Filthy American Here - Why I am leaving ABA therapy Part 2

Jacob here again, story time is over and it's time to talk about where I am, how I'm currently feeling about this job, and why I'm leaving. Over in the UK, where the main author of this blog is from, ABA is banned as a form of child abuse. When I learned I was getting this job and excitedly told my friend I'd be helping autistic kids, I was stunned to find out he wasn't excited about me. After learning how the UK classified it, I looked deep into this for a bit. I needed to make money, but I wasn't going to participate in child abuse. I had 6 weeks of paid training, so I decided to keep researching, keep learning and see what happened. 

The Controversy Surrounding ABA Therapy

Many of the issues leading to the banning in the UK seem to stem from the idea of trying to 'convert' the patient. ABA was aiming to make the patient 'normal' instead of helping them. As we talked in the last post, you can't 'fix' neuro-divergence. It can't just be treated away, whether you're on team superpower or team disability. It's a part of you, it's how you think. 

Trying to 'convert' these kids ended up leaving them with trauma as adults. They had been told what they were doing was unacceptable, the feelings they felt weren't 'normal' and needed to be gone so they could be part of modern society. This worried me as my son had also been recommended ABA therapy to help. 

Discrete Trial Training: An Overview

During training, there was a lot of talk of DTT, discrete trial training, which is simply a system of testing their knowledge or actions with repeating stimuli (requests) recording progress and allowing preferred rewards. This made me a bit nervous, but most of what we had as examples was simply academic things. Vocabulary, identifying colors, social responses. It was basically me being a tutor to a kid who learned differently and needed more frequent stimulation and rewards. 

Then there was NET, a natural environment, which is pretty much all social stuff. I am at the kid's house, watching how they interact. I make sure they know coping skills when they get frustrated, keep them from hurting themselves (if the kid has self-harming behaviour) and I run them through some simple questions to make sure they can communicate well. Things like knowing left and right, up and down, back and front. Also knowing the names of jobs like cashier and teacher. Basically, I'm ensuring they have the vocabulary and communication skills needed in society. This feels a bit like making them 'normal', but also I can see why this is needed. 

The Importance of Communication Skills for Patients

My patient has a lot of feelings and being able to communicate what's happening and how he's feeling with good language skills will help him avoid frustration turning into a tantrum. My patient does have self-hitting behaviour when he hits a certain point of frustration, and I hold his wrists, not hard but firm. This one feels the worst. At the same time, I have seen my son pull his ear or hair and I have stopped him as a parent. While it feels wrong to restrict someone who is not fully in control at times, letting them hurt themselves does not do any good. 

My Personal Experience with ABA Therapy

Overall I think a lot of the larger concerns with ABA therapy are no longer in practice, at least not in the work I've done. I don't think what I'm doing is child abuse or causing any trauma later. But I also don't think it's doing any good. I feel less like a therapist and more like a babysitter who gives pop quizzes every hour. I feel like my biggest contribution is not to the patient but to the parent who otherwise would struggle to get household tasks done while handling the concerns of their child. 

Despite not feeling like I'm doing harm, the AMA (American Medical Association) recently removed verbiage that specifically mentioned ABA therapy. They have not removed it from accepted practices or stopped approving it on insurance, but they have made the verbiage more general to include all forms of therapy. While they haven't solidly stood against it, they are moving towards not relying on it and given the UK stance on it, I imagine the intent is to slowly phase it out as they bring in other more beneficial types of support. 

Why ABA Therapy Banned?

Overall I think the harmful practices that got ABA banned in the UK are largely out of practice. But despite the scientific studies showing modern ABA as the most evidence-based helpful therapy, I don't see it providing the benefits everyone claims. Some of the techniques used for the Natural Environment Training could be useful, but I believe they would be better implemented by a parent. 

Easier said than done of course, and not every parent can be a professional therapist on top of everything else. I think having a third party come in and keep them in another room for a few hours to run pop quizzes and push them to basically have school outside of school might leave them feeling disconnected from their family and as if they are the problem to be solved. I don't have a good solution for that, and there is no doubt kids like my patient need some form of support, but I'm not convinced what I'm doing is the best. 

Conclusion

However, I think at the end of the day, the success will depend greatly on the therapist and the needs of the kid. A kid with decent communication and a really great therapist who can communicate structures to the supporting family as well, they might really show a lot of success from some of the techniques. I might just not be good enough at this. Either way, I am currently searching for other jobs that I can transition to.

For some more info, 

https://childmind.org/article/controversy-around-applied-behavior-analysis/

With love and insanity equally,

J.M.