ABA on an autism list, started by a parent who is new to the neurodiversity concept and pretty new to autism in general, I decided to write about treatment options. You might guess I’m going into a “neurodiversity good, ABA bad” litanny, but not really. You see, it isn’t the specific method used in working with an autistic – though some methods have a more negative reputation than others -, that can be right or wrong, but the aim of the particular intervention, and how it’s used. I know parents, like Kristina of Autism Vox, who use ABA for their child in a way that I do not have a problem with, and I’m pretty sure there are people out there who may not be involved with ABA or other questionnable approaches, but who still hold an attitude towards autistics that does not support neurodiversity.
So, here are some questions that I think can be helpful when deciding on an autism intervention for yourself, your autistic child or another autistic in your care. I am pretty sure this is not absolutely right, and I welcome feedback.
- Does the intervention aim to “cure” autism or have your child “recover”? Remember, autism cannot be cured, and, in my opinion, a cure is not desirable. Therefore, a program’s aim should never be to turn an autistic into an NT. A good intervention would help an autistic to be the best autistic person they can be, not to “normalize” them, get them to “recover” or make them “indistinguishable from their peers”. This may mean that an autistic still exhibits unusual behaviors, if these behaviors are useful to them. For example, rather than forcing a child to pretend play rather than line up objects, use the lining up objects activity to further help the child gain skills.
- Does the program utilize the autistic’s strengths, or focus on their weaknesses? Everyone has strengths and weaknesses. Some strengths and weaknesses are more common among autistics than among the general population. A good therapist would try to get an idea of the child’s (adult’s) strengths and weaknesses, and use their strengths to help them compensate for the weaknesses.
- Does the program use the child’s (adult’s) natural environment, or does it use an artificial environment? One of the major problems with discrete trial training (DTT), one method used within ABA, is that it is often designed around a table setting. However, the best way of helping a child function in the real world is to teach them skills in the real world. Angela Mouzakitis, a certified behavior analyst, has a good commentary on this.
- Does the program use aversives or restraints in non-emergency situations? Good programs do NOT use aversives or restraints other than in acute emergency situations. An aversive is also something that doesn’t bother an NT, but that an autistic child does not like.
- Does the intervention allow for your child to be a child? Some programs, particularly ABA, are so intensive that there is little time for your child to remain a child. Forty hours a week is a lot, you see. You may ask your child’s therapist to teach you appropriate reactions to behaviors, so you can incorporate some interventions within the child’s day-to-day life. This will, once again, help your child learn in their own environmetn rather than in an artificial one.
- Does the therapist focus on age-appropriate behavior? Two-year-olds don’t sit in a chair for a long time and four-year-olds don’t say “Could you please give me ___”, so don’t expect this of your child. It is, however, important that you do not force “child speak” upon a child when they already speak formally. They will have to unlearn it later.
I’m pretty sure I forgot some “criteria”, but can’t remember them now. In any case, make absolutely sure, before you get the autistic in your care into a treatment program, that you understand the program’s purpose, lay-out and what the therapist will be doing with the child (adult) in your care. Do not consent to a treatment proposal you don’t understand. It may turn out to be a great intervention – I agreed to the mental health service proposal without ever understanding it, and still it worked out -, but you cannot be sure unless you ask.