Applied behavior analysis (ABA) therapy is a subject of controversy in the autism and autism community. Some said that they or their children were tortured. Others say the therapy is very beneficial. As a person who wants the best for your child, how can you tell the difference between a success story and a horror story? The signs are there if you know how to look. This article was written for parents of children with autism, but teens and adults with autism can also use it.
Note: This article discusses topics such as adherence and abuse therapy that may be somewhat distracting, especially for people with post-traumatic stress disorder due to ABA therapy. If you are not comfortable with this topic or its content, we recommend stopping reading.
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Method 1 of 3: Considering Therapy Goals
The goal of therapy should focus on helping the child acquire skills and live a happy and comfortable life. Suppressing autism symptoms is not a useful goal.
Step 1. Think about whether the goals of therapy involve accommodation or assimilation
The United Nations states that children with disabilities have the right to maintain their identity. This means that children can be themselves even though they are autistic. Good therapists allow children to be different, and therapy is not centered on eliminating characteristics such as the following:
- Stimming. You may often hear commands such as "hand still" and "hand on the table" indicating suppressed stimming.
- Tiptoe.
- Avoid eye contact
- Desire not to have many friends
- Other unique habits (associating should be a personal choice, not forced)
Step 2. Consider whether the therapist controls the child's emotions
Some therapists train autistic people to show facial expressions or body language that convey happiness regardless of how they really feel.
- No one should be forced to smile or be happy if they are not feeling happy.
- Hugs and kisses should not be practiced or suppressed even if it means hurting feelings. The right to set boundaries is important to equip children to fight sexual and emotional abuse.
Step 3. Consider whether the therapist resists or accommodates the child's brain
A bad therapist tries to keep the child from suffering from autism, while a good therapist works together so that the child can grow up to be a happy and capable autistic adult. Therapists should focus on making autistic people happy, not "cure." The goals of good therapy include:
- Finding a form of steaming that is comfortable and harmless, instead of eliminating it.
- Look for ways to accommodate and reduce sensory problems.
- Have social skills in a friendly environment, including assertiveness and making friends.
- Discuss and meet the child's personal goals.
Step 4. Evaluate whether learning to communicate is seen as an essential skill, or a performance to please adults
Communication should be considered more important than verbal language, including augmentative and alternative behavior and communication, or augmentative and alternative communication (AAC). Initial vocabulary should focus on basic needs, not parental feelings.
- Words like "yes", "no", "stop", "hungry" and "sick" are more important than "i love you" or "mama."
- Behavior must be respected even though the child is learning to communicate, either via AAC or speaking.
Method 2 of 3: Checking Therapy Sessions
A good therapist will treat your child well, no matter what. No one is too autistic or "too low functioning" to receive good treatment and respect.
Step 1. Consider whether the therapist assumes competence
A good therapist will always assume that the child is capable of listening (even if it appears unresponsive), and that the child is doing his or her best.
- Children who do not speak or speak little may have deeper thinking skills than their ability to communicate. His body may not always obey his will so he may not be able to point at what he really wants to point at.
- The therapist should pay attention to why the child does something, and never assume that his behavior is meaningless. The therapist should also not ignore what the child is trying to convey.
- Schoolwork created for 4 year olds is not suitable for 16 year olds.
Step 2. Evaluate whether therapy is teamwork, or whether the therapist is against the child
Self-will is very important. A good therapist will work together and interact on a child level. Therapy is not a fight, and autistic children need not suffer from it.
- Think about whether therapy is more accurately described as cooperation or compliance.
- Children should be allowed to express concerns, opinions and goals. Children should also be allowed to have their own input about their care.
- The therapist should be able to respect a "no" answer. If your child is ignored when he says "no," he will learn that "no" is an unimportant word and will not heed it.
- Find fun therapy for your child if you can. Good therapy feels like structured play.
Step 3. Watch the response to the constraint
The child must be able to say no, and have a therapist listen to his or her refusal. The therapist should not push, pressure, force, or threaten to withdraw a facility or privilege if the child is uncomfortable with something.
- The child should be taken seriously when he says no or expresses discomfort (verbally or nonverbally).
- Bullying and sexual harassment are experienced by many autistic children (and adults). Consider requesting that the child's therapy program include assertiveness exercises.
Step 4. Evaluate the use of rewards and punishments
Reward and punishment methods are effective, but are sometimes overdone or misused. A bad therapist may ask you to limit your child's access to his favorite things to get him to obey the therapist. Pay attention to whether the therapist makes use of or limits the following:
- Food
- Access to things the child likes, such as special interests or dolls
- Negative encouragement or unpleasant physical punishment (such as slapping, spraying vinegar in the mouth, forcing to inhale ammonia, giving electric shocks, etc.)
- Chance to rest
- Too many gifts. As a result, a child's life becomes a series of gifts and exchanges; otherwise, he will lose internal motivation.
Step 5. Consider opportunities for the child to calm down or stimulate
Bad therapy may keep pushing the child even though he needs rest, and even apply it as a technique to weaken the child's desire to obey. Good therapy will give your child as much rest as they need.
- Therapy 40 hours per week is a very demanding task. That time will certainly be tiring, especially for small children.
- A good therapist will encourage the child to tell him if he needs a break, and give it whenever the child or therapist feels that it is needed.
Step 6. Evaluate whether the child feels safe in therapy
Good therapy helps children feel relaxed and safe. If therapy involves a lot of screaming, sobbing, or fighting of will, it's not working.
Problems are bound to happen occasionally, and the child may cry during therapy. If that happens, consider the therapist's role in the problem, and how they might respond
Step 7. See if the therapist cares about the child's feelings
ABA therapists focus on the ABC model, which stands for antecedent, behavior, consequence. While useful, this model of therapy is dangerous if internal experiences are ignored (such as emotions and stress). A good therapist empathizes with the child and tries to see the world from the child's point of view.
- A good therapist is careful not to push the child too hard, and will provide rest if the child needs it.
- Bad therapists will continue if they are causing stress, or even push harder.
Step 8. Consider how the therapist will react if the child cries or gets angry
A good therapist will immediately calm down and show concern (or remorse). A bad therapist may push harder, coerce, or try to "weak" the child and turn the situation into a battle of wills.
- A good therapist will be honest about what happened, and take steps to prevent it from happening again. They care about the child's emotional pain.
- Some therapists are not good at describing a child's violent reactions as "tantrums" and staunchly argue that the behavior should be dealt with harshly as well.
- Weeks, months, or years of frustration and tears can make a previously calm child aggressive.
Step 9. Be aware of physical intervention
Some therapists will physically enforce compliance if the child does not do as instructed. Pay attention to the following interventions:
- Giving punishment
- Pulling and moving the child against his will (including leading the hand of an unwilling child)
- Physical restraint (hitting the table or cornering the child on the floor, not calming)
- Retaining the child (use of a "quiet room" with a locked door, or a chair with straps)
Step 10. Watch out if your child appears to be regressing or becoming timid
Harmful therapy stresses the child, causing weakening or the appearance of symptoms of abuse. The child may act "like everyone else" during therapy or when with people involved in therapy, or even all the time. Watch for the following signs:
- More frequent tantrums
- More anxious, less trusting of adults
- Losing skills
- Extreme behavior, such as demanding, aggressive, overly submissive, withdrawn, lethargic
- Thoughts of suicide
- Increasing stress before, during, or after therapy
- Violence, if it wasn't before
- Other changes in mood, skills, or behavior
- The source of these changes may not be from therapy. However, if the therapist ignores the concern, and/or the child seems very anxious about the therapy or therapist, that's a red light.
Step 11. Consider whether you would agree that non-autistic people should be treated this way
Everyone deserves good treatment, and you can judge by comparing if non-autistic people are treated like autistic people. Imagine one minute. Does it make you uncomfortable?
- Would you frown or intervene if you saw a non-autistic relative or friend being treated the same way?
- Imagine that you are the same age as an autistic child. Would you feel humiliated if you were treated like that?
- If a parent treats a non-autistic child in this way, will you contact the Child Protection Commission?
Method 3 of 3: Evaluating Your Relationship with the Therapist
This section is required if you are interacting with a therapist.
Step 1. Beware of false promises
A bad therapist may be dishonest with you, manipulate you, or make promises you don't keep. They may ignore your concerns, blame you, or blame the child if things don't go as they say. Pay attention to the following:
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Autism is lifelong.
Children cannot be "cured" of autism.
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Autistic people vary.
A one-size-fits-all approach will most likely not meet your child's needs.
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There are many good therapists.
If a therapy claims to be "autism chemotherapy," or that all other therapies are untrue, the therapist is dishonest.
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ABA teaches some tasks better than other therapies.
Physical abilities such as getting dressed or tapping someone's shoulder for attention can be very beneficial. Because based on data, ABA therapy does not produce good results for teaching speech or skills that involve the body and mind (eg, pointing to the correct card).
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Autistic people have real emotions.
If your child is showing fear or pain, that's probably how he feels.
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Autism and happiness are mutually exclusive.
Children can live a happy life as an autistic person.
Step 2. Watch how the therapist talks about autism and your child
Even if the child does not communicate verbally and appears unresponsive, he or she can understand the therapist's words or attitudes. A very negative attitude can hurt an autistic person's self-esteem, and also indicate that the therapist is not treating him or her well.
- Calling autism a tragedy, a terrible burden, a monster that destroys lives, etc.
- Calling the child "manipulative" or blaming him for problems.
- Urge you to punish your child more severely.
Step 3. Think about whether the therapist will let you watch a therapy session
If the therapist is hurting your child (emotionally or physically), they may not want you to know.
- The therapist may say that your presence will interfere, or that you will interfere. The reason is a red light to watch out for.
- If you're not allowed to see a therapy session, but the therapist reports, be aware that there's a possibility that they're distorting the truth or dressing up a serious problem with sweet words.
Step 4. Ask if the therapist listens to your concerns
As a parent, guardian, or family member, your instincts are very important. You can usually tell when something is wrong with your child. A good therapist will listen to your doubts and take it seriously, while a bad therapist may be defensive, deny it, or say they know better.
- A bad therapist may tell you not to trust your judgment. It's a very bright red light. They may be experts, but that doesn't mean your thoughts are meaningless.
- If you continue to disagree, a bad therapist may try to turn the other person against you.
Step 5. Trust your instincts
If you have a hunch that something is wrong, those feelings need to be explored further. If your child's therapy seems to be going wrong, don't be afraid to stop it. There are many therapists out there, both using ABA and other therapies. Don't sacrifice your child's happiness.
Tips
- Therapy that works for some people doesn't always work for all. You are not automatically a bad parent if you stop ABA therapy for your child. Your concerns and choices have a basis.
- Some autistic people cry a lot, especially those who cannot communicate well or have problems such as anxiety or depression. Therefore, crying during therapy is not necessarily a red light. Instead, consider whether the child is crying more than usual, and why. Note that talking about someone's feelings can lead to tears. So maybe it's part of the therapy.
- There are many adults with autism who have had experiences with ABA therapy, for better or for worse. They can tell what is useful and what is not.
- A bad therapist can be pleasant. Don't beat yourself up if you don't notice it right away.
