All forms of Applied Behavioral Analysis (ABA) violate the four fundamental principles of bioethics.
The principles are:
- Principle of Respect for Autonomy – What does the patient wish?
- Principle of Nonmaleficence – "Do no harm."
- Principle of Beneficence – The treatment should benefit the patient.
- Principle of Justice – Things like patients of similar need receiving equal treatment.
Note: I use a bulleted list instead of numbering to emphasize that the principles are non-hierarchical. In analyzing ABA, there is no need to worry about hierarchy as every form of ABA violates all of these principles, but if this is your first exposure to these principles, I do not want to present the wrong idea.
What is ABA?
Applied Behavioral Analysis is presented as a "treatment" for autism and is similar in form and origin to Gay Conversion "Therapy"
Note: I will be using the word "treatment" and "therapy" throughout this article with the meaning, "a course of action taken to induce a change in the subject" and will try to avoid using the quotes around the word to emphasize this every time. It is erroneous to consider ABA to be a medical treatment as it does not benefit the patient.
It was created by Ole Ivar Løvaas, who began his experiments on autistic children in the 1960s. In the 70s, Løvaas branched out and worked with anti-LGBTQ psychologist George Rekers on the "Feminine Boy Project", what we now call "Gay Conversion Therapy".
The idea is to use unrestrained behaviorism in order to eliminate "undesirable" behaviors and foster "desirable" ones.
For "Feminine Boys", undesirable behaviors were things viewed feminine such as attraction to men. For autistic children, they include things like humming and tapping. "Desirable" ones include things like compliancy, obedience, and showing physical affection.
They force the external presentation of those behaviors through reward and punishment in one-on-one sessions. To this day, sessions are still recommended to be done for 25 to 60 hours a week and as soon as they are diagnosed ("the earlier, the better").
ABA is beyond the level of carrot-and-stick; I compare it to the level of turning one's stomach inside out and salivating at the sound of a bell.
The dogs may salivate at the sound of a bell, but are they hungry?
My point is that to this day, the focus in ABA is not the internal well-being of the child, but entirely with the external presentation of characteristics of autism. So-called "modern" ABA continues to use the same terminology Løvaas did for the ultimate goal of the torture: to become "indistinguishable from their peers".
Originally, Løvaas used rather extreme physical "aversives" such as electric shocks and full-arm slaps. He lamented not being able to hurt the children more. Eventually, Løvaas abandoned physical abuse and focused on emotional abuse.
Løvaas abandoned the physical abuse because he knew that it was not "effective enough" to ensure "lasting change". By "lasting change", he meant external presentation of the "right" features.
In what would later be named the Judge Rotenberg Center (JRC), Michael Israel experimented with behaviorism on autistic children as well. When he similarly realized he could not inflict enough pain for his victims to have lasting change, he got inventive.
Previously, he recommended doing things such as repeatedly pinching the soles of the children's feet (to the point of bleeding), spanking, "muscle squeezes", and electric shocks. There was also the issue of the strength of the torturer—excuse me, "therapist"—not being consistent enough in the torture. He requested a device that delivered more electricity. He was refused, but this just led to him developing his own torture device—the Graduated Electronic Decelerator (GED). That's not hyperbole: the United Nations has decried use of the device as torture.
The device was briefly banned by the FDA, but the ban was overturned and is still in use today. The GED is what the #StopTheShock campaign is about by the way, but behaviorism and ABA in general is unethical. Organizations of ABAers made it a priority to get the ban overturned and prominently featured talks about it at their conventions. These are the ones who claim to have "changed".
As both ABA and gay conversion therapy torture work similarly and have a shared origin, many autistic and disability rights advocates refer to ABA as "autism conversion therapy torture" or similar.
"You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense—they have hair, a nose and a mouth—but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person."–Ole Ivar Løvaas, Interview for Psychology Today, 1974
The original idea of "autism" is that we live entirely in our heads and are unable to connect with the outside. We were not thought of as humans. This is why Løvaas adapted a procedure designed to torture dogs and "teach" checkers to pigeons to be used on us. The treatment is to "build a person".
There is an old idea that we are not human in the religious sense either. That we have an "animal soul". Even if this idea has been denied and no matter how much progress we make, we still come up against the lingering sentiment that we are less than human. That is one reason why torture of disabled persons continues all around the world. In the name of "medicine", they are able to commit abuse to the extent that would be illegal to commit to many animals.
"Modern" ABA has, for the most part, abandoned what we call physical aversives—remember, they are not as effective as emotional abuse. Instead, ABA does things like neglect, withholding food, preventing play, physical restraints and physically restraining, physically manipulating the child to perform the behavior, forcing painful stimuli through "exposure therapy", forcing hugs, and more. Some rewards are things like allowing the child to "indulge" in the "right kind" of play and in being allowed to eat.
Note: Somehow restraints, literally moving the child to force what the practitioner wants, "exposure therapy", and withholding food are not considered "physical" aversives.
It is worth emphasizing that restraining children can be one of the most dangerous practices and has resulted in many injuries and deaths over the years.
Note 2: Might as well state this here, many ABA practitioners do not have much experience or training before beginning. I've heard many characterize them as "kids out of high school", but there are of course ABA practitioners of all ages.
Respect for Autonomy
Respect for Autonomy is a principle of bioethics concerned with the wishes of the patient. It includes things like "informed consent".
Many anti-autism organizations recommend that ABA is started as early as possible, with children regularly starting by age 3 and receiving the torture for 20 to 60 hours a week. These anti-autism groups focus their influence and money on "early detection" so that more children can receive the torture.
I believe at least part of this position of theirs is because if enough children are identified as autistic and show progress without the torture, it will help prove they are lying about its effectiveness and its necessity. This is also one reason why it's so important for them to deny late-diagnosed autistic persons or self-diagnosed autistic persons are autistic. If it was possible without the torture, then what did they torture their child for? It is part of the sunk-cost denial/rationalization of reality.
Back to the child starting ABA. No two- or three-year-old child is going to be able to give informed consent at that point, but they can communicate to their parents and the torturer that they are hurt and upset. The parents are thus taught to ignore the complaints of their children as part of the regular practice of ABA.
This is the regular practice, mind you; this is not even considering the ABA practitioners going "above and beyond" the regular practice and who take advantage of the parents being taught to ignore the complaints of their child. I do not think it is outrageous to consider these irregular (I hope they're irregular) practitioners who commit even more heinous acts than the vanilla-flavored torture if the regular practice of ABA empowers and enables them.
Even parents cannot give informed consent for ABA though. ABA practitioners and many (I hope, unknowing) doctors present a distorted view of autism. They are told that ABA is the only way for their child to make any sort of progress and to have any sort of hope of independence and support. ABA is the only way to get their child back. They ignore the fact that the child is growing and learning and advancing in age. The children who effectively mask enough to stop the torture and be recognized as "indistinguishable from their peers" are the ones who are cited as successes, while ignoring the many, many children who do not improve or even regress under the torture.
"Oh, they learned to read and write while they also engaged in five years of forty-hour-per-week sessions of emotional abuse and manipulation? Torture works!"
Parents are taught that their instincts to help and nurture their child are wrong and should not be engaged in.
It gets worse.
Parents can be forced to put their children into ABA programs. Campaigning to save their children from the torture is viewed as being akin to being anti-science. If they are loud enough but unsuccessful, it can also turn into the parent being investigated if they should even be allowed to have custody of their children. This is especially likely for parents who are themselves autistic, which is not uncommon. Autism is genetic. It is even more common for parents who are marginalized in other ways, such as being a person of color or having a low-income.
The entire point of ABA is to violate the autonomy of the child while maintaining the wool over the eyes of their parents. The point of ABA is the brainwashing.
The point is to make the autistic child stop doing what they want and to do what adults around them want.
And yes, this means that they are conditioned to say "yes" to other people. And yes, that has the consequences you think it does.
What is ABA even "treating"? What is the danger ABA is supposedly saving autistic children from? What is the life-saving "necessity" that makes this "worth it"?
Nonmaleficence
"First, do no harm."
I mean, that's pretty clear, right? Do I need to go on?
Well, I will anyway.
First, the ABAers are going to argue that ABA is the only method of "helping" the child. That, even if you agree that it is doing all this evil, it is a "necessary" evil.
Well, ABA sure as fuck is not necessary.
Many defenders will talk about self-injurious behaviors (or SIBs) at this point, like that is the thing that justifies the sort of torture ABA is.
First, please know that you cannot just safely restrain a child if you are untrained in how to do so. Recently, a very bad movie I'm not going to refer to by name demonstrated the exact type of prone restraint that can kill during a meltdown of a child in the movie.
I am definitely not saying that SIBs should not be addressed. I'm also not saying you shouldn't have plans in place for them. I'm saying that SIBs do not justify ABA torture and it is disingenuous to say ABA stops SIBs. Even if that was the only thing ABA was used for, it's still not worth it.
We say "SIBs" and many of us think of the worst possible example, but SIBs also include things like biting your nails too short. Also, non-injurious behaviors get pathologized and treated the same way as injurious ones.
If you accept that ABA works (which there is not reliable evidence to believe—even though their defenders say there is—and there is plenty of evidence to not believe), then the evils that are being committed fall under what is called the "principle of double effect".
I turn to a University of Washington webpage (https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics) that has some guidelines for double effect cases which I will summarize and interpret here:
- What is the nature of the act? The action itself must not be intrinsically wrong; it must be a good or at least morally-neutral act.
- What is the intention of the practitioner/agent? The agent intends only the good effect, not the bad effect, even though the bad effect is foreseeable.
- What is the distinction between the means the agent takes and the effects of the means: The bad effect must not be the method the good effect comes about by.
- Proportionality between the good effect and the bad effect. The good effect must outweigh the bad effect.
The action taken is ABA torture, i.e., emotional abuse and manipulation at best, and frequently including physical abuse. The "effects" can be thought of as a few different ones: we can consider the emotional trauma or the long-term conditions reported from ABA survivors as one of the effects. This would be the one that ABAers would probably want us to consider as the "bad effect". But the intended effect is also bad, the external extinction of autistic behavior is both the intended effect and a bad effect.
If a behavior is injurious, then someone can make an argument that it is good to extinguish it. I won't concede that is good to extinguish it, but I'll concede that folks will argue that it is. There are some injurious behaviors of mine that I'd like to extinguish, like biting my nails for instance. I would not like to extinguish that so much as to undergo brainwashing, but sure, I would prefer if I did not do that.
Is it unfair of me to put that out as an injurious behavior? You may be thinking, "Obviously ABA isn't going to focus on something like that!"
That's not obvious. This is *the* "treatment" recommended for all autistic children. Every autistic child is recommended ABA torture. SIBs are not even a characteristic listed in the pathologizing hell that is the DSM for ASD (Autism Spectrum Disorder). So, any pro-ABA argument that hangs on SIBs being the justification for ABA is a flawed one to begin with.
What about things like rocking, spinning, hand-flapping, and humming? Are we measuring "expected social stigma of acting like an autistic person" here as the thing we are treating? And is their argument that torture is the only way to make the expected social stigma better? Instead of, oh, I dunno', accepting autistic behaviors and autistic persons?
So these are the "effects" we're looking at:
- Long-term trauma
- Extinction of autistic and neurodivergent behaviors
- Presentation of allistic and neurotypical behaviors
I'm not going to grant the "presentation of neurotypical behaviors" as being "good" by default either. Many autistic and neurodivergent persons characterize being forced to present neurotypically—such as making eye contact—as being "physically painful".
ABA is repeatedly forcing autistic children to dip their hands into what feels to them like boiling water, not reacting, and pretending like everything is fine. It teaches children to not listen to their body and their senses. It teaches children that compliancy and obedience to adults is better than what they know feels wrong.
Let's talk about the guidelines again.
The "action itself must not be intrinsically wrong". The actions taken in ABA are intrinsically bad (emotional abuse and manipulation at best), so ABA fails the first guideline. On to the second.
The "agent intends only the good effect". What good effect? Not being perceived as autistic? That's not a good effect. Fails #2, how about the third one.
#3. The "bad effect must not be the method the good effect comes about by". The torture is the method, so fails that too. One of the "good" effects to the ABAer is the bad effect. The torture is the point.
With #4, "the good effect must outweigh the bad effect", folks can believe the "good effect" (which isn't necessarily a good effect) outweighs the harm they are doing, but that's not enough to argue they are not doing harm and by no means enough to argue that the harm is "necessary" in some way.
ABA is harm. That's its whole schtick. And that's the action taken, that's not the "unintended" effects of trauma and compliancy and removing any support from knowing one is autistic. The harm of losing your identity, of extinguishing your "undesirable" behaviors and presenting "desirable" ones, that's their "best-case scenario".
The worst cases are the ones where the "good" effect that was "intended" never comes to be and the child is injured or killed during "treatment".
"Teaching someone social skills" shouldn't result in their death during the lesson.
Beneficence
It is not proven that ABA "works" even in the definition of what the ABAers mean by that. What is clear is that it does not "work" for everyone. Also, by changing the external characteristics of a person through internal torture (or external torture and internal torture for those still using physical aversives), we know they are being traumatized.
It is fairly well-known now that one of the victims of the Feminine Boy Project ended up committing suicide. His sister has stated that in his journal he was scared of admitting what he liked and that the entire thing was just about external presentation. It's not different for autistic people.
Survivors of ABA were taught obedience and compliance and can have issues with establishing boundaries and autonomy.
Survivors can suffer from PTSD and deal with the mental weight of maintaining the shell of appearing "indistinguishable from their peers" or else.
Survivors can suffer from burnout and some do commit suicide.
What was the benefit?
For the cases held up as having "worked"—which again, is not all of them—why do this to them?
Was it that they appear "indistinguishable from their peers"? Was it so they do not know they are autistic and go through their life not understanding why they are different from everyone around them? Was it so they do not learn to self-regulate? So they do not build necessary supports and safety nets? Was it so that they face the world believing that life is just meant to be that difficult and they are weak for not being able to overcome it?
I do not consider that a benefit.
Justice
Equity of treatment is not happening. ABA suggests round-the-clock treatment or at least hours as long as an adult working day—which itself is too long, but that's another essay. ABA is presented as both the only treatment for autism and as the "cure" for autism.
Autism does not have a cure. Why would we ever think that torturing toddlers would be the cure?
The defenders citing the individuals who need the most help benefiting from ABA are both cherry-picking and confusing correlation with causation. Yet, if it was a help to those individuals and is justified for them (which I hope I have proven that by now it is not), then why is it prescribed to everyone?
The American medical system continues to allow ABA to not just exist, but elevates it to a pillar of disabled care which it does not deserve. Insurances will pay for torture, but not for parents to have help they need in order to spend more time with their children. Common co-occurring conditions with autism are lumped in with autism and are "treated" under ABA instead of getting separate diagnoses that might allow insurances to pay for treatment that does not involve deliberate neglect and abuse.
ABA is unethical.
ABA violates the four fundamental principles of bioethics. ABA is torture disguised as medicine.
Thank you for reading. Please consider supporting the author at ko-fi.com/zeroar
Further Reading
"How to Tell if an Autism ABA Therapy is Harmful" – Whenever I speak about ABA, I always include this very robust and helpful article from WikiHow to help determine if a therapy is abusive or not. Because of the insurance situation in America, many folks who want to help autistic children disguise their treatment as ABA in order to get it paid for. If a "therapy" is ABA, it's unethical, but there are cases where it's just called that:
https://www.wikihow.com/Tell-if-an-Autism-ABA-Therapy-Is-Harmful
"If Not ABA, Then What?" – You've made the decision to avoid ABA. Now what? This article has so many resources to explore. It is now five years old and some of the links are broken, but Google can help out for the ones that are broken and it's a good article overall. Easy to read, fairly comprehensive, and loads of information gathered for us to explore. Note: ThinkingAutismGuide.com is a safe website ran by an amazing advocate.
http://www.thinkingautismguide.com/2017/04/if-not-aba-then-what.html
"Why No Autistic Child Should Be in ABA Therapy" – Speaking of the Thinking Person's Guide to Autism website, Shannon Des Roches Rosa wrote this incredible article from the point-of-view of a parent of an autistic child. She is also the senior editor and co-founder of Thinking Person's Guide to Autism.
http://www.thinkingautismguide.com/2020/10/why-no-autistic-child-should-be-in-aba.html
"ABA is NOT Effective: So says the Latest Report from the Department of Defense" – A common line of argument from ABAers is that it is the "only evidence-based treatment for autism". The evidence-base is not particularly strong. The Department of Defense was spending over 300 million USD per year on ABA services and conducted the largest study ever on ABA effectiveness. This article from Therapist Neurodiversity Collective breaks down the study in an understandable way.
You can read the study itself in full here:
If you would like to hear from autistic persons who underwent ABA, you can find a collection of shared experiences and Twitter threads here:
"ABA Funding: Talking with investigative journalist John Summers" – This podcast episode came up the last time I spoke about the ethics of ABA to help explain the stranglehold ABA has over the autism industry. If you prefer an audio format and want to think about how we need to approach combatting ABA, this is a good place to start:
"At the Expense of Joy: Human Rights Violations Against Human Beings with Autism via Applied Behavioral Analysis" – An academic essay written by a Ph.D. social worker, survivor of ABA, and who lost a child to an ABA-related injury. It is worth the read.
https://trace.tennessee.edu/cgi/viewcontent.cgi?article=1105&context=catalyst
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