The ABA-Autism program offered at CapU attracts students nationally, but autistic advocates question whether the controversial treatment with a $75 million price tag should be left in the past
Sarah Rose // Features Editor
Coralie Mayer-Traynor // Illustration
In the late 1950s, a brother and sister scaled the endless fields of Dartmouth, Nova Scotia. Of all the fascinating artifacts these kids discovered in the lush Atlantic seascape, the most terrifying is a terracotta brick beast that towered over the mouth of the Eastern Passage. “Careful, or else they’ll lock you up in there, and the crazy people will get you,” warned their parents. By the time the brother, John Putland, turns 19, he’ll be inside that building, terrified, undergoing electroshock therapy until he’s bathed in bruises from the constant seizures. “It’s me,” he’ll cry to his sister, obscured by the dark humour we lean on to survive. “I was the crazy one all along.”
Depending on when and where you cast a net in history, unusual behaviour could’ve been the mark of a shaman, or a symptom of demonic possession only curable by execution. Atypical is a complicated word more often marred by societal expectations than by the individuals themselves.
The last half century of psychiatric care has been defined by rapid, unprecedented transformation. Putland received electroshock therapy in a hospital opened by Dorothea Dix, the mother of the mental asylum. Less than a year after his violent electroshock treatments, the US Food and Drug Administration approved Lithium, one the most widely studied and prescribed antimanic drugs in the world. Asylums were the perfect labs for controversial treatment—insulin shock, ice baths and lobotomies—once heralded as radical advancement. Now, they are synonyms for abuse and imprisonment. Inside one such asylum, Dr. Ivar Lovaas tested a new treatment approach for autism.
“Enraged bellows at the boy, then a sharp slap in the face. This deliberate, calculated harshness is part of an extraordinary new treatment for mentally crippled children,” reads the introduction to a 1965 Life article on Applied Behavioural Analysis (ABA). Dr. Lovaas argued that autistic patients should be exempt from ethical considerations regarding brutal punishment, and suggested that families use cattle prods to punish their children.
Today, ABA is a massive industry. It’s considered a first line therapy for autism, overseen by the Behavioural Analyst Certification Board (BACB). “The thousands of children with autism in B.C. deserve access to Applied Behavioural Analysis—the single, most research-supported treatment,” says Richard Stock in an interview with North Shore News. Stock is an ABA-Autism program instructor at Capilano University (CapU), a unique program in Western Canada that provides a direct pathway to writing the BACB certification exam. CapU is also the only institution in Western Canada that offers a bachelor’s degree and post-baccalaureate certification in ABA.
According to the BC Autism Support Network, “behavioural analysis is the science of behaviour. ABA is the process of systematically applying interventions, based upon the principles of learning theory, to improve socially significant behaviours to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior.” CapU ABA-Autism Program Coordinator Miriam Elfert’s description of ABA is copacetic to this: “[ABA is about] finding strategies to correct problematic and disruptive behaviour,” although she adds, “we’re trying to help people achieve a better quality of life.” Yet it still feels like something’s missing—there’s no reference to the internal emotions or wellbeing of the people ABA is designed for.
Unlike most DSM-5 diagnoses, neurodevelopmental disabilities like ADHD and autism are still defined by their external impact on society, rather than what the individual experiences as disabling. What have we been leaving out by not turning the lens inwards?
Researchers like Olga Bogdashina have credibly theorized that autism is primarily a sensory difference, from which many of these “problem” behaviours emerge. The diagnostic criteria focus on repetition, black and white thinking, or social communication, which is thus even further removed. This criterion is not designed to diagnose autistics—rather the problems neurotypical people have with them.
The framework of the last half century around autism has resulted in only a fraction of research dedicated to sensory processing or even the dramatically shortened lifespan autistic individuals face from high suicide rates, self-harm, high incidences of PTSD and more. This is the body of research from which ABA therapy emerges, along with Lovaas’ theory that psychiatric patients require punishment for their symptoms. He received widespread acclaim and several awards during his lifetime. Lovaas’ work in ABA inspired him to apply the same techniques to gender nonconforming children. The project’s poster child committed suicide in 2003.
Gay conversion therapy has faced more public condemnation than ABA, despite that both are ongoing. Proponents of ABA and its practitioners claim modern ABA looks nothing like conversion therapy, or the original therapy created by Lovaas. Stock and Elfert echo this sentiment. While fewer ABA therapists use corporal punishments such as electric shock, several institutions still actively use it. Even modern ABA modifications that swap electric shock with the withdrawal of social interaction are refinements designed to make the therapist feel more comfortable. The fact remains—ABA and compliance training is, as Amy Sequenzia writes for the Autistic Women and Nonbinary Network: “violence against our neurology, our identity and our humanity.”
This is where doubt and anxiety permeate autistic self-advocacy groups when discerning how far removed modern ABA is from its marred history. The generation of autistic kids who endured Lovaas’ prototype of ABA are now middle-aged adults speaking about their trauma. Some autistic people who have been through strict behavioural modification as children experience post-traumatic stress. Many doctors and professionals such as Stock present ABA to parents as a necessary early intervention, claiming they will miss a crucial window of opportunity if they don’t.
The provincial government provides caregivers of autistic children under six $22,000 annually for services, which amounts to a total of around $75 million. In order for a service to be subsidized, it must be on the Registry of Autism Service Providers (RASP). The RASP includes occupational therapy, speech-language pathology, physiotherapy and behavioural intervention. ABA practitioners almost entirely deliver these behavioural services. According to Stock and Elfert, there is a 100 per cent employment rate for ABA therapists after graduation. The sheer demand and capital generated by ABA practitioners means the industry holds a lot of influence, despite less expensive—and arguably more humane—forms of intervention.
Elfert says ABA routinely evaluates the impact of interventions. “I work with other professionals such as speech language pathologists,” she said. One former board certified behavioural analyst (BCBA) describes how many ABA students report feeling like their university program subtly pushed them away from other professions. “[My university] specifically discouraged us from collaboration with social workers and school psychologists by insulting their professions, students and professionals,” Jo Ram writes for Neuroclastic.
According to Elfert, many graduates go on to work for non-profits, as special education counsellors or become teachers themselves. She explains that ABA is an extensive field existing outside of autism focused care. Indeed, ABA’s core principle is operant conditioning, a subset of behaviourism that has many uses in various disciplines. However, in ABA, the compliance code in the BACB code of ethics doesn’t differentiate between a human child and a corporation. Which begs the question of what kind of protection it offers and for whom. Nowhere does it explicitly prohibit abusive techniques or require informed consent from the learner outside a parent, carer, or even a corporation’s signature. It’s a worrying position, given the first imperative of any treatment should be to see the patient as a human being, not a corporation or an abstraction.
“[ABA] taught me that who I am is subhuman, increased anxiety, didn’t honour my ways of communication, suppressed my stimming, the movements I used to regulate myself,” wrote Andy Jordyn Carlisle on Twitter. As a non-speaking autistic child from Manitoba, they were subjected to years of ABA therapy at 30 hours a week leaving them with PTSD. Carlisle believes that neurotypical ABA providers can have good intentions and even compassion. Yet they’ve witnessed these providers working with both children and adults that have strong-armed away important autistic behaviours, because of incorrectly attributing intent and motivation. “[The] greatest problem I see with ABA [is] it simplifies autism into only its behaviours,” Carlisle wrote.
“Because ABA does not see us as fully human, we are not allowed self-determination, unless it is really ‘self’ but compliant with the therapist’s determination to change us,” says Sequenzia. Poet, mechanic and academic tutor JayJay Mudridge recounts their 12 years of ABA in an interview with Neurodiversity News: “I can firmly say that ABA stole my childhood, and the resulting (professionally diagnosed) complex post-traumatic stress disorder stole my adulthood. ABA groomed me for every trauma I endured later in my life.”
Mudridge is a survivor of the Judge Rotenberg Center (JRC), a residential school for ABA in Massachusetts that permitted electrocutions until March 2020. “I still wake up with the smell of my own flesh burning in my nostrils some nights,” they said.
These harrowing accounts of ABA are not isolated or unique. Yet they are often drowned out by the air of cult-like reverence ABA garners from neurotypical parents and the BACB, one that seems to marginalize every other approach.
“Autistic people should be included in a meaningful way, there’s been a missed opportunity,” says Elfert, which itself seems out of touch. Autistic people have informed the public of their ABA related trauma for years but are routinely silenced and ignored by those in power.
When people place themselves as experts in issues that directly affect a group of people they can intrinsically never belong to, and then cause direct harm to that population, what recourse is there for the affected community besides self-advocacy? We’ve seen this dynamic play out before in things like racialized police violence.
Perhaps a fundamental issue in psychiatric care is that those whose lives are at stake have never been allowed to hold authority and autonomy over their own treatment or humanity. Violence and institutionalization remain mainstay approaches, and we enforce that Lovaas-esque pedagogy of punishment through educational surveillance, police intervention in mental health crises, and solitary confinement.
“There’s more interest in [ABA] and more collaboration with autistic people, we’re looking more at it,” says Elfert, though it remains unclear why it’s still acceptable to allow neurotypicals to dominate the field of research and autistic focused therapy. According to Elfert, she has seen several autistic students in the ABA program at CapU during her 24 years in the field, but more recently it’s the parents of autistic children coming to the program in larger numbers.
ABA practitioners promote strong scientific backing, suggesting that it works because it achieves its goals. The question remains who these goals are for, and what the more insidious cost of achieving them is. An American study of nearly 16,000 autistic children receiving approximately 30 hours a week of ABA over an 18-month period, showed that ABA had no real effect on autistic traits. Presentation was functionally random regardless if they had gone through up to 6,000 hours of ABA or none.
When the entirety of ABA researchers and practitioners claim ABA is an empirical, data driven practice, we need to take that seriously. Subsequently, such studies’ results must carry weight considering the amount of public service funding providing it. Charting the skill acquisition of a child and then directly attributing it as a result of ABA is potentially misleading, and even dangerous. Consider the same logic applied to homeopathy and other things generally debunked as cult-like pseudoscience.
The data in this study paints a picture of central limit theorem as if out of a probability textbook, meaning the results suggest a completely random distribution of ABA effectiveness. It’s what we’d expect to see when changes are caused by many, unrelated events. ABA as a discipline seems to neglect that all children develop and learn naturally; and autistic children are no different. If autistic kids cannot effectively communicate or demonstrate their knowledge and intelligence, then ABA data gathered is inherently flawed.
“Society attacks early, when the individual is helpless. It enslaves him almost before he has tasted freedom,” wrote revolutionary behaviorist B.F Skinner, often considered the godfather of ABA. While Skinner pioneered many foundational behavioural theories of ABA, he also devoted his life trying to move the world away from punishment. Among his many discoveries was how punishment doesn’t result in learning, it only temporarily suppresses behaviour.
Skinner understood that every aspect of our culture was designed for exploitation. He believed grading was a tool of violence against natural developmental processes. Skinner was so distraught, he imagined a fictional utopia in Walden Two where children could explore their natural talents and interests at their own pace without grades, curricula or punishment. His vision was somewhat realized in things like democratic education, Montessori, and other child-centered and trauma-informed educational approaches that have demonstrated remarkably positive outcomes, including for neurodivergent students.
ABA violates many of Skinner’s groundbreaking scientific discoveries and beliefs. The Skinner of today would arguably be horrified with what his research has been used for.
The real ABA predecessor would be the man who created the field of behaviourism, John B. Watson—arrested for his racialized hate crimes in late 1800s South Carolina. Watson is well-known for his abhorrent applications of classical conditioning in Little Albert, an experiment where he emotionally abused a baby. Yet his books on childcare were considered the standard in the Western world for decades. A testament to his philosophy—both of Watson’s sons attempted suicide.
Watson’s principles are still at work in the advertisements for Autism Speaks and other ABA-affiliated associations. Many ABA descriptions are designed to fill parents with fear that their child needs ABA to live a fulfilling and independent life, when that couldn’t be further removed from reality.
“ABA is not a treatment for autism, per se, but that’s often how it gets characterized,” admits Elfert. “It’s a whole paradigm with a strong scientific backing. It’s dynamic and continues to evolve.” Her words linger and cling to the frame of evidence-based practice as a lifeline, as if everything piled on top of it could collapse like a house of cards. Maybe it could.
The broader field of behaviourism can and does improve quality of life and our daily experiences with the world. Behaviourism is a science after all—and the laws of science have always been amoral. Morality arises from the scientist who chooses to bend the laws of nature into either a Walden Two, or into torture techniques. Watson’s legacy as a racist, abusive man, and the devastation he left in his wake is a testament to his desire for power and control. Our lingering attraction to his work reflects a world built on discriminatory power dynamics. In the words of Skinner, “we are not yet ready to accept the fact that the task is to change, not people, but rather the world in which they live.”
There’s a new generation of kids roaming the fields in Dartmouth behind the asylum that once held Putland and thousands of others. Maybe they still see the decaying brick as a monument to fear, or maybe they see it as a reminder that some things are kept safely in the past.