ABA: An effective therapy for many autistic children in Ontario

Jaime Santana is President-Elect of the Ontario Association for Behaviour Analysis; ONTABA is the largest Canadian not-for-profit professional organization representing behaviour analysis.

Who decides what is normal?

Certainly not ABA practitioners! ABA, or applied behavioural analysis, is not meant to impose societal norms on children or adults with autism, as a recent article in The Pointer suggests. We all need to remember that autistic people fall on a spectrum and ABA therapy may not be appropriate for everyone. And that’s okay.

ONTABA is also committed to open dialogue with all stakeholders in the autistic community on finding ways to continually improve the quality of care we deliver as the science behind behavioural analysis evolves. We will always stand in support of anyone who has been victimized by the inappropriate use of ABA.

We do know ABA therapy significantly improves the lives of people who have complex and significant needs. For example, ABA can help teach someone how to use the bathroom or dress themselves. ABA helps individuals in our care live their best lives. It empowers the individual and, in many cases, the families we’re helping. ABA is the teaching of everyday life skills through practice, encouragement, and positive reinforcement.

The critical point is that people with autism fall on a spectrum with varying abilities to effectively communicate their wants and needs. When thinking of the significant challenges that some individuals with autism may face you have to imagine a child who struggles to ask for food or says “I love you” to their parent for the first time, perhaps not until they are in kindergarten or well into grade school. ABA therapy has helped make this happen for many autistic children. ABA has enabled countless children, youth, and adults with autism to lead a fulfilling life.

We know people may have received some awful services because there was no regulation in Ontario. Now with regulation coming into place, we’re in a better position to protect the public, to field complaints and to make sure that it doesn’t happen again to other people. Behaviour analysts will now be regulated by the renamed College of Psychologists and Behaviour Analysts of Ontario.

Historically, behaviour analysts have been at the forefront in speaking out against the abuse, institutionalization, and inappropriate labelling of people in need of behavioural support. In the 1960s and 1970s behaviour analysts led the charge in demonstrating the true potential of individuals with immense skill deficits, such as those diagnosed with autism, to learn life-changing skills. ABA therapy is of the most benefit to people with significant skill deficits and not an intervention mandated for everyone on the spectrum.

The Ontario Association for Behaviour Analysis (ONTABA) is the largest Canadian not-for-profit professional organization representing behaviour analysis. Our members are educators, students, researchers, and service providers; all committed to the individuals in our care. We do not agree with The Pointer article’s comparison of ABA therapy to “dog training”. This was an insensitive and inappropriate characterization, in my opinion.

It’s through the application of principles stemming from behaviourism that we have helped governments and everyday people realize that all individuals can learn life-changing skills. Our efforts have allowed children with significant needs, some of whom may have been once under-estimated and possibly institutionalized in the past, to live fulfilling lives within everyday communities and within their family homes.

Many parents of autistic children in Ontario are crying out for more ABA therapy. The Pointer article suggests that it’s being forced onto parents because it’s “baked” into the system. I do not agree with this but if more needs to be done to ensure parents are aware of all options, ONTABA strives to learn from the lived experience of autistic individuals and their family members to do better.

It’s important to understand the needs of parents with children with significant and complex needs on the spectrum. These children may not be able to articulate their needs, struggle with self-care whether it’s using the bathroom, feeding themselves, or getting dressed. Those are some examples of the individuals that are in need of therapy. Their parents have a right to access therapy that works for them just like they would for other forms of therapy in their lives, such as counseling and speech language therapy. Parents have to be the voice for those children who don’t have one yet. We sometimes don’t truly hear from parents who have seen how ABA therapy has opened the world to their kids, not even from the ones who had their reservations initially.

Huge strides have been made to evolve ABA, to ensure the therapy is responsive to the needs of the individual with autism. This must continue to improve.

Leah Kocmarek wanted her son Owen to be able to learn to say ‘no’ – to be able to say ‘stop’. Leah wanted this for Owen to help him advocate for himself. “With respect to ABA therapy, we had heard the horror stories about kids being coerced to stop all stims and vocalizations or forced to make eye contact with people,” says Leah. “That’s never happened in our experience. It’s mischaracterizing ABA and providers as a whole. If someone constantly says ABA is abusive (The Pointer article did not include such a claim), it’s not true,” she says.

“The ABA of today is not the same as yesterday.” Michelle Amato is a former obstetrical nurse, who turned to ABA therapy because her son Noah wasn’t speaking at all by the age of two. Despite being in healthcare, she did not know a lot about the therapy.

“They took their time with us explaining their methodology and what ABA is,” says Michelle. “Realizing it was evidence-based, we were excited to work with this team. Within three weeks, we saw progress that we couldn’t even imagine. It happened so quickly. His number of words increased. His recognition and response to things also improved. He wanted to communicate with us. It was no longer parallel play anymore. He wanted to interact with others.”

Alina Cameron is an epidemiologist and was drawn to ABA therapy because of its scientific approach. And, full disclosure, Alina sits on the board of the Ontario Autism Coalition (OAC).

“ABA has a solid scientific basis that is growing exponentially right now,” says Alina. “While it may not be right for every child who is autistic, it’s right for Fiona. ABA is teaching her life-saving skills. When you’re teaching kids not to run into traffic or you’re teaching a kid to eat from all the food groups, you’re teaching them essential skills. “I wasted a lot of time going down rabbit holes questioning whether or not we should do ABA because I saw a bunch of frightening dialogue online that was not based in science. It was anecdotal and I hesitated when I should have trusted the science from the beginning.”

In my opinion The Pointer article, while highlighting the lived experience of some on the autism spectrum who don’t believe ABA was beneficial (even causing negative outcomes) it comes across as widely critical of ABA therapy, with scant information of all the benefits. Even if the focus of the article is on individuals raising reasonable questions which should be addressed, for those on the spectrum who clearly benefit from ABA, the piece did not highlight the profound benefits. It gives a disproportionate amount of space quoting people opposed to much of our work. The article also cites a study I do not agree with, presenting what I believe are scientifically inconsistent claims.

I also strongly disagree with the comparison of ABA to the abhorrent idea of gay conversion practices. It’s unfortunate that the article included this highly problematic comparison with little effort to differentiate between ABA therapy and gay conversion, which is not grounded in any of the scientific or, more importantly, humane considerations of the work we do.

ABA therapy is based in science and like most fields of healthcare, is always evolving. ABA therapy is a sought-after therapy for autistic children in Ontario for two important reasons: because it is tailored to individual needs and because we know from outcomes that it has incredibly beneficial effects on many individuals whose lives are changed for the better. Individual success and goals are developed based on what matters to the child and their family. Meaningful outcomes are defined by them.

Beyond being a therapy for autism, ABA is also used to support a range of populations and conditions like dementia, intellectual and developmental disabilities, acquired brain injury, psychological and psychiatric disorders, education, health and wellness, athletic performance, and organizational behaviour management.

When it comes to ABA, we encourage people looking for our services to receive them from qualified practitioners. ABA can be very harmful if it’s not done properly. Proper training is required. People should only work with practitioners who are supervised by Board Certified Behaviour Analysts who have expertise in autism.

Articles that raise legitimate questions to help us continue to improve our understanding of how ABA therapy should be used, and when it should not be used, are always welcome. But, in turn, articles that may hinder parents from seeking out ABA therapy that could possibly greatly benefit their children, do a disservice to those families. Unfortunately, articles get amplified on social media channels where they are skewed and can spiral into personal attacks. This is not constructive for anyone.

Let’s rise above, seek common ground, continue to improve and reject efforts to divide.

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