When a child is first identified as autistic, the most commonly prescribed type is therapyABA (applied behavior analysis). Although ABA can be helpful for many children, it is not without controversy. Many autistic adults have expressed concern about the use of ABA in autistic children in recent years.
A growing number of ABA practitioners have listened to these criticisms with an open mind and have made changes in the way care is delivered. But the field as a whole has not yet moved in the direction of compassionate care that validates neurodiversity. Here are the red and green flags to look out for when evaluating an ABA provider.
What ABA warning signs should I look out for?
Red flags are signals that you might want to reconsider working with a particular ABA company or supplier. If you are considering ABA for your child or your child is currently in ABA therapy, consider the following warning signs as warning signs. If a service provider shows these signs, they may not be validating neurodiversity and may be using outdated and potentially harmful methods.
Red Flag #1: Parents can't see the session
Parents should be encouraged to monitor and participate in their child's care. If the provider tells you that you cannot join and see what is going on in therapy, that is a red flag. This is especially trueABA therapy at home.One of the benefits of home therapy is the ability to closely monitor your child's sessions. The caregiver may say "it's distracting the child," but a good therapist will work with the parent and child until the child is comfortable, rather than causing the child to be distracted.NOby excluding a parent. There is no compelling reason to exclude you from your child's session. If your child is being treated at a clinic, there should be guidelines that allow you to monitor your child's treatment in person or via video at any time. There should not be a minute of therapy that you are not allowed to observe because you always have the right to protect your child regardless of the therapy they are receiving. HIPPA is not an excuse either!
Red Flag #2: Focus on limiting harmless stimulation
Stimming, short for self-stimulating behavior, is common among autistic children. But many people find that all are stimulating to one degree or another. Focusing on reducing stimulation has historically been a central aspect of ABA therapy, but some providers have moved away from it in recent years as autistic adults have reported experiencing pain when this natural tendency is removed.
People vote for many reasons – excitement, frustration and anxiety, to name a few. Stimulation is also a coping mechanism. So when you stop your baby from stimulating, you have no option for self-soothing, which leads to an inner stress you can't get out of (like a boiled teapot with no room for water). Unless your baby's stimulation is harmful (e.g. repeated head nods), there is no need to stop or change direction. Teaching children not to stimulate can really hurt them in the long run, traumatizing them and in some cases making them believe that their needs, autonomy and wants don't matter. It may certainly be appropriate to discuss alternative behaviors that your ABA team can encourage your child to engage in if their stimulation interferes with other important opportunities. (As always, your child should be at the center of this conversation because ultimately it's about what will help him live the life he wants.) flag to be respected.
Red Flag #3: Force eye contact
Many autistic children and adults find eye contact uncomfortable or even painful. However, some ABA providers may insist that eye contact is an important life skill. Constant eye contact is not required. It is even considered rude or aggressive in some cultures. The only exception according toASANif the autistic person wants to learn to fake eye contact.
The skills taught in ABA therapy should enrich your child's life. These should not be random skills BCBA throws. If your ABA provider tries to force eye contact or "program" your child to do so, consider this a red flag. They are likely working with other outdated and authoritarian practices.
Red Flag #4: Use of Criminal Cases
If your ABA team uses penalties, that's a big red flag. Research shows that reinforcement (such as verbal praise) is much more effective for long-term behavior change than punishment. Often, punishment only helps to temporarily suppress the behavior. However, this does not lead to long-term behavioral change. Punishment does not teach a child what to doshouldDown. Punishment can also have side effects, such as: B. intensification of escape and avoidance behavior and increased aggression. There are also ethical reasons not to use punishment, such as B. causing trauma, increasing anxiety and possibly contributing to depression. For this reason, many progressive ABA providers in recent years have adopted an approach known asABA with assumption of damage.
Red Flag #5: Heavy reliance on food, tokens, or reward systems
The use of food ("food") as a tonic is still common practice in ABA, although many clinicians are moving away from it. Food is considered “primary reinforcer,” meaning that humans naturally value food. We all need food to survive.The food must be available without having to do anything about it.Frequent consumption of food for fortification can lead to unhealthy or disturbed eating habits and the development of health problems.
Token systems (or economies) are also used to reinforce certain behaviors. Token systems can be effective in teaching delayed gratification because we don't always get immediate reinforcement in life. For example, you usually work a week or two before you get paid. The token system works in a similar way, where a child earns tokens for certain target behaviors and can later earn a larger reward for those tokens. However, over-reliance on token schemes is a red flag. Natural reinforcements such as smiles, praise, and attention should always be used in therapy sessions, and therapists must always be creative and exploratory in finding reinforcements that the child likes at all times. If your child is bored during therapy, reinforcements will not work. Other examples of natural empowerment include going for a walk, giving an object after asking for it, and getting help with a task after asking for help.
Abuse of reward systems is a problem because it can seem very similarClassic conditioningwhich is also used to train pets. Children are not animals, they are people. Another red flag to watch out for is endless token economies. If your ABA provider is issuing tokens, but the tokens aren't being exchanged for anything (or anything your child wants), this is not a true token system and is a sign that something is wrong.
Red Flag #6: Ignore a child's emotional or sensory processing needs
Unfortunately, the ABA field has a long tradition of ignoring a child's emotional distress to avoid reinforcing "difficult behavior." Some practitioners may also force a child to repeat a behavior or perform a task when they simply cannot do it – because they are too tired, hungry, nervous or just not up to it at the moment. Needless to say, simply ignoring a child when they are experiencing big emotions is emotionally damaging. Some progressive ABA providers have moved away from this practice into a new movement called ABACompassionate Caring ABA.
Is the child upset because he wants something he can't have, or feels overstimulated or overwhelmedI can notwhat is required of them, there are many effective ways to meet these challenges. The focus should be on teaching effective communication strategies and self-defense skills. If your ABA provider simply ignores your child's behavior until it stops, consider this a red flag. If your caregiver talks or acts as if your child is simply disobedient, disobedient, or uncooperative, instead of admitting that he is struggling, this is also a red flag. (Guardians looking after your child should always assume that your child is doing the best they can).
Red Flag #7: Lots of hours and/or unclear schedule
Some providers recommend a fixed weekly number of hours for all clients. It is not uncommon for providers to recommend 30-40 hours of ABA therapy per week. There are many reasons why this is common, including insurance benefits, a busy client list, and the belief that more hours means better results (it doesn't have to be). It's just not true that all children need a "full-time" ABA, and beware of companies that promote this policy to make more money.
The number of therapy sessions should be tailored to the child's individual needs. Your child must NOT participate in all recommended activities. Many children are overwhelmed by going to therapy, especially if they also have school, extracurricular activities, etc. Consider what fits with your family's schedule and other personal priorities to avoidburn your baby. Remember that even though some ABA sessions may feel like a game, it still works for your autistic child. If you are not comfortable with a referral, don't be afraid to ask for fewer hours or look for another provider.
Similarly, some ABA programs seem endless. There is a saying within the ABA that BCBAs should strive to "get out of work". This means that all the goals set by the family and the child have been achieved. While it is not always possible to provide an exact date for when your child will complete ABA therapy, a good provider will provide clear goals with a reasonable timeline for achieving them, as well as any transition expectations and future directionsredundancy plans.
What green ABA flags should I look for?
There are some red flags to watch out for that can be quite scary for parents. Good news? There are a growing number of progressive and neurodiversity-affirming ABA providers who offer care with a family-centered approach. There are clear signs that the ABA provider is practicingcompassionate and neurodiversity-affirming care. To find quality ABA providers with ethical practices, or if you're wondering if your provider supports neurodiversity, consider these green flags:
Green Flag #1: Encourage, but don't force, behavior
The goal of ABA should be to teach and empowerusefulbehavior and skills.Never focus on enforcing compliance.People with autism and other neurodivergences are much more likely to be abused and misused than the general population.3 Forcing children to follow orders unconditionally can be extremely dangerous as it sets them up for abuse. When looking for an ABA provider, ask about their consent and opt-out policies. Consent-based practices give your child the right to opt out at any time. This requires the provider to create an environment that is comfortable and engaging for the child. When your ABA provider thinks your child has the last wordAlreadyTherapeutic actions, consider this a green flag.
Green Flag #2: Work closely with parents, caregivers and other professionals
Parents and guardians should be actively involved in the child's care. This begins with swallowing and continues throughout the child's therapy. BCBAs should involve caregivers and the child in developing goals and procedures. Rather than a client-expert dynamic, caregivers and their children should make decisions together. Once the goals have been agreed, relatives should also be informed of ongoing progress and the need for change if something is not working for their family.
Childcare must be a team effort. Some professionals have tunnel vision and believe their method is the only way. Through open communication and collaboration, professionals can work together to develop plans that are best for the child. If your ABA provider works in harmony with your child's other providers, this is a green flag.
Green Flag: No. 3: Focus on developing skills to improve quality of life
Developing skills to improve a child's overall quality of life should be the focus of ABA therapy, rather than focusing too much on behavior reduction. ABA programs that address basic skills such as sleep hygiene, potty training, hand washing, and other skills important to the child and family can be considered a green flag.
Green Flag #4: Open communication
You should communicate openly with suppliers. Parents and guardians should always be aware of what is happening with their child's care. They should be kept informed of changes being made, implementation of new goals, the emergence of obstacles to progress, personnel changes, and anything else that affects the care of their child.
Green Flag: #5: Each child's individuality is respected
When ABA therapy was first used for autistic children in the late 1960s, its goal was "normalization." Unfortunately, this attitude persisted for several decades.The goal should never be to force a child into a neurotypical form.it causescamouflagewhich is incredibly harmful. Look for ABA providers who respect and support your child's individuality. Skills can be learned without changing who your child really is.
Green Flag #6: The "Why" behind the behavior is identified and needs met
Every behavior has a purpose.Behavior is communication. Your ABA team should conduct thorough assessments before planning to identify the causes of targeted behaviors. For example, if your child hits other people, why do they hit? Behaviorists have found that many observable behaviors are reinforced by a combination of common functions, including attention, access to preferred objects or activities, avoidance of undesirable situations, sensory reinforcement, or something else. However, discovering which characteristics are most relevant (or the "root cause") of a particular behavior is only the beginning. The ABA team has an important responsibility to ensure that any recommendations have an overall positive impact on your child (and family). Using this example, let's imagine that your child hits others, and imagine that your BCBA decides that the appropriate function is to run away from a task he does not want to do. It is important to dig deeper to find out what exactly they are trying to escape from. Are there things around them that make them uncomfortable? Do you like bright lights or annoying noises? Is the task for them too difficult, too easy or simply not preferred? There are so many variables to consider. If your ABA provider actively looks for the "why" of your child's behavior (which should include asking for insight since you know your child best) and then implements individualized strategies to meet their unique needs, consider this a green flag .
Green Flag: #7: The child is seen as a whole person
Your child is more than his behavior.If the ABA provider sees your child as unique, they are likely to offer more than just a set of new skills. Each child has unique needs, interests, dislikes, personalities and feelings that need to be addressed in therapy. Neurodiversity-affirming therapy services do not see your child's autism as something to be fixed, but as the context in which they can best be helped.
Final thoughts
ABA therapy is not a one-size-fits-all approach and should be tailored to your child. Watch out for red and green flags. Be a proponent of change when things don't seem right. Find the program that best suits your child's needs and your family's preferences.Ask clarifying questionscan ensure your child access to high-quality therapy.