Gorycki et al. (2020) argued against this point by discussing the Professional and Ethical Compliance Code for ABA therapists. They stated that “the ethical code mandates behaving in a way to maximize benefit and minimize harm. Practicing outside one’s scope is unethical. Practicing incompetently is unethical. Instead, behavior analysts create treatment plans based on the client’s needs, as dictated by the client and his/her significant others.” (Gorycki et al., 2020, p.3) The issue is not whether or not ABA therapists follow their own ethics code; the issue is the ethical scope of the practice of ABA, given that the practice of ABA inherently ignores all internal constructs.
Ivar Lovaas, who is revered as the father of ABA, spent the majority of his life expanding and utilizing behavior modification (Smith & Eikeseth, 2011). All of his applications of behavior modification were consistent with the Professional and Ethical Compliance Code for ABA therapists. In the 1970s, Lovaas utilized behavior modification to treat young boys who displayed feminine characteristics. Lovaas believed these feminine “manifestations are indicative of later adult sexual abnormalities, e.g., transvestism, transsexualism, or some forms of homosexuality” (Rekers & Lovaas, 1974, p 173). Lovaas conducted various studies attempting to change these behaviors, despite lacking a basis or understanding of what he believed were sexual abnormalities (Rekers & Lovaas, 1974; Rekers et al., 1974; Rekers et al., 1977). Lovaas’ history and involvement with the Feminine Boy Project in the 1970s is a prime example of applying behavior techniques while ignoring internal constructs. Even though the gay conversion therapy he pioneered was published and peer-reviewed, it has been condemned by many including the American Psychiatric Association (1998) and even other behavior experts Nordyke et al. (1977) and Davison (1978). As ABA is only concerned with observable and measurable outcomes, one can only begin to imagine the unobserved psychological damages caused to the subjects of these failed experiments. Clearly, the ends do not justify the means; and so ethically, there must be a prerequisite understanding of the internal processes of a human being before applying any behavior techniques to modify behavior. Following the rules of an incomplete ethics code does not make a group’s behavior intrinsically ethical.
Thus, the issue at hand is threefold: (1) what behavior is inherent and appropriate, (2) what expertise is required to make such a determination, and (3) what expertise is required to recognize when the treatment is actually causing harm. In dealing with human beings, it is unethical to make an arbitrary decision on what is an appropriate behavior without understanding the long-term ramifications of attempting to change that behavior. At its core is an inherent requirement that necessitates a therapist’s understanding of the internal processes and abilities of the patient before designing a treatment plan, as well as the training to recognize when the treatment is detrimental. ABA therapists are not required to take even a single class on autism, brain function, or child development (Behavior Analyst Certification Board, 2021a, 2021b). This single fact necessarily leads to at least the vast majority of ABA therapists practicing out of their scope. We are unaware of any other profession or circumstance where it is considered ethical to not study anything about the manifestation or circumstances of a condition, and then attempt to treat it. Moreover, it is negligent, dangerous, and malpractice for any professional or paraprofessional to claim expertise and implement interventions for a group they have not vigorously studied.
Furthermore, introduction to psychology academic textbooks describes the evolution of the field, and how it has moved away from the primitive understanding of human beings as being merely a bundle of behaviors (Comer, 2010; Myers & DeWall, 2018). This is also seen in the flourishing of alternate, more developed and more scientifically supported models which incorporate cognitions, internal processes, neuroscience, genetic predispositions, multiculturalism, etc. (e.g., Beck, 1970; Deblinger et al., 2011; Dimeff & Linehan, 2001; Linehan, 2014; Schubert et al., 1968). There would be no need for various psychological orientations if all humans were a mere bundle of behaviors who could be rewarded, punished, or conditioned into achieving anything.
Gorycki et al. (2020) stated in their response that “autism is a neurological disorder” (p.1). This statement is factual, and there is no disagreement here. However, we are compelled to point out that while the acknowledgement is proper, in theory and practice, ABA does not treat autism as a neurological disorder. ABA is far more concerned with outward manifestations of behavior and the treatment of those manifestations, which is a very far throw from anything that could be considered neuroscientific. Even if one was to attempt to dispute this and claim that ABA is concerned with neuroscience, it is notable that in courses required to become a BCBA, nothing exists that could be considered even tangential to neuroscience (Behavior Analyst Certification Board, 2012). To (correctly) claim that autism is neurological, and then proceed to ignore such a glaring obvious flaw within ABA’s claim as a treatment of autism, is seriously concerning.
Gorycki et al. (2020) also defended ABA’s approach to what they describe “self-stimulatory behaviors.” It is unclear if they are referring to true self-regulatory behaviors or maladaptive and/or self-injurious behaviors. This is an important distinction, as research indicates that certain self-regulatory behaviors serve to regulate and calm, and as such it is vitally important to distinguish between the two types of behaviors (Baron et al., 2006; Brenner et al., 1947; Tomchek & Dunn, 2007; Tomchek et al., 2014; Shkedy et al., 2019). Furthermore, it is therefore easily concluded that forcing a child to stop these soothing behaviors is largely harmful, and unhelpful. We hypothesize that the only reason that ABA attempts to “extinguish” such behaviors is, generally, to make neurotypical people more comfortable. While the behaviors may be viewed as abnormal, they help to soothe and calm the autistic person—assuming that the behavior is non-harmful, of course. Yet the practice of largescale extinguishing of all forms of undesired behavior, whether harmful or not, largely continues and persists within ABA circles. The fact that it is claimed that there are “hundreds of studies” that effectively reduce self-stimulatory behaviors that are deemed problematic by consumers, parents, and families only serves as further evidence of abuse (Gorycki et al., 2020, p. 4).
Additionally, Gorycki et al. (2020) cited that the ethical code obligates behavior analysts to refer a client who is not making progress to another professional who might be more successful. On the surface, this is laudable, but this ignores many glaringly obvious potential problems with such a practice. The client may be making progress on goals that will actually harm them in the long run. Going back and forth between “professionals” who are not trained to treat the disorder at hand is unlikely to help. This reinforces the fact that the most basic ethical requirement to practice—competency—is missing from the Professional and Ethical Compliance Code for ABA Therapists. To be clear, ABA therapists have no training, knowledge, or expertise on these behaviors within the context of the autistic brain, while at the same time purporting to be the foremost, scientifically based experts on treating autism.
Regardless, of the specific types of behaviors the authors referred to, Gorycki et al. (2020) essentially stated that ABA is successful at reducing whatever behaviors the “consumer” wants. The fact that ABA is consumer-based instead of neuroscience-based or client-centered is very problematic. We are unaware of any other healthcare profession where the patient or parent runs the treatment. Gorycki et al. (2020, p.4) stated that “if this behavior does not impede their learning and does not pose any threats to their health, then the behavior analyst is ethically obligated to discuss this with the client and parent/guardian.” Firstly, ABA therapists have no training on which behaviors aid or inhibit learning and they do not have training on what behaviors might pose a threat to an autistic individual’s health. (Behavior Analyst Certification Board, 2012)
Secondly, this approach makes ABA sound like a service you obtain to train a person to do or stop certain actions, regardless of the clinical implications. Today, there are still many parents who believe that boys with “female tendencies” need to be treated to “extinguish” behavior that the boy exhibits. An ABA therapist, based on all available evidence, would certainly not be trained to have that conversation with either the client or the parent, yet the scenario is not so different from what occurs in practice. We wish to remind readers that we are attempting to highlight a non-verbal, highly vulnerable population that deserves to be especially protected by the professionals serving them. Under ABA’s consumer-driven model, the dignity of the child is not taken into account. The child’s needs, thoughts, emotions, competence, and autonomy are notably left out of consideration in the so-called consumer-driven ABA model. These aspects of the child have been neglected likely because the people entrusted to help these children specifically have no training on how to study, understand, and treat this population, and so, they must wholly rely on the observations of parents instead of on a theoretically based, structurally sound model. The result is a mishmash of treatments and adaptions that would likely result in abuse regardless of the structural underpinnings of a treatment; this is despite the not-so-great underpinnings of ABA.
Furthermore, Gorycki et al. (2020) did not address self-injurious behaviors in autism and the failure of the Functional Behavior Assessment (the bedrock of ABA) to address these behaviors. Shkedy et al. (2019) demonstrated that self-injurious behaviors in non-verbal children with autism are a cry for help due to their lack of communication skills; ABA therapists overwhelmingly predominantly denote these behaviors as task avoidance. It is precisely because of their lack of training in human psychology that they reach these erroneous conclusions that inevitably cause harm to their clients with autism. Furthermore, Shkedy et al. (2019) demonstrated that there is a plethora of research showing the oversensitivity the autistic brain has to external stimuli with some of them actually causing physical pain. Basic knowledge of these constraints would lead a therapist to avoid stimuli that are torturous, instead of taking on the false assumption that a child is attempting to escape or avoid a task and then continuing to expose them to the offending stimuli. This only results in a therapist forcing the non-verbal child to endure further torture.
We must emphasize that ABA therapists and associations present themselves to the government and the public as autism experts. In fact, many states in the USA have statutes declaring that an ABA therapist is an autism expert or is a qualified autism provider (e.g., Cal. Health and Safety Code 2017; Iowa Code Title IV, n.d., Human Services 2020; Minnesota, n.d., n.d.; West Virginia Code, n.d.). Representing oneself as an expert in a subject one has no knowledge of is usually considered fraud, at least once revealed. At its very core, it is the epitome of unethical action.
The growth of the neuro-diversity movement in autism is a direct result of the practice of ABA on the autism population. It was the attempt to fix “that which may not be broken” that led to this revolt. While there is no consensus in the scientific community on the validity of the neuro-diversity argument, no one has previously researched the catalyst for this outcry—ABA. We are not the first authors to emphasize the abusive nature of ABA therapy, and various others continue to identify this abuse and advocate for the termination of this abuse or for alternative treatments (Hungate, 2020; McGill and Robinson, 2020; Milton, 2020; Robinson et al., 2020; Wilkenfeld and McCarthy, 2020). Wilkenfeld and McCarthy (2020) demonstrated that ABA is unethical from a bioethics perspective. ABA violates autonomy insofar as it coercively closes off certain paths of identity formation. It also violates autonomy by coercively modifying children’s patterns of behaviors to be misaligned with their preferences, passions, and pursuits.
Finally, Gorycki et al. (2020, p.4) stated that “Sandoval-Norton and Shkedy (2019) claimed that the practice of ABA is unethical due to the exclusive use of behavioral procedures.” They then cited research to show that “students served by intensive ABA have significantly better outcomes (IQ scores, language scores, etc.) than those children who are educated with various non-ABA approaches.” Firstly, the exclusive use of behavioral procedures implies ignoring all the internal processes and as shown above, is what leads to the unethical treatment. Secondly, citing research on a different population group does not validate the argument. Any study that uses IQ as a measure of improvement, as was pointed out numerous times in the original article, has excluded nonverbal children with autism since they notoriously do not have any measurable IQ. In clinical experience with hundreds of nonverbal children with autism, not one had a reported measurable IQ on any previous psychological evaluation. In addition, every public school in the USA is required to conduct a psychological exam as part of the Individualized Education Plan process. For nonverbal children with autism, the majority of those indicate that the IQ test was “attempted,” “non-completed,” etc. This results in non-measurable results for this population. Sandoval-Norton and Shkedy (2019, p.3) concluded that “There have been limited, if any, scientifically validated studies on the use of ABA on nonverbal children with ASD.”