Integrating ABA into Practice: Addressing the Misconceptions
This article was written by Dr. Ronald Lee, Program Director for the Masters in Applied Behavior Analysis at William James College. It was originally published in Autism Spectrum News in Summer 2016.
The past few decades has seen drastic changes to the field of autism, at least in part due to changes in the defining characteristics/diagnostic criteria for Autistic Spectrum Disorder (ASD). As a result of increasingly inclusive criteria, professionals in fields such as psychiatry, medicine, education, social work, clinical psychology, and applied psychology may be more likely to see ASD as part of the diagnostic make-up of populations they have typically served. Consequently, professionals in a wide range of related disciplines will benefit from incorporating Applied Behavior Analysis (ABA) principles and techniques into their treatment repertoire. Commonly referred to as “Reinforcement Theory” or “Learning Theory”, these are the principles of learning and behavior that have led to teaching and behavior-change procedures and are dependent on measurable dimensions of observable phenomena as the evidence of change. There seems, however, to be a barrier to including the principles and techniques of ABA within the treatment approach of practitioners outside of the field of ABA. Despite decades of research and thousands of applications supporting ABA as an evidence-based approach for educating and addressing problem behaviors in people with ASD, numerous misconceptions of ABA continue to pervade both professional and lay communities. The purpose of this article is to identify a few common themes among popular misconceptions around ABA and to address the bases for them.
Misconception # 1: ABA is simplistic.
There are a number of misconceptions of ABA based on the premise that its principles and techniques are far too simplistic for anything more than changing and/or teaching simple, single responses. Many believe that the complexity of the interaction between the individual and his/her socio-cultural environment, neurophysiology, genetics, and other factors must be beyond the scope of an approach that reduces this complex constellation to the relation between stimuli and responses. Examples are evidenced in statements such as:
- “ABA treats all individuals alike.”
- “ABA does not take into account the uniqueness of the individual.”
- “ABA discourages or inhibits individual expression and creativity.”
- “ABA teaches children to behave as robots.”
- “ABA denies the existence of thoughts, emotions, personality…”
- “ABA is based on the work on reflexes done by Ivan Pavlov and John Watson.”
- “ABA does not address underlying causes/mechanisms.”
- “ABA is a set of procedures that can be learned over a weekend workshop.”
For example, discrete-trial teaching (DTT) is one of the most well-known ABA-based techniques and has been highly effective in teaching skills to learners with ASD who have been resistant to other forms of instruction. DTT has been implemented on a wide scale, resulting in critiques that ABA is a “one-size-fits-all” approach and can appear simplistic to the naïve observer. Although DTT may appear repetitive and unsophisticated, an applied behavior analyst will incorporate a variety of methods that address numerous behavioral principles concurrently, each of which might affect behavior in a different way. Indeed, the most effective educators, teachers, and mentors are those that navigate the interplay between numerous variables that can affect the behavior of the individual in the moment and in the future. Additionally, the applied behavior analyst will also shift from intensive and strict DTT approaches to looser, more naturalistic forms of instruction as the learner progresses. Unfortunately, applications of DTT and other ABA-based techniques by insufficiently trained practitioners will produce undesirable effects and this is no less true of techniques in education, therapy, counseling, medicine, or other professional disciplines. Only advanced and thorough training in the principles of behavior will expose the multitude of variables that are in effect during the seemingly simplest of teaching procedures.
Misconception # 2: ABA is not generalizable.
A second category of misconceptions speaks to perceived limitations on the generality or applicability of an ABA-based approach. ABA is perceived to be useful in 1) specialized settings, 2) with specific populations, 3) for certain types of behavior, or 4) for a limited time and 5) only as long as ABA treatment persists. For example:
- “ABA is only effective for severely impaired individuals and cannot/should not be used with higher-functioning people with disabilities or neuro-typically-developing people.
- “ABA is only applicable for severe problem behavior like aggression but not for bizarre behaviors like self-injury, psychotic speech, or delusions.”
- “ABA is only useful for teaching simple responses or self-care skills.”
- “ABA can’t be used to teach complex or abstract behavior like language, problem-solving, and understanding of concepts.”
- “ABA is a laboratory science and techniques cannot be carried over into real-world settings.”
- “ABA can produce changes in behavior but those changes don’t generalize outside the treatment setting.”
- “ABA techniques are unnatural or contrived, and so they don’t mimic the real-world.”
Although ABA has had its largest impact in the field of autism and developmental disabilities, it has also been effective in a diverse range of fields addressing problems on the individual, organizational, and community-level. This includes, but is not limited to, clinical/mental-health settings, business and industry, clinical and applied health psychology, and education. The behavior analytic analogue of Industrial-Organizational Psychology, Organizational Behavior Management (OBM), is one of the most rapidly growing subfields within ABA. Despite great differences in the setting of work and target populations, applied behavior analysts in the fields of OBM and ASD rely on the same basic principles of learning and behavior change. Ultimately, this set of misconceptions reflect the need for more demonstrations of the effectiveness of ABA in fields and settings other than ASD.
Misconception # 3: ABA is unethical.
A third category of misconceptions consists of criticisms based on the idea that ABA-based approaches are unethical, harmful and should not be used. Proponents are explicitly anti-ABA and their dialogue is designed to elicit contempt of ABA. They argue:
- “ABA is dependent on the use of shock or other uncomfortable and aversive stimulation.”
- “ABA makes children dependent on edible reinforcers, and children don’t learn for the sake of learning.”
- “Reinforcement is bribery and is an unethical practice.”
- “ABA is like animal training and is inhumane.”
- “ABA practitioners seek to control people.”
The care and rights of the individual client are at the fore of the practice of applied behavior analysts. Prior to the field of ABA having established its own code of professional ethics, the Association for Behavior Analysis adopted the American Psychological Association code of ethics to guide professional practice. The role of ethics continues to be of paramount importance to the field and is a required component for the continuing education of all nationally certified behavior analysts.
Unfortunately, some criticisms of human-rights violations are based on cases in which behaviorally-based interventions have been implemented without appropriate or sufficient oversight, resulting in neglectful or abusive conditions. Additionally, the phrase “behavior modification” has been used synonymously with non-ABA-based techniques such as sedative medication, shock-therapy, and frontal lobotomies and its pejorative sentiment now also includes ABA. Although the history of the practice of behavioral therapy includes cases of the misuse of behavioral techniques, these make up a small minority of cases that have been illustrated through decades of applied, clinical, and experimental applications resulting in meaningful change. Ultimately, much anti-ABA sentiment have little to no facts to support them and are gross overgeneralizations.
Applications in the field of autism have demonstrated the extent to which ABA is an important component to intervention. Although misconceptions and criticisms of the field of ABA are generally based on some version of fact, they rarely apply on any level greater than superficial appearance and/or for more than a small number of cases. Moreover, it is becoming increasingly relevant to clinicians and educators to receive advanced training in ABA as the field of ASD changes. As the need and demand for ABA services increases, it is critical that professionals with a comprehensive understanding of the principles of behavior are prepared to fill that need.