ABA Therapy: 4 Myths & Truths

Transcript for Podcast Episode: 132

ABA Therapy: 4 Myths and Truths

Hosted by: Dr. Mary Barbera

You're listening to the turn autism around podcast, episode number 132. I'm your host, Dr. Mary Barbera. And today is a solo show with just me talking about applied behavior analysis, ABA therapy. What it is, is it just for kids with autism? And I'm going to be talking about the myths. At least from my perspective about ABA therapy.

What is ABA?

So let's get to this important emphasis. Thanks for listening to another episode. Um, I have been seeing so much online over the years, but really recently I've been seeing questions and I'm seeing things that just aren't true about ABA out there. There's a lot of questions, namely, what is it? 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? And so there's all 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 it? What is ABA? And I'm discussing four myths, um, about ABA. So let's get to myth.

Myth 1: ABA Was Created for Kids with Autism:

Number one, which I think is pretty prevalent out there. And it is ABA was created for kids with autism. So that is indeed not true. Here's the truth. ABA stands for applied behavior analysis and behavior is, um, which was, uh, happened before the term applied behavior analysis was coined.

So behaviorism was a split off from the field of psychology back in the time in the early 19 hundreds to mid-19 hundreds, when psychology was very cognitive. Cognitive only really Freud in those sorts of, of theories and behaviorism emerged during the time with the work of, of Watson and BF Skinner among others.

So behaviorism and applied behavior analysis. And is based on the experimental research with animals and in labs as well as with humans and all the experimentation happened around how animals.

And humans learned and how they responded to reinforcement the term applied behavior analysis and the field of using ABA principles with humans started in 1968 with the, um, publication of the journal of applied behavior analysis, which is still the most prevalent, prominent journal in our field.

So ABA applied behavior now is the science of changing socially significant or important behaviors. So just like gravity, if you, if a behavior is reinforced, whether you reinforce it or its reinforced automatically, it will maintain or go up. So ABA, as I said, was coined in 1968 and stems off of the research.

And behaviorism as a split off from psychology. But in, um, that all happened in the early to mid-19 hundreds, but in 1970s and 1980s, psychologists and researchers used the body of animal resource research. They used Skinner's analysis of verbal behavior and his other books and papers on behavioral psychology and in the 1970s and eighties.

Uh, began to develop procedures for helping kids with developmental disabilities. And many of these kids back in the 1970s and eighties were in psychiatric wards and institutions. And that was also the period where, um, not great treatment. Medically was being done in psych units. Um, and there was a real push to de-institutionalize children and adults from these institutions.

So it was, um, back then in the seventies and eighties where, um, ABA was really being used to help kids. Who were previously institutionalized, um, begin to prosper outside of the institutions. So, as I said, ABA is the science of changing behavior. Um, 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 and we get a thumbs up on Facebook or a five-star review on apple podcasts. If you liked this podcast, hint, hint, um, but we, um, we get reinforcement. Um, all around us every single day, everything we do. So the science of ABA is like the science of physics. If you reinforce the behavior, it will go up.

And if the behavior is not reinforced, it will most likely go down. In addition to. Uh, science. ABA is also used as a term to describe treatment packages for kids with autism because of the night, the work beginning in the 1970s. And this is where the controversy I think comes in. So as I said, this was a really rough time for, for psychology.

Um, And applied behavior analysis because we were using it to help kids who were previously in institutions, even the medical field back then, I'm a registered nurse. And I was trained in the 1980s and, and the research, um, in the 1970s and eighties. And. I was doing clinical rotation sometimes. And in psychiatric wards, like the medical care and, and, um, the behavioral care within institutions was.

Very, it was very variable if you will. But in 1987, Dr. EBR, low boss from UCLA published a classic study using 59 children with autism in California and 19. These 59 children got very intensive 40 hour week ABA services, and almost half of them, eight out of the 19 of the small group who got the experimental treatment became indistinguishable from their peers.

By first grade. Um, this study does have many flaws. It, it, um, low boss is. Given credit for a lot of the work of that, but there were other researchers also involved with that and other studies, and this was really a movement towards deinstitutionalization, but some of the early Lova studies, um, And other studies early on did include, uh, punishment and things that right now, and over the past couple of decades, would we deemed unethical, um, by most people.

So, but yeah. The low bus study was credited for being the classic study that really changed, uh, the world of ABA and got ABA services into the forefront of people's minds, especially parents. So out of those, 19 kids, like I said, eight became indistinguishable from their peers by first grade. And this study was followed up by a very important book that I've mentioned a few times in the podcasts along the past couple of years, this important book was in 1993, Catherine Maurice, a parent of two children on the autism spectrum.

Um, wrote a book called, let me hear your voice. And then. Book based on the Lova study, opened the flood gates to ABA for young children with autism and created the need for, um, behavior analyst certification. And that became a national certification in around the year 2000. Give or take. So. I became a board certified behavior analyst in 2003.

And this is before Facebook and before Google searches. And so I really up until that point, um, up until after I became a board certified behavior analyst, um, I didn't realize that ABA was controversial. Um, back in the late 1990s, when Lucas was started showing signs and was diagnosed, um, everybody told me to get Catherine Maurice's book and that my best chances.

The best outcome for Lucas were to, uh, use applied behavior analysis. So there has now been, um, several hundred studies on the benefits of ABA for kids with autism. And ABA is still the most evidence-based treatment. Um, even listed as the most evidence-based treatment by the US surgeon general way back in 1990.

So with major advocacy groups, such as autism speaks and efforts from autism parents, such as Lori Unum, who, um, Is an attorney and she's traveled the United States, um, advocating for insurance companies to be mandated, to pay for ABA. And we did, I did a podcast interview with Laura Unum that I can post in the show notes.

But now as of 2021, all 50 states in the United States do mandate do have laws that mandate ABA coverage by insurance companies. Although, if you are like a self-funded system. For instance, my, the hospital system, where my husband is employed, they, um, still do not have to provide ABA therapy. So there are some exceptions.

If you work for an employer with a small number of people on board, you don't have to, um, cover ABA and there can also be wait-lists and expensive copays. So it's not. Uh, uh, Paul foolproof, you get a diagnosis and you get ABA handed to you on a plate. There are some people, especially adults with high-functioning autism who are conversational and, and very, um, eloquent writers on, on social media.

There are some people who do not like ABA. They are an IABA and they look okay. Had autism as a gift and believed that children and adults with autism are not disabled, just different. Yeah. And unique. And 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, just like the medical research.

Some of the early behavioral research, as I said, was not ethical, but it has evolved just like medical research to being very high. Ethical with research standards in place around the world. So we have evolved, um, and there is also are also very many varieties of treatment packages, uh, who all, all the, um, creators of these treatment packages and the people that, that put these procedures in place all.

Um, consider themselves doing quote unquote, ABA, but ABA approaches really differ and can look very different. So, and I consider my ABA approach to be very different than many others. Um, I, with the turn autism around approach use the science of ABA. First and foremost, I am a board certified behavior analyst at, with a doctorate.

Um, so I use the science of ABA, definitely as my umbrella, overarching theme for everything I do. I also utilize BF Skinner's book and work. Um, on the analysis of verbal behavior. So he wrote a book, a Skinner, wrote a book in 1957 called verbal behavior. And so I make use of all the science of ABA, BF Skinner's analysis of verbal behavior to make sure that all language which is taught is taught as naturally as possible.

And I also utilize the four steps of my turn autism around approach, which is child-friendly positive based off my decades as a mom to Tucson. One son Lucas with severe autism who just turned 25 years of age and another son who's in medical school. His name is Spencer and he is on one of the fan favorite podcast episodes, episode number 85, which we can link in the show notes.

And Spencer's interview is all about being a sibling of a child with autism. My approach is also based on the fact that I've been an RN. The mid 1980s. Um, as I said, a BCPA D with a, with a PhD. So. The, the other methods that are in place. Um, they are in place based off the science of ABA too. But I think because I have a very good, unique background as a mom, as a medical professional, as a behavioral professional, I can really see a lot of the different sides.

And, um, now my approach is out there a way. Okay. So myth number one is ABA is, was created for children with autism. And hopefully now, you know, the truth that ABA is a science and it wasn't created for kids with autism. It kind of emerged as a treatment package for kids with autism, but that, um, it was created it starting in the early 1900.

Myth 2: ABA Doesn't Always Work:

Okay, myth. Number two is ABA. Doesn't always work. So. I'm here to tell you the truth that the science of ABA is always working. Um, and all of our behavior that we do, we're doing it because it is being reinforced. All forms of teaching speech therapy, occupational therapy, and parenting are operating under that umbrella, that science of ABA, if I were teaching in a lecture and you were live and I said, okay, can you raise your hand?

And. Or raise your hand. If you have a red shirt on, or raise your hand, if you want a prize and you raise your hand, um, and I give you a prize or I say, good job, raising your hand. Um, that is all ABA. I am giving you a direction you're following it. Um, and I'm giving you some kind of reinforcement, whether that's a prize or just praise.

Um, we do a lot of things because we're reinforced. Internally or long-term reinforced the fact that I am sitting down to record this podcast is not like, oh, goody, I get to spend hours creating the podcast. And then, uh, Recording the podcast and putting it through our podcast production method. Um, but it is my goal, my mission to get this information out to the world.

I run a completely online business. Now I have employees and contractors and all of you listening, and that is my work. Um, and so it is reinforced. Uh, to get this done, to get this out there to the world. So as you can see, everything is operating around the science of ABA, whether you like it or believe in it or not.

I heard a really good analogy. Once when, when, um, Dr. David Palmer was doing a lecture and he said, you know, the whole, um, when people make the comment, ABA doesn't work. He gave a really good comparison that hopefully I won't mess up by, by restating it because it was a long time ago. Um, but he basically compared, um, ABA to gravity and said that if you are in a room and you've got a fan that's going, or multiple fans that are going and you have a feather flying around the room. It doesn't drop.

It kind of looks like gravity is not working because these fans are on making the feather float in the air longer than it should, which is a variable that's at play. And, but if you had a closed room with no fan, the feather will fall. Gravity will work. So if you have multiple people in an advertently reinforcing a problem behavior, and you, or you're a BCBA in a clinic, or you're a busy mom of three, and you have a child in an ABA program at home, but you have multiple things that you're working on.

Um, things like talking and reducing tantrums and you want to work on sleep and picky eating and, and life is happening and the siblings are running in the room and, and things are happening. It's like a fan and a feather. It's not your fault. But these variables that are at play, making it seem like ABA is not working the principles of reinforcement, shaping chaining extinction.

Are all ABA principles and they are all working and 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. But in addition to ABA being science ABA is also the term, as I said, for the treatment packages for kids with autism.

And I will agree that some treatment packages for children with autism don't always work well. Don't always lead to the best outcomes. Kelsey, for instance, is our community manager within our online courses and community. She was featured on, um, a recent episode with a behavior analyst, Amy Evans, and we can link that in the show notes.

And Kelsey was also featured in podcast, number three, Mary barbera.com forward slash three. And we can link that in the show notes as well, but Kelsey's a good example of that. Uh, of, uh, ABA program that wasn't working. Um, so she, I also talk about Kelsey, um, in my new book, turn autism around. Kelsey's a single mom of two boys.

They both have a diagnosis of autism and she lives in Canada. Back years ago when her first born son Brentley was two and a half, she moved back to Canada. And, um, when he was two and was diagnosed, uh, Kelsey had a friend, uh, who was a behavior analyst and she told Kelsey the importance of getting ABA going as soon as possible.

So Kelsey did move back to Canada and started ABA therapy, um, around two years. Two and a half years, something like that. But Kelsey was driving an hour each way, um, to an ABA clinic where a board certified behavior analyst was there, a programming for Brentley, but Bradley was crying. He was running out the front door of the clinic, running three blocks into the street. And, um, he was also banging his head on hard surfaces up to 100 times a day. And he was, um, she required him to either be in a harness, a backpack or on a leash. Um, when Kelsey 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 things that were too hard for Brentley.

Like colors, um, identifying colors when really your first point of business should always be to look at, um, reducing those unsafe behaviors, for sure, but also looking at Friendly's ability to Mand, which was lacking. So ABA, that's not utilizing a child-friendly and positive approach, um, continues to give ABA a bad thing.

These are not malicious professionals who are trying to cause any, any harm. They are working on the wrong skills and behaviors in the wrong order and not being open to parent and professional feedback. So, um, there are as many of you know, that are listening, different quote unquote flavors or types of ABA programming and my approach is very child-friendly, it's focused completely on positive reinforcement and helps a child increase talking decreased tantrums and reach his or her fullest potential, which is to be as safe, as possible, as independent as possible and as happy. As possible. So hopefully we have dispelled that 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's not because, um, the science isn't working it's because the people aren't working on the right skills in the right order. Okay.

Myth 3: ABA is Only for Children with Severe Autism and Needs to Be Done in a Clinic or Special School:

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 a lot 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 ABM. The truth is, is that the science of ABA, like I said, a few times already is operating all the time.

Even if you don't believe in it or the like ABA, it works for all of us. It works for me as a typical adult. It works for my son, um, who is now 25 years of age with moderate, severe autism. And let's talk about Lucas for a little bit, Luke. Um, went to typical preschool and to public school all of his years from the time he was two until he was 21 with the exception of one and a half years, for half a kindergarten and all of first grade, those a years, half a year of kindergarten.

And first grade he did go, he was busted an hour away each way to an ABA school for children with autism. Once I learned how to provide ABA in public school classrooms. I became a behavior analyst, right when Lucas was in, uh, first grade, I believe. And once I began working with the Pennsylvania verbal behavior project, we brought Lucas to our home, to our school district and he began, um, public school again.

But. That doesn't mean that we stopped ABA. In fact, Lucas got ABA his whole life and still learns all of his new skills with an ABA focus. He learns new language skills, self-care skills, vocational tasks, chores. He learned how to ride a bike, tie his shoes. He learned how to shower independently. He learned how to dress independently.

Do the wash, fold the wash. Um, we also used ABA principles and the eight board certified behavior analyst for many, many years. I'm still with him today in some capacity. But we, in addition to using ABA to teach him all those skills, we also used ABA principles to keep his major problem behaviors like self-injurious behavior and aggression at, or near zero.

And while we increased all of his, uh, pro-social or quote-unquote good behaviors, um, I also believe as a registered nurse and a behavior analyst, that there are medical issues that are getting in the way of many of our children in clients' lives. I did a really one of my very favorite podcasts of all time with Dr.

Michael Murray on podcast number 28. We can link that in the show notes. So if you think. You've ruled out medical issues or the family has ruled out medical issues and you're just treating things behaviorally and not making progress. Um, there could be significant medical issues involved and we can link that in the show.

Also, if you are wondering where ABA can be done, or if home ABA is better than school ABA or vice versa, um, you will 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. So ABA does not have to be done at a center at a school.

It's not just for, uh, kids who with severe autism it's for everybody.

Myth 4: ABA is Expensive and Only Professionals such as BCBAs with Extensive Education can put and ABA Program in Place:

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 the intensive ABA programming.

Luckily in my state back then 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, um, all 50 states do have laws requiring insurance coverage for ABA in most situations. However, there's lots of you out there that still don't have access to quality ABA.

Um, you're living around the world, you're living in the United States and the ABA that you do have access to is not producing great out outcome.

Turn Autism Around Approach and Resources to Access Quality ABA:

So here's 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, severe autism, the four steps to the turn autism around approach, which I did a podcast on each step.

We can link that in the show notes as well. The forest. Again, our assessment planning, teaching, and evaluating, using easy data. I also believe that NAB CBA can learn the turn autism around approach and make their ABA programs better. There's a lot. Of need as daily, I get messages, emails, and comments, where can I find a professional, a school or program that uses Mary's approach right now it's very difficult, but I'm hoping in the coming years, that that becomes more and more.

What we see a very child-friendly. Positive involving the parent as the captain of the ship to really look at the whole child and the whole family to make the most progress, you can sign up for a free book resources to read chapter one and have all the [email protected]. So read my new book and consider buying books for your team or parents.

You might be able to get a grant. I've known a few people that have done that already. You can attend a free online workshop to more, learn more about joining my online courses and communities. Um, before or after you read the book, joining the online course and community will provide. Um, 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.

And if you've already finished the turn autism around a book and you want to take a survey for a chance to win a prize. Go to Mary barbera.com forward slash book survey. And let me know your thoughts. I would love to read your feedback. So here's a summary of what I've covered on this podcast. ABA is a science like gravity.

It's always working ABA treatment packages can bear. 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 fourth step, turn autism around. Manding should be at the center and focus on the parent as the captain of the ship with, with lots of coordination between home school and community is really key.

Any highly motivated parent or pro can learn how to start or revise an ABA program and to put the four steps of the turn autism around approach in place. As I said, you can get all the details about my book. And including free book [email protected].

Hopefully I've answered the question. What is ABA? And I've addressed the four myths that I could think of. Um, and I hopefully you've enjoyed this session, so I will see you right here now next week.