ABA Therapy: 4 Myths & Truths

You’re listening to the Turn Autism Around podcast. I’m your host, Dr. Mary Barbera, and today is a solo show with just me talking about applied behavior analysis, or ABA therapy—what it is, whether it’s just for kids with autism, and the myths and truths about ABA therapy, at least from my perspective. So, let’s get to this important episode.

Thanks for listening to another episode. Over the years—but especially recently—I’ve been seeing so much online that just isn’t true about ABA. There are a lot of questions, namely: What is ABA? Does my child need ABA? Is it just for kids with autism? Is it just for kids with severe autism? Is it costly? Is it a bad thing? Is it always a good thing? There are all of these concerns and controversies about ABA, especially as it relates to ABA as a treatment for autism. So today I’m covering the question: What is ABA? And I’m discussing four myths about ABA.

So let’s get to myth number one, which I think is pretty prevalent out there: ABA was created for kids with autism.

That is not true. Here’s the truth. ABA stands for applied behavior analysis, and behaviorism—which came before the term applied behavior analysis was coined—was a split off from the field of psychology back in the early to mid-1900s, when psychology was very cognitive and Freudian in its orientation. Behaviorism emerged during that time through the work of Watson and B.F. Skinner, among others.

So behaviorism, and later applied behavior analysis, was and is based on experimental research with animals in labs, as well as with humans. All of the experimentation centered around how animals and humans learn and how they respond to reinforcement. The term applied behavior analysis and the field of using ABA principles with humans started in 1968 with the publication of the Journal of Applied Behavior Analysis, which is still the most prominent journal in our field.

ABA—applied behavior analysis—is the science of changing socially significant or important behaviors. Just like gravity, if a behavior is reinforced, whether you reinforce it intentionally or it is reinforced automatically, it will maintain or increase. So ABA, as I said, was coined in 1968 and stems from the research and behaviorism that split off from psychology. But while all of that developed in the early to mid-1900s, in the 1970s and 1980s psychologists and researchers began using the body of animal research, Skinner’s analysis of verbal behavior, and his other books and papers on behavioral psychology to develop procedures for helping kids with developmental disabilities.

Many of these kids in the 1970s and 1980s were in psychiatric wards and institutions. That was also a period where not-great treatment, medically speaking, was being done in psych units, and there was a real push to deinstitutionalize children and adults from those institutions. So it was back in the 70s and 80s that ABA was really being used to help kids who were previously institutionalized begin to prosper outside of institutions.

As I said, ABA is the science of changing behavior, with ABA principles operating every day all around us. We get paid to do work. We get a speeding ticket if we go too fast. We get a thumbs up on Facebook or a five-star review on Apple Podcasts if you like this podcast—hint hint. We get reinforcement all around us every single day in everything we do. So the science of ABA is like the science of physics: if you reinforce a behavior, it will go up, and if the behavior is not reinforced, it will most likely go down.

In addition to being a science, ABA is also used as a term to describe treatment packages for kids with autism because of the work beginning in the 1970s. And this is where the controversy comes in. As I said, this was a really rough time for psychology and applied behavior analysis because it was being used to help kids who were previously in institutions. Even the medical field back then—and I’m a registered nurse who trained in the 1980s, and I was doing clinical rotations in psychiatric wards—the medical care and behavioral care within institutions was very variable, if you will.

Then, in 1987, Dr. Ivar Lovaas from UCLA published a classic study using 59 children with autism in California. Nineteen of those 59 children received very intensive, 40-hour-a-week ABA services. Almost half of them—eight out of the nineteen in that small experimental group—became indistinguishable from their peers by first grade. This study does have many flaws. Lovaas is given credit for a lot of that work, but there were other researchers involved as well, along with other studies, and this was part of a broader movement toward deinstitutionalization.

Some of the early Lovaas studies, and other studies from that time, did include punishment and things that right now—and for the past couple of decades—would be deemed unethical by most people. But the Lovaas study was credited as the classic study that really changed the world of ABA and brought ABA services to the forefront of parents’ minds.

Out of those nineteen children, as I said, eight became indistinguishable from their peers by first grade. That study was followed by a very important book in 1993. Katherine Maurice, a parent of two children on the autism spectrum, wrote a book called Let Me Hear Your Voice. Based on the Lovaas study, this book opened the floodgates to ABA for young children with autism and helped create the need for behavior analyst certification, which became a national certification around the year 2000, give or take.

I became a board-certified behavior analyst in 2003, and this was before Facebook and before Google searches. Up until after I became a BCBA, I didn’t realize that ABA was controversial. Back in the late 1990s, when Lucas started showing signs and was diagnosed, everybody told me to get Katherine Maurice’s book and that my best chances for the best outcome for Lucas were to use applied behavior analysis.

There have now been several hundred studies on the benefits of ABA for kids with autism, and ABA is still considered the most evidence-based treatment, even listed as such by the U.S. Surgeon General back in 1999. With major advocacy groups such as Autism Speaks, and efforts from autism parents such as Lori Unumb—an attorney who has traveled the United States advocating for insurance companies to be mandated to pay for ABA—we now have much broader access. I did a podcast interview with Lori Unumb, and we can post that in the show notes.

As of 2021, all 50 states in the United States do have laws mandating ABA coverage by insurance companies, although there are some exceptions. For instance, if you are in a self-funded system—my husband’s hospital system, for example—they still do not have to provide ABA therapy. If you work for an employer with a small number of people, they also may not have to cover ABA. And there can still be wait lists and expensive co-pays. So it’s not foolproof—you do not just get a diagnosis and have ABA handed to you on a plate.

There are also some people, especially adults with high-functioning autism who are conversational and very eloquent writers on social media, who do not like ABA. They are anti-ABA. They view autism as a gift and believe that children and adults with autism are not disabled, just different and unique. They feel that ABA is used to try to control a child or change them into something they are not.

They are also concerned that the early research focused on punishment with animals and humans. And just like medical research, some of the early behavioral research, as I said, was not ethical. But it has evolved—just like medical research has evolved—into something highly ethical, with research standards in place around the world. We have evolved. There are also many varieties of treatment packages, and all of the creators and practitioners of these different packages may describe themselves as doing “ABA,” but ABA approaches can really differ and can look very different.

I consider my ABA approach to be very different than many others. With the Turn Autism Around approach, I use the science of ABA first and foremost. I am a board-certified behavior analyst with a doctorate, so I definitely use the science of ABA as the umbrella and overarching theme for everything I do. I also utilize B.F. Skinner’s work on the analysis of verbal behavior. Skinner wrote a book in 1957 called Verbal Behavior, and I use the science of ABA and Skinner’s analysis of verbal behavior to make sure that all language is taught as naturally as possible.

I also utilize the four steps of my Turn Autism Around approach, which is child-friendly and positive, and based on my decades as a mom to two sons: one son, Lucas, with severe autism, who just turned 25 years of age, and another son, Spencer, who is in medical school. Spencer is featured on one of our fan-favorite podcast episodes, episode number 85, which we can link in the show notes. Spencer’s interview is all about being the sibling of a child with autism.

My approach is also based on the fact that I’ve been an RN since the mid-1980s and, as I said, a BCBA with a PhD. The other methods out there are also based on the science of ABA, but I think because I have a unique background as a mom, a medical professional, and a behavioral professional, I can really see many different sides of this. And now my approach is out there and available.

So myth number one is that ABA was created for children with autism. And hopefully now you know the truth: ABA is a science, and it was not created for kids with autism. It kind of emerged as a treatment package for kids with autism, but its roots go back to the early 1900s.

Okay, myth number two is: ABA doesn’t always work.

I’m here to tell you the truth: the science of ABA is always working. All of our behavior is occurring because it is being reinforced. All forms of teaching—speech therapy, occupational therapy, and parenting—operate under the umbrella of the science of ABA.

If I were teaching in a lecture and you were there live, and I said, “Raise your hand if you have a red shirt on,” or “Raise your hand if you want a prize,” and you raised your hand and I gave you a prize or said, “Good job raising your hand,” that is all ABA. I am giving a direction, you are following it, and I am giving you some kind of reinforcement, whether that is a prize or just praise.

We also do many things because we are reinforced internally or through long-term consequences. The fact that I am sitting down to record this podcast is not because I’m thinking, “Oh goody, I get to spend hours creating the podcast and recording it and putting it through our podcast production process.” But it is my goal, my mission, to get this information out into the world. I run a completely online business now. I have employees and contractors, and all of you listening—that is my work. So it is reinforcing to get this done and to get it out there into the world.

As you can see, everything is operating around the science of ABA, whether you like it or believe in it or not. I once heard a really good analogy from Dr. David Palmer during a lecture. He compared ABA to gravity. He said that if you are in a room with a fan—or multiple fans—going, and you have a feather flying around the room, it doesn’t drop. It kind of looks like gravity is not working because the fans are making the feather float in the air longer than it should. That is a variable at play.

But if you had a closed room with no fan, the feather would fall. Gravity would work. So if you have multiple people inadvertently reinforcing a problem behavior, or you are a BCBA in a clinic, or you are a busy mom of three and have a child in an ABA program at home, but you are also trying to work on talking, reducing tantrums, sleep, picky eating, and life is happening, and siblings are running into the room and things are constantly going on—it is like the fan and the feather. It is not your fault, but those variables are at play, making it seem like ABA is not working.

The principles of reinforcement, shaping, chaining, and extinction are all ABA principles, and they are all working. Like gravity, they will always work. Sometimes the variables make it look like it’s not working. So the science of ABA, just like gravity, will always work.

But in addition to ABA being a science, ABA is also the term, as I said, for treatment packages for kids with autism. And I will agree that some treatment packages for children with autism do not always work well and do not always lead to the best outcomes. Kelsey, for instance, is our community manager within our online courses and community. She was featured on a recent episode with behavior analyst Amy Evans, and we can link that in the show notes. Kelsey was also featured in podcast number three, mbarbera.com/3, and we can link that as well.

Kelsey is a good example of an ABA program that wasn’t working. I also talk about Kelsey in my new book, Turn Autism Around. Kelsey is a single mom of two boys. They both have a diagnosis of autism, and she lives in Canada. Years ago, when her firstborn son, Brenley, was two and a half, she moved back to Canada. When he was two and was diagnosed, Kelsey had a friend who was a behavior analyst, and she told Kelsey the importance of getting ABA started as soon as possible.

So Kelsey moved back to Canada and started ABA therapy when Brenley was around two or two and a half. But Kelsey was driving an hour each way to an ABA clinic where a BCBA was programming for Brenley. Brenley was crying, running out the front door of the clinic, and running three blocks into the street. He was also banging his head on hard surfaces up to 100 times a day. Kelsey had to keep him in a harness, backpack, or on a leash when she was out in the community with her two-year-old and her baby, Lincoln.

The ABA staff at the clinic were trying to work on skills that were too hard for Brenley, like identifying colors, when the first order of business should have been reducing those unsafe behaviors and also looking at Brenley’s ability to mand, or request, which was lacking. ABA that is not utilizing a child-friendly and positive approach continues to give ABA a bad name.

These are not malicious professionals trying to cause harm. They are working on the wrong skills and behaviors, in the wrong order, and not being open to parent and professional feedback. There are, as many of you listening know, different “flavors” or types of ABA programming. My approach is very child-friendly. It is focused completely on positive reinforcement. It helps a child increase talking, decrease tantrums, and reach his or her fullest potential—to be as safe as possible, as independent as possible, and as happy as possible.

So hopefully we have dispelled the myth that ABA doesn’t always work. The science always works. And if ABA is not working, or any kind of therapy is not working, it is not because the science isn’t working. It is because people are not working on the right skills in the right order.

Okay, myth number three: ABA is only for children with severe autism and needs to be done in a clinic, center, or special school.

I hear things online like, “We left ABA and he’s back in public school. He got ABA when he was little. Now they say he needs to work on more functional life skills. He’s too high-functioning for ABA.” The truth is that the science of ABA, as I’ve said a few times already, is operating all the time. Even if you do not believe in it or like ABA, it works for all of us. It works for me as a typical adult. It works for my son, who is now 25 years of age with moderate to severe autism.

Let’s talk about Lucas for a little bit. Lucas went to typical preschool and public school from the time he was two until he was 21, with the exception of one and a half years—for half of kindergarten and all of first grade. During that half year of kindergarten and first grade, he was bused an hour each way to an ABA school for children with autism.

Once I learned how to provide ABA in public school classrooms—and I became a behavior analyst right around the time Lucas was in first grade—and once I began working with the Pennsylvania Verbal Behavior Project, we brought Lucas back to our home school district and he began public school again. But that does not mean we stopped ABA.

In fact, Lucas received ABA his whole life and still learns new skills with an ABA focus. He learns language skills, self-care skills, vocational tasks, and chores. He learned how to ride a bike, tie his shoes, shower independently, dress independently, do the wash, and fold the wash. We also used ABA principles and a BCBA for many, many years, and still do in some capacity today. In addition to using ABA to teach all of those skills, we also used ABA principles to keep his major problem behaviors—like self-injurious behavior and aggression—at or near zero, while increasing all of his pro-social or “good” behaviors.

I also believe, as a registered nurse and a behavior analyst, that there are medical issues getting in the way of many of our children’s and clients’ lives. I did one of my favorite podcasts of all time with Dr. Michael Murray on podcast number 28, and we can link that in the show notes. So if you think you have ruled out medical issues, or the family thinks they have ruled them out, and you are just treating things behaviorally and not making progress, there could be significant medical issues involved.

Also, if you are wondering where ABA can be done, or whether home ABA is better than school ABA or vice versa, you’ll want to check out my video blog on home versus school ABA and what to look for when you’re looking for a good placement for your child. We can link that in the show notes as well. ABA does not have to be done at a center or a school. It’s not just for kids with severe autism. It’s for everybody.

And our final myth, myth number four, is: ABA is expensive and only professionals such as BCBAs with extensive education and experience can put an ABA program in place.

This definitely was true back in 1999 when Lucas was diagnosed with autism and needed intensive ABA programming. Luckily, in my state, even two decades ago, ABA was provided via medical assistance, which Lucas qualified for based on his disability, regardless of family income. And as I said, now all 50 states do have laws requiring insurance coverage for ABA in most situations.

However, there are still lots of you out there who do not have access to quality ABA. You may be living around the world, or in the United States, and the ABA you do have access to is not producing great outcomes. Here is the good news: with my online courses and my brand new book, Turn Autism Around, I believe that any highly motivated parent or professional can start or revise an ABA program for toddlers with signs of autism or older children with moderate to severe autism.

The four steps of the Turn Autism Around approach—which I did a podcast on for each step, and we can link those in the show notes—are assessment, planning, teaching, and evaluating using easy data. I also believe that any BCBA can learn the Turn Autism Around approach and make their ABA programs better.

There is a lot of need, as daily I get messages, emails, and comments asking, “Where can I find a professional, a school, or a program that uses Mary’s approach?” Right now it’s very difficult, but I’m hoping in the coming years that this becomes more and more common: a very child-friendly, positive approach that involves the parent as the captain of the ship and really looks at the whole child and the whole family to make the most progress.

You can sign up for free book resources, read chapter one, and get all the forms at turnautismaround.com. So read my new book and consider buying books for your team or for parents. You might even be able to get a grant—I’ve known a few people who have already done that. You can also attend a free online workshop to learn more about joining my online courses and community, either before or after you read the book. Joining the online course and community will provide a lot of videos and a lot of support to get you from step A to step B, whether you’re a parent or a professional.

So here is a summary of what I’ve covered on this podcast. ABA is a science, like gravity. It is always working. ABA treatment packages can vary, and we want all ABA programs—for toddlers with signs of autism through adults with severe autism—to be positive, to use a verbal behavior approach, and ideally to also use the four-step Turn Autism Around approach. Manding should be at the center, and focusing on the parent as the captain of the ship—with lots of coordination between home, school, and community—is really key.

Any highly motivated parent or professional can learn how to start or revise an ABA program and put the four steps of the Turn Autism Around approach in place. As I said, you can get all the details about my book, including free book resources, at turnautismaround.com.

Hopefully I’ve answered the question, What is ABA? and addressed the four myths that I could think of. I hope you’ve enjoyed this session, and I will see you right here next week.